Habari to all my dear friends and family,
Sorry for the delay in getting this to you -
First, I am well and slowly adjusting to the pace of African life.  It has been an adjustment.  If nothing else I have learned to walk slower, talk slower and overall enjoy each moment.
Everything in life does not have to be done in a "New York Minute".
This is how the Tanzanian's live and work.

Since my last post - although school did not start until 3 weeks ago - I was busy.
I went to Arusha (a one hour plane trip from Mwanza), the beginning of September with 3 doctors who were running a 1/2 marathon, of which I did a 5 K.  It was nice to see another part of Tanzania -

 September 29th is International Heart Day and Bugando Medical Center had a heart walk in full Tananzian style with a band which played the entire time which was to the bottom of Bugando Hill and back.  This picture is of a pediatric cardiologist from Germany who has been here for the past 4 years.  There are a lot of heart problems especially in children, mainly from congenital defects and rheumatic heart disease which we know is very preventable.  Some of the surgeries can be done at Bugando, but most patient's are sent to Nairobi.  The day following the heart walk - there was a free screening for children under 18 of which over 250 were seen.

Some of you have asked me about the weather, the food and how accessible most things that I have previously taken forgranted.
The weather is about 70-80 degrees most days - some days warmer - very little to no humidity and usually a gentle breeze - somewhat like Hawaii.  The tropical sun is very hot - and mid-day is not a good time to be out and about.  However, coming from the Northwest, I don't think I have every sweated so much.
Tanzanian food is interesting - alot of carbs - with a flour mixture called ugali - which they form into a ball and then dip into vegetable or fish stew.  Most eat with their right hand - and before and after each meal they wash their hands -  The markets are full of fresh fruits and vegetables, tomotoes, avocados, mangos, pineapples, potatoes, carrots, onions, garlic, papaya, (most everything you would want).  You buy your fruits and vegetables from the local mamas who sell in the market or by the side of the road.  There are a few small grocery stores - which have unpredicable items - nothing like what you have in the US - more like a 7-11.  I have learned to adjust.  Occasionally there will be something like Philadelphia Cream Cheese - and all the ex-pats go crazy.

I was invited to one of the secretary's home for lunch and it was a true experience in seeing how the local people live.  Very simple life - without running water - but she did have electricity and even a TV.
She lives about a mile from the main road where she catches a bus to work at the medical center.  In fact she has to take two buses.

As I mentioned school has now started for both the Diploma Program at Bugando and the Bachelor of Science in Nursing -Education at the Catholic University of Health and Allied Sciences (CUHAS).  They really are a different group of students.  The Diploma students are generally young (early 20's) and mostly men (there are 5 females in the 2nd year and 9 in the 3rd year).  Their english is fair -
The BSN-ed students are older - have more nursing experience - and if they came into the program from secondary school and without previous nursing experience- they had done quite well in the sciences.  Their English is much better and they seem to be able to grasp more complex topics.  Last week I gave two lectures to this group on the cardiovascular system along with common disorders and they were able understand and discuss later with me what they had learned.
It is very difficult to be talking to a group of students and look out into the audience and see alot of very blank faces - but once I got over that - and tried to make things easier to understand it seemed to get better.  I have to say this is really a work in progress as to how to bring more interaction into the lectures and not just have them copy everything down.  They seem to be very good at that.
I enjoy more spending time with the students on the wards - As I have mentioned there are been very little to no clinical supervision of the Diploma students on the wards.  Currently the 2nd year Diploma students are spending 4 days a week on the clinical wards.  The first thing they do is make beds, of which they wear gloves and masks (not sure why) and then they "dust", wiping down the beds, etc.  The mopping of the floors is done by the cleaning staff.  Then they go for "chai" and finally around 1 pm they pass medications along with the staff nurses, which is a story in itself.  It is rewarding to have them present to me one of their patients and tell me about them.  I have been encouraging them to look things up when they don't know, rather than wait for me to tell them.  Unfortunately there is a sense of "learned helplessness" which has come from a long history - Once they look things up, I have them ask me again and then we spend time going over their questions and what information they have found.   I have also been working with them on some of their clinical skills (like starting IV's and taking blood pressures, etc).

Overall, I am very busy.  I have moved into my permanent housing while I am here in Tanzania.  I will send you a picture of that in my next post - and hopefully it will not be so long in between.  I am living with alot of staff and faculty of Bugando -

The internet and electricity continues to be sporadic - although the hospital is on a generator so is usually not affected.

I have met some great people, many from Europe who are working with organizations at Bugando.

Thank you for all your ongoing - prayers and support.

Salama -
Dorothy

Karibu Tanzania !

Greetings to all my dear friends, family, colleagues and those who want to know about my adventure in Tanzania Nursing.
First off, sorry for the delay - as you can imagine the past almost two months have been crazy to say the least.  After 2 weeks of Peace Corps/SEED Global Health Orientation in Washington DC - with may I add a swearing in of our service at the White House - we arrived in Dar es Salaam on July 21st.  Our first week in Dar was spent meeting the US Ambassador and then the President of Tanzania,  President Kikwete.

The group I am pictured with are all the doctors and nurses who will be serving in Tanzania for the next year.  We are a mix of cardiology, family practice, pediatrics and internal medicine,OB/GYN, midwifery, community health, women's health and general nursing.  Our ages range from early 30's to late 60's.  

Two will be in Dar es Salaam,  one in Mvumi at the Medical Officer's Training School, two in Dodoma at the Mirembe School of Nursing, two at Sengerema District Hospital and two at Bugando Medical Center.  There are also two other Peace Corps Volunteers, spouses of two of the SEED Global Health Volunteers who are serving as well.  One at Baylor Center for Excellence in Mwanza and one in Dar es Salaam.  

After one week in Dar es Salaam with a brief exposure to Swahili, we then went by bus to Dodoma, about 6 hours on a two lane "highway".  Dodoma is actually the capital and where Parliament is located, however it is a small town - We stayed there for one week, working more on our Swahili...and now ninasema Kiswahili (I speak just a little Kiswahili).  

We left those that would be staying in Dodoma; at Mirembe School of Nursing and Mvumi and went back to Dar es Salaam for one night before flying to Mwanza.  Here is a picture of the traffic jam in Dar - 

Traffic in Dar

Plane to Mwanza

Mwanza is where the large regional hospital for the Lake Zone (Western Tanzania) is located and where I will be teaching.  It is 900 beds with some of the sickest patient's, as they are referred from surrounding District Hospitals.  Although it is old and certainly not to US standards in appearance, it is well organized and clean.  The hospital is located on a hill and overlooks Lake Victoria (2nd largest lake in the world) so definitely reminds me a bit of home with the water.  Mwanza is the 2nd largest city in Tanzania and the launching point for safaris to the Serengeti which is about two hours east.

                                                         Bugando Regional Medical Center

Road up to the hospital

I will be teaching in both Bugando School of Nursing and the Catholic University of Allied Health Sciences.  Bugando has a Diploma Program in Nursing - similar to the LVN/LPN program in the US and CUHAS has a Bachelor of Science in Nursing Education.  Fortunately when I arrived, the students were in the process of taking a national final exam and the new class will not start until the middle to end of September.  I have had a chance to meet with the faculty and sort out the courses they would like me to teach.  The biggest need is in the clinical supervision of the students on the wards.   It should all be very interesting.  

I am now familiar with day to day African life.  The Tanzanians are very warm and wonderful people and operate on "Tanzanian time".  This will be a welcomed adjustment.  Greeting one another is the most important part of any encounter - With asking what is new, how are you doing, are you peaceful.  Everyone answers, nzuri or njema (fine).  

Life here is hard, everyone works hard just to live day to day.  The unemployment is high (around 40%) and the median age, if you can imagine is around 17-18.  Only 2% of the population is over 60.

English is taught in the secondary schools -and from what I have observed is not the best, but should improve, hopefully after I spend some time with them.  It will be mutual as I'm sure my Swahlili will also improve.    The nursing courses are all taught in English. 

My housing right now is very nice - in a compound of 4 houses behind a guarded gate.  That is how most "ex pats" live.  In the next month, I will be moving to housing closer to the hospital.  Right now we walk a path over dirt to the paved road leading to the hospital  It takes about 20 minutes.  

A week after arriving here I took the ferry over to Sengerema - where there is a district hospital and where we will be giving some inservice training to the nurses.  This really reminded me of home.  It also gave me a wonderful opportunity to see more of Lake Victoria.

                                                       Ferry to Sengerema

   I have also attached a few pictures of some of the birds and other creatures around my housing, as well as a picture of the lake from a restaurant.  Certainly more will be coming.

Thank you all for your support.  I am happy I came, although there have been days, I thought "what was I ever thinking".  I must add that this place really does "grow" on you and I can see why so many told me "I'd go back in a heart beat". I am so looking forward to working with the students and improving health care and nursing in Tanzania.