Sunday, February 15, 2015

Random Photos

Dear Friends,

We are all home now, safe and sound, although Sarah Lebens went on to Seattle to visit fiance Andrew.  I could not post photos from Ilula and even the text was tough.  So here are some random photos that didn't get posted.
Our Morning View

Diocese Dignitaries

Dr. Saga

Mt. Selebu

Saga, Moody, Bishop Mdegella

Red African Tweety-bird

Russel and Andria King

Dr. Saga and Mwamoody

Tuesday, February 10, 2015

A Wedding in Africa

Dora Saga died in November, 2013.  She was as beloved a friend as is her husband.  Her death was tough on Dr. Saga.  He managed a brave countenance while the wazungu medical people were here in January, 2014.  However, just after we were here last year, Dr. Saga’s daughters took him aside.  The three boys had returned to their jobs in Dar es Salaam after a couple weeks, but his two daughters stayed for a couple months taking care of him.  The conversation went something like this, I believe.

“Dad, we have noticed how sad you are.  We want you to be alive for a long time.  So we think you should get remarried.”

“And,” they added, “we have chosen two women for you to choose from.”  Now of course I wasn’t there, but I did have the conversation first hand from Dr. Saga.  He said he knew both women and Dora had known them and worked with them for twenty years.  He also remarked that he thought someone was courting the one he was interested in and he had better get busy!  Mwamoody confirms the veracity of my recollection.

Yesterday was the culmination of the year-long courtship. 

We got up to a beautiful morning.  The day before there had been a huge thunderstorm which took out the electricity for a while.  In the middle of the night, Moody discovered we had no water.  He reluctantly called Dr. Saga, who called Habakuk, who in the morning once again turned on the water.   “Thirty minutes,” Habakuk said.  (More like 300 minutes.)  Of course, the tank had been emptied and so it needed to fill along with any pipes lower than the tank before there was actually water available for us to use, which wasn’t by 10:00 AM.  We all managed however, and the water was available to the toilets by the time the wedding service was over.  Whew!

The wedding was to start at noon, then the reception at 2 pm in Ilula Mtua.  Of course, the bishop was an hour late, so the time frame started off behind, generally as expected. 

The ceremony at Ilula Lutheran Church was lovely – what we could see of it through the many photographers!  The choirs were wonderful of course.  There were many honorees at the service too.  Rev. Msigwa was drafted into translating for Mchungaji Lamont who delivered the first portion in Swanglish, some in Kihehe and the remaining in actual American, with which Msigwa is very comfortable.

A pretty familiar order of service followed and concluded with the bishop officiating.  Then pontificating for another 15 minutes, mixed with some further introductions.  I think the shortest wedding I have ever witnessed was about 10 minutes.  Pretty sure this one was at the distant other end of the spectrum.  We still loved it!

A few of the dignitaries retired to the guest-house for cocktails, but generally settled for beer and use of our now functioning our “facilities.”

The bride and groom came out of the church to cheering and adoration.  Soon, people boarded buses to go to the reception just a few kilometers away.  When we were ready after refreshments, we made our way to where the buses were, but they were gone.

A real treat was a small brass band that played before the wedding.  If we had to wait for the bishop, this was compensation.  They played several numbers and we enjoyed it!

We bumped into the trombone player as we were looking for a ride and he offered to bring us to the reception hall.  We clamored into his vehicle, 14 of us.  But it was only a short distance.

The reception was fun and we enjoyed ourselves.  We were escorted to tables in the front, each table with an interpreter.  The tables had sodas and fruit juices and one table had some wine, so we visited that table!

A crazy MC presided.  Families were introduced, special guests too. There were a couple skits.  One number was a guy doing a quick change through several costumes.  Another was a sort of acrobat, in what I would call a hobo costume, certainly in contrast to the finely dressed people at the reception.  His shtick was breathing flame, but was so-so at best.  Actually, several of us wazungu did a Hehe dance, which was much more impressive, if you ask me.

There were several processions with gifts to the bride and groom.  Gifts were brought forward.  Three identical fifty piece place service sets along with glasses, mugs and other necessaries for housekeeping (and entertaining large groups).   There were pieces of fabric, nearly bolts, not merely 6 foot katangas.  And what would a Tanzanian wedding be without a live goat?  It was brought by for men, raised above their heads.

In place of a “dollar” dance, they used processions, women to Anitha and men to Dr. Saga.  Each of us dropped a few TZS on the katanga as we came forward.  Looked to me like it netted at least as much as a dollar dance would have.

The wedding was truly classy.  Someone reported it was the biggest wedding Ilula had ever seen.  I don’t doubt it!

Our hosts arranged for us to be brought back to Ilula in three vehicles and about all I remember before I quickly fell off to sleep was the hope that all of us were in the guesthouse as I had locked the door.  Oh well, they can knock.  Zzzzzzzzzzzz.

It’s the rainy season.

What a beautiful morning this morning.  It was sunny, bright and hot.  There were a few high clouds but would have been a great day to walk.  I admit I did not out of sheer laziness.  Bed felt so nice!  Moody slept in because he was a little under the weather yesterday, home from Ruaha with the Kings, Lamont and Terry.  Of course, they had a wonderful time at Mwagusi.  Gary has been many times. Moody said, “Ruaha never disappoints!”

There was just a little adventure in the air because the group was going to Iringa.  We have taken a dala dala or larger cruiser to Iringa numerous times in previous years, but on the heels of a rollover, no one was anxious to use the dala dala for travel.

Nick delivered his talk on skin infections and Sarah Lebens hers on diabetes.   They went well, if to a small but adoring audience, half of whom don’t speak English.  This is an exaggeration.  Most do understand some and were definitely on the adoration side.

Esther, one of Anna’s young friends who works for her, was to go to Iringa with the six who planned to go, myself, Nick and Grace to stay home.  Later we found Esther to be here at Ilula and have not seen Nick.  Our surmise is that Nick went with the group to fill out its capacity of seven since Esther could not go.  It is possible Nick is sequestered in his room, but I don’t think so!  Moody had some translation to do before Saga’s wedding, so he also drove to Iringa for some Kihehe tutoring.  They aren’t back as yet.

Grace, who developed a survey to assess whether or not we are doing any good here for the Tanzanians had another great idea.  With her first survey, we got some long-desired data confirming what we wanted to hear.  They like us!  Dr. Anne, who is a master at research, offered Grace some advice.  Anne noticed that most of the survey answers to the Likert-style (“on a scale of 1 through 9”) questions were all lined up in a vertical row, i.e. all 7 or 9, but without variation.  One of her suggestions was to ask the questions in such a way that similar questions might have answers at the opposite ends of the scale.  This would likely prevent all the answers to reflexively be the same and possible generate more candid feedback.

So Grace set about rewriting the questionnaire in that fashion with editing help from Sarah and Emily.  Then she took the concept step further.  She had the questionnaire translated to Kiswahili by a wise, smart man whose name is Mdege Pele.  He took a day to do so and got a little extra help from Mpeta too.  I think Mpeta typed it for her also.  Once typed, we printed 80 copies and with Mdege’s help distributed them all throughout the hospital and OPD (out patient department) with requests to complete the form and drop it in the anonymous collection box in administration. And we accomplished all this before lunch.

After lunch I took a nap and awoke to thunder, certainly not uncommon in the rainy season.  There were even a few droplets before I returned to the guesthouse from and errand to administration (where I shook the box to find some questionnaires already there and  I hope we don’t find any “Yankee go home” love letters).

Two-minute fill rate
Grace went off to shower with the nice warm water she had collecting sun in the yard.  Then the train roared through!  Well, on the corrugated metal roof, it kinda sounded like a train.  A little anyway.   I thought I heard a little hail but did not spot any.  Grace later confirmed it however.  I was pretty impressed with the torrent.  Pretty sure there were cats and dogs mixed in, but the rain was just too heavy to see them.

I was also impressed that the red 300-liter barrel filled in about 8 minutes.  It collects off the roof, into the gutter then into the barrel.  And then it REALLY started to rain.  I am sure we were up in the two-minute-barrel-fill range. Last year’s record was a five minute barrel-fill. 

Pretty exciting stuff if you ask me!

Friday, February 6, 2015

A Nursing Perspective -"Take 2" from Sarah Martin

Some of you may have read my previous post about the difference in nursing here in Ilula and most of what I previously noted is still true but I would like to add a few notes and tidbits I have picked up in my last couple weeks here. 

There is a major shortage of well educated medical staff here - be it nurses or physicians. From what I can understand, this shortage is nationwide in Tanzania. According to the head of nursing, Ilula hospital has approximately 21 nurses and if they were staffed to provide appropriate ratios (about 6 patients per nurse) they would require 52 nurses. Essentially they have half the nurses they should have for safe patient care. This helps to give me some perspective when I start to get frustrated by the practices I see. There are what seems to be the equivalent of what we call medical or nursing assistants in the states. These staff have one year of training and from what we gather, are trained to do personal cares and vitals but are not medicine administration or assessment trained. Due to the shortage, and I think also in part to cultural practices here, these staff reconstitute, draw up, and administer medications (oral, IM, and IV). Krista and I have been frustrated at times to watch the trained nurses sit around while the assistants do tasks that seem to be outside of their scope and training. I do have hope that as the nursing school here in Ilula opens and more trained staff are available, that these practices may change but as most things around here, I understand it will take lots of time. 

Nurses here do not regularly assess patients, even the very sick patients that would likely be in ICU or intermediate care at home. The highly acute patients get the same level of care as those that aren't so sick. Situations that would be medical emergencies at home are taken with an air of lightness around here such as a child seizing for long periods of time or an arm presentation (requiring immediate C-section at home). This has lead to what I perceive as anger and frustration from many members of our american group because some babies/kids have died while we have been here due to what some have thought is lack of monitoring and lack of thorough frequent assessment. This is a hard pill to swallow for me because potentially preventable death of babies and children due to what seems to be a lack of nursing responsibility and care seems... Innately wrong. But yet this is not my country, my hospital or even my place to simply insert myself or my practice. We have a partnership with the staff here and have been careful to not pass much judgement or blame on our friends here. As nurses in the US we take responsibility for the care of each patient and care deeply about the impact and outcomes of our care - that does not seem to necessarily be true here. I am curious to know whether their teamwork style of caring for patients - for example where one nurse does admissions, one nurse places IVs, and the other passes medications - leads to lack of personal responsibility when it comes to patient deaths or poor outcomes. On the other hand, perhaps the staff have blocked out the pain of losing patients and kids because it happens so much here and would break you eventually if you didn't become resigned to it. Certainly lots of food for thought. 

HIPPA does not exist here. You are trying to give out paper files (charts) to patients in a room of 8 people plus families? Just yell each name out to find out who is who. The first day I saw this practice, I just watched in awe. 

The nursing staff here have been very kind to us and let us invade their space and watch them work. It has been quite the experience. We have seen some very sick kids that we thought would not make it, recover and even be discharged from the hospital. It has been a joy to watch some of these hard cases be so successful. 

The last part of our dwindling group (we now have 10 of us total) will be returning to the states a week from today. I think people are most excited for warm showers and a change in food (the talk of a big salad upon arrival has been spoken by many - lots of starch and carbs here with very little protein or veggies). All in all though, I don't think any of us are ready to be back in the snow and cold most of you are experiencing. So much love sent from Tanzania to all of our loved ones back home! 

Tuesday, February 3, 2015

Ilula Orphan Program - Emily and Laura Kvasnicka

My sister Laura and I tagged along with the group but since I won't start medical school until August and Laura is interested in law, we decided to spend our time at the Ilula Orphan Program as volunteers. We've been home for a couple days now, but we weren't able to complete our blog post while we were there due to a lack of internet.  We wanted to share some thoughts with you about our experience.

The Ilula Orphan Program was started by Berit Skaare, a Norweigan who lived in the United States for many years. It's a huge operation that includes caring for the 36 girls who live at the center but also coordinating sponsorships for 1500 kids in the surrounding area to attend school, assisting foster families with education and material support, a high school for girls from the orphanage as well as other children from around Tanzania and several other projects (more info here: . Laura and I stayed at the center and spent our time helping with a variety of these projects plus varnishing, cleaning and of course playing with the little girls at the center!

We were blown away by the kindness, generosity and joy of all the people we met there. Every Tanzanian staff member was committed to their job, but also to making sure everyone else was comfortable and happy and we were always greeted by cheerful "jambo's" and "habari za azubuhi's" and laughter when we mixed up the proper replies. Even more fun were the girls. We spent most of our time with the little ones who were 10 and under since the older girls were in school and had a lot of chores.  Even though they didn't speak English and we didn't speak Swahili, we still were able to have a lot of fun with them. We discovered their fantastic personalities and enjoyed teaching them games from the United States and having them teach us their games.  It was so sad to leave them!

More than what we were able to contribute, we feel like we learned so much from all the people we met.  We'd to leave you with a list we made of things that we learned and want to remember every day.

-Be generous
-We are extremely lucky to live the life we do
-Don't worry about what you don't have, focus on celebrating what you do have
-You don't have to be the best at something to do it and enjoy it (For example, I'm not sure a Tanzania would know what you meant if you said that you can't sing, a common statement in America. In Ilula, everyone sings and there's no question of ability!)
-Focus on the moment and don't worry about timing
-Put down your phone!
-Be joyful
-Trust in the future

We're so grateful to IOP for hosting us and the medical trip for letting us tag along!  It was a wonderful experience! Asante sana!

Sunday, February 1, 2015

Post by Jessica Quirk

This week I met three high-school age girls that a few of us are going to sponsor for school.   They are all orphaned and living in foster homes that we call kinship foster-care in the states—living with aunts, uncles and extended family. We learned several weeks ago that without sponsors these three girls would have to drop out of school. In the months right before this trip my care was stolen and I experienced many unexpected expenses. For the thirty days before coming to Tz I was living off my credit card, something I find very uncomfortable. I knew the $300 would go a long way for me at the end of the semester so two of us decided to sponsor one student together. I really wanted to meet them since we were are staying so close to them but it was hard too, to feel like I had so much power over their future. The day we met the girls they were very quiet and shy. They do not speak English and it turns out that they do not speak Swahili very well either and they could not really understand our oddly accented attempts to communicate with them. I was worried that they felt forced into coming to meet us and that they might resent how easy it is for us to have such a dramatic impact on their life—almost on a whim. I wanted to talk with them about my own experience in foster-care but I did not want to presume to understand what they are going through. I hope to find a way to sponsor the student Grace and I are paired with through high school and hope that through our letters I can be supportive in other ways.

Jessica Q.

Saturday, January 31, 2015

Ilula Nursing School Dedication

Today was an eventful day at Ilula Lutheran Hospital, unlike any other day.  It was beautiful, like so many other day here.  Gary and I went walking in the fog.  He ran on as I walked back.  By the time I returned from the forty minutes total of out and back, the sun was up and the fog was burning off nicely.

Last night the troops watched a good movie, “The Last King of Scotland,” the story of a Scottish doctor who became the personal physician of Idi Amin, known to my generation, represented in this case by Gary and me, as the ruthless dictator of Uganda and the antihero of the “Raid at Entebbe.”  I think they were surprised that I grouped him with Hitler.

Everyone was a on alert because we were expecting guests by 8:30 AM.  The guesthouse was spiffed up and presentable by the time they arrived.  And kept arriving.  There were a lot of guests.  Anna fed them all and of course there was enough to go around, I think five loaves and fishes, metaphorically speaking.

Dr. Saga had made a detailed schedule.  Mwamoody sensed the ensuing need for more sodas and went for them and we were glad he did!  We would have been pronounced poor hosts had we run out.  The doings were supposed to begin at 9:00 AM.  Remarkably, Bishop Mdegella arrived on time, something he is not known for.  Even he was sensitive to our honored and charming guests, Andrea and Russell King, representing the Peter J. King Family Foundation the generous donors who have supported Ilula’s Medical Education Buildings and other buildings built specifically for the Ilula Nursing School.

Somewhere around 9:30 AM or after, we strolled to the area of the education building where the hospital had put up as many chairs as could be found and the Ilula Nursing School Dedication kicked off.  First came several numbers from the combined Ilula Lutheran Church choirs.  I only wish everyone reading this could hear them.  I will try to get one number from Radio Furaha, even if the recording is not ups to the finest quality.  After the choir, the sealing of the time capsule and the blessing and dedication of the Nursing School processed.  There were several speeches, mostly way too long, but of course my opinion might be tainted by the fact that I do not understand Swahili.  The hit of all the speeches was one of which I did not understand a word and in Kihehe, by my esteemed colleague Mwamoody.  He is nearly legendary here as the mzungu who speaks Kihehe.  People he does not know call him by name and he often has a conversation with them.  People laughed delightedly as he spoke to them.  Richard Lubawa could hardly contain his own laughter as he translated for us wazungu.

Russell and Andrea received gifts from community members and showed off the new shirt and Katanga (or whatever they are called).   The speeches eventually concluded and once again the choir sang.  It was one of the most beautiful songs I have ever heard, full of the loss and sadness and pain caused by HIV/AIDS.  To add emphasis, the women covered themselves and their heads and all sang sitting on the ground.  It was startlingly beautiful and mournful. 

Going on from this evocative song hardly seems fitting, but just as those of us left behind by HIV/AIDS and other ordinary losses, the dedication did go on.  I can only say how privileged and honored I felt to have been present for this wonderful dedication.

The last item on the dedication service schedule was a tour of the three buildings.  They are very fine, indeed.  Now to fill the dorm with students and teach them excellent nursing skills (then build a second dorm for the next class, of course)!

It’s funny how a long dedication service stimulates the appetite.  Anna and her crew did themselves proud.  The rabble ate by the administration building and the honored ate at the guesthouse.  I am sure I only got to eat at the guesthouse because I live here.  Actually, we did have two eating stations to accommodate the big crowd.  The food was excellent and there was plenty.  Anna should have a bonus!

But for me and Mwamoody, the rest of the wazungu crew took off for a jaunt in Iringa about noon.  Most will return tonight and we are off to Image (pronounced Ee-mah’-gee, not im’-ij) for dedication of the new library, also funded by the King Family Foundation.  I am looking forward to the students and faculty dancing for us, always a treat.

Now I sit looking out over one of my favorite views in the world, looking across the savannah at Mount Celebu, with a few birds nearby and cowbells off in the distance.  There are clouds rolling in and we have had a bit of rain but no drenching downpours.  It is peaceful and I feel reverent as I look out over this stark and beautiful land.  

Bwana asifiwe!