don't forget the M.D.

finally, the surgeon arrived.

This past week an American plastic surgeon arrived from Texas along with an anesthetist. We had several patients waiting to see if he could operate on them. On Monday, he spent the day meeting with all the patients and telling them what they could expect from surgery. He arranged 6 surgeries. 3 cleft palates and 3 burn traumas. Us students sat down at lunch and divvied up the surgeries so we would all have a chance to scrub in on something we wanted to see. The surgeon said 2 students could scrub in per burn trauma, and 1 student could scrub in per cleft palate, and as many people were invited to watch as could fit in the theater. My scrub in surgery was this morning, however I've been in the theater everyday watching. Its absolutely incredible to watch plastic surgery. The first surgery on Tuesday took 8 hours from start to finish (she was a burn trauma patient with the most work to be done of anyone). Her entire left arm had been incinerated to the point where her elbow was in a locked bent position and her hand was locked in a vertical position. The incident had happened 2 years prior. She had no movement besides at her elbow, and her face was also badly burned. The surgeon took skin grafts from her thigh to graft the back of her hand and her elbow, and a full thickness graft from her stomach to graft her lip. Its incredible, the intricacy involved with reconstructing anatomy after fire took it away. He said he could have done more for her, cosmetically if he had been in the U.S. but he made due with what was available to him in our hospital. Either way, the girl walked out with her hand and her elbow back to an extended position, thus allowing her to hold her arm straight down at her side, instead of it permanently being in a cocked position. And with the full thickness graft on her lip, she had more movement at the mouth.

Because the first surgery took so long (our doctor was used to working with residents who would normally take up the task of suturing up the grafts after they had been put into place, but since none of us are actual residents yet he had to do everything on his own) he pushed all the surgeries back. So the second day, he performed two cleft palate surgeries and fixed a harelip on one of the patients as well. Again, amazing. I feel like being a plastic surgeon is one of the hardest fields in medicine because you have to be familiar with the entire anatomy of the human body! Unless, of course, you specialize in a certain area of the body. But this surgeon moved from hand to arm to lip to mouth to eye with such ease, I can't imagine how much time he spent memorizing everything everywhere.

Then this morning, it was my turn to scrub in. I chose a burn trauma. The woman's whole left side of her face had been burned. She had no ear (just a hole) and, originally I thought her eye had been burned out, but it was actually still there, and the pupil had been spared (the bottom half of her cornea was burned) thus leaving her with the ability to see somewhat out of it. But her eye lids had been burned so she couldn't fully shut her eye. I got to stand right over the body, hold the hooks that kept the skin apart as he was cutting away from the tissue underneath, so he could see where he was cutting. I got to suction up blood that spilled into the eye socket, and cut the stitches as he made them, and some other little stuff too. It was fascinating. The whole time I got to ask him questions, and learn about the when to use certain tools and how to fix certain things. I got to look through the layers of tissue and at the facial muscles. I've seen all of this stuff in my anatomy text book, but seeing it in real life, in front of your face is so much better and cooler. Ocular muscles and facial muscle names started coming back to me (even though I took my anatomy final a mere 3 months ago). I can't describe how cool this experience was.

Yet still, I know I could never be a surgeon. The patience, concentration and dedication to your work (you can't leave the theater until you're job is done!) is too much for me. I'll stick with the babies :) I'm happy though, that I've been able to see so much medicine here. I don't think I mentioned it before, but last week I got to sit in on 2 cesarean sections. Two different doctors performed the operations, so it was neat to compare techniques and styles. I just like the work of delivering babies into the world. Something about the fact that the fate of a brand new human life is in the mercy of my hands is special to me. Plus, as a midwife you work with the mother-to-be prenatally until the baby arrives. You develop a relationship. I like that better.


My time here is quickly winding down. This weekend we're heading back to Arusha to stay in a Masai village for the weekend. They slaughter a goat for us and dance around in their traditional ceremonious way. Part of Masai tradition surrounding slaughtering a goat is the milk, the blood and the meat. So we will be presented with each from the chief. yep. I'll be drinking goat's blood this weekend. Then the women take the skin of the animal and create bracelets from the fur. Every part of the goat is used. We'll also have an opportunity to learn the beading that they do. I will take many pictures and post them as soon as I get back to the U.S. for those of you who have asked, sorry, I forgot to bring my camera cord so I can't upload any photos. That, and the internet, although readily available to me now, is still incredibly slow.

Then, next Friday I'll be on my way to Zanzibar which is where I'll stay until my flight back home leaves on August 7th! I can't believe I'll be on a plane for the U.S. in exactly 2 weeks! I can't believe its the end of July already. I hope I get a little bit of summer in the states before fall comes around. I can definitely use some sun and warmth right now. It has been raining in Machame for almost 6 days straight. bah! I'm supposed to be in Africa, nice, warm, Africa. The Texans thought the same thing. They're dying right now. At least I'm used to cold weather! Ohh Africa. Yesterday in surgery, the power went out. It was classic. I'm so used to it now, it doesn't even phase me.

I'll write more next week after the Masai village.

Seeing Life

it's pretty much official. I have decided what I'll specialize in as a nurse practitioner. this morning, Tamara and I watched a live birth. a whole new meaning has been brought to the phrase "the miracle of life". literally a miracle. I'll start from the beginning...

for the past several days, Tamara and I have been getting antsy, the shadowing opportunities have been dwindling (in short- 2 boy medical students came last week, and being male they have been given most of all the opportunities available: surgeries, hospice runs to the Masai camps, ward rounds, etc. and between them and the other medical students here, Tamara and I have been left in the computer lab for an entire week. being female and American, I've realized I have 2 strikes against me). So for the past few days, we've decided to take our own initiative. We have been visiting the labor ward, hoping to see something, anything. after 3 visits to the nurse in the ward yesterday, she finally told us that there would be an induced labor the next day (today) after church. we asked her if it would be okay if we came to watch, and she shrugged and said fine.

like persistent little kids, we arrived in the labor ward this morning promptly after church. this was it. I could feel it. sure enough, the nurse came out from the holding room and said the induction had already begun- 5% dextrose had already been administered followed by a drip IV of oxytocin. the woman was about 5-6 cm dilated and her contractions were about 10 minutes apart. finally, we had been invited into the delivery room. all within a matter of about 30 minutes from the administration of the induction drugs the baby was crowning. the poor woman didn't receive any pain killers, nor did they have stirrups, so she was holding her own legs apart and pushing as hard as she could. it was super incredible to watch. as the baby's head came out, I immediately noticed how blue it was, the umbilical cord had wrapped around its neck. with one final push, the entire baby was expelled (along with a lot of blood) and the nurse quickly worked to get the cord undone. at last, we heard the baby gasp for air and let out a long wail. we got to stay to watch how the cord is cut from the mother, and how the afterbirth is taken out. then, one of the nurses prepared an injection (with technique that would make anyone cringe) and tried to explain what it was for. we didn't quite understand, either to stop the uterus from contracting, to reduce blood loss, or to make the uterus contract one last time to expel the remnants of the afterbirth. then proceeded to give the woman the injection in the thigh, with no gloves on. sanitary.

it was absolutely incredible. I felt really bad for the new mother though, first because they immediately took the baby away to have it measured and cleaned, and then they placed it in an incubator without ever letting the mother see it. apparently, the mother gets to rest on that bed for 1-2 hours with the baby in the incubator, and then they move both of them to the post natal ward. but secondly, I felt bad because the woman had removed her kanga for the birthing process, and was thus naked, which was fine, up until the birth was over. the woman was shaking so bad because of the cold. the only thing the nurses gave her to warm up was a single sheet of hospital bedding. how uncomfortable must she have been? I won't go into much more detail about the unsanitary-ness of the whole thing, but I'm not sure that I would want to sit on that hospital bed given how many births have occurred there, and the clean-up procedure.

after the birth, Bob (a Nebraskan who has been here for 4 years working with Machame hospital to delegate money to areas needed from the direction of his Lutheran church at home) came to find someone to help him. I went with him to do an inventory of a shipment of drugs that came for a local dispensary effort. It was really interesting to see the differences between Tanzanian generic names and the names I'm used to in American pharmacies. and, no matter how dorky I sound, it was nice to be around the familiarity of drugs. yes, I miss being at work in the pharmacy. never thought I'd say it.

so overall, the best day yet at the hospital. we got to watch the baby laying in the incubator. less than 5 minutes old. it was amazing. finally, we did a computer training with the head doctor at the hospital and he was really interested in the fact that we were medical students. he made it clear that he would definitely let us in to see the cleft lip surgery next week. I'm so excited. I'll really leave here on a high note. Tonight, Tamara and I are going to go over to the guest house (where the other volunteers at the hospital are staying) to make dinner. Its fun hanging out with the other volunteers, there are 2 boys from America, 2 boys from Scotland, and 5 girls from England. all of them are in their early 20's. we have our own little community here with inside jokes and funny stories that Tanzanians wouldn't find funny.

Next weekend, we'll be in a Masai village, a once in a lifetime experience. and on August 1st, my program here ends, and I'll leave with 2 of the British girls to go to Zanzibar until I leave on August 7th. It'll be a nice little summer vacation before I get back to the US and work on trying to find a job in Cali...

Changing Scenery

I don't have a journal with me at this time. So here's a peek into my journey so far: from inside my head. Putting the thousands of dollars of tuition for a Psychology major to good use. Me at my culmination of my education as I have taken it.

Every morning I attend mass inside our German-Missionary established hospital. Swahili. The only words recognizable Yesu (Jesus), Baba (Father), unpendo (love). Glancing outside the open window frame I see birds I've never seen in my life. There is also a tree that lowers its branches to the ground, offering its velvety-pipe cleaner- looking flowers to the grassy land below. How did these birds develop? Why does evolution create so many of the same animal in such vast arrays of shapes and styles and colors. Wouldn't one kind of bird be good enough? Obviously not. But why?

How did language develop? How did the first person to contact another language begin to communicate with the other person? Where did war begin?

I have so many questions. I used to think that when I got to be my grandparents age I would understand the world. I no longer think this is possible. I think the only thing age gives you is the peace to accept that a time will come in your life where the desire to know no longer surpasses the will to find out.

I signed up for a change in scenery. I asked to be challenged and pushed in ways I couldn't even dream of. I thought that placing myself in a new situation with brand new surroundings would enlighten me. Would give me perspective I couldn't find in the U.S. The Kili waterfall hike we took last weekend, took me to the top of a hill the German Missionaries carved out to place the Stations of the Cross on. There was a stone gazebo at the very top that over looked the land out to Kenya. Think. Think of all the people below you right now. Think of all the people ahead of you right now. Think of the ocean that resides beyond your eye. See the single stream of sunlight that managed to break through the thick layer of clouds up above. What else is above me that I can't see?

I like to think. I should be thinking. I just finished 17 continuous years of schooling. Where do I go from here? Well, apparently I already answered that: Tanzania. So then, where do I go from here? Ok, again, already answered: California. But when do you stop going from here? Should you stop going? I can think wherever I am. I don't need to sit on top of a hill in Tanzania, or on a wooden bench in a church.

I think a lot of times people try to "get away" to find things they were blocked from in their current position. I don't think I have to do this anymore. I love to travel, that will always be a part of me. But I don't believe in the "get away" part any more. I think its nice to confront the things that need resolution right where you are. Traveling across the Earth this time, only brought me to the realization that everyone here has the same fundamental problems as the people I left back at home (wherever that is). Traveling brings many things to light, new languages, new fashions, new skin colors, new birds. The processes of thinking will never leave you. Thank goodness. I like my mind right where it is.

I wish I had infinite knowledge. But the reoccurring realization that I don't humbles me. Its like a warm blanket in the cold. I guess coming to a new place is a good idea if you really want to think. At least, if you get tired by the same thought, all you have to do is glance up for new stimulation. Quietness helps too, or at least the inability to make sense of any noises sounding around you. Its so relaxing here. Its like at any given moment I could just as easily fall asleep as take another step forward. I get 1 more month. I get 1 more month to make sense out of anything that has crossed my mind in the past 6 weeks. In the past 22 years. Well, but there I go contradicting my self again. I get to think for the rest of my life. I don't need to be here to finish anything. Maybe just start something. Maybe continue something.

But why does that bird look so different from the ones at home?

Happy 4th of July

Well, I can't hide it even in typing so I might as well say it. Today is the saddest day of my trip. I keep thinking of everyone at home, on this mostly likely warm and sunny Friday, getting off of work for a 3 day weekend, going downtown to watch the parade, grilling out and watching fireworks with friends and family. I love fireworks. I would kill for a real cheeseburger or a hot dog. Real ketchup and mustard. okay, that's enough.

I hope everyone has a wonderful holiday.

Fridays at the hospital are slow. Real slow. We aren't shadowing today, although morning announcements mentioned there would be a birth this morning up in the labor ward. We weren't invited and the Patron of the hospital locked himself in the secretary's office, he's too busy to assign us. So we're in the computer lab waiting for staff to come in to teach. No one has come in in 3 days. I think they're either getting frustrated of trying to type without looking or they don't see the value in what we have to teach. Tamara and I have started shadowing every morning for about 2 hours this week, but we're in the computer room from 11-3 every day with a half hour break for lunch at 1. It seems like plenty of time for staff to come in, especially since the hospital virtually closes down at 12 and only special cases are taken after that time. Its ok though, we get internet. Lately we've just been bringing books. We stole away with about 10 novels left behind at the GSC office in Arusha from previous volunteers. We're going to need to reload soon though.

Shadowing has been interesting. We've pretty much stuck to the ground level of the hospital, where the general clinic and the CTC (care and treatment clinic- for HIV positive people) are. Yesterday we shadowed orthopedics. Lots of patients with cysts and aches and pains. No surgeries yet. Next week Tamara and I are going to talk to the patron and see if we can work out a semi-concrete plan to shadow in the morning and have specific staff come in to train so we don't just sit around all day. I also hope we can move up to the second floor next week where the labor ward and operating theaters are. Next week Monday is a Farmer's holiday saba-saba (7-7) also nane-nane is a holida (8-8). It'll be nice to have a short week next week.

We're going to leave early after lunch today and go into Moshi this afternoon. It was one of the volunteer's birthday's yesterday. She lives in Marangu which is on the other side of Moshi from us (farther away from Arusha). We're going to have a Sally's brithday/our Nation's Birthday party... well, more like dinner and then getting back to Marangu before sunset at 7. All of the volunteers who are still in Arusha are coming out to Moshi this weekend for this. Tomorrow we're climbing a little way up Kilimanjaro to the waterfalls. It should be beautiful, but its so cold up here, I can't even think about getting into water. If you can imagine: Moshi is at the base of Kili and Marangu and Machame (where I live) are on either sides of Moshi but up the mountain. So I live part way up Kili and 2 of the others live part way up kili but about 2 hours away from Tamara and I. So not only is it winter in Tanzania right now, and the rainy season won't leave us alone, but we're part way up a mountain. I would give you a temp if I had ever seen a thermometer, but by my judgment, I'd say its about 55 in the mornings with rain and clouds and then it can warm up to about 70 in the afternoons when the clouds pass and the sun comes out. Needless to say, when I packed for Africa I didn't bring the right kind of clothes. My hands usually go numb at the hospital because its a partially outdoor hospital and the concrete keeps all the cold damp air in, and there's not enough time with the sun to heat up the place. I don't know how the patients deal with it through the night.

Happy Independence Day to you all. Eat lots and lots of food for me!

Endless Plains and Cow Bells

The Serengeti is a Masai word for endless plains. And Ngorongoro is a Swahili word for the sound a cowbell makes. This is where I was. I'm not sure why Ngronongoro is associated with cowbells, but boy was the Serengeti an endless escape. Picture the Lion King. Its all we could think of. We spent 2 days and 1 night in the Serengeti. It was the most sun I've seen this whole time in Tanzania. Not a cloud in the sky (it is a savanna). The rest of Tanzania hasn't yet managed to escape the rainy-cold season that is supposed to end in May global warming? It was gorgeous flat land covered in long grasses that get trimmed by all the herbivores like gazel, impala, zebra, and buffalo. Occasionally massive boulders would spike the horizon. Being completely puzzled at how they arrived in such random locations we learned they were called copgees (not sure how to spell it) and they were volcanic waste products of the Earth's fault line hiccups. It was stunningly beautiful. about 5 minutes into the park grounds we saw a lioness walking about 4 feet from our car with 7 lion cubs. Talk about the cutest thing you'll ever see. The cubs acted like puppies with paws too big for their bodies, they would flop around behind the lioness and then prance along to keep up with her long strides. She looked over at us occasionally as we crept along side her for 10 minutes but never wavered from her 4 foot distance from us. incredible.

We were completely spoiled for 3 days. Peter-our guide was a cook before he was a safari guide. It was easy to tell, his meals were all catered to Muzungu's so we had amazing meals for breakfast, lunch, and dinner. However 4 out of the 6 of us ended up paying for it later with stomach problems because we've outgrown our acclimation to Western food. We slept in tents in unprotected campsites. Meaning we set up camp in the middle of the park with no fences to keep any of the animals from us. Our night in the Serengeti was complete with a visit from a scavenging giraffe through our campsite at 2 in the morning.

We spent one day in Ngorongoro. By the way, both of these places as well as Lake Manyara (my first safari a couple of weekends ago) are located either in or near the rift valley where the start of the human race is thought to have began. "Lucy" the oldest human fossils to be collected came from the rift valley. Anyway, Ngorongoro is a crater formed from an implosion of a volcano. All of the animals in the crater are naturally domesticated.. meaning they can't escape so they never leave during migration. There is a "circle of life" total balance between predator and prey in the crater. We literally saw thousands and thousands of wildebeast and buffalo and zebra. We also saw more lions and cubs at the side of the road. Rhinos, servel cats (they look like leopards but aren't) and so much more. There are 55 species of animals that live in the crater. The crater is a lot colder than the Serengeti. You have to stay bundled the whole time. but eventually in the afternoon the sun comes out and you feel a little warmer. The crater is less deserty than the Serengeti. There are lakes and rivers where you can find different animals taking a drink. There are trees and lush areas where you'll find the monkeys. Its marvelous. So we also stayed one night in Ngorongoro but not in the crater, rather around the rim of the crater. As we were setting up camp to have our tents over look the crater, Larance (our safari driver) kind of gave us a look like "you really want to set up your tents at the edge of the camp?". We asked him if it was a bad idea, and he kind of shrugged and said no, but if it were him, he would put the tents in the middle of the other tents. But the sunset was so beautiful and our tents were already half up so we decided to stay on the edge of camp. As dinner began, Peter came out to tell us to come to the kitchen (a fence-enclosed area where food can be kept and not eaten by animals). When we stepped into the kitchen it was hard to pick our jaws up off the floor. An elephant was standing right at the fence, so you could walk up to where it was and feel its breath on you. Its giant tusks were poking through the holes in the fence a little. Since there was a barrier, we could walk straight up to it, touch it for sure, but we didn't because, well you can imagine why not. It was amazing. Its completely different seeing an animal from standing up in a safari car above everything, to seeing such an enormous animal from ground level, straight in front of you! After dinner we had preveously gotten supplies to make s'mores for Peter and Larance so we had a camp fire going and we were all enjoying the treats. I decided to go back to the tent because I was so tired and we were going to get up early for a sunrise game drive, so I causally walked back, but I didn't have contacts in, and my glasses were in the tent, I saw to gray blobs about 10 feet in front of me. I kind of froze in my tracks, having no idea what kind of animal I might be facing more elephants? Buffalo? I quickly jumped into the tent, found my glasses and put them on just in time to see the rest of the herd of zebra surround my tent. Umm where does this happen? I heard munching all around me even though I could only see out the front door. Even though zebra are pretty harmless, I was a little nervous that I was all alone in my tent, away from all the other tents and people. After a little while I saw flashes of light and I knew people were taking pictures. Immediately the zebra scampered away. Then a little while later I heard the voices of the girls coming back to the tent. My tent partner Sally came inside and she was telling me her side of the zebra story. But all the other girls in our group were still by the camp fire far away from us. about 5 minutes after sally and I snuggled in to go to sleep, I heard munching again. Thinking it was another zebra I peeked my head out of the tent, again without my glasses. When I saw a gray blob larger than what a zebra should be, I ducked back in to get my glasses and peek outside again. A giant cape buffalo (the most aggressive animal in the serengeti) about 3 feet from our tent door. When the blood rushed back to my head I decided I could stay where I was with my head outside of the zipper door, and as long as I didn't make sudden movements, it wouldn't see me and I could just watch. There are no words to describe how exhilerated and frightened I was at the same moment. Meanwhile, Sally- deathly afraid of buffalo, was Harry Potter style petrified in her sleeping bag in the corner. She was ready to run out of the tent to where the others were when I warned her that the buffalo had no idea we were in the tent, and he would probably be more likely to attack if she ran out. Aside from when I went cage diving in South Africa with great white sharks swimming all around me, I have never experienced something so dangerous at such a close range. My only regret- theres no way I could have taken a picture of it from outside of my tent, and the pitch blackness wouldn't have allowed me to take a picture without a flash.

All in all, the best trip yet in Tanzania. Worth every penny. When we got back to Arusha Sunday night, Peter wanted to take us all out to dinner to thank us for being such a great group, but we had all already arranged dinner and sleeping at our old homestays. Since my old mama lives so far away from where the rest of the girls lived in Arusha, I just stayed with Tamara's family. Its cool to see how other families exist here. Tamara lived in a mansion, and had what seemed like a million people coming in and out of the house all day. Very different from my home in Arusha with just my mama, sister and house girl.

Today, Tuesday we came back to the hospital. We talked to the head doctor and told him about the shadowing opportunities. Right away he smiled and walked us over to the clinical officer station. I shadowed one doctor and Tamara shadowed a different one. We shadowed for about 2 hours, and then came back to computer train. It is super interesting to see how hospitals run here. I got to assist with stitching up a patient who had a deep laceration on his inner ankle. and when I say assist, I mean I got to cut the thread after the stitch was made. But the doctor was so nice about explaining everything as he went along. I also got to look at the x-rays taken to see if a man had fractured his hip. Obviously HIPPA and patient privacy doesn't really exist here. I got to look on to all the patients health records and drug records. The drug names are mostly the same here, and working in the pharmacy for so long kind of helps me understand whats going on. Most of the cases are malaria, some UTIs, and diabetes. I'm happy though, that I'm getting the opportunity to see daily processes and how patients are handled throughout the hospital.

one interesting thing I still don't quite understand is patients diagnosed as hypertensive still have to come back to the hospital every 2 weeks to get their blood pressure taken. I guess I'm not exactly sure how it goes in the US but I do know, patients don't go back every 2 weeks. It seems like a lot of hassle both for the patient and the doctor to handle so many cases of patients returning just to get their BP checked. Plus, the doctors only write out prescriptions for drugs for 2 weeks in advance. So if the patient didn't come back, they couldn't get their next 2 weeks of medicine. It seems really inefficient and I tried to explain to the doctor that in the US doctors write out hypertension prescriptions for a whole year because its a chronic disease. I don't think he understood what I was getting at. ohh well. Also, when the doctor was suturing up the patient, I couldn't help but cringe the whole time. I don't think a single aseptic technique was being followed. There were "sterile gauze" in a rusty metal box: unwrapped, the sterilizing liquid used to clean the wound was in a big plastic jug that was kept on the dirt floor and had dirt all over it. The scissors I was handed to use for cutting the thread was rusty. The doctor didn't even wash his hands before he put on the gloves to work. And after the procedure he only rinsed his hands with tap water. Its incredible, the things 3rd world hospitals get away with, because there are no other options. I just hope nothing bad happens to me here so I have to be operated on!