Zanzibar and Masai Village thus Culminates my Time in Africa

Some concluding remarks...

A week's log of living among the Masai:

Sunday:  a trying time on an overcrowded bus traversing the 7hrs over hot, dry, and extremely dusty roadways before our arrival in the secluded village Engaruka.  Our accommodations are quite modest yet comfortable.  Our dwelling is a mud house with a dirt floor.  Beds are of a soft mattress that is raised up off the floor.  We do showers from a bucket and use the out house for our bathroom.  It's camping practically.

Monday:  when we discover that Masai don't truly understand the benefits of a hearty breakfast.  They think it odd my request for coffee before we've even given thought to breakfast.  They take tea and coffee WITH breakfast not as a wake up morning drink.  And that brings us to breakfast, white bread.  There is also peanut butter which we have to use quite sparingly.  It hardly suffices since we have to trek a half hour to clinic; hunger pains set in often before we leave for clinic each day.  Lunch and dinner are better, rice and beans with perhaps some goat mixed in, quite tasty actually.  Clinic is a bore most of the time.  Not much medicine happening because it's such an isolated clinic without any kind of ancillary support.  Still, we see lots of gastro and upper respiratory illnesses.  They do what they can with what they have (which I can't stress enough is NOT MUCH)  On another note, in the afternoon I took a motorbike ride about 45 min down the road to get a good view of the active volcano here that the Masai call the Mountain of God.  The last time it erupted (not violently, just some smoke and lava overflow) was 2 years ago and its norm is to go every 3 or 4 years.  Also got to see a really cool scorpion right before bedtime only a couple feet from our house entrance.  Had to be about 3 inches or so with an impressive stinger.  I'm happy our beds are raised.  Also, I was just drifting off to sleep when I felt a legitimate earth tremor....then another about 10 min later.  All I could think was how exciting it'd be to see that mountain of god get fired up!

Tuesday:  when we were all missing our mzungu food to the Nth degree.  Breakfast again is the same white bread with a thin film of peanut butter, and dinner from the night before which was the ugali (flavorless white starch with the consistency of mashed potato made from cassava and maze flour) with a little spinach just isn't enough calories to satisfy.  I am starving but we did have a great bean and corn mixture for lunch which quieted my growlings.  The afternoon we visited the spiritual healer who uses local medicines to treat his patients.  He also fortune tells by reading stones that he pours out onto a dark goat's skin.  I did not consult his mysticism but just observed.  The other girls did consort, giving them a glimpse of their future in terms of whether marriage was soon coming or how many children to expect.  It seemed all quite benign but that was when I really reflected upon their tribal culture and how closely they live in conjunction with nature where I identified their one big fallacy; they worship and praise creation instead of the Creator.  The mountain of god is their temple and nature god is what they serve. The Lion King really does hit the nail on the head when identifying with their spiritualism.  The Masai do not believe in the after life.  They live and when they die they go back to dust to become a part of this physical world (the circle of life).  Walking back we got to see a dung beetle rolling its dung ball...I was excited from a biologist's stand point.  Only ever saw one of those on the discovery channel.

Wednesday:  the time to experience Masai disco, that is a Masai dance where the men do their jumping and the women dance and shake, each party trying to attract and impress the other.  It was quite comical actually with their guttural chants and high pitched squeals mixed with their odd dancing styles.  I was excited to take part in this event, half the time giving serious reflection as to what was happening because it was just THAT strange.  You can see the men's dance and song on a video I posted in my web album which will help you visualize what I'm talking about.  Go to this link and remember to scroll towards the very bottom:  https://plus.google.com/u/0/photos/113979206884651606903/albums/5834838552272766513?authkey=CMviyoX1rsiPigE

Thursday: when we realize just how much free time the Masai people can have.  After clinic, there was no cultural event scheduled so we did our simba time (resting under a shade tree, especially during the brute heat of the day).  Sometimes there was so much simba time that it got quite boring.  The Masai really do have a low stress life style and it shows, many of them can live to be over 100. Our guide Lewis' grandmother lived until 107!  Anyway, with so much down time, there is only so many books to read or round of rummy to be endure, especially when trying to forget about our appetites that perpetually gnawed at us.    

Friday: when we sacrifice a goat.  While traditionally the Masai give a goat to the nature god to plead for rain, we didn't really do any kind of sacrilegious ceremony or prayer.  We pretty much just cooked a goat for lunch.  The Masai smother so as not to lose the blood because they like to drink it mixed with crushed spleen, which is supposed to give them strength.  They also like the taste of the raw kidneys, so along with the blood drink, we also got to try some of the kidney as well.  (I even tried roasted scrotum which still had some hair on it which was quite tough like a bad calamari.  I ended up having to spit it out).  Pics are up from that experience.  Beware, the bits where I'm lapping up blood is a little graphic.  Fun experience, but definitely one I don't need to have again.  Because the goat was slowly suffocated, the meat was quite tough and unenjoyable, quite disappointing actually because I was incredibly hungry at time of consumption.    

Overall we had a great time in Masailand.  King Lewis (pics of him also up, he was our guide for our week in Engaruka) was exceptional to tell us about the sexual practices of the tribal people, how women used to also be circumcised just like the boys as right of passage from child to woman.  Now that genital mutilation is illegal, the tides are changing and many Masai are seeing how poor of a practice female circumcision was.  Female empowerment is becoming a bigger deal too.  Where once Masai culture was all about polygamy and definitely a man's world where the Mamas did everything from construct the houses, to cook and do laundry, and raise the children while the men just herded their cattle and had sex with their many wives.  That traditional model is changing where many Masai men are choosing monogamy and to share some of the family responsibilities.  A partnership instead of a one sided marriage is becoming the more attractive option for many.  There are still the traditionalists who have their many wives and fulfill the traditional gender roles, but I think outside influences are creeping in.  

Also I have some pics of Zanzibar which pretty much speak for themselves (see captions).  I had a great time just basking in the sun and enjoying the crystal clear Indian Ocean.  Good times but especially after enduring the camping conditions at Masai village, it was time to come home.  Remember to scroll towards the bottom.   Here is the pics link one more time:  https://plus.google.com/u/0/photos/113979206884651606903/albums/5834838552272766513?authkey=CMviyoX1rsiPigE

Safari!

Back from safari and had a blast.  Pics are up at:  https://plus.google.com/u/0/photos/113979206884651606903/albums/5834838552272766513?authkey=CMviyoX1rsiPigE  Remember to scroll to the bottom for the most current photos.

We started out in Tarangire which is quite famous for its baobab trees and herds upon herds of elephants.  It was so amazing and probably my favorite out of all the parks because getting so close to so many beautiful creatures was just awesome.  We also saw several lions, baboons, warthogs, ostrich, and giraffes upon other things.  After Tarangire, we drove up to a campsite atop a mountain that overlooks Lake Minyara which was fun for watching the sunrise the next morning.  We also spent a good day in the Serengeti, which we had to drive through the Ngorongoro crater conservation area to get all the way out to the Serengeti (Masai word for plain).  And boy, the Serengeti is the African Kansas, a vast expanse of grasslands with the occasional tree and watering oasis scattered about.  We saw tons of wildabeast and zebra on our drive out; the wildabeast migration from Kenya is about to peak here in March/April, so it was a great time to see literally a countless number of these creatures.  The Serengeti was also great for leopard spotting as they sleep in the trees (we saw 3 which is quite rare to see so many on just one trip).  We also saw more lions, water buffalo, giraffes, another elephant or 2, lots of hippos in those watering holes I had mentioned.  Serengeti was a fantastic time, but the population of animal life was not nearly as dense as in Tarangire, where there were animals and elephants around every bend in the road.  Lastly, after departing the Serengeti, we spent a night & day in the Ngorongoro crater where we got to see even more herd animals, hyenas, literally thousands of flamingoes blanketting the lake at the crater floor (a carpet of pink!) and 1 black rhino!  With our finding the black rhino we completed our task of catching a glimpse of Africa's BIG 5: the elephant, water buffalo, lion, leopard, and the rhino.  So exciting and all of us on the trip were hoping and praying that we could at least do the top 5!  In the end, we got to see so so much more, a very successful safari to say the least.  Pics that you won't see are of the leopard (well, there's a poor one in the album I shared above) and then the rhino is completely missing because we only got a good view through binoculars.  More on the Ngorongoro Crater, it is a very interesting geological feature b/c it used to be Africa's largest volcano before is spewed out all of its internal contents which left a hollow cone pillar that then imploded, collapsing in upon itself to form the bowl shaped feature, a flat plain making up the valley floor with impressive mountains all surrounding.  

Besides the animal life, I will comment that the star gazing and sunrises in the Serengeti and Ngorongoro were absolutely incredible.  I was most impressed with the stars.  About 5:30am each morning the moon dipped below the horizon leaving the brilliance of the milky way completely uninhibited.  I've never seen stars so bright, and the milky way looked like clouds in the sky; it was so prominent.  Furthermore, I got to see something that can only be seen along the equator, the southern cross on one horizon with the big dipper on the opposite horizon.  Absolutely spectacular!

Here is a pic of my safari mates; 3 Australian medical students from a school in Sydney who were heaps of fun!  Henry, Henry, & Sheektah, and that's our beige colored (not the green one...that one just pulled up as I was snapping the pic) Toyota land cruiser in the backdrop.  Cheers guys!

Peds snapshot

I’ve seen some shocking things while working on pediatrics so far.  I went to the NICU last week on Friday, but to be honest, I couldn’t really stand the humid 90F incubator room for too long; widespread heating is required for lack of individualized incubators.  While there isn’t much we can do for them medically given our setting, we ended up feeding this little babe who was found back in January, lying (and crying) in the waste contents of a latrine.  Maggot scars are all over his body, and while he seems fine medically (at least from the basic investigations that they can do here) he is failing to thrive.  But that is no wonder.  The hospital is understaffed, and so he may get fed every 3 or 4 hours but otherwise, there is no one to pay him attention and show him love.  Also, because he is without a birth mother, he only gets this cow milk based formula, which I’m pretty sure is lacking in a lot of the essential vitamins (and fed from a little cup…they don’t even have proper bottles here!)  Cows milk is really bad for infants in general.  Food products aren’t fortified like we have come to expect.  When working on the pediatric floor, I’m amazed to see so much marasmus, kwashikor, and rickets (diseases of malnutrition).  And when I ask about incorporating vitamins into the diet, the interns and attendings just laugh because vitamins apparently are not even an option here, not that they are too expensive for any local to afford, but literally there are none for purchase.  It’s incredible to me that so many of the wretched diseases that I am confronting should not even be an issue, and it’s heart breaking that once these children do succumb to disease, there is very little that is offered for intervention (as is all too commonplace).  The money and the resources just aren’t available.  For a lot of these sick kids, the crux of the matter is social and economical, requiring a bit of education and money. 

We have also seen the typical pneumonias and bronchiolitis and maybe even some unconfirmed malaria cases; nothing here is legitimately diagnosed.  Again, it’s the best guess based on the limited studies we have at our disposal (and the history and physical, of course).  AND when we do get labs, even labs as simple as a blood picture, we can’t really trust it.  Every practicing physician at Mt. Meru knows that the laboratory is unreliable, so order tests at your own risk.  Absolutely mind-blowing.  Anyway, I’m digressing, let me expound upon these before mentioned febrile illnesses.  Several of these children with the probable pneumonias are seizing from fever.  It looks like here instead of treating the seizure by decreasing the fever with Tylenol, they go for the big guns (completely contraindicated) using a heavy duty sedative and anticonvulsant, phenobarbital.  Now any doc knows that phenobarbital also decreases respiratory effort so watch out when using it.  It is horrific that so many of the kids I’ve seen here are getting phenobarbital to treat their febrile seizures.  Apparently, when diclofenac (another NSAID like ibuprofen that they love to use) or paracetamol (Tylenol) doesn’t do the trick, they reach for phenobarbital and Valium.  CRAZINESS!  Here even the simple treatment of bronchiolitis (which back in the States is inhaled albuterol and maybe a course of systemic steroids to calm down the inflammatory process) baffles me.  I think their medications are in such short supply or the parents can’t afford the medications, the staff have to resort to nebulized saline solution and hope for the best.  I’ve also seen oral albuterol being given which takes a lot longer to take effect and is not nearly as effective.  I was told also, for a child with bronchoconstriction that epinephrine instead of albuterol could be used because albuterol is ineffective in children under 6mos of age.  That’s really quite false and is not the current recommendation back home, but again, I don’t have to understand everything that goes on here.  I’m just taking it in and pondering my reflections.   

The most shocking thing I’m seeing by far is the nutritional deficits that are killing these kids.  We had a child on the floor who died just a day or so ago from rickets (Vit D deficiency which interferes with bone mineralization).  And since we have no vitamins, the best we can do is educate about proper nutrition and hope for compliance, truly shocking. 

Besides the bleak yet beneficial hospital experience, I am truly enjoying life here.  I wrote a couple weeks ago about settling into the rhythm of African life.  I love that Witness gives us a predictable breakfast variety depending on the day of the week, yet provides consistency with brewing coffee each morning.  I love that Polo is our day security guard who comes every Wednesday to relieve Innocent on his day off.  Polo is a dear older Tanzanian who doesn’t speak a lick of English but is so friendly and reminds me a little of my grandpa. I really look forward to our meetings each week.  And I’ve been having fantastic discussions with my ‘lover friend’ Emanuel our night security guard, hearing about his aspirations to start up his own real estate company and maybe do schooling to become a teacher.  His was the church I visited my first week in Arusha.  Sunday evening is Emanuel’s night off, so that’s when Solomon comes who has given me equally intriguing conversation telling me tales of his father’s death at an early age making him grow up all the faster to support his mother and sister; and yet all the hardships of life have not squashed his aspirations of being something more than a night guardsmen; he too wants to further his education, a privilege that we too often overlook as such, instead calling it by another name, drudgery (at least I have).  And the conversations are not one sided; they like to ask me about America aka Obamaland (as they call it) with questions like ‘why do you like guns so much?’ or ‘why don’t you like Obama?’ Even if for but a brief time, these Tanzanians have been my family, and as I’ve settled into the ebb and flow of the slow-going lull that is typical of Africa, my Tanzanian family has been a welcomed comfort. 

***I am fully aware that some of my housemates might read this and take offense to that last paragraph.  All you Aussies, Brits, and fellow countrymen have been a fun-loving bunch as well :) Still, I think I depended on your company too heavily, when the whole point of being in Tanzania is to experience the true flavor of the land, which is at the heart of the locals NOT the other mzungus.  Still fun getting to know you all! ***  

A Valentine's Death

This story begins the day before Valentine’s; there wasn’t much happening in the Gen Ward, no organized rounds since my favorite doctor and chief of medicine, Dr. Mcooley was absent.  He’s the one to keep things organized and actually takes the time to talk us through his thought process concerning each and every patient.  And he’s quite good despite the ever-limited resources he has at his disposal.  Since there wasn’t much keeping me on the general wards yesterday, I decided to mosey onward to casualty (their ED) where I no sooner stepped into the department, I saw a few guys carrying in a 20 something man who was clearly unresponsive and just writhing about.  Initially, my first impression was that he was seizing, but after we extracted a very limited history from his non-English speaking friends and family, apparently he was delirious and agitated, possibly from alcohol withdrawal.  He was a chronic consumer of the local gin (Konyagi) taking approximately 500ml or more each day.  3 days ago, he grew sick with headache, fever, vomiting & diarrhea and stopped consuming his regular alcohol intake as a result.  For the past 3 days his agitation and altered mental status had only worsened, and upon his presentation to the ED, all of us medical students were thinking that this was probably a case of delirium tremens from alcohol withdrawal.  With the onset of his other sxs occurring prior to abstinence, there could be another etiology to consider (and the docs here were great to think about cerebral malaria and typhoid) BUT they completely dismissed the idea of alcohol withdrawal, which delirium tremens (DTs) if not properly managed will kill a person.  Yesterday, I left the ED thinking that I would follow up with the patient in the morning since he was admitted to the men’s ward.  When I left him, he was properly sedated with benzos (fills a similar receptor to alcohol and helps offset the withdrawal syndrome that causes sweats, tachycardia, delirium and seizures and potentially leads to death).  Anyway, I went to the ward this morning and found it odd that I couldn’t find my patient.  As soon as I stepped into morning report though, I heard them talk about my guy; he was treated with quinine to address possible severe malaria and was also given cipro to address a possible typhoid.  I don’t think any definitive tests were actually done.  They cost money that most cannot afford; also the tests are rarely done in an expedited manner as to actually help in appropriate management.  We did do a rapid antigen test for malaria while in the ED the day prior which was negative (yeah, it’s a poor test in a high prevalence area…whether it be negative or positive, doesn’t really matter.  If the doc thinks it’s malaria, that’s the treatment the patient will get…which begs the question, what’s the point of the test???)  In morning report, after the intern expounded upon what was done for the patient, she nonchalantly continued that at 0100 this morning, the patient died; there was no discussion as to why the patient may have died, no question to what could have been done differently in patient care.  I asked them if alcohol withdrawal and management was a consideration during the whole event.  Apparently b/c the sxs of headache and vomiting began BEFORE the patient stopped alcohol, there had to be a better explanation for his current condition.  They didn’t seem to get that alcohol withdrawal could be a huge complication of the patient’s condition independent of WHY the patient stopped drink, and so he died.  He died I believe from the dangerous DTs that he was experiencing because the doctors refused to address his alcohol abuse and withdrawal.  Instead they fixated on a possible infectious cause.  So yes, I believe there was patient neglect and mismanagement and he died needlessly on Valentine’s Day.  I will add that although I am here seeing all this happen before me, I am still trying to put the pieces together.  I have not personally reviewed the patient’s full chart, but I have only heard from the medical student and intern after asking them about the case.   

I will further add that from a couple of posts ago, I was shocked about the management of a patient with thrombocytopenia (low platelets) of unknown cause and bleeding. Since there were no platelets available to do replacement therapy, the attending ordered that Vit K be given.  I had said that this would do nothing for the patient b/c it acts in a totally different way that can’t substitute for platelet deficit, BUT I found out that this attending is Dr. Moshi, a known drunk on the wards.  He was probably intoxicated that day as he is most days (which doesn’t make it right, but gives me some kind of reasoning behind his crazy decisions!) And I kid you not!  All the med students and interns have come to expect this behavior from their attending.  This is one incredible, unforgettable place I’ve found myself the past several weeks! 

On a lighter note, I wanted to mention some cultural differences I’ve observed between Americans and Tanzanians concerning the word love, fitting for today : )  My local friends have come to call me ‘lava friend’ as so the pronunciation sounds in their local accents, but they really mean ‘lover friend.’  To my Western mind, lovers are people who have sex, definitely something MORE than platonic friendship anyway.  Not here.  Yesterday the night security guard Emanuel took the night off, and I asked our cook Witness where he was.  She questioned me concerning my inquiry about Emanuel and went on to add, “you love Emanuel.”  Initially it felt weird how loosely they throw around the word ‘love’ here, but I’m getting used to it, and I know that they mean nothing by it.  I think it’s much easier for this people to be affectionate since their society is still quite closed off when broaching sex…and thus the lines in the sand are rarely skewed, and they have the freedom in their usage of ‘love’ expressions.   That’s my observation anyway…Happy Valentine’s Day everyone!

Weekend in Kampala, UG

I'm currently typing on the plane ride back to Tanzania.  It has been a good trip , and I am quite sad to say good bye to Joshua as well as his family that I had the privilege of meeting this time.  I met his great grandmother and grandmother (whom he calls mom sometimes since she raised him) aunt, uncle and several cousins.  His biological mom died of AIDS when he was quite young, and his dad stays uninvolved in his life.  I also made friends with his soon to be fiancé Tabitha.  She is Rwandan whose parents were killed in the genocide of the early 90s.  We hear on the world news about such tragedies of Africa such as the civil wars and the AIDS crisis but I've been given a more personal perspective meeting people who live out the very stories that we only can imagine from our tv and computer screens.  I also got the chance to see Moses again who I met on my first trip here when the orphanage in Mityana was still up and running.  He was care taker and mentor to the boys who stayed at the home.  Very happy to reconnect with him.  He is currently working Uganda's coffee industry several hours outside of Kampala city center but one day hopes to attend seminary.  He feels lead to be a preacher.  Moses has an inspiring story of how Christ worked in his life.  He too was orphaned like so many here bc of AIDS, and when he was in his darkest hour, God sent him Joshua who was pivotal in Moses' accepting Jesus.  And that's sort of how these two got together and worked in Mityana to develop the orphanage. (And so fitting I think to have a modern day tale of Moses and Joshua : ) While the orphanage is no more, these two are still as close as brothers, and I'm confident that they will begin working together again towards community development sometime soon.  Joshua continues to labor on in his village outreach project based in Senge, an outlying suburb of Kampala.  We went there on Sunday to attend church, meet the pastor, and see the well that they just completed at Christmas.  The pastor was kind enough to have us for dinner afterwards consisting of the typical Ugandan cuisine of mitaki (cooked mash of plantains) potatoes, rice, greens, steamed pumpkin, beans, as well as chicken and some beef.  Quite nice!  We get more western style food at the house in Tanzania, so it was fun for me to eat more traditional food this weekend.  I'll add one other quick tale concerning my birthday.  The last time I was here, I wanted a Ugandan soccer jersey but failed to acquire one.  Joshua remembered this from 2.5 years ago and when I said it would be my birthday on Saturday, he went out and got me the jersey for my gift.  I was completely unsuspecting and couldn't believe he remembered, so thank you Joshua.  I was really touched.  I had a great time hanging out this weekend, and I am hopeful we will meet again in the not too distant future.  Joshua also told me that he and Tabitha will probably be 'introduced' soon...their version of a public engagement before friends and family and that he would want me at his wedding, so guess I'll be keeping that in mind for a future visit!  

Thanksgiving tainted by a little bit of frustration

Since I've gotten older, I have come to appreciate my mornings more and more, the daily routine of awaking refreshed to a brand new day.  The possibilities of a new start are endless.  There is nothing better than easing into the day just as the sun is coming up over the horizon with my cup of coffee in one hand and my Bible in the other.  Even here in Tanzania, where coffee is not a part of the normal wake-up routine, and definitely not the drip coffee that we Americans have grown so dependent upon, I have found that our kitchen is equipped with a proper coffee maker, and our house mom Witness has realized how important my coffee is to me each morning.  She brews a half-pot that is ready for my consumption by the time I even walk down the stairs.  I'm quite thankful for this small gesture!  My coffee along with the fresh fruit (mangos, pineapples, and watermelon) served at every breakfast as well as the warm summer sun shining in through the open window makes me so thankful to be here.  I hate winter and being cold, and this place is the exact opposite, perpetual tropics.  I am settling into the natural rhythm of life, having adjusted to the 9-hour jetlag weeks ago.  I get a great night sleep most nights, and try to maximize my day in and out of hospital.  And I feel blessed.  The house has been somewhat full (12 people total this week and more dudes (about half and half now), so balance of the sexes restored!)  Most of them with the exception of 2 are Aussies who are all quite enjoyable people...I'm just getting to know some of them.  So bottom line, things are good, and I have so much to be grateful for!  

However, the challenges of the hospital ensue.  Since starting Gen Med I have realized that this hospital has very little resources to spend on its patients.  Internal medicine is a field highly driven by imaging (XRAYS, CTs, MRIs) and labs (CBCs, BMPs, CMPs, UA); if these basic tools are not available to the physician, medicine becomes very much a guessing game (and a frustration!)  Thus is the case here at Mt. Meru, where patients must pay for EVERYTHING before it is actually ordered and done.  No money means one less resource from our very limited toolbox. I am finding that anemia and thrombocytopenia are quite common on the floor.  While they are able to get a FBP (full blood picture) here apparently, they can't do the differential, at least not these past couple of days.  The machine is broken or they just aren't doing the diff in the lab for whatever reason.  No one seems to know, nor do they seem to care.  Case in point, we have a patient who came in with the chief complaint of bleeding from the gums and fever.  She was anemic (a Hg of less than 5, normal in women is 12 or 13) and thrombocytopenic (platelets around 20,000 normal being above 150,000 so pretty low!)  We have no means available to determine why she is thrombocytopenic, but the anemia is probably secondary to her bleeding.  We have no platelets at the hospital to replace the ones she is lacking.  Instead, the attending told us to give Vit K and whole blood (to help her anemia) and let's hope for the best.  I’m sorry, but if there are no platelets, you can push as much Vit K as you want, and the result will be quite unsatisfactory.  Whatever.  Our hands are tied.  I felt that modern medicine in the States is lacking at times.  This is just downright ridiculous.  Furthermore, this patient has fever with her bleeding, so hemorrhagic fever is on the differential (not that we can do a proper work-up to prove or disprove.)  I found it quite odd how nonchalantly everyone was throwing around the possibility of Ebola without any thought to maybe doing infection control, moving the patient, doing some kind of isolation if it were Ebola.  Nope, she remains on the women’s ward in a room filled with all the other patients.  At least she has her own bed unlike some.  Maybe that’s enough infection control to keep everyone satisfied…

Needless to say, I’m trying to stay positive, but with the situation being as above, I had a difficult time yesterday.  God has brought me here for some good purpose, and I’m still trying to work it all out.  The best I can do for now is to continue to be thankful for all the things I’m enjoying and even be grateful for the challenges that seem like thorns in my side.  What doesn’t kill you only makes you stronger, character building : ) 

I should have known something about yesterday was just off; the day felt weird from the start.  The annoyance at the hospital only put fuel on my fire, and it all culminated yesterday evening when I got word that my friend and landlord in Crossville had just passed.  He had been sick for a while, chronic kidney failure, and while I know that his suffering in this life is over, it doesn’t make the grieving process any less difficult.  I’m more grief stricken for his wife who married him even before she left high school.  Gosh, they’ve been together for nearly 56 years!  My mind is filled with wonder of how she might get on without him now when he has been her whole life for practically all of it!  Also, I’ve never had to do this from such a far distance, confront death.  Thankfully I was able to get ahold of my mom who will be sending cards and flowers for condolences, but I feel quite helpless here.  I knew that he had been sick and getting worse, but I never thought he’d pass while I was away.  I will admit that for now, from here, it is much easier to deal with than if I was actually back in Crossville.  I can be somewhat distant from the whole situation for the present time, but my mind still wanders to those age-old fears of loss and change and wonder of what the future will look like now for me and mostly for his surviving family.  

The Importance of a Good Name

I know that I said I would be doing gen med this week, but I decided to stick around in obstetrics one more week since this was also my mid-wife friend Kelly's final week with us.  Kelly has been a great resource on the labor wards and has talked me through several of the births I conducted.  Gonna miss her!  Also, I will miss one of my favorite labor and delivery nurses, Hilda.  She seemed guarded to our presence at first but has really warmed up to us by the end.  She was also a great one to learn from.  

Upon saying our goodbyes yesterday, I bumped into one of the Kilimanjaro Christian Medical College (KCMC) students named Treasure, who I've been working closely beside these past couple of days.  Yesterday was the first time I asked his name and did proper introductions; I almost choked up when he said his name.  I know the scripture verse that talks about how valuable it is to have a good name.  Now the interpretation of this verse can go 2 ways, having a name that literally means something special and good to declare over a person's life.  (For example, Glenn's literal translation means 'Prosperous One').  Or having a good name could just mean having a solid reputation, one of integrity, honesty, and trust.  In this culture, I think that the former is what most hold to when naming their offspring.  So many names have been Emmanuel, Noel, Innocent, and now Treasure.  What a beautiful name for parents to bestow upon their child, that they can know just by their name alone how much they are loved and valued, and reminded of such every time their name is spoken.  

This is Treasure.  I was even more excited when I discovered he's a Ugandan from Kampala!  I'm heading back to his home country next weekend for my birthday visiting a good friend of mine who I haven't seen since my first visit to Uganda 2.5 yrs ago.  

This is Hilda; she was such an awesome lady to work with!

Middle is my friend Kelly from Manchester,  England and soon to be fully qualified practicing mid-wife as of end of February.  The right is Hilda and on the left is the head janitor of the labor ward who I witness doing a delivery the other day (I blogged about it in my previous post!)  Now you have a face to put to the story : )