Sambasha

October 28

Today we presented to a class of 30-35 middle school students. They filled the classroom nearly past capacity and the students were within a foot of Whit and I as we stood with our backs to the wall at the front of the class. Three students occupied each desk instead of the allotted two. Although the students were in an English medium school, they were still not quite fluent so we needed a translator. However, the man translating was much more reliable than Mama Hindu was in the village. We could tell he was portraying our message rather than his own as we would break every couple of sentences for him to catch up.

The students were very attentive, just like the first class we presented, and they asked many questions. Many of their questions pertained to transmission of HIV, the effectiveness of condoms, and the origin of the disease. Even though we present about pregnancy, puberty, and general health, their questions and attention is always directed at HIV.

Our interaction with this group was very intimate despite the translator. Even though each presentation we give is just as important as the next, it is so nice to present to groups like these students who have just as big of an impact on the our self-esteem as we do on their educational experience.

October 26

We visited our first Maasai village today called Sambasha. It was a beautiful little community right at the base of Mt. Meru and was about a 30-minute dala dala ride from our house. Upon arriving, we were greeted by a group of women who sang and danced for us, and they were amazing at trilling their voices. It was such a warm and welcoming gesture that gave me a sense of comfort and belonging.

Whit and I started the day working in the very small antenatal clinic, which is about the size of the house we live in. The clinic has no electricity or running water and plywood walls and curtain doors separate the few rooms. Several women were in line to see the one nurse who would weigh their babies on an apparatus that looked like a fruit scale in a grocery store, but the metal basket was replaced by a meat hook. The mothers then put their babies in a cloth sling that then hung from the hook...it was quite innovative. The mothers are also responsible for bringing their medical records in the form of a card, as well as their babies’ cards as there is no filing system. In a way, I am envious of their system because they actually have access to their medical records.

We then went to the other side of the wall with the lone doctor who spoke enough English to help us understand what he was doing. He was administering vaccines to babies, checking the progress of pregnant mothers, performing HIV tests, and teaching us the paperwork in case we go back, which it looks like we will. The vaccinations seemed fairly routine, but his examinations of the pregnant women boggled my mind. He started with a sheet full of data to collect, such as weight, blood pressure, gestation, HIV status, and others, but two-thirds of his list he couldn’t record because he lacked the equipment. There is no scale other than the baby scale, no blood pressure cuff, urine test strips, or even a stethoscope. I never would have imagined a doctor without a stethoscope, but that is the poverty these villages have to deal with. In order to determine how far along the women are, he simply asks them, and one lady told him that she was 10 months pregnant…not very accurate. We could easily see the lack of nutrients in the village because all of the pregnant bellies were very small compared to what we are used to.

We saw the doc run an HIV test (they test all pregnant women), which was a rapid test that took only 5 minutes for results. If any tests come back positive, they have enough ARVs to give them during their last month of pregnancy to reduce the chances of infecting the child. He wrote down the result, and in the book, 1 out of 6 mothers were HIV positive. This was a very shocking and scary moment. They have a high percentage of positives, but give no long-term ARVs, counseling, or services; they only can refer positive individuals to hospitals in Arusha, which are easily an hour walk from this village.

We then presented to the group of women who first greeted us, as well as some of the mothers from the clinic. We shared with them how to reduce transmission of HIV and how to protect their babies from the disease, among other things. The building we were in was their community building made of cinderblock with a dirt floor and tin roof, and the rain started to fall on the tin drowning out our voices for nearly ten minutes.

I have very mixed feelings about our presentation. The message we shared was very important to the well-being of these people and is something they need to hear over and over if their behaviors and attitudes are to change for the better, in terms of spreading HIV. This made me very excited about what we were doing. However, we had very little control throughout the whole presentation as we had to use a translator. Mama Hindu, the coordinator of the CWCD that we are working through, translated for us and asked us to present a sheet at a time, which was a lot of information. We would present our info to her in English for a few minutes, but she would check her phone several times and not really pay attention. She would then speak to the women for 2-3 times as long as Whit and I had talked for. I really felt like she either already had a good grasp on the info and didn’t need us, or she didn’t want to share some of our points, or something, but it was very frustrating and disheartening to feel like our help wasn’t really needed, once again.

The only question that was asked after our presentation was about how the men in their village are not open to the idea of condoms, and they wondered what they could do about that. I don’t know much about Maasai culture, but know that this has been a struggle for them ever since the fight against HIV started. It was difficult to think that this was still their only concern, and that I have no simple answer for them…very difficult.

We were waiting for the dala dala after the talk, and received word that it was stuck just down the road. It took about 15 people nearly an hour to push our bus out of the 6-inch-deep dust. It amazes me how green everything is here despite the drought. Huge banana trees sprout up out of the thick, dry dust and they seem to be the camels of the plant world. It’s quite remarkable that they can still grow such large amounts of fruit.

Written by Zach

Oldonyo Langai

25 October 2009

Today was the worst day of my life, physically. There were 8 of us the in house that decided it would be fun to climb Oldonyo Longai, which means Mountain of God in Maasai. The Maasai climb it whenever they have a drought to pray to rain. It is the only active volcano in Tanzania and its last eruption was in February 2008. It is good for us on the weekends to try to get out of the house and get our minds off of whatever we were working on for the week if possible. Since climbing Meru and Kili are much more expensive, we decided this would be a good alternative. For $100 plus transportation, divided by eight people, the cost to climb was about $100 per person. We had heard that this climb was harder than both Meru and Kili, but then again, we have also heard that Kili and Meru aren’t that difficult to climb. Some past basecamp volunteers have done the climb, along with Moses, the coordinator here, and no one advised us against doing it. I guess the last group went with 6 people and 2 of them gave up part way through, tried to go back down by themselves, got lost and had to sit there until someone found them the next morning. Although that made me a bit nervous, the girls that gave up were not exactly physically fit. The story that did make me nervous was that some guy who had climbed Kili took one look at Oldonyo Langai and said, “No way”.

On the way there, the scenery was beautiful. We saw our first giraffes, wildebeest, ostrich and several types of antelope. We drove along the Great Rift, which is the largest continental rift in the world. It was so beautiful and there were many little villages along the way. We drove in an 8 passenger Land Rover that had a lift top. The driver let us put it up during part of the drive so we could stand on the seats and look out the top. It was very fun and made me look forward to hopefully going on safari. After quite a while our driver pointed out the mountain that we were going to climb and we all started to get a bit nervous. The volcano was completely black and gray and its only contours were big cracks and crevices created by the lava from the last eruption. We all kept making jokes about paying the driver to drive us to the top, or just paying someone off to take some photos and we’ll photoshop ourselves into them, etc. We all still wanted to do it, but it was much more intimidating than we had expected.

We got to the base of the mountain at about 5:30pm and were going to hang out at this little campground until we were ready to start climbing around 11pm. Our driver, Douglas, drove our group and the guides to the base of them mountain and we were ready to start climbing around midnight. The whole drive we couldn’t see anything, not even the mountain in front of us it was so dark. All we could see was what the headlights lit up, which was the "road" made out of cracked lava that we were driving on.

When we got to the base, we got out to start our climb. Within the first 10 minutes of climbing I was already thinking that I wasn’t going to make it. We were walking at a very fast pace up a hill that you had to lean in to. I knew that at this pace, we would never make it to the top. After about a half hour, I surveyed the people around me to see how they were doing and after getting the general consensus that this was too fast, I yelled at the people in front and the guide to stop for a break and to slow down. After about a three-minute break, the guide was started back up the mountain. A foretaste of what was to come...

We were told that the climb would get cold and that we should bring warm clothes, but that was an understatement. None of us really prepared well with warm clothes, so when the wind picked up and brought freezing temperatures we were miserable. After climbing we were quickly moist with sweat, and when the wind blew it was almost unbearable. There was a little bit of moisture in the air that was making the dust and ash stick to our clothes and skin. The wind dried out my eyes, and also blew in dust and dirt, but it was impossible to wipe anything off because my hands were covered in dirt and I couldn't wipe my hands off because my clothes were completely caked in dirt.

Since it was the middle of the night, all I could see was the small circle of ground that my headlamp lit up, but it almost seemed like a blessing that I wasn’t able to see the distance below or above. The climb was about 1600 meters, but every meter was a challenge. We were doing about 50 meters every 15 minutes and at some points I thought that every step would be my last. I would look to the side of where we were climbing from time to time, half expecting to see the bones of climbers past. During much of the climb we were walking up deep dirt and ash, so every step I took I would slide back down half the amount of my step. And it was so steep that all of us had to monkey the climb the whole way up on our hands and feet. For every 5 steps taken, maybe the distance of 2 was gained. Sometimes it was so slick and steep that you would take a step and slide back down a good 3-4 feet, trying to cling with your hands to the crumbling rock. By the end of the day, my hands were completely raw. Each step took every ounce of strength and concentration I had.

About five hours in to the hike we took an hour long break, which was bitter sweet. I was so physically exhausted that I could not have possibly kept going, but the wind blowing on my sweaty body made me feel as though I might freeze to death. I was torn between not being able to climb any more and freezing. I didn't want to go on, but I REALLY didn't want to be left behind.

We had about another hour of climbing after our break before we would summit, but we made it in the 6 hour time frame that the guides gave us. When we made it to the top, finally, I was in such a bad mood and so mad about the climb that I didn’t even care to look into the volcano. It was very cloudy and we couldn’t see the sunrise, nor anything else around us. There was only about a three foot rim around the top of the volcano to sit on and the wind was so strong you could not stand up. The guides offered for us to walk around the rim once and we all just stared at them dumbfounded. Obviously we did not take them up on it. We sat there for about 5 minutes and were begging to go back down. Although I had been dreading the climb back the whole way up, there was nothing more that I wanted than to be as far away from Oldonyo Langai as possible and as fast as possible.

Descending the mountain was like skiing down a mountain of ash in tennis shoes, except for the times it was like scraping your butt on a cheese grater. There was not one inch of me that wasn’t caked with dirt. Most of the time we were sliding on our butts because it was too steep to walk down. Rocks along the way would get pushed down and would often come within inches of someone’s head. I was hit in the arm or leg by several coffee mug sized rocks on the way. There were certain times during the climb when I thought my life calling after this would be to tell as many people as possible to never climb this mountain. After the longest 12 hours of my life, we finally made it to the bottom. I have never been in such a bad mood in my entire life. Our driver was incredibly impressed that we had all made it, but I was not in the mood for praise. I was just mad.

As we felt we had not been adequately warned about the difficulty and dangers of the climb, on the drive home we asked our driver a lot of questions. He told us that it is definitely the hardest climb in Tanzania and that many people die on it every year. We were also told that 80% of people don’t make it to the top. I just continued to get more and more angry when I thought about how stupid it was for us to climb the mountain. Every decision for the rest of my life will be affected by our experience on that mountain.

Sorry for the long blog about nothing really with our work here, but none the less it was an experience for us here that will definitely leave a lasting impression.

(The first photo is a picture looking back up after climbing part-way down. The second photo is of us on the way down. I didn't know they were taking a picture so my tongue was hanging out and I have a unibrow made out of ashes, but it is a pretty accurate portrayal of how I felt the whole time :) You can also get a slight idea of the grade of the climb.)

Written by Whitney

New Possibilities

21 October 2009

First off, thank you all so much for your prayers and e-mails. All of your advice and encouragement helps to keep us motivated yet keep things in perspective.

Although our frustrations with St. Elizabeth still linger, we have created a completely new plan, and have regained our excitement. We found a contact through fellow volunteers at the Arusha Center for Women’s and Children’s Development and heard that they periodically go to rural villages to present certain topics and issues. Whitney and I let them know of our interest in possibly joining them to present on the topic of HIV/AIDS and whatever other health related topics that they saw fit. So we went in to meet with a lady named Mama Hindu, who runs the organization, and it turns out that she had big plans for us. Little did we know that she already had big plans for us after the other volunteers told her of our ideas. So we discussed our ideas over a ginger soda (which is offered every time anyone visits her).

Our new goal is to visit 8 villages (some far and some near to Arusha) over the remainder of our time here to convey our message about healthy living and how to prevent disease transmission, especially HIV/AIDS. In a way, it sounds like a small prevention campaign in a very rural setting. After our first visit to each village, we will return and work on ideas and find supplies that are greatly needed, and will then plan a follow-up visit to each. Also, each village on our schedule has a hospital of some kind, probably a one-room hut or a simple awning, that we are going to help out in.

Transportation is a major cost for this project, and the close villages will cost about 65,000 Tanzanian shillings (about 50-55 USD) and the far villages will cost about 95,000 Tsh. Five of the villages are far enough away that we are going to stay there for a week to reduce the transportation costs and make our time the most cost effective. I can't wait to live out in the "bush"; it will be kind of like elk camp. If it works out, some of the money that we received through the spaghetti dinner at our church in Buffalo, WY, and any subsequent donations that we receive will be used to help fund the transportation costs and to take minor medical supplies, such as gauze, needles, and ointments if possible, for these villages.

Part of our plan will involve bringing people in from the villages to get tested or to receive treatment in Arusha, and we are going to try to find some HIV tests that Whit and I can take to the villages to administer ourselves. Working with the villages should only take up 2-3 days per week, so we are still planning on working at St. Elizabeth’s; we hope to gain more of their trust in hopes that they will be able to utilize our skill sets. We also hope to refer some patients to them that we meet in these villages, if possible. We will need a translator to go with us who knows English and Swahili until we feel fluent enough (if we get that far), but apparently we might also have to find a translator who knows both Swahili and the tribal language of the village that we are in because some of the village members don’t even know Swahili. Communication will still be very difficult, but we are getting used to that fact.

This is a great opportunity, but we know that it will not be easy and we are keeping our expectations at a reasonable level. We have realized that progress will be slow, and are just grateful for another opportunity to meet new people.

(The picture is of the school at CWCD that Mama Hindu oversees. A few volunteers in our house teach at this school. The building on the left has most of the classrooms in it, and the building on the right is a library and computer room in progress. It could take them 10 years to finish it since they are strapped for funds.)

Written by Zach

Challenges

20 October 2009

We have been here for about 2 1/2 weeks now and are already seeing many of the challenges of working in a foreign country, especially with something like HIV. Our hospital, though very welcoming, was not really prepared to have us come in and work on anything. Most people who come here stay for about 3 months max, so they are fine with shadowing and just kind of hanging out for that time, but Zach and I had hoped to do more while we were here. Sure, we may have been naive and had higher expectations than we should have, but we were hoping to make at least a small difference in the lives of the people here.

Yesterday we went early to the hospital to talk to the director about what sort of projects or programs we could work on while we were here, since our time here is substantial. He gave us a standard reply that we should go on rounds and go out into the community with the outreach nurse at the HIV clinic everyday, observing the patients and doctors. Although that would be incredibly helpful in preparing ourselves for school when we got back, we did not travel all this way to help ourselves. We asked if we would be allowed to translate some pamphlets into Swahili and hand them out or hang some posters in the clinic with information about transmission, staying healthy, safe sex, medications, etc. He said that would be fine, so we had planned to start on that right away. Unfortunately, later that morning, we were talking with one of the doctors in the clinic and the topic of condoms came up. He said that they didn’t have them there and if anyone asks for them they just tell people “not to indulge in such things.” Although we have to respect their rules as a Catholic institution, it is frustrating to work with this issue and not be able to discuss and teach the things that will help prevent the spread of the virus.

We stayed home from placement today to work on our Swahili, as we figured it would be more productive than going in today. The faster we learn the language, the sooner we will actually be able to make some progress here. We are going to start looking and asking around for some possible places where we might better be able to use our talents and passion, but with the politics, bureaucracy, financial state and stigma that surround HIV here, it will be challenging.

It is ironic that when I was at home all I could think about was getting over here and working with the issue face to face, and now that I am here, I feel like I was making more of a difference selling pins on campus and sending money over (making sure it ends up in the right hands, that is, like PIH J). There are so many things that need to change on a societal level before any real progress will be made here. Although I was aware of this before I left, I somehow thought that where we would be would be different and we would feel productive and accomplished when we left. I am still hopeful for that and will continue to work towards it, but if nothing else, when we leave we will at least have a better idea of what needs to be done and when we come back again, will be more prepared for the challenges and better armed with tools that will help us accomplish our goals.

(The picture here is of the street we walk on to get home everyday. It is called Mianzini, which means “the place of bamboo” in Swahili. The walk is all uphill and it takes us about 25 minutes to get up it, but it is good exercise. Most of the time the street is very crowded with cars, people, dogs, chickens, goats and children. Since there is no sanitation system here, most of the trash ends up in the gutter and is burned in small piles periodically. The smells as you walk down the streets here are at times overwhelming, both good and bad: the smell of rotting food, then of barbeque and spices, burning trash, a cart full of sweet oranges, BO and strong cologne...the list goes on and on. I think the smells are something that will stay with me for a long time.)

Written by Whit

Dala Dalas

18 October 2009

We finally made it to church this morning. The Arusha Community Church is in the back of the parking lot of Selian Hospital, which we walk past everyday on our way to work. Although Dave and Eunie weren’t there, we met Nathan Simonson and a few other people that we will be able to keep in touch with here, so it was great to be there. The service was not quite what we were expecting, but we will hopefully get used to it and learn to love it. We are looking forward to going again next week.

17 October 2009

Today was better. Zach and I slept in until almost 8am and then I watched a cute movie called ‘Jersey Girl’. We had breakfast and then got ready to go to the Snake Park, just outside of Arusha.

We took a Dala Dala there, which was cool and it was only 1,000 Tsh for each of us. The dala dala was packed all the way there and back, which was uncomfortable, but definitely an experience. For those who don’t know, dala dalas are the public transportation here in Arusha (and I think a lot of East Africa). They kind of look like old VW vans, and they have about 16 seats in them. There is also a bench right behind the front driver’s seats, on which the “conductor” sits. Each dala dala has a conductor that hangs out the window on the sliding door and yells out their current destination. Whenever anyone wants to be picked up, the conductor is signaled by the passenger on the street and he bangs on the side or roof of the dala dala to let the driver know to stop. If you ever need to take one, you just have to listen for the destinations that the conductor is yelling (which is harder than it sounds, by the way). They are also notorious for stuffing them so full that everyone is like sardines. One volunteer said she has been in one with 28 people in it, where everyone sits or lays on each other or whatever they have to do to get in. There is really no such thing as personal space here. Another volunteer said that she was on one that was completely full and they stopped to pick up a guy who also had with him a tire! They shoved in the tire and the guys squeezed in. They sell t-shirts here that say “I survived a Dala Dala ride”, and I think by the time we leave we will have earned one J.

Anyway, when we got to the park, we chose to do the camel ride to a Maasai village instead of go in to see the snakes, which we thought we could do at home. Two Maasai men were our guides. The camels were fun, but definitely scary when standing up and sitting down. It was about a 20 minute camel ride to the village. When we got there, the guide told us that the group of huts we were visiting belonged to the family of the 85 year old elder who lived there. He had 9 wives during his day, and now their children and children’s children live there. About 10 kids ran up to greet us right away and wanted to be held and played with. They liked to have their picture taken and also wanted to take pictures themselves. We got some great pictures and felt truly out with the natives. The people there didn’t even speak Swahili (let alone English), but only their native tribal language. Overall the camel ride was fun, and worth the $8 each J, but it was also very touristy…our camels were from Sudan.

When we got back to Arusha we headed to the city’s soccer stadium to watch the futbol match between Arusha and Moshi. It was a men’s league for guys who didn’t quite cut it in the premier league, so it was pretty good soccer and a lot of fun. We are hoping to catch a few more games while we are here.

(The picture is of Zach with one of the kids at the Maasai village.)

16 October 2009

Today was a rough day. I didn’t feel good so I didn’t go to placement and I was very homesick all day. Zach went to placement without me, so I was also feeling lonely in the house without him. I feel like we have been here for longer than 2 weeks and I started to feel a little panicked at the thought of how much longer we have to go. My emotions have definitely been running high (I can’t imagine why!) and it is pretty draining. I go back and forth about 5 times a day between missing home so much and loving it here.

Some of the things I don’t like about it here: dust, not staying with Zach, feeling helpless at the hospital, being laughed at on streets, and endless bargaining.

Some of the things that I miss at home: my family, hot showers, Kleenex, feeling clean, paved roads.

Some of the things I love here: the food, the weather, the music, Mt. Meru, the market, the children, Swahili, traditional dress, and lots more.

My dog from home, Taboo, also died today, which was hard. I almost felt a sense of relief because I have been worried about it for probably almost two years now, and how my family would handle it. Fortunately, they are doing fine, but I still wish I could be there with them. Although I had pretty much said goodbye to him before I left, not expecting him to be alive when I got home, I don’t think it will really set in that he is gone until I get back and he is not there to greet me.

Written by Whitney

The Theatre

15 October, 2009

Today was a long and taxing day emotionally, and physically as usual. We wanted to get to the hospital for morning report, which starts at 7:30 every morning, so we left the house at 6:50. Morning report is just a chance for doctors and nurses to discuss patients and cases that may be peculiar. During the report, the power went out, and all the doctors and nurses just ignored it and continued on as planned. I thought to myself about the chaos and panic that would ensue if a hospital back home lost power; so many lives would be at stake. But here, there is no life support, and nobody relies on electricity to stay alive.

After the meeting they told us there were three scheduled surgeries today, but they needed to wait for the generator to be repaired, which would take about an hour. So Whitney and I went up to the medical ward to watch the Dr. go on rounds through the HIV inpatient wards. This was the one part of the hospital that I thought could completely break me down, so I had to somewhat leave my emotions at the door. As we watched, we couldn’t understand the conversations (and some of the patients could barely speak), and I felt like I was just looking at these people who had been battered and beaten by the disease that Whitney and I have been trying to fight and prevent, and I realized just how much worse the fight is going in Africa. We are in a whole different ballgame now, and are going to be pushed to our limits. Seeing these patients was a very humbling and motivating experience.

After rounds we moved downstairs to the surgical unit, which is called the “Theatre”. While we were waiting for the room to be prepped, we helped fold gauze pads because they come unfolded in bulk here, and then they autoclaved them to sterilize them; the generator also shut down a few more times and I kept thinking about how primitive all of this seemed. Once the room and the patient were prepped, we prepared to enter the “Theatre”, which consisted of changing our scrub top, putting on designated shoes, caps, and masks, and that was it. There was no scrubbing or washing or anything, we just walked into the operating room. This particular patient had a baseball-sized goiter on her throat and was in for a thyroidectomy. I kept thinking back to physiology and we pieced together possible causes of this ladies goiter; college is finally coming in handy.

The following are some of the shocking events and sights during the surgery:

- They left the door and windows open and the window screens had holes all over and a fly was buzzing around the OR.

- They had no tray for the tools and the surgeon just layed the used ones on the cloth covering the patient. Several tools were dropped and everything seemed very unorganized.

- While operating, the surgeons cell phone went off and I could not even imagine trying to concentrate with a scalpel in my hand while my phone was ringing. One of the nurses answered her phone during the procedure as well.

- The tools were not shiny like on TV, and the sheets, table, scrubs, and room all seemed very worn and patched up, but they save lives in that situation everyday. These professionals are amazing at making due with limited supplies.

- To wake the patient up from anesthesia, the nurse started smacking the lady in the face, as if being operated on wasn’t enough physical shock.

- I asked when they were starting the second of three surgeries, and the nurse told me that the other two had to be postponed because if they tried to sterilize the instruments in the autoclave that they would blow out the generator.

This surgery was my first ever, and it blew my mind. We have been raised in such a germophobic society that thrives on sterility, yet people die of nosocomial infections every day in American hospitals. Here, they are much more relaxed about sterility, and success rates in surgery are very high. The operating room is called the “Theatre”, and now I can see why.

Written by Zach

15 October 2009

This morning at the hospital we went on rounds with one of the doctors in the inpatient HIV ward. It was my first real emotional break since we’ve been here. I am not quite sure what it was, but I think the doctor had more to do with it than anything. We went through each bed and the doctor briefly filled us in on symptoms and asked us what we thought the diagnosis might be. We came up to a bed of a man who looked like he might be about 30 or so with skin lesions all over his body, bad thrush, and was severely malnourished…clearly HIV, and bad. The doctor told us that yesterday, when we was admitted to the hospital, he had 18 t-cells. He was only started on ARVs when he arrived. He was laying curled up in bed with a blanket covering him and was wearing a winter coat and hat. The doctor shook him awake and told him to sit up (although I could not tell exactly what he said, the tone was not kind). He rather roughly started taking off his covers, hat and jacket and began showing us the lesions on his back and the thrush in his mouth. I just stood there thinking how much I wanted to help him gently sit up and take his jacket off and give him a hug and tell him to “hang in there just a little longer and the medicine will start to kick in!” His wife (or girlfriend) stood next to his bed looking both sad and stressed. I had been blinking back tears since the first patient on rounds, but this one sent me over the edge. I went out into the hallway where a bench lining the wall was full of people. I stood with my back to them, looking out the window and trying to wipe my tears as inconspicuously as possible. We wear lab coats and scrubs to work so hospital staff knows we work there, but to the patients we look like doctors. I could not be disguised as a distressed relative, so I’m sure it did not look good for the “doctor” to be outside the HIV ward crying. I stood there for several minutes trying not to move, but I just wanted to go home. Unfortunately it was only 9am and it just wasn’t really an option.

Later we went into a surgery and observed a thyroidectomy, but I was weepy all the rest of the day and into the evening. I only tried not to think about it.

Written by Whitney

Ukimwi Klinika

13 October 2009

Today was our second day at St. Elizabeth Hospital, but really our first day of being able to observe and interact with doctors and patients. We spent the day in the CTC, which is what they call their HIV clinic. It is in a small separate building next to the hospital, and it had a separate waiting room and doctors offices, which is nice so that the patients don’t have to feel embarrassed to be there. The clinic is also for people who already know that they are positive and are coming back for check ups and treatment.

We spent the day with Dr. Robby, who was really great. He seemed young, but knowledgeable and friendly toward the patients. He also had a lot of questions for us about HIV in the states, which was cool to talk about and compare the two places. They are indeed VERY different! We struggled a bit since everything was in Swahili, but Dr. Robby translated a lot of it for us during or after the patient visits.

There was a lot of things I wanted to write about, but they are not all very well related, so I am just going to write them down in bullet points…

-The clinic normally sees 80-90 patients per day, with the patients normally coming once per month for check-ups.

-They have pretty strict requirements for putting people on ARV’s here. You must be physically ill (which they call clinically eligible) and also have less than 200 CD4’s to be put on meds. The doctor couldn’t believe that we start people on ARV’s right after they test positive in the states.

-All the treatment and drugs for HIV patients is free, along with the doctor visit. It is all paid for by an organization called EGPAF (Elizabeth Glaza something AIDS Foundation). The inpatient care is also partially cared for, but they do have to pay for their bed and for their IV drugs.

-One young guy came in today who had a CD4 count of 55, but since he was not showing any clinical symptoms (illness) he was still not put on ARV’s. I was floored. He was also engaged to be married soon, but still had not told his finance his status. I think the doctor kindly suggested that he do that…Tanzanians are a very polite and soft spoken group of people.

-We saw three small children come in today who were positive. One of them was by himself and looked like he had come from school. He complained of severe stomach pain and cried through most of the visit.

I handled the clinic today better than I had expected, also. I am not quite sure what to think of everything yet, but am just trying to absorb everything and learn as much as I can about HIV here. So much to soak in. That’s it for today.

(The picture is of the waiting room at St. Elizabeth's where the pediatrician and the pharmacies are.)

Written by Whitney

First day at work!

This morning was our first day at St. Elizabeth's hospital, and I was so excited and ready to start working. After a 35 minute walk, we arrived and started our orientation and tour of the hospital. Tesha, a nurse, showed us around, which was quite frustrating at times as she spoke very quietly and I missed a lot of what she was saying. But the following are the parts that I was able to pick up on.

We first met with Dr. Kwai, who seemed to be the head doctor at the hospital. He asked us what area we wanted to work in, and upon hearing that we had been trained in HIV testing and counseling, he was very excited. He told us that the HIV/AIDS ward at this hospital was the only one treating patients in Arusha, and that it was only 1 of 7 in all of Tanzania. Even more shocking was to hear that it had only been in existence for 4 years. It shocks me to hear that the only place to be treated for HIV in a city of 2 million has only been around for such a short period of time, especially since the disease has been around for 30 years. It just goes to show that things progress so much slower hear, than back home.

We then went around to meet many of the other doctors, nurses, and midwives that work at the hospital, and I have never felt so welcomed by so many people. Everyone hear is so polite and inviting and they all told us that we should just pop in if we want to see what they do. Our first stop was the Ultrasound room where we got to watch a pregnant woman find out that her baby was healthy, but I couldn't understand anything because the doctor only talked to her in Swahili (another incentive to learn the language). We also met Graeme, a Scot who is also volunteering at our hospital.

Tesha then took us to the pharmacies, the first of which was the infectious disease pharmacy, where they house all of the medications and testing supplies for HIV, TB, and malaria. I could not believe the array of medications that they had; there were numerous pills of many different families of medicines, they had liquid forms for children and patients who had trouble swallowing, and they had medications in shot form. Dr. Mack, who ran this pharmacy, showed us the three HIV tests that they use: a Unigold rapid, an SD rapid, and a third that I couldn't see the name of. The resources they had were amazing considering the how short-lived this clinic was, but it also goes to show how much money is being poured into infectious diseases by outside contributors. Mr. Mack also showed us the record keeping system they use for the medications they dispense, all in paper, and each patient is given a number through the government and that number is the only ID that the hospital records. This is very helpful for these patients who are terribly concerned with stigma. This pharmacy was a wonderful surprise and I feel confident that Whitney's and my skills will be well utilized in this department. I am also so excited to be able to test patients and then treat them. All the work that we have done so far has only been on the testing side, and now we will get a very comprehensive look at infectious diseases.

We stopped in the other walk-up pharmacy that they had for their other medications, and it was a complete 180 to the first pharmacy. The shelves were nearly bare and many of the slots were empty. So much concentration seems to have been put into the infectious diseases that the medicine people need for other ailments are terribly overlooked.

We walked through the rest of the hospital, which included the X-ray station, part-time dentist office, surgical ward, maternity ward, opthamologist, the ward for HIV patients, wards for other patients, and the outpatient clinic. Although the safety and sanitary standards seemed much lower than I have ever known, I was greatly impressed with the many different services that they provide their patients. Privacy in Africa is very different, and quite frankly non-existent. As we toured the hospital, we interrupted several patients during their visits, and many other people did as well. With a system like this, it is easy to see how people are scared to visit the doctor for various reasons because there is such little privacy.

There were 2 waiting areas, both outside, and they were full of people seeking medical attention. This hospital sees a lot of people, which was evident after seeing their filing system. There were two adjacent rooms that were stacked floor to ceiling with charts that didn't have any numbering or labeling tabs. There were also boxes on the floor with files in them, and Whitney joked to me that it looked a lot like some of the systems you would see back home. A lady was in there looking for a chart when we went in, and 5 minutes later when we left, she was still looking.

All in all, I was very impressed with our placement and am looking forward to our first actual day of work. We couldn't stay to visit with the doctors because we didn't have our lab coats.

The picture is of the Maasai woman that we bought a bracelet from during the "Amazing Race". She was funny and we had a good conversation with her.

Written by Zach

12 October 2009

Mambo! Today was our first day at placement. We left the house early and got to the hospital a little before 8am. The walk isn’t bad because it is down hill most of the way, but on the way home is tiring. We walk past Selian Hospital everyday to get to ours’, so that is pretty cool.

The hospital was pretty nice. There were a surprisingly high number of doctors there (around 10-12 probably) and the hospital has many different wards and services. It has pediatrics, gynecology, surgery, opthamology, HIV/AIDS, TB, malaria, dental and a general medical, plus a few more that I may have forgotten. The hospital also seemed pretty organized, as far as Africa goes. I think it is definitely one of the nicer ones in Arusha, but in a Westernized country, it would be considered a condemned building probably. Everyone was very nice and welcoming, and they were excited to hear that we will be there for 6 months. I think most volunteers they get stay for 3 months max, so they were pumped. We also visited the lab where they analyze the samples and they were pretty excited that I had a chemistry degree J I will do what I can there with them, too. I think one of the things that was most strange there was how much they are going to let us do. In the states we are considered amateurs and is cut throat to get to work in a hospital, where here, we are considered highly educated and will pretty much have free reign to do what we want.

We got to into all the different areas, but I was obviously most interested in seeing the HIV/AIDS patients. There were three rooms for the patients, separated by males and females. The rooms weren’t full, but there were many beds per room. I was nervous to see the patients at first, thinking I might get a little emotional, but I did good and kept it together. There were two doctors with the patients, which made me feel better and think that they were being taken good care of. I was also really impressed with the pharmacy for the HIV and TB patients, which was separate from the regular pharmacy. It was well stocked and was clean and organized. They had 1^st, 2^nd and I think even 3^rd line drugs for HIV and three different kinds of tests, including UniGold tests, which we are familiar with. They also had a finger prick rapid test, but not by a company that we recognized. The pharmacist there was specialized for the HIV patients, also, which is awesome. It is nice to see a program so well established. Even though we might have been more help somewhere with less resources, this will be a great place for us to learn a TON and get a feel for medicine in Africa. When we have a good knowledge of that, and are better at our Swahili, we should be able to go to places more rural and be able to help.

The hospital administrator said that St. Elizabeth’s was the first hospital to have an HIV/AIDS ward in Arusha, and only the 7^th in all of Tanzania. The amazing thing is, though, that the program is only 4 years old. Before that, I guess it was hit and miss if you had HIV and needed treatment in Arusha, and sadly, it is still like that for most of the country.

Tonight we are having “Thanksgiving” dinner because it is Canadian Thanksgiving today. We are hoping to celebrate the “real Thanksgiving” in November J, since there is one other American in the house with us.

Yesterday was Sunday and we got up early to go to church. We planned to go to the Arusha Community Church, which is where most of the white people go here, so the service would be in English and we would be able to understand the service. We walked around town for two hours, but couldn’t find it! When we got home, we checked the directions again, and it was just where we thought and had been looking. We must have walked around it over and over, and just never saw it. I will e-mail the Simonson’s probably this week and ask for more precise directions so we can go next week.

Well, you’ll be hearing more from us soon, after we get a little more time in the HIV ward of the hospital. Love and miss you all.

Written by Whitney

Maji Moto

10 October 2009

It is a torrential downpour right now. When it rains here, it really rains. I can’t believe the power hasn’t gone out yet. Electricity here is touch and go, but it works often enough to get your phone and computer charged up to last a while. The flashlights that you bought for us, Grandma, have come in really handy!

Today we went to Maji Moto, which means “hot water” in Swahili, but it was actually just a natural spring. The water was not warm at all, but more like the temperature of a swimming pool in the states. We drove on dirt roads for miles through really dry desert, and then we all of a sudden came up on this tropical lagoon. It was literally a desert oasis. It was absolutely beautiful. On the road (Arusha to Moshi Road) there we also saw our first glimpse of Kili. It is pretty amazing the first time you see it, so that was fun. It was pretty cloudy and covered up quickly, but it is nice to be able to see we have seen it now! We also saw a new view of Mt. Meru, which was also really cool. I am excited to drive the road all the way to Moshi to see more of the Tanzanian countryside.

Yesterday was our last day of orientation with Basecamp. We had our last language lesson and started the “Amazing Race”. This is our final test to check how comfortable we are in town. It started with an Ugali eating contest at lunch (no, Zach didn’t win, but came in at a very close second), and then we headed into town to complete some tasks. We were 5,000 Tsh each and had to send an e-mail from an internet café, buy a Maasai souvenir and some various fruits. A bonus would also be given to anyone who brought back a pineapple also. Zach and I ended up tying for 2^nd place, but he ended up winning in a tie-breaker quiz about geography of Tanzania. He won a t-shirt that says Mzungu on it J

Tonight I think the group is going to Maasai Camp to dance and hang out with the locals. Zach and I are probably going to go, but we are still not quite sure how we feel about the whole party scene here. We’ll see.

Tumekwenda sokoni!

October 7-8

Hamjambo! (How are you all?) Hope everyone is doing well? We had our first presentations yesterday at the CWCD that Whitney told you about. The seven new volunteers (including Whitney and I) split into two teams, and we presented several issues to a group of “college” (actually high school or trade school) students who were learning to be teachers. Our topics included pollution, hygiene, pregnancy, spread of disease, first aid, sexual health, and nutrition, and we taught to two different classrooms. I couldn’t believe how interactive and curious the students were; they were not embarrassed to ask questions about issues that are normally very hard to talk about. I have presented to students in a similar manner many times in Wyoming and often get no questions. Many people in America don’t want to embarrass themselves in front of friends, especially when they can just go home and Google any questions that they have; I was the same way through a lot of my schooling. But yesterday, the students had a pure desire to learn, and even though we are by no means experts in anything that we presented, we had very valuable information for these students. Having such interactive listeners makes presenting difficult topics much easier.

It seems that students who have the chance to learn don’t always take advantage of it, and those who lack schooling (like those at CWCD) have a great desire to learn and take advantage of every chance they get. Even though these students went to an English medium school, there was still an obvious language barrier as we had trouble understanding their questions, and they clearly had trouble understanding some of the words and concepts that we tried to teach them. This was even more motivation for me to keep learning Swahili, and Whit and I are giving it our best shot.

The charger that we ordered for our small camera battery ended up being the wrong charger and both of our batteries are dead. So Nelson (one of our orientation coordinators) looked for one while he was downtown. He did find one, but it was 130,000 Tanzanian schillings, which is over 100 dollars for a small charger. Apparently that is how electronics are, along with other things that don’t sell very well in Arusha. Another example: we went into a small shop and found a 1 kg bag of oats (the size of Quaker Quick Oats that sell for a couple dollars back home) and they were asking 25 dollars for one bag and a smaller bag of pine nuts was 50 dollars. We are stuck eating what the locals grow, and I have no problems with that because everything that we have tried has been very delicious, although not near as spicy as we usually like.

We had our first shopping experience at the central market this morning, and it was quite nerve racking trying to bargain for the first time for our food. We know the basic bargaining language, but it is still a very new concept. At the market, there are hundreds of vendors selling the exact same produce, so we just had to ask around about prices (in Swahili) and find the areas where people give the best deals. I always feel like what they ask outright is reasonable, and downright cheap, but we still have to bargain. Whit and I got tomatoes, avacados, hot peppers, bananas, carrots, and onions for less than 5 dollars.

We also visited our hospital for the first time today, but were not able to take a tour or meet any of the doctors. It was a big bummer because I have been so ready to get started at our placement, but we’ll have to wait until Monday to really see what the hospital is like. We did walk past the maternity ward though, and it looked like there were about 15 new mothers and their babies in a 20’ by 20’ room. If that is any indication, the hospital will probably be pretty cramped for space and quite busy, but we have been expecting that.

I guess that’s about it for now, but we are going to try and put some pictures on the blog shortly and maybe send some through e-mail. Hope you all are enjoying reading as much as I’m surprisingly enjoying writing it. I can’t believe I’m do so good at keeping up in my journal. We’ll keep you all updated. Kwaherini (good-bye all).

Written by Zach

Hamjambo!

October 4, 2009

Today was the second day of orientation here at Basecamp. We have had breakfast, a short talk and then walked into town, mostly to get acquainted with where things are and feeling comfortable walking in the streets. It has been a little overwhelming, but overall great. The streets are pretty rocky and really dusty, so when a car drives by you almost have to stop and cover your face to avoid inhaling it all the time. All the plants and trees along the sides of the road are not green, but rather brown from a thin layer of dust that constantly covers everything. There are also far less white people than I had expected to see. Unless we have been at a place where they are known to hang out before heading on Safari, I have only seen one or two. Even still, the people leave you alone and do not hound you for money at all. Most of them barely make notice of you, unless they say hello as they pass by. Also something I had not expected, but much appreciate. I would have to say the craziest thing about Arusha so far has been the driving. It is kind of scary sometimes and often feels like you are in a video game where there are people flying here and there and bicycles and push carts and chickens flying…pretty entertaining.

Today we also went to the used clothing market and I got a pair of pants to wear around sometimes. My dresses are nice to wear, but sometimes you need to wear pants and it is culturally acceptable for the most part. For dinner tonight, we went to a place called Khan’s for orientation that serves Indian bar-b-que. It was delicious and very local. We sat at a picnic table on the side of the road and drank freshly squeezed passion juice. Yum.

We unfortunately didn’t get to go to church this morning because of orientation, but we are going to go next week. There is a church next door to our house, though, so it was nice to hear the singing all morning. It is also a school during the week, so we can hear the kids playing during the day, which is also kind of fun.

October 6, 2009

We are still in orientation week and enjoying it a lot. We have had our first two days of language training and then gone into town in the afternoons. The language training is hard, but we are going to practice and stick with it until we are confident with using it.

Yesterday we went to town to get cell phones, which we can call within Tanzania really cheaply and we can receive calls for free here also. It is cheap to call from the states with a calling card, so if you are interested in getting our number, just e-mail me and I’ll send it to you because I don’t want to post it here J Yesterday we also went to the Meru Market, where you can buy all sorts of crafts and things made by the locals. I think I could probably spend all of our money there, but we are going to have to pick just a few things to bring back, since we are limited in what we can carry back. We are going to look into the cost of shipping things though, because it just might be worth it.

Today we went to a place down Ilboro road from our house called the Arusha Center for the Development of Women & Children. We met the lady who runs it, Mama Hindu, and she gave us a soda and a bracelet made by Maasai women. She made a microfinance program for women, mostly Maasai, and teaches them about women’s rights and things also. For the children, they run a school, but they don’t have enough teachers and can’t afford to feed them, so they can’t have a full day of school since hungry children can’t concentrate or learn anything.

October 7, 2009

Last night we went to a show called “Mama Africa”. It was kind of like the African version of Cirque de Solei, with a lot of contortionists and gymnasts and jugglers and things. It was only 4,000 Tsh for both of us, which is less than $3, so it was definitely worth it!

Today we went to the ICTR to watch one of the war trials from the Rwanda Genocide, which is one things that I really wanted to do while we were here. I was not sure what to expect, but it was really fascinating. We actually got to see a trial that was kind of exciting. A witness for the defense was being cross-examined about his witness to a crime committed by a man named Dominique, who was a government official in Butari. He was being tried because is thought to have tricked a group of Tutsi’s up a mountain and told them they would be safe, but ultimately led them into a trap where they were all killed. What was cool was that we were able to actually understand what was going on and got a full picture of what had happened during that time. I thought it was pretty amazing that even though the incident was 15 years ago, the questions and answers were so detailed. It makes you wonder how much is true and how accurate it all is.

Well, that’s about all for now. Sorry the installations are so long, but we are trying to keep it thorough J We are still loving Arusha and feeling more and more confident and comfortable here. I know that when we can move out of the volunteer house, we will feel very comfortable and safe moving into a place of our own. We hope you are all doing well and hope to hear from you soon.

(The picture posted here is of the street that we walk down every day to get to town, with the view of Mt. Meru in the background.)

Written by Whitney

First impressions

October 3, 2009

Aside from our situational problems, our time here in Arusha is wonderful although very overwhelming so far. I still haven’t adjusted to the 9 hour time difference, and when I do get to bed, there are so many dogs that bark in a chain reaction that completely interrupt the sleep cycle. We walk everywhere though, so that helps to wear me out during the day.

Walking through town is much like what I thought it would be, however, there is no way to prepare for it. I have never seen poverty like this in my life, but each and every shop looks so inviting and the produce and merchandise look very inviting. The adults are always very friendly, but the children are magical. They are starting to learn English in school, and when we walk by, it is their one chance to really practice. Their exclamations are either “Good morning,” or “How are you?”, but they repeat it over and over until we respond or wave…so precious.

Two things that are very frustrating are learning Swahili, although we are improving, and bargaining for goods. Although many people speak English, Whit and I really want to learn Swahili to enhance our experience and it will improve our conversations with the local people, but I hear words that I should know and want to say a word in Swahili that I have learned many times, and I just can’t think of it. I guess I shouldn’t get to impatient since it’s our fourth day, and everyone is complementing Whit and I on our Swahili skills. Swahili will also help us with bargaining at the market, but in order to bargain, we have to know the prices of things…and there are a lot of prices to learn…agh.

We have seen two very different sides to African culture thus far: the local people who live in rampant poverty, and the ex-pats who live very comfortably in the city. Walking through town is almost strictly interacting with native Africans, but we have also seen the posh and exclusive world of white people (mzungu) in Arusha. We went to a concert at a restaurant with an Italian who lives just down the street from us, Lupo, and it felt like we were back in the states. The atmosphere would be very comfortable and low-scale back home, but here in Arusha, it seems very out of place.

Some interesting things that I have heard and seen:

For Dad, I have seen chiminillas here and in Nairobi.

For both of the Dads, I met a guy who farms trout about thirty minutes from here.

We found the office that the Simonson’s own for their safari business and are looking forward to meeting them.

Whit and I learned how to make ugali from Isaac, the cook, and I love the food here, but everyone says I will get sick of it….don’t think it will happen.

So many things are still confusing and overwhelming to me, and I will write more once we adjust to living here and start our placements on the 12^th.

Written by Zach

The Arrival

September 30, 2009
Tonight is our first night in Africa, we arrived in Nairobi a few hours ago after three long flights. When we finally got through visas and baggage claim, we stepped out to look for the person with our names on his sign who would take us to the Milimani Backpackers Hotel. There was nobody there for us. Stressful to say the least, the emotions of being far from home with no one really to call finally hit me. We ended up finding our own taxi to the hotel. When we got there, they didn't have our reservation and we ended up paying much more than we were quoted, but we were happy to be done traveling for the day.

October 1, 2009
Today was yet another big day in our trip. We left Nairobi at 8 am after eating breakfast at the hotel. At first on the bus, we were driving through the streets of Nairobi on our way out of town. They were full of people and the buildings next to the road varied from shanties to tall, shiny highrises.

The road was long and slow. Though much of the distance was spent driving on pavement, the majority of the time was spent on horrible dirt roads. The trip was about 7 1/2 hours including the stop at the border to get our Tanzanian visas. We passed through many small towns and saw lots of countryside. In the small towns, we were amazed at the labels on the small metal shacks that lined the sides of the road. One building that had no windows and no roof was labeled "Engineering Services". (Funny aside: as we were on the shuttle the line from Blood Diamond that Leo DiCaprio often says kept running through my head, "TIA...this is Africa". When we got to Basecamp later I found out I was not the only one with that line in my head, and "TIA" is becoming a common phrase in the house when unexpected or shocking things happen :) ) It must take an amazing engineer to work under those conditions. Along the areas of the countryside, we saw Massai herding their goats and cows and some wildlife. We saw zebras and what we thought were impala, which turned out to be gazelles.

So when we finally arrived in Arusha, we got to the Impala Hotel. It was very nice, but unfortunately Moses was not there to pick us up. After paying the receptionist US $4 to make a call, our ride was on the way. On our way there, Moses kept asking all these questions about our trip; "Was anyone there when you got to the airport?", "Did you stay at the Milimani Hotel?", "Did you get picked up by the shuttle this morning?". We explained to him what we did and he told us what happened on his end: he got a call from the Milimani last night that we had never been picked up from the airport, then he got a call the next morning that we never showed up at the hotel, but he had been informed earlier that we did in fact arrive in Nairobi, based on our purchased visas. He was also told that the Impala shuttle did not pick us up. At this time, he and basecamp were panicked. Headquarters called our parents AND the US Embassy to tell them we were lost! Our first intention when we got to the house was to send an e-mail to set things straight with our surely-panicking parents. Supposedly what happened was that there are two Milimani hotels, a hostel for backpackers for $25, and the Kivi Milimani where we stayed, which
was nicer and more expensive. At the airport, we didn't see anyone with our sign, and neither did the other volunteer who arrived on our flight. By chance, we and the other volunteer ended up at the expensive Milimani, and the shuttle to Arusha picked us up there (still not sure how that worked out since it was the wrong hotel).

We are hoping to be able to write often, but our internet situation is not what we expected. We will be getting a cell phone soon, that gets free incoming calls and is cheapest to callers through a calling card. So we will give out our number as soon as possible.

Guess that's all for now. We hope our next post will be a little happier and more about life in Arusha.

Written by Whitney...more to come from Zach later :)