Karah Waters
Karah Waters
Tanzania 2017
VIEW FINAL REPORT
Mambo! I am a recent nursing graduate seeking to experience healthcare and African culture in Tanzania. I will be working in a hospital in Dar es Salaam as well as a clinic in the Kidodi village. Join me as I embark on this escapade of being engulfed in healthcare abroad.

Simba vs. Yanga

August 23rd

Today I really got an amazing cultural experience!!!

I went to not only a football (soccer) game in Tanzania but also my first one ever!

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It was absolutely unbelievable! We took a bus and said we were with the U.K. embassy. This football game was so popular because of the teams playing so we had to tell a little lie to be able to be let in. We of course already prepaid for our tickets and everything. The President and Parliament were even there. Everyone in Tanzania LOVES football! The game was being broadcasted in Kenya, Uganda, everywhere! When you’re in Africa you literally feel like a celebrity simply because you’re white. We had a big bus take us to the game because everyone in the house went and three of the staff members so 23 total. When you have 20 mzungu’s (white, foreign people) people S T A R E.

When we walked into the stadium trying to get to our seats everyone stood up and started cheering for us. It was the funniest thing! Everyone was shouting at us cheering us on and taking pictures. I can’t even tell you the number of pictures that are of me on strangers phones. People would come up to you and put their arm around you and just take a photo. However, we ended up having to change our seats. The football games get extremely heated and especially these two teams because they are big rivalry teams. The crowd is literally splint amongst Simba fans and Yanga fans. For our safety we had to move because Yanga fans have the reputation to get a little bit rowdy. I was SO happy we did because I was wanting to root for Simba! Last year Yanga beat Simba so I always like to go for the underdog. Before the game it was really cool because people would come by with Polaroid cameras and take a photo of you. If you liked the photo you could buy it.  IMG_5636

IMG_5674Random people would even come up to you to take a photo with you and buy it simply because we were white. There was a little boy (probably 9 years old) sitting beside Alex and I and he was at the game all by himself. The stadium was absolutely huge! It reminded me of a UT football game! I was amazed that this little fella was so brave to come to the game by himself!

The game was absolutely unbelievable!!! Both teams were playing so good and no one was scoring any points because of how good both teams offense and defense were. The game ended up going into overtime and then that tied so then it pretty much went into sudden death. I was so captivated and into the game! It was unbelievable! Luckily I was surrounded by my England friends so they were able to answer any questions I had about the football game!

And!!! Simba won! The fans went crazy!!!

They had these red explosives that were shooting off in the stands and everyone was going wild. However, Faraja (one of the men from Work the World) became very serious and told us to put our phones away. Supposedly people can get very out of control at football games and Faraja didn’t want any of us to get hurt or get anything stolen. As I looked down at the field I could see ambulance after ambulance and so many police officers. People from the other team were beating on Simba fans because of the win. Supposedly on game day if you walk near one of the sports clubs in the other teams colors you will get beaten and can even die. We got escorted out by police officers and made it safely on our bus. It was so cool seeing all the Simba fans prancing around fully hyped. One lady kept twerking on the hood of every car since we were in dead stop, bumper to bumper traffic. It took forever to get home but it was a bomba bomba game and one that I’ll always remember!

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Rafikis!

The Pink Ladies


 

8/19/2017
I met these lovely ladies when I was back on the mental health ward. They just welcomed me with open arms at Muhimbili. They’re second year nursing students about to go into their third year! The day I went to the methadone clinic they were there as well. We talked for hours and hours and they invited me over to their student hostel after placement.

They made me feel at home and introduced me to all of their friends. We had dance parties and they did my hair. They showed my their rooms and we talked about our family and just life in general. How Africa differs to America. The various tribes they’re in. Even though we come from two different parts of the world we’re still so similar. They made me dinner as well. They invited me back another time and waited for me to get off of work. They made me even more food like maandazi, pilau, and tambi na maharage. Different ladies would make me various things and bring everything together for me to eat. I really love trying Swahili feed and eating it like they do, with your hands. They even bought me sugar cane juice from their mini store downstairs that’s for students.

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This is Beatrice with dinner she made me in her room!

This dish in particular that Beatrice made was very interesting! It was sweet spaghetti noodles with beans.

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I definitely have gone out of my comfort zone so many times here when it comes to food! Luckily, I haven’t gotten sick or anything from things yet!

During our various conversations I learned that they had never had a burger nor pizza. They explained to me that very few people in Tanzania have actually had “white people food.” They said that if you eat “white people food” then you’re doing very good in life and you have a happy life. I tried to explain to them that in America you can get burgers for very cheap. Like on the Dollar Menu. However, they asked how much is $1 USD compared to Tanzanian shillings. $1 USD equated to 3,000 Tanzanian shillings. They said that they could eat three meals with that much money in one day. This kind of took me back and really opened my eyes. I insisted that they let me take them out for burgers, my treat. I just had to introduce them to their first burger experience!

We met up on a Saturday at Salt which is this Western restaurant near Oyster Bay and Coco Beach. It’s the only Western restaurant around and one of the few places that sells burgers. They were in awe at the restaurant! I have never really been put in the position where I’ve had to explain what everyday typical things are. For instance, they’d ask me questions about the menu like what ketchup was or what macaroni and cheese was. It was kind of funny because typically they’re the ones telling me what all of the different things in Tanzania are but now I was able to share a little bit of home with them even though we weren’t in America.

There’s a lot of different and unique types of burgers on the menu. Of course your regular beef burger, chicken burger, salmon burger, etc. They would ask me to explain what each one was and what everything on the menu meant. I ended up asking each of them what they like in Swahili food like if they prefer spicy over sweet, etc. and made my assumptions that way and based that off of how I ordered for them. It was such a fun meal!

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We made a toast for them almost being done with the semester. The school year is switched here. They’re about to have summer whereas in America summer is ending.

After lunch we went to Coco Beach and strolled along the shore and I took them to the cliffs. My friend there, who’s a lifeguard, walked with us to the cliffs. It was just so much fun relaxing with them. It was also nice having them there because they were able to translate what everyone was saying to me.

This is definitely an experience that made me very honored and humbled and a memory that I’ll always cherish.

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Rafiki Florida

September 3rd
I would love just to write a quick post about one of my rafikis, Florida. My first day on the Pediatric Oncology Unit she greeted me with open arms. She is also a nurse at Muhimbili. She’s shared her lunch with me countless times at work

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Ugali, fish, and cabbage

and she has taught me so many Swahili words. Labor Day weekend she invited me to her home. She lives in Kigamboni which you have to take a ferry from Dar to get there. She met me at Muhimbili where we took various buses to finally get to the ferry. It was so amazing to actually see how local people use transportation in Tanzania daily. She lives over an hour from the city but with traffic that can double even triple the commuting time. Public transportation costs about 600 Tanzanian shillings; however, if you were to use a taxi to take you to the island it could be around 25,000 Tanzanian shillings. I had been to Kigamboni before to go to Kipapayo beach in a taxi. But my experience was a lot different this time. I truly got to experience African culture.

When we were in the waiting area to get on the ferry there was honestly probably 700 people. Imagine being in a big enclosed room with no room to move because there isn’t any extra space to move. I had bodies up against me on all sides. I had never been so claustrophobic in my life. There was no AC (which is typical in Dar) but it just made me feel very anxious. Moreover, there were beggars just lying on the ground all around. It was very heartbreaking. A lot of them didn’t have limbs and couldn’t walk. With everyone crammed together you have to be very careful because you can very easily get things stolen. I had my backpack wrapped around the front of me and I was carrying my phone and money in my bra. Once the ferry arrived everyone pushed one another so they could get a good spot on the ferry and not have to stand. It looked like a stampede of ants dispersing everywhere. For such a little lady Florida sure can go fast. I’m like twice the size of her but she is so determined and fierce. Luckily we were able to get a seat on the ferry.
Once we arrived on land we went to the local market and got some onions, tomatoes, and rice. She had already gotten fresh fish before we met up. She wanted us to have lunch before we went to the beach since it’s cheaper to make food at home compared to buying it at the beach. When I asked her how much it was at the beach she said 10,000. Which is about $5 US dollars for food. From the market we had to take another bus to her village. That was about 30 minutes. It was a pleasant walk from her bus stop to her home and all of her neighbors were so kind and friendly.

It’s always so different when people see you here. You literally feel like either you’re a celebrity or you look really funny. Everyone just stares. The children who are brave will come up to you while others may cry because they’ve never seen a mzungu before. Florida had a very comfortable place to live in. Her home was made out of concrete compared to her neighbors who had homes made out of dirt. She didn’t have any electricity or running water. She has two sons, one is 15 and the other is 9, and when they’re back in town from boarding school they stay at her parents. They don’t like staying at her home because they can’t play their video games there since there’s no electricity and they don’t like how dark it gets at night. However, she bought her home a few years ago and she’s saving up for electricity. She said it’s about a million dollars which is around $500 US dollars. She made food for me and it was so eye opening watching her make it. She had a little stove she used that was on the ground.

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This was her stove and the big circular device on the ground was how she went about picking up the pan and taking it off the stove. The big blue container on the right is what she had her clean water in. It wasn’t clean to drink but she cooked and bathed with it.

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You have to mix the rice in here and take out any dirt that does not belong

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The fish that she cooked over the stove

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Meal time!

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We ate rice, fresh fish she got that day, tomatoes, and onions. I told her I would eat like a Tanzanian. They eat with their hands. It was very good! And she made it so fast so we could go to the beach. After we ate we got on another dala dala and then on a piky piky which means motorcycle. They’re a big type of transportation in Tanzania. I was TERRIFIED. I asked her if there was anything else we could use but she said no. I have seen SO many horrific accidents in the ED at Muhimbili that involved motorcycle accidents. I kept having flashbacks of all of those patients. I was in a dress too! So I put the helmet on, plopped my other leg on the opposite side, and grabbed onto the guy in front of me. Just burying my head against his back with tears filling my eyes. I was so scared because there aren’t speed limit laws. However, he didn’t go too fast. I told him to go pole pole which means slow but it’s still fast compared to America. The motorcycles took us to the beach!

We went to South Beach which is a public beach; meaning that I was the only white person there. I purposefully didn’t bring my bathing suit because it brings a lot of unwanted attention. I brought shorts to put on underneath my dress and I was just going to tie my dress with a knot at my hips and go in the water like that. However, Florida insisted I put her bathing suit on. I kept saying it was okay and I wanted to go like this but she insisted I just wear my bra. I had a lace bralette on underneath my dress. She just took the dress off and said go like that. In her mind it was completely normal! A lot of people at the beach will go in their bras rather than a proper bathing suit and the guys will wear their skin tight underwear.
I        was        m o r t i f i e d.
I put my hair down immediately and got in the water as fast as I could so I was covered. It was so funny to me how natural she thought it was and how I practicality felt indecent on the beach even though a bra is practically the same thing as a bathing suit. We swam and swam in the ocean and it was so much fun.
Florida doesn’t know how to swim and I promised her I would teach her. She was doing really well for being a beginner! I was really proud of her. In addition, I’ve finally learned what to say to the guys here! If you tell them hapana which means no, I have a boyfriend, they don’t care. However, if you tell them you have an mchumba (fiancé) or that you’re married they’ll say congratulations and typically leave you alone. So any guy that would come up I would say that. I just kept having to say it over and and over again and eventually they’d swim away. We stayed in the water until the sun went down and Florida asked if I was okay with spending the night with her. My initial gut feeling was that it would be safe and I just thought, when would you ever get to have an authentic experience like this again? So I agreed.
We ended up taking two more piky piky’s and we actually went to her parents home. I got to meet her two sisters and her nephews and nieces, her parents, her son, her grandmother, her mom’s sisters, and family friends. It was absolutely amazing. They welcomed me to dinner and made me a plate. It was rice with potatoes on top. It’s so nice to see how close families are here. Even if you’re not family here you’re still family. I can’t tell you the number of times people call me sister or dada (when means sister in Swahili). People will refer to boys as kakas (which means brother). Countless times at the hospital I’ve seen nurses and doctors call patients mama (mom) or baba (dad). Even on the dala dala people will get up to let an elderly person sit and will say, Mama, and help them to the seat. I asked why they do this and it’s because they have the same respect for one another like a sister, brother, mother, or father. It’s quite lovely and really makes you feel safe for some reason. Tanzanian people are truly loving.
After I got to bond with her family we then took a dala dala to her home which was 30 minutes away. I had never been out that late on a dala dala. It was almost 9 at night. We got dropped off near a market and she insisted on buying me panties and a tooth brush for the night. It was so thoughtful and sweet. After buying it we then took a piky piky to her home. It was pitch black in her home and almost 10 at night. We used our phones for flashlights. She said we need to take a shower since we had salt water on us so she warmed up a bucket of water for me on the stove. She didn’t have a shower but in the bathroom there was a toilet in the ground. I poured the water on myself over the toilet hole in the ground. She let me use a kanga to dry off with and let me use one of her pajamas top.
This experience was so funny and different. I literally slept beside this woman with her pajama top on and the panties she got me. She said a night time prayer in Swahili and prayed how Catholics do. Even though I couldn’t understand everything she was saying it truly touched me. After that she said how even though she didn’t have electricity we could use her phone as a radio. She turned on her little flip phone to the local radio station and put it between us. It was Swahili singing and there was some static. H
owever, she began snoring within 10 minutes and I just laid there w i d e awake. I kept thinking, I’m in the middle of a village right now sleeping next to a lady I’ve known for a week in Africa. Life is too funny. When would that ever happen in America? I was in and out of sleep all throughout the night. We got up at 5:30am on Labor Day so we could head to the hospital. When we brushed our teeth we brushed them outside on her front porch. She also just threw her trash and spoiled food out her front porch. It was a very different way of living and was very eye opening to see. We then took the local transportation to Muhimbili. SO many people use public transportation to commute. It was mind blowing to me! Hundreds of people waiting in line to get on the ferry. There weren’t even enough seats so, so many people just stood by the cars on the ground level.

 

September 9th
Yesterday Florida and I went to Bongoyo! I promised her I would teach her how to swim more. It’s very sad how a lot of the native people in Dar have hardly been to the really nice places of Dar because it’s too expensive. I’ve been to Bongoyo once and it’s such a nice little island but she has never been and she’s lived here her whole life for 40 years! It costs 46,000 (almost $25) for me since I’m not a local and 26,000 ($15) for her. I told her it would be my treat for the day since she treated me last week! It was honestly so much fun! I couldn’t get in the water and swim because of my armpit but it was still very relaxing and fun. I loved just walking the shoreline listening to the seashells role down the sand as the waves came and went. While we were on the boat ride to get to the ferry we met a gentleman who was Portuguese. He was also 22 like me and was there working. He’s doing an internship for his masters program. He’s majoring in economics for undeveloped countries. Which is something that really intrigues me! He spent the whole day with us and it was honestly so much fun!

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Pedro!

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Honestly one of the best meals I have ever had. Florida ate the brain and eyes for me though, haha.

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Such a communal meal. An American, Portugal, and Tanzanian all at one table who hardly know one another. Great conversation.

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Mzuri sana Florida!


Him and Florida talked about football and he helped practice with her swimming since I couldn’t. We had a delicious lunch on the island. Florida taught me how the brain and eyes are one of the best parts of the fish. I trusted her opinion but couldn’t make myself try it. After the beach we got ice cream which was the perfect ending to my last full Saturday in Dar.

It’s just so amazing how God places so many amazing people in your life right when you need them. Florida made my experience in Oncology amazing and I am so blessed to be able to call her a friend. She’s such a strong and sweet woman.

Aga Khan- September 5th

Being the Patient
This last week was probably the first time I was really home sick and wanted to go home. When you’re not feeling well in a foreign country it really makes you long to be home. I honestly wasn’t sick or anything! I was just in a lot of pain. Thursday of last week I had a little red spot under my left armpit. Over the next 5 days it kept getting bigger and was hurting more and more. It got so bad to the point that on Tuesday, September the 5th, when I was at work I couldn’t even lift my arm up. I had to hold onto my arm at the hospital to help decrease the pain. When I got home from work I knew I needed to get it checked out. I went to Mo who is the program manager and asked him if I could be seen by a doctor anywhere. He said that I will go  to Aga Khan and that it’s a mzungu hospital. Meaning that it somewhat similar to western hospital’s. This is a private hospital in Dar which is a lot different to Muhimbili which is a public hospital and is the biggest regional hospital in Tanzania. Private hospitals are way too expensive for people to afford in Africa so the everyday person in Dar would not go to a private one. 
I was extremely hesitant and scared that I was having to actually go to the hospital! In AFRICA. I made sure to get two different kinds of international health insurance because I was so worried about something like this happening and the last thing I wanted to happen was to get treatment here. Not that it’s a bad place but it’s severely under resourced and not everyone abides by hand sanitation and proper sterile technique. It was SUCH an eye opening experience being on the flip side of the healthcare system. Like being a patient rather than a nurse or healthcare professional. My heart was beating so fast and I was so scared. I didn’t know what I was going to have to have done. Mo said I would go with Jessica who is the program assistant and they called a taxi for me and we were off. I kept asking Jessica if there was another place we could go to like a doctors clinic like we have back in the states like a Walgreens walk in clinic or fast pace. However, she said that there aren’t any places like that and if there are they’re extremely rare and under resourced. So you have to go to the hospital. We got there and walked up to a counter to explain what was going on. Everyone was speaking Swahili around me and Jessica would translate after they were done talking. The woman at the counter had told Jessica since I was a new patient and had never been there before that I needed to check in and give my information to the new patient area. We went to this room and opened the door but no one was there. So we waited outside the room until a gentleman approached us and asked if we needed to be seen. A few moments later he got a lady who told me to come into the room. She spoke English as well as Swahili. I sat down and she went to a computer. There was a tv that I could view that showed everything she was typing. She asked my name, DOB, emergency contact, etc. Instead of asking where I was from she just put foreigner. She asked what doctor was I seeing. I told her I didn’t know. After she got my information she then made me a folder with all of my information. She told me to go to billing with the folder. I went to billing (which by the way nothing was laid out easily. Everything was all over the place). Once I arrived to billing they asked me what doctor did I need to see. I honestly had no idea! I thought a skin doctor maybe? Jessica said we weren’t sure so we’d have a nurse look at me. We then went to a hallway where a nurse was sitting and taking someone’s vitals. Jessica explained the situation and she said to have a seat and that she’d be right with us. However, once she finished with that patient she left the hallway and went to another room. She then came back to the hallway a few minutes later and started talking to someone on her cell phone. It’s so interesting here how the doctors and nurses will do that! I’ve seen several nurses hanging up IV bags and then they get a phone call on their personal cell. They’ll stop what they’re doing with the patient right there and will begin to talk on their phone and have a full on conversation. While we were waiting Jessica explained how she was at awe at the hospital. She had never been in one like this before. In my head I was like, “Really... ? This place compares to nothing back home really.” She was saying how clean and nice it was and how fast we were being seen. For me though I thought it was taking AGES. However, in other hospitals’ like the public ones you can wait multiple hours just for someone to sign you in.
30 minutes went by and I was getting a little upset. How the culture is here can be very different and almost annoying. Usually I can let it role off my back and it doesn’t bother me. Everyone is just very hakuna matata, no worries. No one ever rushes or stresses about things. There’s a saying they use, “Swahili time.” Which basically means they’ll get to it when they get to it. They may say they’ll be there at 8am. They may be there by then or they may be there at 10am. Not because they’re late but just because. Jessica told me to sit beside the nurse because she may have forgotten about us. So I got up and sat right beside the nurse while she was still on the phone with her friend. She looked at me and soon ended her phone conversation. She apologized to Jessica in Swahili and simply said she had forgotten about me. Without even asking my name or telling me her name she simply asked me what was wrong. I showed her my arm. She didn’t even touch it or look at it for more than 5 seconds. She started making phone calls to the hospital and got me a spot with a Dr. We went upstairs where we waited once again for the doctor to see us. Someone finally stepped out of one of the rooms and summoned me into his office. He was on his phone talking with someone at his desk. He pointed to the chair for me to sit down. Once again, I was just twiddling my thumbs while he was on his cell phone with a friend. It was so strange to me! He was an Indian man problem in his late 50’s or early 60’s with a thick accent and peppered hair. Once he got off he just looked at me and was like, “So, what’s the problem?” No introduction or anything! I explained I had a big red bump under my armpit and he just said go sit over there. He was pointing to an examination table. Once I sat down he walked over towards me and touched the mass under my arm. Without gloves on or anything. After looking at it for about 10 seconds he was like, “That’s an abscess. We’re going to have to make an incision and drain it.” He began writing orders down. It was so different compared to the US. Typically the nurse will get your vitals, take your history, etc. And the doctor will ask you the same questions. No one had even asked if I had any allergies! He began to collect his backpack and belongings while saying I would have to have surgery. S U R G E R Y ?!?! I tried to maintain my composure and simply said, “How big will this incision be?” He said, “Oh, not that big. It’ll be a minor surgery.” He just summoned me to the door at that point and we stepped outside his office. When I asked him where we’re going he explained that I had to go to billing and pay and that his assistant would do the minor operation in the OPERATING ROOM. At this point I was holding in all my tears and fear. It was like I was in a bad dream. This was something I had to address and get fixed. I couldn’t ignore it. But the place I was in was extremely scary. It was like facing a fear you never knew you had all of a sudden and you knew know matter what you did you couldn’t prevent it from happening. He pointed to billing which was on the same floor we were on and then he pointed downstairs and said to go through those doors. I literally felt like I was walking to my death. I may be over exaggerating here but I really did. Every step I took, every breath I breathed, every time I swallowed my heart beat just kept getting faster and faster. I wanted to run out of there and not look  back. The doctor then left and I approached the billing counter where I pre-paid for the surgery, dressings, and the 5 minute doctor consultation. Jessica and I then went downstairs to the operating area. We were just standing in the middle of the hallway waiting for the assistant. Within 15 minutes a lady probably in her late 20’s or early 30’s approached me. I felt a lot better with her compared to the main doctor.  Her interactions with me were better and I was more at ease with her. She explained she was the assistant and would be doing my surgery. She pointed me to the operating room I would be in. I sat up on the bed and just took a big gulp. I was staring around the room just taking everything in. The lights were a bit dim and there were mosquitoes flying nearby the bed. I looked at the sheets on the bed and there was a dark droplet of blood that had stained the sheet about 2 inches from where my legs were hanging off the table. The assistant began to get everything prepared. I was eyeing her like a hawk. Making sure she never contaminated her sterile field. She didn’t. I was very relieved and at the same time impressed. It made me feel a little bit better knowing that I was in competent hands of someone. 
It was time for the minor procedure. I was lying down on the bed with my left arm up over my head. She tried injecting me with an anesthetic but it didn’t work. She kept asking if I could feel what she was doing. She was stabbing the needle in my armpit. I could feel it. So she tried injecting more in me. After three times of doing this it still wasn’t working. She ended up saying that she was just going to have to proceed with the surgery. I could feel EVERYTHING. She sliced my armpit open and drained everything. I was positioning myself against the wall clamping my eyes shut trying to keep my tears from coming out. However, I broke down. I was just bawling and bawling. The pain was hellacious! Jessica came over to me and started rubbing my leg. It felt like it was taking her so long to do it. Every second seemed like ages. The pain was unbearable. She ended up having to stuff my armpit with gauze 2 inches deep. 2 INCHES! I didn’t realize how deep it was stuffed until the next time I went to the hospital to have the gauze changed. I had to go back everyday and then every other day for almost a week. When I wore my bandage under my armpit it was quite uncomfortable. One of the staff members said I looked like a bouncer because I had my arm always positioned outwards, haha. Too funny. But that was just because of how thick the dressing was.
When I went back to the hospital the nexy time around it was worse theb before. I don’t know how it was possible but it was so dreadful. I honeslty couldn’t remember another time I had been in such pain as I was in that day. I
feeling of being white in hospital. everyone stared. I was an outsider. not their normal person you’d pass by in the hall
chaotic
waiting, not too bad actually
Jessica thought it was great
how they feel but in their shoes and they were in US?
Didn’t even ask allergies Everything happens for a reason. When I got back from working I talked with Mo who is the program manager and asked him if there was anyway I could please go to the doctor to get it checked out. He called for a taxi and I went with Jessica, the program assistant to which is a private hospital. Mo kept saying it would be a mzungu hospital which meant it would be a lot like a western hospital and not like the one I work at. The one that I work at is a public hospital and not in a harsh way but I wouldn’t really want anyone to even touch me there. I was so scared that I was having to actually go to the hospital! In AFRICA. I made sure to get two different kinds of international health insurance because I was so worried about something like this happening and the last thing I wanted to happen was to get treatment here. Not that it’s a bad place but it’s severely under resourced and not everyone abides by hand sanitation and proper sterile technique.
It was SUCH an eye opening experience being on the flip side of the healthcare system. Like being a patient rather than a nurse or healthcare professional. My heart was beating so fast and I was so scared. I didn’t know what I was going to have to have done. I kept asking Jessica if there was another place we could go to like a doctors clinic like we have back in the states like a Walgreens walk in clinic or fast pace. However, she said that there aren’t any places like that and if there are they’re extremely rare and under resourced. So you have to go to the hospital.
We got there and walked up to a counter to explain what was going on. Everyone was speaking Swahili around me and Jessica would translate after they were done talking. The woman at the counter had told Jessica since I was a new patient and had never been there before that I needed to check in and give my information to the new patient area. We went to this room and opened the door but no one was there. So we waited outside the room until a gentleman approached us and asked if we needed to be seen. A few moments later he got a lady who told me to come into the room. She spoke English as well as Swahili. I sat down and she went to a computer. There was a tv that I could view that showed everything she was typing. She asked my name, DOB, emergency contact, etc. Instead of asking where I was from she just put foreigner. She asked what doctor was I seeing. I told her I didn’t know. After she got my information she then made me a folder. She told me to go to billing. I went to billing (which by the way nothing was laid out easily. Everything was all over the place). Once I arrived to billing they asked me what doctor did I need to see. I honestly had no idea! I thought a skin doctor maybe? Jessica said we weren’t sure so we’d have a nurse look at me. We then went to a hallway where a nurse was sitting and taking someone’s vitals. Jessica explained the situation and she said to have a seat and that she’d be right with us. However, once she finished with that patient she left the hallway and went to another room. She then came back to the hallway a few minutes later and started talking to someone on her cell phone. It’s so interesting here how the doctors and nurses will do that! I’ve seen several nurses hanging up IV bags and then they get a phone call on their personal cell. They’ll stop what they’re doing with the patient right there and will begin to talk on their phone and have a full on conversation. 30 minutes went by and I was getting a little upset. How the culture is here can be very different and almost annoying. Usually I can let it role off my back and it doesn’t bother me. Everyone is just very hakuna Maratha, no worries. No one ever rushes or stresses about things. There’s a saying they use, “Swahili time.” Which basically means they’ll get to it when they get to it. They may say they’ll be there at 8am. They may be there by then or they may be there at 10am. Not because they’re late but just because. Jessica told me to sit beside the nurse because she may have forgotten about us. So I got up and sat right beside the nurse while she was still on the phone with her friend. She looked at me and soon ended her phone conversation. She apologized to Jessica in Swahili and simply said she had forgotten about me. Without even asking my name or telling me her name she simply asked me what was wrong. I showed her my arm. She didn’t even touch it or look at it for more than 5 seconds. She stRted making phone calls to the hospital and got me a spot with a Dr. We went upstairs where we waited once again for the doctor to see us. Someone finally summoned me into his office. He was on his phone talking with someone at his desk. He pointed to the chair for me to sit down. Once again, I was just twiddling my thumbs while he was on his cell phone with a friend. It was so strange to me! Once he got off he just looked at me and was like, “So, what’s the problem?” I explained I had a big red bump under my armpit and he just go sit over there. Which was the examination table. Once I sat down he walked over towards me and touched the mass under my arm. Without gloves on or anything. After looking at it for about 10 seconds he was like, “That’s an abscess. We’re going to have to make an incision and drain it.” He began writing orders down. It was so different compared to the US. Typically the nurse will get your vitals, take your history, etc. And the doctor will ask you the same questions Didn’t even ask allergies Everything happens for a reason.
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OR Day

August 21st

My experience in the OR was absolutely amazing!!!

 

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It was a nice break to get away from my second week in the ED. We got to go to the theatre at 8am and stayed in the OR until 5:20pm. There was one surgery right after another with no breaks. By the end of the day I was very hungry! I had the chance to see five different operations.

CAUTION: if you don’t like reading about gross things like details of surgeries you may not want to read any further!

Without giving out patient information I’ll summarize everything I saw! The first surgery was a laparotomy. It was crazy watching the surgeon pull out all of the organs. I was able to see how the liver was black due to the illness and see the small intestines and large intestines out of the body. I’ve seen two operations back in the United States but none of them dealt with the abdomen.

The second surgery was a radical mastectomy where they removed an entire breast. This was very interesting to watch and observe! You could see the muscles once they removed all of the adipose tissue. It was very insightful! It’s so important for a woman who’s had a mastectomy to not have her blood pressure taken on that arm because of the removal of the lymph-nodes on that arm. During the surgery I was able to see how much of the breast they actually remove. It almost goes into the woman’s armpit which is where the lymphatic system runs.

After that surgery I was going to see a proctoscopy and biopsy. However, due to the patients condition once he got on the operating table they canceled the surgery.

The fourth surgery was an insertion of a GFT. The patient had dysphasia due to severe tongue cancer. I was able to see the surgeon take out the stomach and place the tubing in. Since the patient can’t swallow properly the insertion of the tube will allow them to feed her through the tube and bypass the throat and go directly into the stomach. They wanted to try this first before they looked into radiation.

Now... the last surgery was UNBELIEVABLE. I had never seen anything like it before. The patient had KS, Kaposi sarcoma. People were also saying elephantiasis. The surgeon said that what this patient had was a rare tropical disease! His leg was 20 times the size of the other one and he also had a fungal infection on top of it. The surgeon said I could take a photo and the patient gave me his permission but unfortunately I’m not sure if I can share it on social media. The patient began having this condition 7 years ago but he couldn’t afford medical help so it progressed to this state. They had to do a AKA: above knee amputation on that leg. I had never seen an amputation take place. I always had wanted to but I never thought I would be able to stomach it. With it being the last surgery of the day as well I was starving and really wanted some food on my stomach because I had a headache and was a little light headed. All of those things aren’t a good combination when you’re about to see a lot of blood and an intense surgery. However, I made it through the surgery without getting queasy or anything! It was absolutely amazing. Just watching the surgery take place was unbelievable. The patient wasn’t put under anesthesia so he was awake for the entire surgery; which blew my mind! He had a sheet dividing the lower half of his body and his face. This is similar to what they do when a woman has a c-section. They gave him a spinal tap so he couldn’t feel anything below his abdomen. However, he could hear everything going on. When it comes to patients I just really put myself in their shoes and imagine how I would be feeling if I were them. For this patient I kept thinking of all the sounds he was hearing and smells he was smelling. Sorry if I’m going into too much detail but during operations they have to burn through the flesh to stop the bleeding. Especially in a leg where there are a lot of veins and arteries they would have to stop the bleeding by burning off the vein in a sense. The smell that comes with that isn’t the best thing in the world. Also, you can hear the sound of flesh being cut. Having to hear the sound of my leg being cut off and smelling my skin burning would not be okay. I just couldn’t imagine what he must have been thinking. As I’m still working on my Swahili I’m able to carry out a conversation in greetings, goodbyes,  and introduction. However, for more in depth in conversations I’m still learning. So I could just small talk with him. The biggest surprise with this surgery was when it came down to the bone, literally. So the appliance they had to saw the bone kept breaking and they weren’t able to cut it. So they improvised. They ended up pulling up the leg and bending it backwards manually breaking the femur. There was a loud pop and the bone was officially broken. When in Africa you see things like this. I couldn’t believe it had happened! Remember that the patient is AWAKE. So he heard his own bone crack! Can you believe that?!?! CRAZY! Furthermore, the doctors and nurses were laughing about it.

Overall, I was very happy about the clinical practice that goes on in the OR/theatre. They have a “Time Out” session right before the surgery just like we do in the US to make sure they’re operating on the right patient in the right place. They did their best to obtain and retain a sterile field. I still saw some not so good things like re-sticking the patient with the same needle or beginning the surgery as the nurse was going over the time out sheet.

Though it was a long day it was a bomba, bomba day! Bomba means fantastic in Swahili. I had only ever seen 2 surgeries in the OR in the US but here I saw 5 in one day!

My Experience in the ED

August 19, 2017 Saturday

I’m currently writing this in the pitch dark. It’s night time in Tanzania and all of the electricity just went off. A few nights ago after tossing and turning all night because of hearing various sounds throughout the night I woke up in the morning at 5:30am to the sound of heavy rain, electricity no longer working, and a leak in the room. All of the electricity goes out periodically here; both at the house and hospital. There are a lot of things that I’ve experienced here on a regular basis that I wouldn’t typically experience at home.

Sometimes the water goes out when you need to wash your hands or even while you’re in the shower. The toilet will stop working, sometimes the toilet is an actual hole in the ground,

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having to hand wash clothes, not having any toilet tissue in any of the public restrooms, constantly having to have bug spray on because misquotes are everywhere at all times, no AC anywhere, etc. However, I can’t even complain. There are so many people here who don’t even have a proper toilet. I’ve seen people washing their clothes in puddles of water and in the ocean. A lot of people in Africa don’t even have electricity. I am very fortunate both here and at home.

When I look back on this week I’m not gonna lie, it has been a really hard one. I’ve just really had my ups and downs. Especially with seeing so many painful and tragic things in the ED. Today as I reached my half way mark I had a mix of emotions. At first I was excited to be halfway done but the more I thought about it, it made me very sad. Of course I miss my dear family, boyfriend, friends, and the little things that America has like oatmeal chocolate chip cookies or AC but I’ve finally made some really great friends with the Tanzanians and feel like I’ve got a good bearing of this city. The people at the Work the World house have been amazing and I’ve been great friends with everyone since day one! However, it’s just different with making friends with the native people. A lot of people come and go at the Work the World house. Everyone that was here when I arrived has left now. The two girls from Belgium that arrived the same day I did just left an hour ago. It’s been so hard saying goodbye to everyone. There’s been people from all around the world: England, Belgium, Netherlands, and Australia. So far I’ve been the only American which has been hard. But everyone has taught me so much about their healthcare systems and cultures.

When I met with the Lumos committee I will never forget what one of the people on the committee told me. He said to be sure to

really make an effort to get to know the local people.

I couldn’t express how it has been the best and most rewarding thing I have done since I’ve been here. The people and culture are literally my ultimate favorite. I’ve never met people as kind as I have here. If you show them a little interest they will pour into you times a million and give you four fold. Everyday is literally a new adventure. I never know what’s in store. Of course I know I’ll be waking up at 5am to get ready for the hospital and it’ll be an hour commute. I may or may not have a seat on the dala dala. But, the hospital is always a surprise. Which nurses or doctors will I see today? What patients will come in? What new friends will I make? What will my evening be like? I hardly ever leave the hospital at the same time in the afternoon/evening. It may be 3:00p or it may be 6:00p. Sometimes a nurse will take me to her home or student nurses will make me dinner and let me come into their hostel. Everyday is literally a new adventure!

My first full week in the ED was extremely eye opening. Everyday felt like I was in an episode of Grey’s Anatomy. I won’t go into too big of detail because I know how some people don’t have super strong stomachs and because of patient confidentiality but I would see patients all over the spectrum: SEVERE motor vehicle accidents, SEVERE burns, accidents with bombs, gun shot wounds, several head hemorrhages, tetanus, TB, malaria, many cardiac arrests, machete accidents, and so much more.

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I’ve seen tragic things at the same time. There was a patient who’s blood pressure was 300/200 and was having a stroke. She didn’t have the money to afford a CT scan which is about 170,000 Tanzanian shillings which is about $60 US Dollars so they wouldn’t let her have one. When I asked what’s going to happen to her they said she’ll remain there until her condition improves or worsens. If it worsens she’ll be sent to palliative care. It was midnight and she had arrived early afternoon. Her condition was only worsening. She was struggling for each breath, she was bleeding out blood, and her blood pressure wasn’t dropping. The only thing they were giving her in the IV was dextrose. I was so confused and upset on the inside but I simply had to remind myself of this phrase, “It is what it is.”

I’ve faced a lot of ethical dilemmas while I’ve been in the hospital. There are so many ethical decisions being made that I don’t always agree with or understand but I’ve learned to just observe everything going around and accept what is happening. For instance, my last day in ED there was a patient with 3 wounds to his head. We believe they were gun shot wounds. He started going into cardiac arrest so we began CPR. However, when we would do rescue breathing for him the air would come up through his head and more blood would gurgle out. Eventually he went back to a normal sinus rhythm but shortly after he was somewhat stable his B/P dropped and he went into cardiac arrest once again. Right then and there all of the nurses and doctors began talking about whether they should do CPR again. They stated his pulse was gone and asked if anyone had any issue with leaving him as is. No one advocated to continue so they just left him. My insides flipped over in that moment. I had just never seen that happen before. From what I’ve seen in the US the doctors and nurses will try everything in their power to keep the patient alive unless they have stated they’re a DNR. This patient was probably in his late 30’s. I honestly haven’t seen anywhere on any patients charts if they’re a full code or DNR so I’m not sure if they have that here but I’ll have to ask. This is an example of just one of the many situations I’ve seen where ethics go into play. I could see where the healthcare team didn’t see a purpose in continuing CPR because of the overall outcome of this patient. However, it was just hard to see people giving up on someone to live.
There are two other patients that I would like to talk about that really stood out to me during my time in the ED. I had both of these patients on the same day. Let’s call the first one Rob and the second one Jim. I won’t be able to go into too much detail due to patient confidentiality.

Rob was an older man who has been suffering from various health conditions one of which was cancer. He came into the hospital with a chief complaint of overall malaise and weakness. He didn’t seem 100% orientated and he was struggling to breath. We put a non-rebreather mask on him to increase his 02 level. However, he kept trying to pull it off. The doctors and nurses ended up restraining his hands to the bed so he would keep his mask on. When I was in the SICU at Vanderbilt a patient was so delirious because of the lack of oxygen that he kept trying to pull off the mask, just like the patient was doing here, so the doctors and nurses gave him a light sedative to keep him calm. I thought it was the best thing they could do since they didn’t have the sedatives available. However, he was really having a hard time breathing. It’s always so important to observe your patient and listen to what they’re saying. A teacher at Belmont once taught me that a nurse is nothing without their assessment. However, they kind of just left this man in the corner of the room. About an hour later his breathing stopped all together as they were attempting to intubate him. Due to his various health conditions they didn’t feel it would be a good overall outcome if they attempted CPR. Almost an hour after his death various doctors were still practicing how to intubate. They had the device in his mouth and one after another doctor would practice and clean up their technique. This made my stomach sick and made me so sad. With patients I always try to think of them as an actual family member. This man was just a few years older than my Dad. I wouldn’t want anyone doing that to my father! No way could I do it on this man. Some of the doctors asked if I wanted to practice but I said no. I understand their reasoning so they’d know how to do it on future patients (some American intern doctors were teaching them how to properly do it). But I still didn’t feel right about it. After they all practiced intubating him they just left the room leaving him there. My mind immediately went to what I had learned in my Adult Health 2 class about postmortem care. During my SICU clinical experience back in the US I had experienced my first death of a patient and that was the first time I had done postmortem care. I was incredibly thankful for that experience because it helped me in that moment. Although the postmortem care was a bit different here I was able to do it. One of the hardest things here in the hospital is not being able to speak Swahili fluently. From context clues and simply observing the situation I was able to identify who his daughter was. I wanted to so badly be able to speak with her in her language but all I could say in Swahili was that I was very sorry. It was so interesting to watch how the healthcare professionals treated her. It’s just not what I’m used to seeing in the US. I just kept putting myself in her shoes. If my father had just died I would be a basket case. She called her mother on the phone to let her know. It was all so heartbreaking. To make the situation even worse I was watching what the nurse was doing on the computer screen. She was JUST NOW PUTTING IN HIS TRIAGE INFO and how he presented upon being admitted. She wasn’t even the nurse in the room that saw him once he got there so she was making up a lot of it. It was over an hour after his death and she was just now putting in all of this info that had happened upon his initial admission which was about 4 hours ago. This just surprised me so much. She was documenting on a dead man from when he was alive hours ago because it wasn’t done yet. The situation with this patient really made me sad. What if I had just listened to him when he was taking off the mask. Maybe he was just trying to show us he wasn’t breathing properly with it on and that’s why he was trying to take it off and we should’ve intubated sooner. I’ve faced a lot of situations in the ED that made me question how good my nursing skills are. I don’t have that many clinical skills under my belt since I’m a recent graduate but I just can’t help but think if I maybe had more experience I would’ve been able to save more patients lives.

Later on in the day the second patient that I would like to talk about came in, Jim. He was about my age and was a very fit young man. Looked like someone that nothing could hurt. He was very muscular and healthy looking. Just full of life. However, like many of the patients he was involved in a motorcycle accident and was laying on the bed lifeless. The doctors put me in charge of suctioning and manually bagging him. I did this for about an hour before we transferred him. As we were transferring him I was still bagging him. We took him all the from the ED to the surgical intensive care unit. Which was a good 10 minutes walking distance. They were strolling him and I was bagging him while I tried to dodge running into people. Once we got to the SICU we were able to get him hooked up to the ventilator. However, the SICU was the most eerie place ever. I felt like I was on an episode of The Twilight Zone. The windows were tented with this dark pink/purple tone so you couldn’t see out of them and there were all of these constant noises that would come on every few seconds and play in harmony with one another. It was pure white on the inside and all the patients were lying across from one another in the ward not moving or talking since they were mostly all on ventilators. It was just a very creepy feeling I got. And all the doctors were dressed in a different outfit with white shoes on. The facility seemed great though. It seemed like they had a lot of money going towards that ward which was nice to see.

The teachers at Belmont have taught me SO much! I hold onto everything I learned while at school like a treasure. It’s really helped me while I’ve been here.

Pediatric Oncology August 28-September 8

August 28-September 8

My experience in Pediatric Oncology these last two weeks was absolutely unbelievable despite me having strange things going on with my health.

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My first week was a weird week for me because I was having some serious GI complications. It made me miss 2 days at the hospital. It makes me really upset with myself when I miss work but you can’t take care of other people until you take care of yourself. Luckily, I’m all better now. However, this last week I actually had to go to the hospital for a minor operation. I’ll write about that in my next post. In this post I’ll talk about the Oncology Ward.

My first day on the Pediatric Oncology Unit was unbelievable. I absolutely fell in love with all of the children!

I’ve always heard people say how hard Oncology can be, especially Pediatric Oncology; however, I love it. Of course the children are very sick and it can break your heart. But, children have such a special place in my heart. So even though these children are sick and sometimes lifeless which is the exact opposite of how children should be, it’s when they need you the most. I’m so honored that so many parents and children knew me by my name! On Monday I was beside the medicine closest and a lady walked passed me. I remembered her face but couldn’t really remember anything else. I said hello and how was her morning and then she said both my first and last name! I probably met her once last week but she remembered my name and everything. There are two units in the Oncology Ward. There’s upendo and tumaini. Upendo means love and that’s where the really critical patients are. The Tumaini Ward means hope and that’s where the less critical patients go to or where patients from Updeno transfer to when they are improving. I spent most of my time in the Upendo Ward.

The children honestly make your heart grow 20 times bigger. Being with the children really made me want to know more Swahili so I could communicate with them and play with them more. Most children don’t understand you can’t speak Swahili. They’ll keep speaking to you. I realized though during a lot of the play time with children you don’t need words to communicate. It was so interesting getting to play with African children. For instance, there’s a playroom you can go in where the children have different things to play with. When you walk in all of the children smile ear to ear and just run up to you yelling, “Mzungu!!!!!” We were using clay and they were making food to eat like chipati’s or ugali. It was funny to me because that’s exactly what children would do in America except it’s just different foods. They’d also play doctor with me. They’d pretend to put an IV cannula in me and would tell me to not cry and shh. Since they’ve been in the hospital so much that’s what they’ve been exposed to so they were reenacting what they’ve had to do.

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Handsome Uma! My first kiddo friend! He loved wearing my name tag everyday!

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Her little smile could literally light up the world!

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This is the play room where all the fun games happen! Mzungu alert!

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PHOTO 1- There was never a day where I wasn’t holding at least 2 children’s hands.

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PHOTO 2- They always wanted to take me somewhere

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PHOTO 3- And we are off again!

Sometimes the kids would also hurt you. Since I’m white they find me very interesting! They’ll get my hair out of my bun and just pull and pull on it trying to get it to come out. This one little girl kept jumping up and popping me in the eye. She would pull my arm hairs and all the children kept pinching my skin. No matter how much I would say no, hapana, they would literally mock me and just laugh. I had to hide in the nurses room so they would stop hurting me. But for the most part they were very sweet and loving. It was very interesting to see how they do some of the things in the ward compared to what I’m used to seeing in America. I was able to understand why we do a lot of the things we do in the states. For instance, there’s this big bottle of liquid morphine that just sits in the unlocked cupboard in the middle of all of the patients.

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The parent will simply bring a cap size clear container to you which means there child is in pain and they need the morphine for them. Without documenting or anything you simply fill the cap to the top and that’s it. You don’t go assess the child or follow the parent with the medication to make sure the child actually takes it. In addition, the nurses typically give the parents the medications to administer to the children. No documenting is done (or at least any that I’ve seen). Of course the nurses administer IV medications and IV flushes and will put a check mark beside the action in the patients file but other than that the parents are in control of the actual pills.

I saw a situation where this went very bad due to miscommunication on various ends of the spectrum. Me and a doctor from Ireland named Rincy were looking at a patients lab values over the course of a week and documenting them on a chart so you could see a trend. However, the child’s K+ level was 2.4 two days ago... The lab value hadn’t been rechecked since then and the child was taking a potassium tablet. However, upon further investigation and talking with the Mom we discovered that the child had ran out of the tablets a few days ago. The mother simply didn’t understand. It was the mothers responsibility to tell the nurse or doctor that she ran out of the medication so they could order a new prescription. However, if it was properly documented and the nurse distributed the medication then this problem wouldn’t have occurred. The scary thing to think about is what would have happened if we hadn’t of caught that? Who would have? And when? A low potassium is critical and needs first priority.

This situation taught me the importance of patient advocacy. If you don’t advocate for your patient and truly know their chart then who else will? That responsibility falls on you. We are so lucky in America to have almost an entirely paperless system. There are far less accidents that occur. Another example is having to read the doctors orders on each patients chart. It’s very interesting how they do their orders. The doctor will write it inside each patients chart and then a nurse will go through all the charts and write all the orders in a notebook where all the orders are together in one spot rather than various folders. I did this job one day. Writing down all the orders literally almost took me all day.

Moreover, reading the doctors handwriting was absolutely horrendous sometimes! I could easily see how someone could write the orders down wrong. I would have to ask various nurses sometimes what the doctor was trying to say because the handwriting was quite horrific.

As far as infection goes I could see how easily a child could be infected due to germs of other children. The unit was a ward so there would typically be 6 children in one room. Now add family members and brothers and sisters and that’s a lot of people in one room that can transmit germs. One little boy was being tested for TB and he was still around all of the other children. Infection control was something I constantly worried about. Furthermore, all the patients share the same bathroom and toilet. Inside the ward there’s just the room and the communal showers are in a different room. The hospital cooked food for families that lived too far away and couldn’t bring food from home. However, if they did live close to the hospital they were expected to bring their own food from home.

On EID Day there was hardly anyone at the hospital. I didn’t even realize that Friday was a holiday. It’s a huge Muslim holiday. How people explained it to me is that it’s kind of like Easter to Christian’s. There was only one nurse on the Upendo Ward taking care of the patients. I found this to be my golden opportunity and I basically became this nurses side kick all day. Since there were very little hands and so much to do I was able to get a lot of experience that day. I helped prepare all of the IV flush medications. In America typically all the medications are already mixed for you. However, you prepare the entire medication. In the bottle it starts out as powder. You have to draw up a certain percentage of sterile saline (depending on which medication you have to dilute) and mix it with the powder. You even have to  do normal saline flushes this way. They do not come pre-made. This is something I never even thought about having to do. We are so blessed in the US to have all of these things already made for us.

EID weekend was a very interesting weekend and we had to take extra precautions. There were lots of parties going on and the Work the World team warned us not to be out late because a lot of thieves are out and about during the holiday. There was a huge party at Coco Beach which is just down the street from where I live. I was meeting up with someone near by and as I left the house there were stampedes of people on the side of the road walking. It was evening time and they were all leaving the big celebration at Coco Beach. Most were all dressed in hijabs and typical Muslim clothing. There were probably 100 people walking down the street in the same direction I was trying to get to. I ended up walking on the road. About 2 minutes had passed by as I was walking and I just felt someone hit my arm. I turned around to find a Muslim woman glaring at me. She asked me why is it that American women (how she knew I was American I have no idea. Most people think I look either Greek or Italian here maybe due to the curly hair) think they can just walk so fast in front of everyone else? She spoke very good English but she was being very passive aggressive towards me and I actually got extremely worried because I was not in a safe environment. Of course I was wearing respectful clothes for the culture and I had done nothing wrong. I was walking on the road so I didn’t even push my way through people. It was a clear opening. People in Tanzania do tend to be very hakuna matata (no worries) and don’t typically rush. I’m just a fast walker in general. I explained as nice as I could that that’s not why I was walking fast. I was walking fast because I was late meeting a friend (which was true). In that moment I saw the friend out of the corner of my eye. I began to walk towards him and she just glared at me as if I owed it to her to continue having a conversation with her when she was practically yelling at me. I explained this is my friend right here. She just rolled her eyes and continued walking with her friends. That has honestly been the only bad encounter I’ve had with a Muslim person here. All of them are so sweet and kind. This situation just really caught me off guard and reminded me to always be cautious and safe with my surroundings.

The last thing I’d like to talk about are two little boys from Muhimbili. One is 15 (almost my little brothers age) and the other is 11. Both of them loved to draw. This reminded me exactly of my little brother, Grantley. He loves to draw as well and I could see the same passion Grantley has in these little boys eyes. They had their drawings on loose printer paper. That day after work I decided I’d run by the little grocery store and get them a sketch book and some art pencils. I honestly can’t not put into the words the feeling I got when the boys saw what I had got them. It humbled me so much. Their eyes lit up as if it was Christmas morning and they kept saying God Bless You. My last day at the hospital I got those boys each a football. They had asked me for one weeks ago but I didn’t know the place to get them. I asked Faraja (one of the staff members of Work the World) if he could get me some if I gave him the money and he said of course! As I pulled the footballs out of the bag (red and white for Simba colors of course) their eyes were even bigger than before when I gave them the art supplies. They grabbed the balls and they were off to go and play with them. That’s the last time I saw the two boys. Best moment ever.

I’m definitely going to miss all of those children.

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And I’ll always remember the special moments like a child just running up to you to hold your hand and walk around the unit with you. Or when I had seven children just clinging to me for about 10 minutes. One of the grandparents had to tell them to let go of me so I could go to the nurses station.

My favorite painting in the hospital. There is beautiful artwork all around the children's hopsital.

My favorite painting in the hospital. There is beautiful artwork all around the children’s hospital.

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Mukumi National Park and Maasai 25/08/2017-27/08/2017

The Safari Journey

On the Way to Safari
25/08/2017

I literally can not contain my excitement to be going on the safari! Today is finally the day! My favorite animal in the entire world is an elephant or in Swahili tembo.

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Two female elephants and one of their babies

I’m going to actually be able to see them in their natural habitat and home! It’s a 7 to 8 hour drive to the national park! Therefore, I have a lot of time to just think and write about everything I’m feeling. I’m really happy I’m able to get out of Dar and see the more rural area of Tanzania. Though a lot of people live in Dar (which is a huge city and Capitol of Tanzania) a lot more live outside of the city and the rural areas are more representative with how the majority of people live in Africa. The last 2 hours I’ve just been mesmerized with simply staring out the window and observing my surroundings away from Dar. It took forever to get out due to so much traffic. It’s so different to see so many people take local transportation to get to work. There are so many bus options you can take. There’s this thing in the city (the name of it isn’t coming to mind) which is where people get on the bus and there’s no traffic. There’s a lane made just for that bus in between the two main car lanes on the road and it never has to sit in traffic. There’s a specific lane just for those buses (kind of like a subway). Just like the dala dala the people were PACKED on it. The people on the buses here literally looks like sardines in a can. All you see is a big blob of people because everyone is squished together. I love taking the buses because that’s how the people here travel and you feel more like a local. I like to call the dala dala bus rides dala dala yoga. This is the main transportation I take every day to and from the hospital. You just never know which body part is going to be stretched.

Here is a link that discusses what the bus system is like: http://www.eastafricatravelguide.com/tanzania/get-around.html

When you look out and see the shops/road side stands and homes it can be kind of hard to take in. Imagine a big, black metal pot of boiling water over a fire where a beautiful mom dressed in a colorful, bright dress and kanga is cooking food over. Right beside her are 10 people both standing and sitting eating food and conversing. There’s dirt and trash all around them. Behind them you see a row of run down shops which kind of look like mini road side stands/markets where people are selling various goods like oranges, corn on the cob, nuts, etc. All around them are people commuting to work. They’re either waiting for bus’ or waiting to cross the road. Right behind the road side stands and all the people commuting and cooking you see these little shanty shacks/homes. They are all piled together. Some are completely closed in but others you can see where there’s an opening.

Something that’s really been on my mind lately is how can I accurately convey what I see? No matter how many photos I take or how much I describe what I see it’s just not the same and can’t do it justice. You just have to experience it for yourself in order to truly understand the experience. This makes me so sad because I know a lot of people in my life who will probably never come to Africa. It’s so sad because Africa teaches you SO much and exposes you to a new way of seeing life. The people here are unlike any other people I have ever met. Knowing that some people will go their entire lives without seeing this side of the world is heartbreaking. We can learn so much from one another. How can I bring this world and life to my other world and life in America? How can I help further Africa develop as far as healthcare and educating people goes?

As you progressively get more and more out of the city you begin to go through villages. There are hardly any shops. You see Maasai herding cow and oxon. It was so eye opening to be able to see this side of Tanzania rather than just the city. It makes me quite sad because most people who have recently been born and live in Dar weren’t brought up by a tribe. Since Dar is the biggest city in East Africa it has a lot of Western influence.  Therefore, the younger generation that live their tend to lose some of the ways of their people. That’s apart of Africa that makes the culture so rich. I am saddened when I see a lot of western influence here. Rather than a woman wearing a bright colored, long dress you may find her in a pair of jeans.  So plain and stereotypical of where I am from. The majority of people I have met in Dar seem to have an admiration for how we do things in the western region. They try to mimic how we dress, act, and do things. To an extent, it is a good thing.

There are some great things that they can learn from our infrastructure and mold into their own social infrastructure as they see fit. The main two I think they could learn from is taking a look at our foundations that could help the growth of their economic capital and social justice. On my connecting flight from Istanbul to Tanzania I met two gentleman who worked for the Tanzanian Constitution Forum. I have been able to be in contact with them throughout my journey so far. They travel all over the world in hopes to learn from other countries and change their constitution so that they can help their country grow to its fullest. They do a lot of civic education and public engagements to educate people in Tanzania to take a stand and fight the government to implement and reform their constitution. This is an amazing thing to be apart of and I was so blessed and humble to talk with them for hours in the airport waiting for our flight. However, I just don’t want the people of Africa to ever lose their heritage and culture. Being able to travel somewhere different than what I am use to seeing is like finding a gold gem in a cave of brown granite. Every place is unique and beautiful in the world. We can definitely learn from one another but we must remember to hold onto what makes us, us.

Now back to transportation. A lot of my nursing friends explained to me that buses are their way of transportation to get home (the ones that weren’t born in Dar). It’s the cheapest form of transportation. Although it would be quicker to fly it’s best on the wallet to take the bus. The bus is not air conditioned and it probably fits about 60 people on it. There are so many different kinds of buses that people take depending on which region they’re going to. Mikumi National Park is in the Morogoro region. Bear is in the south and that’s a 14 hour bus ride. But the bus is the most common mode of transportation I would have to say.

 

As I’m staring out my window and seeing everything of course the wheels in my head start spinning. I keep thinking of everything from a health perspective. What type of healthcare and treatment do the people in rural areas have? How close is the nearest hospital and what are their resources like? Muhimbili National Hospital in Dar is a government run, regional hospital. So the most severe and sickest people are typically seen here. People in the rural areas who can’t get the resources they need in their region are sent to Dar to get treatment. However, they have to take the bus because that’s all they can afford. Imagine if you’re severely sick and you need treatment as soon as possible but you have to get on a bus that could take 8, 14, 16 hours. I honestly can not even fathom that. That’s so scary to think of. There were so many accidents we passed by where big semi trucks were in ditches and completely flipped over. I just kept wondering if the people survived those accidents. It’s so heartbreaking to come to the realization that so many people simply die due to lack of resources and poverty. If you can’t pay for treatment then you simply don’t get treated. Moreover, we would pass by SOO many people riding motorcycles extremely fast without helmets. At one time I saw three gentleman riding a motorcycle with no helmet on. They were all in flip flops and t-shirts around my age maybe a bit older. They would just weave in and out of the lanes. Overtaking is such a big thing here and everyone does it continuously. When we went to the village and were actually on one of the buses I honestly couldn’t tell you how many times I saw the bus overtake cars when there was a car coming in the next lane. Maybe 20 times at least?

In addition, this was the first time I’ve seen actual speed limits and police pulling people over. They even pulled over our safari vehicle once for overtaking someone. When I asked our safari guide, Rama, why is that In Dar there’s no speed limits or anything he explained that since Dar has so much traffic there’s no need to have speed limits whereas compared to the rural areas you could easily go 100 because there’s hardly any congestion once you’re out of the city. Rama taught us a lot. He explained in habitation areas the speed limit is always 50 kilometers per hour. These are areas like schools, zebra crossings, etc. However, once you’re out of those zones you’re allowed to go up to 80. However, when we were on the bus going to the village I caught the bus going 120.

Overall, I would absolutely love to do research to see the percentage of health habits as in smoking, food intake, and so on. In addition, to studying infectious diseases and how the government of Tanzania can have certain grants that go towards vaccinations as well as pass legislation that will help hone in on these problems. How can I be apart of that? Sometimes I feel like a little green pea just sitting at the bottom of the Indian Ocean. How can I be apart of helping their health system? Where do I even begin?

 

Mikumi National Park Part 2: Safari and Maasai
26/08/17

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My safari rafikis!

This weekend was an absolute dream come true. We got to see every kind of animal you could imagine: elephants, giraffes, lions/lioness, zebras, baboons, pumas, etc.

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Antelope are known as the McDonald’s of the savannah because there are so easily eaten as prey because of how many there are. Do you see the “M” on their back end near their bottom?

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There were literally everywhere!

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Such big antlers

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Mommy and baby baboon!

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One of my new favorite animals. They are so smart. We got the chance to feed them fruit before we got into the park.

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A class that took a field trip to the park!

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There’s a highway that runs right through the national park! Semi trucks go SO fast on it. We got the chance to see some giraffe’s crossing. This is so common to the local people. It is like seeing a deer for us crossing the road. I was constantly in awe!

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Even rare ones that I never even dreamed of living like the colored plum thrush or the lilac breasted rola which is a type of starling.

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It took everything I had in me to not leap out of the safari jeep and hug the elephants.

Some of the quick fun facts that I learned: 6% of a giraffes body weight is made up of their heart because their heart has to pump so much blood all the way up to the head and down to their legs. Giraffes also just have seven vertebras. Giraffes live to be up to 30-35 years old. Elephants spend about 16 hours a day on feeding and consume around 250 kilos a day. Rama then went on to explain how elephant poop is actually used for quite a bit of things. Their poop can treat epilepsy and is also used as insect repellent. He also said that some people even smoke elephant poop. Rama would also tell us all of the different legends and stories of some of the animals and trees. One of my favorite stories was the story of the baobab tree. This tree is literally upside down! I’ve attached an article that tells all about it because it is just so fascinating!

http://nature-explored.com/baobab-info.htm

The roots are the branches. The belief is that the trees were drinking all of the water in the land so God punished them by turning them upside down. Some of the other trees that were very interesting to encounter were the tamadrina tree and this one tree used for brushing teeth! Ukalia divenorma (brush teeth with tree) and you can use the leaves as lipstick. It makes your lips yellow.

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The Baobab Tree! We actually got to get out of the jeep in the middle of the Savannah and climb this magnificent tree!

Moreover, it was so fascinating seeing all of the symbiotic relationships among the animals in the savannah. An example of this are the zebras and the giraffes. Typically anytime you see one you see another near by. Giraffes are able to see things far in the distance and protect the zebras in this way; whereas the zebras have wonderful hearing and see things closer to the ground. Therefore, they work together in not being prey. There is a similar relationship with the birds and the buffalo. Everything really does work in harmony. Seeing it from the aspect of animals was so mesmerizing.

Furthermore, I was able to get up close and personal with the lions and lionesses. I had no idea how lazy the male lions were. The lionesses typically do all of the hunting. Anytime you see a lioness you know her cubs are nearby. Right when we got into the park zone we saw a lioness run across the road to get to the other side where her half eaten carcass lay under the brush. The adrenal I got was amazing!

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The lioness and her prey! First thing we saw to begin our safari journey!

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This lion literally slept here all day long! It was crazy being so close to the King of the Jungle being completely nonchalant with everything around him.

Even though this a beautiful beast of the wild that could easily eat us all just laid a foot away from me. Rama taught us how they see objects as a whole. Since we were in a jeep much bigger than she was she didn’t even pay us any attention. It was so fascinating! He also told us stories of people who had been eaten by them because they simply weren’t being smart. For instance, one driver of a semi-truck stopped because his engine was over heating. Instead of waiting for a car to pass by and help him (because power in numbers) he stepped out of the car to fix it himself). For a few days people drove by this truck that was still running. Once the vehicle finally died someone noticed the driver was missing. A few days later near the vehicle his clothes were found covered in blood and ripped. On our way to the park we actually stopped on the road to help fix another vehicle. Rama did not know him but stopped because if there is more than 1 person they are less likely to be attacked. The male lions also mate up to 6-10 hours a day when the females are in heat!

Another interesting fact is that hippos can only breath for 5 minutes underneath water. They stay underneath the water all day because their skin can easily be burned and is very sensitive to the sun. There eyesight is also very bad. They travel in a signal line and if you get in the way of one of the hippos and make it lose its path from the others it will get very aggressive and attack you. So you always want to stand clear from the hippos when they are on the move. When the hippos mate and the baby is born they separate. The female wont bring it back to the male because he will kill it so he stays the top dog. Hippos live for around 35 years and can send a message to one another up to 8 kilometers away! As for some other creatures that live near the water, like the crocodiles, I learned that they live up to 45 years old.

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Right by the hippo pool! They come out at sunset.

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This is actually a hippo on top of another hippo. It was such a beautiful thing being able to see the animals in their natural habit just doing natural things like pro-creating.

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One of the many hippos in the water on this sunny day!

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Rama telling one of his amazing stories! He was telling me the legend of the hippos and why the people believe they were cursed of having easily burned skin.

 

After a full day of being on the safari and looking at animals we then got invited to go to a nearby village and

meet the tribe that lived there, the Maasai.

I was extremely ecstatic to get the chance to visit them! Maasai typically live in the outskirts of the national parks! They herd cows mainly and are known as nomads.

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Here’s a picture of the tribe we got to meet!

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The elders of the village

As we were walking to meet the tribe we ran across some children. Being out in the country it is very common for people to never see a white person. There were 2 girls one around 7 and the other around 3. The 7 year old was carrying her baby brother. The 3 year old was carrying a giant machete. When the 3 year old saw us she just burst into tears because our appearance scared her. She had never seen a white person! They don’t have access to things like TV, newspapers, magazines, etc. out in the country aka: the bush. She hid behind her big sister until we walked by.

I was looking down around me admiring all of the bugs that I had never seen before and then I saw an ant pile. Rama saw me looking and asked if I knew what the people use ants for. I had no idea. He went on to tell me that the people use the ants to test for diabetes. He said that if the person is positive when they pee on the ground the ants will be attracted to it because of the sugar. I was so amazed at the ways people test for things here compared to back home. I mean, it was absolute brilliant since high blood sugar equates to DM but just how they use their resources is wonderful!

After our 25 minute walk we finally arrived to our destination! I got the chance to be fully engulfed in the culture of the tribe. We were greeted by the women upon our arrival. They began handing us clothes and helping us put it on in addition to jewelry. We danced with them and got to hear them sing. We got to tour their home and see where they kept their live stock. We got the chance to ask them any questions we had.

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We got the chance to hold some of their live stock before they went up for the evening.

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Herding time for them to go in for the night

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This is the home the family lives in. It was the size of probably a garage. Maybe smaller.

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Inside their kitchen. To the left is one of the bedrooms which is where Simone is coming out of and to the right of me is the other bedroom. That’s their home.

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I was able to see how the culture was inside of this tribe. They literally lived in their own little world. They hardly ever leave their little region and land. Maybe once a month the man of the household will go into town to get supplies but they mainly use everything they have right in their own home. The little 8 year child carried a giant knife to protect him from any wild animals that may come.

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Remember, they live right outside the national park! I couldn’t imagine having to defend myself against a lion or hyena! Especially at that young of an age. He looked so confident and like a mini man. The Maasai believe the look of their wealth come from their live stock. If they need money for medical purposes they will never look at one of their cows to sale. That is their wealth. They hold on to their animals and land for dear life. No matter how in need of money they may be in.

The women do all the house work (lugulu) and the men have all of the leadership roles. They are trying to balance out gender now and now both males and females go to school. Moreover, some controversies were brought up. The main one was female genitalia mutilation (FGM). This is something that I had read about in my world religions class at Belmont with the Maasai tribe. However, I was actually getting to see it in real life and talk with the people who actually practice it. I was trying to get a better understanding and grasp of why the people do it. Supposedly they feel that if they make it unpleasable for women to have sex then they wont cheat on their husbands. A big problem in the past were women working for prostitution but now that education and schooling is in place it’s not as big as it used to be but there is still a lot of it. I actually went to a place close to where I live in Dar where prostitution was going on all around me. I was shocked and so uncomfortable. There was a hotel attached to where I was and you would see the girls take the men upstairs where they would do their service. A lot of the men were actually older, white business men. I was so sad to see this going on. Furthermore, a lot of things we take for granted knowing is not common knowledge in this village. For instance, polygamy is a common thing in Tanzania and in this village the elder had 10 wives. If his friend were to come and visit it is understood and common courtesy to let the friend sleep in your room with one of your wives. Education on STD’s, most importantly HIV and AIDS, is not understood in many of the villages. Getting to visit the village was an amazing, eye opening experience!

 

You can’t even imagine how many questions I kept asking during this safari journey. When everyone would be sleeping in the jeep (since it was an 8 car ride) I was constantly in Rama’s ear asking questions. Just getting a better grasp on the culture and society. In Mikumi which is apart of Morogoro, the region, there are 4 main tribes that commonly live there: Lugulu, Sagala, Vdundone, and Pogoro. On the drive to and from Mikumi you pass by Ew Lugulu Mountain which is so big and absolutely stunning! The sulu reserve goes though the mountain. There is also a sizo plantation which runs below the mountain and the plant is used to make rope.

Rama also taught me many phrases in Swahili! The common theme of our trip would be him saying, “Twende? (lets go?)” and our response, “Ndio (yes)!” Everytime we would stop to look animals before we could move on to the next spot he would say “Twende?” and we couldn’t move on until we all said, “Ndio!” I loved it! Some of the other phrases he taught are listed below (and please excuse if I mis-spelled anything. I wrote it out by how I would say it):

Habari awko (how are you? Can ask to someone your own age)
Habari zah sai easy (say to anyone anytime)

Nikoo sa e d a nini (how can I help you?)

Eww may ah mmm ka jaye (how did you sleep)? 

Ew si ku mway muh (good night)
Lala salama (sleep well)

Uhm may choka (r u tired?)

He also told me why greetings are so long in Swahili. Literally anytime you greet someone it always takes a few minutes. Words from Rama, “We have formal long greeting when we ask how one another are doing simply out of respect. You respect them like you respect your mom.”

Lastly, as we were driving back to Dar we went through a village that was selling these beautifully colored woven baskets, in Swahili: Ketunga. I got the chance to get three of them.

Selfie with the best tour guide ever! Rama!

Selfie with the best tour guide ever! Rama!

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The Circle of Life- I felt like I was in the Lion King during my time on the Safari

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Mental Health Ward

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August 15th

I’m sitting outside with the sun shining on me as it begins to set. This Saturday is coming to an end and as it’s ending I’m reflecting on these last 2 weeks that I had at the hospital. I have been in the Mental Health Ward and it has been such an eye opening experience!!! At first I was really worried because I didn’t know what to expect. I had heard how it was very different in some aspects. However, I absolutely loved it.

I spent my first few days in the male acute ward and fell in love with the patients. In the psych ward they have an acute ward for males, a general ward for both females and males, PPI which are private rooms for people with private insurance, Occupational therapy unit for groups, a day clinic for pediatric and adolescent patients, and a methadone clinic. I had a chance to go to each of these units; however, I spent most of my time in the male, acute ward because I was able to see and learn a lot there!

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This is the outside of one of the acute male rooms. It looked a lot like a prison and you had to use a key to unlock the gate to get in

When patients first arrive they are immediately admitted into the acute ward (if they are males) and then when they calm down they’re admitted into the general ward generally after being in the acute ward for 24 hours (sometimes longer). A lot of the male patients upon admission are aggressive. I witnessed quite a few. The family members that bring them in as well as the staff hold them down to the bed and restrain both arms and legs. At first I had a hard time dealing with this. In America, restraining patients is a last ditch effort. We go from least invasive to most invasive. Once they get the patients tied down they then administer medications. Both through the vein and an IM (intramuscular). However, when they administer the medication through the vein they don’t insert an IV cannula. They do it strictly with the needle into the vein. It’s quite a big needle and sometimes the patient is thrashing around on the bed. Typically the needle is jerked out and the nurse re-inserts it several times until they’re able to get it all in. In America we never restick the patient with a needle. This was quite different to see. I’ve never seen medication injected directly into the vein without the use of an IV cannula. It also made me nervous for a needle stick injury. It would be very easy to accidentally stick yourself with the needle with the patient is trying to fight you putting the needle in.

A lot of the patients were admitted with psychosis due to drug use. The most common drug of choice was cannibus. Patients were also admitted because they weren’t being compliant with their medications. Therefore, the patient may come in because they’re being manic from their bipolar disorder. There were also patients there who had schizophrenia, grandiose due to psychosis, aggressive/agitated patients, major depressive disorder, etc. A lot of the patients were highly educated and had a college level education. A lot could speak English as well. In the acute ward there are two rooms. Each room has 6 patients so a total of 12 patients. However, the rooms didn’t really look like rooms. They looked a lot like a jail cell. The male patients wore blue scrubs and the female patients wore red.

Inside the acute ward there was one patient that absolutely broke my heart. He was found on the street (they think his family just dropped him off and left him) and brought to the mental health ward. He is mute and seems to have some sort of mental disability. A lot of patients with mental disabilities are seen as someone who has a mental health problem. They tried sending him to an orphanage but things didn’t work out there so he has been in the acute ward for 2 years now. T W O Y E A R S. I just couldn’t believe it. The rooms aren’t that big and there’s nothing to do inside the room. Every now and then the patients are able to leave for OT but that’s not that often. Since he is mute he’s unable to tell anyone his name. In addition, he’s not able to write so he can’t write his name. He’s literally known as Unknown. They don’t have a name for him. They’ve tried putting his picture in the newspaper, on the news, and on radio broadcastings to try and let his family know he’s at the hospital because he’s unable to give the staff any information about his family and where he’s from. However, know one has shown up. In one regard it’s wonderful that the government pays for him to be there and that he’s not left out on the street but it’s very sad that he’s been there for so long. They’re trying to get him a permanent home but it’s still in the making. I’ve learned that you can’t change things in the hospital but you can have an open mind and just understand that’s the way it is. Before I came here a native had told me to

Be compassionate but not emotional.

That’s the one phrase that I’ve kept in mind over and over again. I’m not here to compare and contrast how we (America) do things compared to how people in Africa do things. I’m here to see how they’re able to manage and use the resources they have here. Countries can learn a lot from one another. Whether that be a developed or undeveloped country.

The man in charge of the acute male ward is named Clemence.

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He is SUCH a sweet man and taught me so much!

He’s been there for 10 years and went to college at Muhimbili. He’s such a sweet man with a huge heart and shows compassion to all of the patients. He was so good at explaining how a lot of people in Africa aren’t educated on mental health conditions and people may think the patients are bewitched and such. He also explained how the police force aren’t educated on mental illnesses. A lot of the times the police officers will see a person acting out. Maybe the person is being overly manic and destroying things or acting out in public and the police officers will beat the person and then bring them into the hospital. There was one patient who would scream in pain any time you would touch him and his upper lip was extremely swollen, bruised, and bleeding. When I asked what happened to his lip Clemence explained that he was acting out in public so a police officer bit (yes... bit) him on the lip and they beat him before they brought him in. They did this simply because they weren’t aware that he couldn’t help what he was doing due to his condition.

Moreover, a professor and clinical instructor invited me to a class presentation that his students had where they presented a case of a patient. This was very eye opening! I learned a lot by getting the chance to attend the class. They use a lot of the same terms we use in America for their patients and they also use NANDA! Which is North American Nursing Diagnoses. So a lot of the same nursing diagnoses we use in America they also use in the mental health ward.

Getting to go to the Methadone clinic was a very unique experience. A lot of the patients who have addiction problems to drugs and/or alcohol will go to the clinic to get methadone which is a type of opioid. It is bright green and they drink it at the clinic. It’s in liquid form so the patients can’t try and sell it which they could if it were in pill form. The patients who are seen here have to want to get help and have to no longer use the substances they have been using. Each and every day the patients come to the clinic to get the methadone and then leave.

A lot of the patients who suffer from addiction and have risky behaviors tend to also have risky behaviors sexually. Therefore, a lot of the patients being treated at the methadone clinic also are being treated for HIV. Since they HIV and their immune system is lowered they tend to also have TB. Almost all patients with HIV also have TB. Before the patients can get their methadone they have to come and get their TB and HIV medications. Since the patients really want their methadone, it helps increase the compliance of them taking their other medications first so they can get their methadone. I know back in America it is extremely important for patients with TB to take all of their medications each time. Patients are typically on TB meds for an entire year and take up to 6 pills. At the health department if patients don’t come to take their meds then staff members will call them and even go to their home. It’s so crucial to be compliment with the medication regiment. I thought it was very smart for them to put all 3 medications (methadone, HIV, and TB) in the same clinic. Since there is methadone in the clinic there is a risk for people coming in with guns to try and get the methadone. They said that it’s happened in the past where people have come with guns. So I was extra cautious. However, nothing like that happened while I was there. I also got the chance to see a patient in the clinic get reassessed with how he’s doing with his addiction and no longer using drugs. During the interview there was one thing that really stood out to me. When he was asked what his annual income was he said 350,000 Tanzanian shillings. This is less than $200 US dollars. I just couldn’t believe it. On a typical week here I usually take out 200,000 which is $89 US dollars for food and commuting each day on the bus and tuk tuks. I just couldn’t fathom it.

The methadone clinic was different then any other clinic I’ve been to in America. The experience I’ve had in my mental health rotation and my senior practicum which was in a child and adolescent psych unit back home in America  was quite different compared to here. There aren’t rehab programs here or a place for children to stay in patient. The day clinic for children and adolescents doesn’t admit children for overnight. In addition, there is not a problem with self mutilation among pediatric patients here. The most common issue with children and adolescents are drugs. This was a great thing to here! I had to explain to the doctor and nurses how children in America do self mutilate and will sometimes try to kill them selves. It was the first time they had ever heard of self mutilation. However, one of the nurses did tell me that on the adult unit a patient would bite at his fingers and literally chewed them off. Other than that, the patients don’t tend to harm themselves as often as I’ve seen in America. Furthermore, there was also a difference with not having a geriatric unit. The older patients tend to stay in the acute ward and aren’t put in the general ward because the other patients are too intense there and there isn’t as much observation in the general ward. There are about 30-40 patients in the general ward and they all share one room. So the older patients just stay in the acute ward until they are discharged.

Overall, I was able to see a lot of admissions, discharges, and transfers. During my time in mental health I learned a lot! The biggest issue I see is the need for educating others on mental health and imploring more time for the patients to have in OT and getting out of the room on a day to day basis. There are some things they can’t help like being understaffed and not having as many psychotropic drug options as we do in America. However, I was able to learn a lot here from the patients, nurses, and doctors. I’m excited to see what my next two weeks will be like in the Emergency Department! I did a night shift once in the ED already and it was a very interesting experience.

Nane Nane Day

Nane Nane Day is a holiday in Tanzania known as Farmers Day. Nane in Swahili means 8. They call it Nane Nane because it the 8th of August. And August is the 8th month. This was last Tuesday and we got the day off at the hospital. I chose to spend the day going to the local, public beach which is walking distance from my house. It’s called Coco Beach. I went with my two guy friends and upon our arrival we were greeted by this lifeguard.

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His name is Daniel

He was so kind and showed us around the entire beach. It was absolutely breathtaking. The tide was extremely low and where we’re sitting was filled with water within 2 hours of the photo. Something Daniel kept mentioning was to be true to your heart. He explained how he’s a ‘survivor’. He came to Dar with just the clothes on his back and no money nor place to live. However, he now has an apartment where he can call home and enjoys his life greatly just by living simply. Daniel was a huge example to me of what it means to be humble and to be a hard worker. He would like fun of me and just find laughter in the smallest of things.

After going to the beach a group of us from the Work the World house had made an appointment to go to the local orphanage. I had brought a few things from America to give the children like playdough, pencils, crayons, glow in the dark stars, etc. But I collected a few more items at the local market like coloring books, clay, food, water, candy, etc.

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This is the outside of the orphanage

Going to the orphanage was so hard. I just kept thinking what would happen to the children in the future? They were so precious and so happy to see us. I felt uncomfortable about the orphanage home and how it was run. A lot of the supplies we brought the children would go in the backroom and just give it to the owners. We had heard that the owners take most of the things we bring and give it to their own children. There were two children who really stood out to me. One was this little girl on my shoulders and the boy in the middle. IMG_5226

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A lot of the children have never seen a phone before and are SO amazed at taking photos

Some of the children just didn’t seem like children to me if that even makes sense. You could tell they had not been properly loved or shown affection. There was a little boy who was no older than 3 years old and all he did was sit and cry. His face looked so sad and he seemed so despondent. It was heartbreaking. You could also tell they have had to fight for everything their entire lives. When I opened my backpack to hand out goodies they were pushing and fighting and trying to rip apart my backpack. I had a hard time getting them to calm down and then once they’d get a pack of crayons or pieces of candies they’d just hide them in their hands and pockets and not really even use or eat them. There were some children who had never even seen coloring books before and didn’t know how to use crayons.

After leaving the orphanage I was so sad and didn’t really know what to think of what I had experienced. A lot of the orphans are there because their mother died during childbirth and the father couldn’t stay home to take care of the baby because he had to work to provide food for the family so the family had no other option but to put them in an orphanage so they could be properly seen to.