Karah Waters
Karah Waters
Tanzania 2017
Jambo! 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.

What a Journey so Far!

WOW. WOW. WOW.

How do I explain the experience I have had so far with words. I am in love with the culture and people here. I can’t believe it has already been almost two weeks since I arrived! I will try to start from the beginning! I loved all of the people that I met on the flights. When I landed in Istanbul I was very nervous just with everything that I have heard going on in Turkey. However, I was greeted at the gate by two fellas that were both from Dar. Just seeing their bright, warm smiles put me at ease. The one thing that was so shocking to me was when I was flying over Africa. It was night time and it was pitch black outside. It looked as if we were flying over the ocean. No lights anywhere. Every now and then I would see a twinkle of light down below but the only light that really showed was the moon. Once I landed in Africa it was 2:30AM. All of my flights ended up getting messed up so I was about 5 hours late getting in. However, I was as excited and energetic as ever! I was a bit nervous with getting my Visa and Business Permit but it all worked out great. As I walked outside to meet the people picking me up from the organization no one was there. It was almost 4AM at this point and there were people everywhere. Taxi drivers were trying to get me to go with them.  People dressed in hijabs and everyone was speaking a different language. I backed up against a wall just so I was aware of my surroundings. After traveling over 24 hours and hardly sleeping on the plane all I wanted was a person that I knew to come pick me up. I was a little frightened with being in a foreign country at 4AM. I made a few phone calls and they were there in about 30 minutes. I was so happy to get to the house and take a shower. I was so excited to see what was in store for next few days!
This first picture really represents how it’s been in Tanzania so far.

Half way walking blinded because of the unknown but loving every step.

The people in Tanzania are absolutely amazing and so loving. My admiration and love for these people is abounding. Every day I am more and more astounded. The people here are so hardworking and gentle hearted. They reach out to you with open arms. These photos are from last week. A nurse that I had just worked with for 2 DAYS simply said to me,

“You’re coming home with me today, okay? I get off at 12:30PM.”

And buh-bam, she drove me all the way to her home from Dar. She has 3 beautiful daughters and 1 handsome baby boy who is the youngest. Just like my family. Her husband is a pastor and they welcomed me into their home.

I had dinner with them and got to play with their children!

and they took me to their church. They are Lutheran and that church service was absolutely unbelievable. I have never had to place myself in a situation where I was the minority and didn’t understand a language being spoken around me. Although I could not understand the words of the songs at church I was so touched. Everyone was so happy and dancing to the songs. I could understand what they were saying even though I didn’t know the words.
Then she drove me all the way home. Simply just because.

The nurses and doctors I have worked with over these last few days have been the ultimate kindest healthcare professionals I have ever worked with. On my first day one of the guys took the bus with me and walked me home because all of the other interns had left and I was worried about going home by myself. It was about an hour and a half of his time and he did it just because. A nurse bought me a Pepsi on my first day as well simply because I looked tired. There have been multiple times where people share their food with me during lunch. This was my first official meal in Africa:

and this is actually what I had for dinner this evening!

untitled  Octopus !!!

I have been very adventurous with the food and I try to eat everything I am offered!

Everyone has been so helpful with teaching my Swahili. The nurses love teaching you new words. I also have a Swahili teacher at the Work the World the House. His name is Jacob

j

Swahili teacher He is such a sweet man!

One of the main words I hear ALL the time is:

MUZUNGU

This means white, foreign person. Everyone says it and will call you that. It is kind of funny. People will be talking in Swahili and all of a sudden you will hear “muzungu” and you know they are talking about you even if you don’t know what else they are saying. Whenever I walk by everyone stares. The children love playing with my hair. I am definitely the minority here and it is a very interesting perspective to be the minority. People will try to raise prices if you’re a muzungu. Whether at the market or on the tuk tuk which is a type of transportation kind of like Uber but very different at the same time. They call it the “Muzungu Price.” You have to bargain the prices so they don’t rip you off, haha. Another type of transportation that I take every day to and from the hospital is the Dala Dala which is kind of like the local bus. My first time walking to the bus stop (which is about a 10/15 minute walk) I had tears that just filled my eyes. There were people sitting next to garbage. So many of my senses were being affected: visual, sound, and smell. I was so glad I had sunglasses on because my eyes were very watery. However, I have gotten used to it now.

Susha mocho This is a view from inside the bus

view from the dala dala

This is the bust stop I get on in the mornings and off in the afternoon. It is called Mocho. In order to get off the bus you say,

“Susha Mocho”

Dala Dala time

This is a picture of us heading to the Dala Dala in the morning. At the hospitals they ask us to change into our scrubs once we get there and change back into our street clothes before we leave to limit the spread of germs.

Typically in the morning you will get a seat. However, in the afternoon after the hospital you have to stand. They cram everyone onto the bus and you literally feel like a can of sardens. I like to look at it like Dala Dala yoga. What pose can you get into? Sometimes I will have a persons face right next to mine or a mans armpit or three children right beside my face.  It costs 400 shillings for each ride. Tanzanian money is very cool. For every 10,000 Tanzanian Shillings it is a little less than $5.00 US dollars

tanzanian shilling

This is my favorite bill because it has an elephant on it.

I have learned a lot of street smarts here. For instance, you should never have your phone in your hand or even be talking on it while you’re on the bus. Someone will just reach into the window and take your phone. Even when at work you want to keep your phone and money on you at all times. Also, you never want to carry around a purse. If you do, then someone will come up behind you and cut off the string and run with it. I’ve also learned how to wash my own clothes by hand!

Washing clothes time This is Heather from Canada!

The last thing I will be talking about is my clinical experience over the last two weeks and a couple of places I have been to on the  weekends when I am not in the hospital. I have been in Ward 36 the NICU (Neonatal Intensive Care Unit) and Ward 33 which is Antepartum and Postpartum. It is very fascinating to see what the babies here have compared to back home. A lot of babies are born with congenital defects as in hydrocephaly and encephaly. The other day I saw twins that were conjoined together because the mother didn’t get enough folic acid at the beginning of her pregnancy. A lot of the Mom’s suffer from pre-eclampsia. Most of the times it is caused from Malaria. All women are supposed to get a prophylaxis during their third trimester whether or not they have malaria just as a precautionary measure. However, not all mother’s get it. In addition, you hardly ever see father’s with the babies. Every three hours the mother’s come and breast feed the babies. It is very different compared to the US. The Mom’s will literally walk into the unit with their tanga’s down (which is a type of fabric they where) and they breasts just hanging out. At first it was a shock. I walked onto the unit and saw 100 + women half naked. And they breast feed right beside one another. During birth the father’s are not allowed to be in the room. It is just the mom and the nurse/midwife/doctor. Also, the Mom’s take full care of the baby. For instance, one day when I was helping weigh the babies I noticed that a diaper was soiled. I asked where a diaper was so I could change it and the nurse looked at me like I was crazy. He said that the mother takes care of it. And that she will be back in a while to do that. Very different compared to the US. If a mother came to the hospital where her baby was and found it in a soiled diaper that would not go over very well. More over,  in the NICU, the babies are so close together. Sometimes there will be 6 babies in one bassinette. Germs and infection is so crucial to be aware of in the NICU. It is very different compared to the US. Also! They have no IV pumps in the hospital! I hung a bag of blood that was being transfused but there was no IV pump to set it up with. You just have to estimate how fast you want it to drip. Moreover, there are quite a bit of orphan babies from their mother’s dying at child birth. The hospital is allowed to keep them for 3 months. During that time they wait for a family member to come and claim them. At first I thought that was CRAZY. Why wouldn’t the Dad come that instant to come and get their baby? However, the Dad has to work and would not be able to take care of the child. If he doesn’t work then the rest of the family will starve. Therefore, sometimes the Dad has to save up money over those three months so they can pay to have the baby taken care of in an orphanage. So, so sad. Lastly, it is very interesting being in a country where it is 1/2  Christian and 1/2 Muslim. Going into work on one side there is a mosque and on the other there is a temple.

Some of my fellow co-workers in Ward 36 NICU

Some of my fellow co-workers in Ward 36 NICU

Overall, I have had good nurses/mentors during my OB/GYN clinical rotation. The next two weeks I will be in Mental Health! I am very interested to see what I will learn there. Although I’ve seen such heartbreaking things with babies dying and seeing people suffering, my eyes have been opened up so much. It makes me so upset when I hear people call people from Africa “poor” or “unfortunate.” The people here are living life to the fullest  and are so rich in culture and tradition. Yes, they may have poverty and tragedy, but the people here are so kind hearted. What happened last week in Tanzania with the nurse inviting me to her home would have never happened back in America. We can learn a lot from the people in Africa. I feel that people back home have heard so many negative things and have a picture painted of what it’s like in Africa, but you simply need to see it with an open heart and mind. People are most scared of the unknown. Which is why I feel people in other parts of the world can become so frightened of places they have never been to.

 

 

Side Adventures:

So breathtaking!

Bongoyo Island! So breathtaking!

Bongoyo boat

 

Getting to go to a Graduate level Midwifery class for the evening after work!

Getting to go to a Graduate level Midwifery class for the evening after work!

Blessing came to visit me at work and we played Doctor!

Blessing came to visit me at work and we played Doctor!

Made a stop at Slip Way to play with crabs and get the best ice cream ever!

Made a stop at Slip Way to play with crabs and get the best ice cream ever!

Sunset Cruise

Sunset Cruise

Fishermen we met on the cruise. They greeted us with dancing and "Mambo!"

Fishermen we met on the cruise. They greeted us with dancing and “Mambo!”

My journey so far

I’ll write again sometime soon!

Heartbreaking Day

Today was probably the

hardest day I have ever had with being a nurse.

It all just felt so unreal. I was doing rounds with the nurses and getting report on the babies when we stopped at this one baby who was not breathing. The night nurse simply stated that he had aspirated the milk the mother was feeding him at midnight and the doctors did not tell her anything was wrong. Then at 4AM she continued feeding it and it aspirated more milk. The nurse said he had been like this for a while. They merely poked his chest and just stared at him. I looked at him and could see that he had a heartbeat but no inhalation or exhalation of the lungs. His toes were purple/blue. A nurse was fumbling with the ambu-bag. She was trying to get the air to go in while she was doing compressions. She didn’t have a proper seal on the mouth. I didn’t know I had this in me but all of a sudden I just took control. I grabbed the bag from her and began doing rescue breathing. I told her there was no need to do compressions because the child had a heartbeat. A lot of the times here I try not to enforce my way of doing things which is the way things are done in the US. However, this was a special circumstance. Every second counted. But in Tanzania, there is never an urgency or rush when an emergency is taking place. Everyone is very “hakuna matata” and don’t worry about things. The nurse wanted to suction the baby and do a blood glucose test before giving oxygen. There were no noticeable secretions. Prioritization here is very different. ABC’s are key: airway, breathing, and circulation. I continued doing rescue breathing. Then a doctor walked in and asked if I could show him how to do it.

NO ONE knew how to do CPR.

I was flabbergasted deep down inside. As we were trying to save this babies life I taught 3 people how to do CPR. On top of all of that, the NICU room that we were in has a heater to insulate all of the premature babies. So on top of no AC in the hospital the room was at 38 degrees C which is 100.4 in F.

As we continued doing rescue breathing then all of the mothers came in for breast feeding. In addition to having 20 babies in the room we now had 20 moms and 8 healthcare personnel. The room is not that big. The mothers just watched as we were trying to save the babies life. In my head I knew the baby needed to be intubated and hooked up to a ventilator if he was going to make it. With him already having enough lack of oxygen to turn his toes blue he was bound to have had brain damage which wasn’t allowing him to breath on his own. The doctor’s explained to me that they only had two ventilators and they were both being used and it would be about a month before we would be able to get one for the baby. I asked if there was anyway to get one from another hospital. But there was not any way. My heart broke into a thousand pieces. As I was bagging the doctors were giving the baby adrenaline to help the heart continue perfusing all of the blood and they hooked him up to normal saline. They also gave him 3 boluses of dextrose. Some of the things they did I questioned but they were doing all that they could. One of the doctors asked me when I could stop bagging. She wanted to just hook the baby up to a nasal prong and give him oxygen that way. I explained that since he is not using his lungs that oxygen wouldn’t work. We are being his lungs by doing rescue breathing and forcing the air in which the nasal prongs would not do. Another nurse was too scared to try and do the respirations for the baby. It was very frustrating and sad to me. If this baby was in the US they would make it. As soon as they had told me there was no ventilator I knew in the back of my head this baby was going to die. Throughout this whole process I kept seeing red ants crawl on the baby. I was confused as to where they were coming from. I pulled back the babies diaper and they had bitten him so much that he was bleeding around his private area. I looked down beside my scrubs that were pushed up against the table that I was leaning on to give him the rescue breaths and there was a cockroach the size of my pinky toe.

This was the first time in my life where I was the one in the hospital who knew what to do. There was no one else I could turn to higher up to help me or have a solution to the problem. It was a scary thought. I just kept doing what I had been taught in nursing school. In the back of mind I was just so thankful to have such amazing professor’s who taught me all that I knew in that moment. After 3 hours of rescue breathing for the baby I knew I had to be ethical and use my critical decision making. I was only prolonging the baby to live. As soon as I stopped breathing for the baby I knew he would die. There was no way I could do this continually for days. However, I didn’t want to stop until the mother came back.

It is custom here to let the baby die and then tell the mom after it has already happened. They feel that it is too painful and causes more suffering whenever the mother has to watch the baby die. However, I just couldn’t settle with that. I wanted the precious baby to be in his mother’s arms during his last few moments on Earth. None of the doctors or nurses would tell the mother for me that the baby was dying. It made me so sad that I couldn’t communicate with her in Swahili to let her know everything that was happening. I simply walked her to the baby and was able to get her to understand the heart was working but not the lungs. I placed her finger in the babies hand and patted her on the back. As I shut the door behind me I tried my best to keep the tears inside of me. I walked down the long corridor to get to the stairwell. As soon as I was out of sight from everyone the tears just poured. I was so overwhelmed and heartbroken. It was around noon at this point and I really wanted to just go home. But I forced myself to carry on with the day. After this situation, it only went down hill. I found two other babies that had a heartbeat but were not breathing. I also did rescue breathing for them. One of the babies pupils were fixed and the oxygen sat was 44%.

All three babies died today. I left work with my head held down as the sun shined on my back. I know the babies are no longer in pain now but I just had a really hard time with accepting how it all happened. In the US it would have never gotten to that point. We have the NICU babies hooked up to machines that constantly take their vital signs. They don’t have anything like that here that would alert them to a babies V/S dropping. There is also 1 nurse to 35 babies here whereas in a NICU at home it is more like 2 or 4 babies to 1 nurse. Today was just a very heartbreaking day.

Today is the DAY!!!

Leaving the states!

I can not believe that today is the day that I am heading out of the states to begin working internationally. In Africa.

A place I have always dreamed of going to. It doesn’t feel real. All of my bags are packed and I have so many thoughts running through my head. I am currently sitting in the Nashville airport at my gate. I have a 3 hour delay because of “air-traffic.” This is going to be the beginning of a very long journey! haha. But hey, everything happens for a reason. A few extra hours to the trip doesn’t even compare to the time I have been waiting to do this! Everything all feels so surreal. It has been such a journey transitioning from college and being an adult in the “real world.” However, this trip is something that makes me not feel uneasy or question what I am doing. There is nothing else I could picture myself doing than doing this right now in my life. It is something I have always had a desire to do and now it is officially happening. People that I am sitting beside probably think I am crazy because I am just smiling from ear to ear because this moment is finally here and they just see it as an annoying 3 hour delay. I was supposed to land tomorrow at 9:00PM, Tanzanian time; however, now it is looking a bit later. I have a few stops before I get there: Newark, Zurich, Nairobi, and then finally Dar es Salaam!!! I guess the most exciting and at the same time scary thing I am looking forward to is simply the unknown. I have no idea what the culture is going to be like once I step off of the plane in Africa. I have been doing my best on my Swahili! Hopefully I’ll be able to understand some things when I go to pick up my Visa and Business Permit once I get off of the plane. I can hardly eat anything because I am so excited and anxious. Hopefully all will go smoothly with the next flights and no delays will happen!

I guess the main thing on my mind right now is just all of the support and love I have seen in these last few days. I wish I had more time before I left to see all of my friends and family. I got back from being a camp nurse in WI (which was quite an interesting experience at an all boys camp!! I LOVED it!) this Monday at midnight and I have been preparing and packing my bags for Africa ever since! I have received so much support, love, and words of affirmation. I knew I had an incredible support group but it really hit me over this week how many amazing and caring people I have in my life. I hope to carry that with me to Africa and really engulf myself in their culture and get to know the people who live there. I know I will see so much hardship. Hardship I have never laid my eyes on. In those moments of hardship, and pain and suffering that I see I hope to be able to help in anyway that I can and freely commit myself to service. I have been blessed with so much I hope to pass that on to everyone I come into contact with.

I guess I will be writing you from Africa in my next post!!! Kwaheri (goodbye)!

In Almost a Month…

Karibu! My dear grandmother’s friend who lives in Dar es Salaam taught me that saying. It means greetings/welcome in Swahili. Thank you for joining me on this very exciting journey I will be pursuing! I can’t believe everything that is going on in my life! So much has happened in such a little amount of time that it is hard to process everything so quickly. But I am so blessed and humble for everything that is happening. I am currently writing my first blog in good ole’ TN on my porch next to my cat. As I look out into the woods and watch the breeze blow through the trees and feel the cool wind against my face I try to figure out how to say what I am feeling. In a little over a month, July the 14th, I will be leaving for Africa, where I will be interning and working as nurse. My first 9 weeks will be at Muhimbili National Hospital in Dar es Salaam. At this hospital I will be exposed to many clinical rotations. I am very interested to see the comparison and contrast in the hospital’s there compared to US. My first two weeks I will be in OB, my next two weeks mental health, the following two weeks will be in ER/trauma, and my last three weeks in the city hospital will be in pediatrics. My last week in Africa, week 10, I will be doing the Kidodi village experience where I will be staying with a host family in the village and working in the Kidodi Village Rural Healthcare Clinic. My heart bounds with joy and fear when I think about all of the things I will encounter. I will be traveling by myself on a flight that is about 24 hours long. I currently am finalizing all of my vaccinations and prepping myself to learn Swahili.

Almost a month ago I graduated from Belmont and I begin working as a camp nurse in Wisconsin in two days. I will be there for a month right before I leave for Africa. Yesterday I took the state licensure to become an actual registered nurse (RN). It takes about 48 hours to hear whether you passed or fail; so fingers crossed! With all of that going on, the reality of working in Africa for almost 3 months has not felt as real. However, as the days are getting closer my heart beats faster and it is becoming more of a reality. The main thing I am most excited for is just getting to know the people. I love engulfing myself into other cultures. When I am in Africa I will be the farthest away from home I have ever been as well as for the longest amount of time I have ever been away from TN. By being away so long I feel that I will be able to really live the culture that I am going to be going into. Although I do not know anyone else who will be doing Work the World, which is the organization I am going with, I am excited to see what is in store. One of my main goals is to really get to know the people in Africa and make the most of every second I am there. I will be working in the hospital from 8AM-4PM, Mon-Fri. I will have the evenings free and the weekends free. During those free times when I am not learning in the hospital I hope to really explore the area and become friends with the local people who live there. I will definitely be stepping out of my comfort zone but that is the only way we can truly grow. I guess the next time I will be writing will be right before I leave! I’ll talk to ya soon! And thank you so much for joining me and reading my blogs! I can’t wait to experience this Lumos Journey with you!

-Karah