Karah Waters

Tanzania 2017

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. Read More About Karah →

Mental Health Ward

Aug 15, 2017

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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!

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.

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

Aug 15, 2017

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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.

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.

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.

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.

Adventure with Mcha

Aug 15, 2017

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It’s hard to believe I’ve officially been in Africa for an entire month. The first few days and weeks it didn’t feel real. I would wake up every morning in disbelief that I was actually in Africa. It wasn’t until the trip to Zanzibar which was when I finally accepted I was in Africa. Throughout the week I’m at the hospital, Muhimbili National, from 8a-3:30p. The commute to and from work is about an hour. The weekends are when I go on adventures. Two weekends ago was when I went on an adventure to Zanzibar. We had a tour guide by the name of Mr. Alewei and we did so many amazing things. We left Tanzania early in the morning by ferry and met Mr. Alewei upon arrival. I learned that Tanzania’s original name use to be Tanganyika. It wasn’t until 1964 that Tanganyika and Zanzibar joined together. The “Tan” is for Tanganyika, the “Zan” is for Zanzibar, and the “Nia” means to come together. The first day we got a tour of Stone Town which is a very historical part of Zanzibar. We took a boat to Prison Island where we had a tour. When slaves would act out to their owners in Zanzibar they would send them to the island to be prisoners. There were huge turtles on the island that we got to feed and play with! The oldest one was 192 years old.

They are protected by Zanzibar and have a safe home on the island. We snorkeled on the island and then went to a place where we had a spice tour. There were SO many types of spices! They would pull off a leave on a plant and have you smell it and guess what it is. I ate the bark from a cinnamon tree and it tasted just like Red Hot gum! After smelling all of the different spices we watched a man climb the coconut tree and throw down the coconuts. They then cracked the coconuts open for us and we got to drink the juice. The people from the spice tour made us grass crowns, bracelets, rings, and necklaces.

Mr. Alewei is the gentleman squatting. And these are some of the great friends I have made who are also working in the hospital.

It was absolutely amazing! Afterwards, they fed us fresh fruits that are all grown on the island. There were fruits I ate that I had never heard of before like laichi and jack fruit. The next day we got the chance to swim with dolphins and go to Jozani which is a national park. The forest was so breathtaking! I got the chance to see SO many monkeys in their natural habitat! It was unbelievable. The monkeys would run right in front of you or right beside your feet and swing from branches just in front of your face. There are two monkeys native to the island. One of those monkeys you can find all throughout Africa; however, the Red Colobus Monkey is only found in Zanzibar.

This is a baby monkey being nursed by its mother.

I also got to see Mangroves all throughout the forest. These are trees that can only live in salt water and the roots of the trees actually grow above ground because of the lack of oxygen under ground.

Zanzibar was such a beautiful place and it was quite different compared to Dar es Salaam. You felt a lot safer in Zanzibar. I could actually carry my phone in my hand while I was walking out in public and carry a bag with me. Thefts weren’t as prevalent there as they are in Dar. The economy of Zanzibar relies so heavily upon tourists whereas Dar doesn’t have as much tourists. There is a lot more poverty in Dar compared to the people who live in Zanzibar. However, there is still poverty there. I passed by many homes and villages that were very rural and looked poverty stricken. Moreover, the population of Zanzibar is very diverse! 90% of the population is Muslim. A lot of people spoke in Arabic and there were many buildings that had Arabic writing. Luckily, a guy that was on the trip with me, Saqib, knows Arabic and was brought up Muslim. He taught me a lot and I had the chance to hear him speak to some of the natives in Arabic. It was really cool to see. A lot of people were in hijabs and modestly dressed. There are also a lot of Muslim people in Dar but not as much as I saw in Zanzibar. Dar is about 50% Muslim, 50% Christian. So although I had an absolutely unforgettable experience and trip to Zanzibar there is one person that I really hold dear to my heart and was my favorite part of the trip. Everyone, please meet Mcha.

Mcha from Zanzibar

He’s a 15 year old boy who’s a fishermen. I was attempting to go out to the sea with a friend from Work the World named Saqib, because the tide was really low and there was about a mile or so of shallow water and then you could reach the reef. He approached us with his fish he had caught that day, which you can see in this picture

and asked if we were trying to go out. He spoke very little English but we were still able to communicate with the broken Swahili we new and the broken English he knew. He led the path and along the way he showed us his world in the water. This was a time that I really learned the importance of non-verbal language. Even though we couldn’t communicate through words I could still understand everything Mcha wanted me to. He would find beautiful sea shells and just hand them to me. He would find star fish after star fish and I never once spotted one.

He would find these sea creatures in shells and told us the names of all of them. There were sea urchins EVERYWHERE! He would make sure we didn’t get hurt by them. As we were heading back there was a little rock in the water. All of a sudden he said there’s an octopus underneath there! I had NO IDEA how he even saw it! It didn’t look like anything would be underneath the small rock. He reached under the rock and I saw ink everywhere in the water! HE WAS RIGHT! There really was one!!! After battling and battling and the tide rising and rising he eventually won the fight. Thr water was at first just below our mid-calves and it was now way above my knees. The tide had risen a good 2 feet and we still had a good mile to go to get to shore. We made it back just in time and that’s when I captured the first photo up above. This little boy has a heart of gold and is such a hard worker. Could you imagine supporting your family at the age of 15 and fishing all day long so your family has food to eat? He had an even younger brother too who was also fishing. Him finding things so easily in the sea taught me how I need to change my perspective.

If you’re walking blind and not looking for things around you then you’ll miss them. Just like I missed all of the beautiful things in the sea until he showed me. That’s something Africa as a whole has taught me. To really open your eyes.

What a Journey so Far!

Jul 26, 2017

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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!

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

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.

This is a view from inside the bus

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”

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

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!

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

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:

Bongoyo Island! So breathtaking!

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!

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

Sunset Cruise

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

I’ll write again sometime soon!

Heartbreaking Day

Jul 26, 2017

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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!!!

Jul 14, 2017

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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…

Jun 8, 2017

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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

An African Wedding 03/09/2017

Mar 9, 2017

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My dear Grandmother’s friend had a friend who lived with her in the US when he came to America for college many years ago. He is originally from Tanzania and actually invited me to his nephews wedding! He is the gentleman I talked about in my very first post.

Please meet Mr. Tony!

I got the chance to go to the wedding and it was WONDERFUL! Everyone was so welcoming and it was such a neat experience to be apart of. Imagine going to a wedding where you can’t understand anything anyone is saying! Of course some spoke English and I understood a few phrases but I couldn’t even try to fit in. I stood out like a zebra in a room painted entirely of pink. It was so fascinating to see the different traditions compared to a wedding back home. The evening began with Mr. Tony sending a taxi to pick us up and one of his son’s took us home after the wedding. Their kindness was unbelievable.

Mr. Tony’s daughter who is currently at Uni in Germany but came home for the wedding.

My good friend Simone was my plus 1 since my boyfriend wasn’t in Africa. She killed the dance floor! At the beginning of the reception the husband’s family makes a big line with family members on each side and the brides family walks in between them. Everyone is dancing in the big celebration line and they hug each of their new family members (the members of the brides family) into their family. Simone and I got to be apart of the husband’s side of the family and dance in the line and cheer everyone into the family. We all were seated and then the wedding party comes through and then the bride and groom came dancing in to their song. There was a spokes person at the wedding and TV’s set up everywhere so you could see everything going on.

The two family’s coming together and the bride and groom in the center!

Weddings are VERY BIG in Africa! Everyone in the community pitches in money for the wedding. If I wrote everything out from the night it would take you a year to read so I am just going to write out the main high lights! Before the bride and groom popped the champagne it went around the entire reception hall and everyone touched it. It was then given to the bride and groom to pop open. There was A LOT of dancing, singing, and ceremonial things that went on.

This was right before the husband was given the spear.

One of those things was the husband receiving a large spear. It is a tradition in their tribe to get this upon marriage. It shows that he is the man of the house. It is meant to stand up right in his and his wife’s bedroom. However, when he passes away it is supposed to be turned upside down. The wedding began around 5PM and we didn’t start to eat until 10PM. A lot of the foods were from the husbands tribe. I tried a bit of everything (which was A LOT). It was all delicious! We ended up leaving around midnight; however, the wedding was still going on!

It was truly an unforgettable night! They accepted us as family and were so loving.

Such bright colors everywhere! We were right by the ocean!