Daily routine and first week at Tengeru Hospital

After our introduction to the house the night before, the next day we got up at 6 am to get ready for the first day at the hospital. In Tanzania, everyone is up around sunrise, which is definitely something I needed to get used to. Steven’s house is up on a hill about a half hour walk from the main road, but luckily he has offered to drive us down in the mornings since he leaves at 7, saving us a lot of time and energy. From the main road, it’s about a 10 minute daladala ride to the Meru District hospital in Tengeru, commonly referred to as the Tengeru hospital.

Walking into the hospital

Walking into the hospital

Most of the hospital looks like these buildings

Most of the hospital looks like these buildings

We were somewhat familiar with the hospital already, since we had visited with the full EWH group instead of going to Mt. Meru hospital in Arusha again. Because of this, we had started working on a lot of the machines and we were introduced to the hospital’s fundi (handyman), Shami. Shami has some basic knowledge as an electrician, but the hospital doesn’t have a biomedical technician, so there are plenty of broken machines.

There is a dedicated workshop for us, which is really nice and fairly unusual, but from the last visit we saw that it was completely filled with broken machines, junk, and even a broken motorcycle, making it really hard to navigate. To top it off, for some unexplained reason there is a giant stuffed elephant hanging from the window – weird, but somehow it makes the workshop seem more homey.

Kasper on the motorcycle

Kasper on the motorcycle

The workshop is adjoining the laundry building, with a thin wall in between that lets us hear all their conversations. Right outside, there is an outhouse that we learned pretty quickly to avoid at all costs, and to the side of the building is the trash burning pile (there isn’t any garbage infrastructure in Tanzania, everyone burns their trash).

View of outside the workshop and the outhouse

View of outside the workshop and the outhouse

The trash burning pile next to our workshop

The trash burning pile next to our workshop

There are villages right behind these bushes with lots of children, chickens, and dogs running around

There are villages right behind these bushes with lots of children, chickens, and dogs running around

Despite the various smells that sometimes waft into the workshop, the scenery is still pretty unique – a village is right across the courtyard with no division between it and the hospital, which means that often dogs, children, and chickens roam around the hospital grounds. There’s also a water tap outside the window where women hang around all day doing laundry.

The layout of the hospital in general consists of dozen or so separate buildings, with one road through the center of the complex and grass with dirt paths running between them. There is a small waiting area with stone benches, but it’s usually full so there are always patients and families of patients sitting around in the grass.

First, we wanted to clean up the workshop a little bit so we could actually see the tables and have a real place to work. While cleaning up, we found a lot of potentially useful spare parts and a few broken machines that had been hidden in all of the junk. We also found a lot of other things, like old jars of bulk chemicals, questionably dirty scrubs, old missionary cassette tapes, and some even stranger things.

The state of the workshop before cleaning up

The state of the workshop before cleaning up

After cleaning up a little, with the stuffed elephant in the background

After cleaning up a little, with the stuffed elephant in the background

No idea why this was in here

No idea why this was in here

Kasper on the motorcycle

Kasper on the motorcycle

Finally, after finishing making the workshop at least partly usable, we broke for lunch. There was a hospital canteen we could eat at, but it looked pretty sketchy (a couple of guys in a dirty concrete building in the corner of the hospital), so we went back to the place we had eaten with the whole group the past Friday. There was no reason to go to a different place, because virtually every local restaurant serves the exact same menu – in fact, the options are so much the same everywhere that most restaurants don’t even have a menu. There are three starches to choose from – wali (rice), chipsi (fries), or ndizi (starchy bananas, not sweet), and three meats to choose from – nyama choma (roasted beef), mbuzi (goat), or kuku (chicken). Most of the time, I went with kuku chipsi, since beef and goat tended to pretty tough and included a lot of bone, fat, and gristle. Besides the lack in variety, the other problem was the service that left much to be desired – often, the server would forget our order after placing it so we had to ask several times, turning lunch into a two hour affair. This depended a lot on the place we went to, so we soon started looking around for a speedier lunch spot.

View of Mt. Meru from Tengeru market right near the hospital

View of Mt. Meru from Tengeru market right near the hospital

After lunch, we went to the head Matron, Naomi, to ask if we could be shown around to the different wards to introduce ourselves. This was where my Swahili lessons really came into play – at each ward, we started with a general habari za asubuhi (good morning), and then after exchanging greetings I would launch into the little speech I had prepared:

Sisi ni wahandisi (we are engineers)

Tunataka kurepea mashine na vifaa wako (we want to repair your machines and equipment)

Kuna mashine hiifanya kazi hapa? (are there machines that don’t work here?)

This pretty much exhausted most of my ability in Swahili, so most of the rest of the conversations were in English, since most doctors were at least conversational in it. As we went through the wards, Kasper kept a list of the broken equipment and the ward it came from so we could sort through it later. There was a lot of broken equipment in the workshop already, but after going through each ward, the number of machines that hadn’t made it to the shop was much bigger.

The X-ray machine at the hospital

The X-ray machine at the hospital

Inside the X-ray film drying room

Inside the X-ray film drying room

A big broken autoclave we saw on our tour

A big broken autoclave we saw on our tour

We had a couple of strange encounters, like when the head nurse of the maternity ward immediately put a wedding invitation in my face and asked if I could contribute some money – but for the most part, the doctors were very kind and grateful for us being there. EWH has been coming this hospital for several years, so they already had a good impression of the students that came every summer.

By the time we finished the tour, we had a long list of machines to organize and prioritize. It was around 4 pm by this point, which is when a lot of the staff went home, so we decided to follow their lead, especially since we wanted to stop at the supermarket and it took around an hour to get home.

On the way back, we didn’t have the luxury of Steven driving us up the hill, so we started the half hour climb prepared for a hike. It was tiring not only physically as we climbed up the steep rocky hill with motorbikes passing by every so often, but also mentally as we were obligated to greet every single person we passed. It was fun after the first dozen or so people, but eventually cycling through all the Swahili greetings we knew while trying to climb the hill got pretty hard.

We had some fun moments on our climb up though – we stopped to take a break in a small clearing that let us see a nice view of the valley below, and we realized we could actually see Mt. Kilimanjaro between the hills over 50 miles away! We also had lots of groups of young kids just getting out of school passing by, and they all greeted us with a “good afternoon” (or a “good morning” if their English lessons at school weren’t as advanced yet), and they walked alongside us holding our hands on the way up.

Part of our walk up Meru to our house

Part of our walk up Meru to our house

Kilimanjaro from our walk up Mt. Meru

Kilimanjaro from our walk up Mt. Meru

Another picture of our walk uphill

Another picture of our walk uphill

After getting back to the house, we started making dinner for the first time. For me, cooking dinner by myself was something I had rarely done, but luckily I was living with Kasper who at 27 has plenty of practical life experience. I was pretty surprised how good our meals have turned out, and dinner has become one of the things I look forward to every day.

Kasper's Kitchen

Kasper’s Kitchen

Power goes out a lot, so we cook in the dark sometimes

Power goes out a lot, so we cook in the dark sometimes

I contributed a little to dinner too with some guacamole

I contributed a little to dinner too with some guacamole

The rest of the week went pretty similarly, with the same routine of waking up, hospital work, shopping, walking home, cooking, cleaning, and sleep. More about the technical work we did and the first weekend in Month 2 coming up soon!

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First impressions of Tengeru and Month 2

Our first month of the EWH Summer Institute is over, and now begins month two where we begin most of the real work for this summer. We finished up our Swahili and Medical instrumentation classes, and I packed up and said goodbye to my homestay dad Nuru and the house I’d been living in for the past month.

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Braden, Nuru (my homestay dad), and me in front of our house

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David (our coordinator) and Nuru

To finish it off, I also documented my daily trip to TCDC from my house.

Starting from our bunk bed for Braden and me

Starting from our bunk bed for Braden and me

Our living room

Our living room

The road right outside Nuru's house

The road right outside Nuru’s house

Some of the many chickens that roam around everywhere

Some of the many chickens that roam around everywhere

Same with the cows

Same with the cows

The view of Meru from the one of the main roads

The view of Meru from the one of the main roads

Looking down towards the paved road intersection where we catch our daladalas

Looking down towards the paved road intersection where we catch our daladalas

A school on our walk down, the kids are always outside in their uniforms

A school on our walk down, the kids are always outside in their uniforms

On the daladala with the conductor hanging out the side as usual (this is an extremely empty one

On the daladala with the conductor hanging out the side as usual (this is an extremely empty one)

The gate for TCDC's campus

The gate for TCDC’s campus

Finally, we said our goodbyes to the rest of the group as we all headed our separate ways. The area I would be living in, Tengeru, was only 20 minutes away by daladala, but groups would be heading out as far west as Karatu and as far east as Moshi, Marangu, and Hiruma near the Kenyan border, almost 200 miles away!

Saying goodbye to some other people in our group

Saying goodbye to some other people in our group

The Karatu guys

The Karatu guys

This second month, we would be living independently, cooking our own means, doing our own laundry, and going to work in the hospital every day. Some were staying in hospital doctor’s compounds, some in apartments, and some in houses in the area – for Tengeru hospital, my partner Kasper and I would be staying in a guest house on the grounds of the property of a man named Steven Ndosi, who is retired after working at TCDC for 25 years. Kasper is a student at the University of Aalborg in Denmark, and is also working on his bachelor’s degree in biomedical engineering after coming back to school from two tours in Afghanistan as a medic in the Danish Army. Steven picked us up in his own car, and immediately took us to the Tengeru market where we would be buying some of our food and introduced us to some of the shopkeepers and the market vendors, also telling us about the best places to get certain items. He even took us to a compound nearby geared towards tourists that had a swimming pool, restaurant, and (most importantly), wifi, and introduced us to its owner as well.

After this tour, and the car ride home, I soon figured out that Steven wasn’t your average Tanzanian; he was essentially famous in the area. Almost everyone we met around Tengeru and Nkoanrua lit up as soon as we mentioned we were staying with Bwana Ndosi (Mr. Ndosi). Another unique part about him was his passion for Tanzania and improving the lives of its citizens – barely an hour after meeting him for the first time he started talking about the problems with the weak coffee farmer’s cooperatives, the issues with infrastructure and the problems with the under-utilized natural resources in the country. While we were eating lunch, I happened to ask him what he thought about corruption in Tanzania and its government, and he stopped me and said he had too much to say on the topic for lunch, and we would talk when we got home; we ended up talking for over an hour about that topic when we got there. To top it off, when my partner Kasper mentioned that he was Danish, Steven immediately started having a conversation with him in Danish – apparently he has been to Copenhagen several times through the TCDC school we were studying at last month. TCDC is much more than just a language school, I learned, offering classes in business, politics, and science and hosting students from all over Africa and the world. He even had dreams of building a school on some of the land he owned in the area.

After taking us around the Tengeru area, he took us to his home in another town called Nkoanrua, which is near Tengeru and around 800 feet or so further up the slopes of Mt. Meru. This area was fairly rural, and is dominated by the Meru tribe. The Meru people are traditionally farmers, growing bananas, coffee, yams, and other vegetables, unlike the lowland Maasai people I talked about before mostly raised cattle and goats.

Steven himself has been a coffee farmer for almost his entire life, and when we got to his home, he took us on a tour of his coffee fields, explaining that others in the village thought he was crazy since coffee takes so long to develop and it wasn’t very profitable. One of the major issues he was telling us about earlier was the weak coffee unions. Many coffee farmers had stopped growing coffee in recent years since they couldn’t support themselves anymore, partially because of a lack of encouragement from the Tanzanian government and partially because of exploitation by coffee sellers. These sellers only offered them rock bottom prices and took advantage of the farmers’ lack of education and ignorance of the high coffee prices in western countries. This barrier is something Steven has overcome with his education (a Master’s degree) which he says is one of the most valuable things he owns, allowing him to find his own sellers and bypass the coffee middlemen.

After the coffee tour, he showed us his family compound, which included a main house for him and his family and a guest house where we would be staying. Spread thoughout the compound were tables for drying and processing coffee, as well as trees growing avocados, papayas, oranges, and more coffee. The guest house was nice and homey, with a small kitchen, a bathroom, and two bedrooms for me and Kasper. We didn’t even have to cook the first night, because he and his wife Magdalena (the head chef at TCDC) invited us over for dinner. We had some fresh coffee grown in his farm, and he informed us he would bring us some coffee and avocados over to our house all grown on his property. Kasper and I were blown away by his generosity, and we felt very good about our living situation for the next month.

A banana tree with a friend

A banana tree with a friend

Coffee growing right outside our back door

Coffee growing right outside our back door

The main area of the compound with the coffee drying table

The main area of the compound with the coffee drying table

Close up of the coffee beans drying

Close up of the coffee beans drying

Living area

Living area

Nice little kitchen

Dining room

Nice little kitchen

Nice little kitchen

Western bathroom!!!

Western bathroom!!!

My room

My room

More about our first day at the hospital and the things we’re working on there coming soon!

Safari to Manyara and Ngorongoro

Last weekend (7/4 and 7/5) I had the quintessential African safari experience, booking four Toyota Landcruisers to take us to Lake Manyara on Saturday and Ngorongoro Crater on Sunday. Both these areas were decently far away, near the city of Karatu, which has a drier climate and is known for its red soil. On the way there, we passed through many areas of arid semi-desert with many Maasai children herding cows and goats along the side of the road.

The drive out to Karatu passed by lots of herds of cattle and goats

The drive out to Karatu passed by lots of herds of cattle and goats

Inside our landcruiser

Inside our landcruiser

We stopped in Lake Manyara National Park first, which is famous for its tree-climbing lions. Lake Manyara itself is a shallow lake in the Great Rift Valley which splits Africa from the Red Sea all the way down to Zambia, and is situated below a long wall of sheer cliffs. We drove straight from the highway onto the park’s dirt roads, and we opened up the Landcruiser’s roof so that we could stand up with unobstructed as we drove through – as long as we dodged the tree branches and acacia thorns.

The rooftop view of our landcruiser

The rooftop view of our landcruiser

Almost immediately, we saw entire troops of baboons (nyane) walking through the fields, from the intimidatingly big alpha males to the small babies clutching onto their mothers’ backs and stomach. After a while, the trees opened up into some open grasslands and swamps, and I caught my first glimpses of wildebeest and zebra. Next came the hippo pond, where we saw plenty of hippopotamus (kiboko) hanging out in the swamps and rolling around in the mud with some white birds resting on their backs.

Baboon enjoying a snack

Baboon enjoying a snack

This baby monkey should try bull riding

This baby monkey should try bull riding

Hippo with some white birds hanging out

Hippo with some white birds hanging out

Zebra

Zebra

Wildebeest taking a break

Wildebeest taking a break

Next came a small group of giraffes (twiga) in the distance, which actually ended up being the only giraffes I saw the whole trip, even though they’re not particularly rare. I kept looking out for the tree-climbing lions as well, but they never made an appearance. Stopping for lunch in a picnic area near the shore of the lake, we saw some vultures feasting on a recently dead wildebeest as well as the huge numbers of flamingoes in the lake itself, grouped in such huge numbers they looked like pink islands in the distance.

A few giraffes (twiga)

A few giraffes (twiga)

Group picture by Lake Manyara

Group picture by Lake Manyara

The cliffs around the lake

The cliffs around the lake

Lake Manyara with its flamingo islands

Lake Manyara with its flamingo islands

Overall, Lake Manyara gave me a great taste of what was to come the next day in Ngorongoro Crater, which was going to be the more spectacular of the two trips. The excitement for the day wasn’t over though – we soon arrived at the Acacia Farm Lodge in Karatu, which was our hotel for the night. I wasn’t sure what the expect in terms of accommodations.

I immediately knew we were in for quite an experience as we pulled up the hotel as we were greeted by most of the hotel staff standing in front of reception singing and holding glasses of fresh guava juice and hot towels to wipe off the layer of dust accumulated on my hair and face from the open roofed Landcruiser. After weeks of cold bucket showers and other more spartan living conditions than I was used to, being suddenly thrust into a world with gourmet chefs, hot showers, huge suites, and a swimming pool were quite a shock. This was the rich tourist’s experience of Tanzania, which we fortunately got to have for a pretty cheap price with our group discount and negotiations with the safari outfit.

Swimming in the pool when a wedding party randomly came by

Swimming in the pool when a wedding party randomly came by

Refreshed and clean, we left early the next morning to the main event of the weekend, Ngorongoro Crater. The crater itself used to be a huge volcano that collapsed into itself when it went extinct, creating a 100 square mile circular hole in the ground ringed by sheer cliffs. It also had the effect of concentrating a ton of animals inside, a huge enclosure like a natural zoo.

The early morning was extremely cold as we headed up into the damp clouds in the mountains surrounding the crater, making standing up in the Landcruiser a chilly experience. After heading through thick clouds up and down the mountains, finally, we emerged beneath the clouds spectacularly into the huge open space of the crater. Words don’t do the scene justice, but luckily I have pictures!

The first view of the crater with the moon hanging overhead

The first view of the crater with the moon hanging overhead

Some parts of the crater were completely treeless

Some parts of the crater were completely treeless

The clouds hung over the crater rim

The clouds hung over the crater rim

Lake Manyara was amazing, but Ngorongoro crater reached an entirely new level of safari experience. It legitimately looked like something you might find in a nature documentary or a zoo – huge herds of wildebeest mixed with zebra, water buffalo, impala, and ostriches just casually roamed around the landscape, unafraid of the Landcruisers, all mixed together. Again, pictures do it more justice.

A view of the huge herds

A view of the huge herds

Warthog

Warthog

An impala

An impala

A jackal

A jackal

An ostrich

An ostrich

Two wildebeests take a break from sparring

Two wildebeests take a break from sparring

We also saw some hyena, as well as some great bustards (another kind of large bird). There was also an extremely rare black rhinoceros (kifaru) in the distance, one of only a couple dozen in the entire park. I also saw a pride of lions in the distance, watching over the whole scene.

A hyena we disturbed from sleeping on the road

A hyena we disturbed from sleeping on the road

A rare black rhino (kifaru)

A rare black rhino (kifaru)

Simba!

Simba!

My favorite part of Ngorongoro, though, was in the acacia forest near one of the edges. All of a sudden, we found ourselves in the middle of huge group of elephants (tembo) snacking on the huge thorns of the acacia trees without so much as a second thought. Some of the larger ones were bigger than the entire Landcruiser, and they were definitely intimidating as they stood guard over the young when the walked right in front of us.

The acacia thorns the elephants were eating were ridiculously huge and sharp

The acacia thorns the elephants were eating were ridiculously huge and sharp

Another elephant (tembo)

Another elephant (tembo)

The elephants were just as big as the landcruisers

The elephants were just as big as the landcruisers

They got so close to us that our drive grabbed my leg and told me to sit down, and I absolutely followed his instructions. The funniest moment of the day came after our driver, George, quieted us all down and it was silent except for the munching of the elephants and the snapping of pictures from the other Landcruisers around us. During this silence, George accidentally leaned on the horn of the Landcruiser, making us all jump and getting stares from other tourists, drivers, and elephants alike.

Eventually, we made our way out of the crater, getting some more spectacular views. On the crater rim, which wasn’t more than 100 yards wide in places, we could see both the crater below and the valley floor on the other side.

Ngorongoro crater

Ngorongoro crater

On the way back to Arusha, we rounded off our weekend safari tour with a stop at a traditional Maasai village. While we were there, we got to witness and participate in some of the traditional dances, where the Maasai jump as high as they can in sandals made out of car tires. They also showed us the dark and smoky interiors of one of their traditional mud huts, demonstrated traditional fire making with sticks, and explained to us their traditional diet. The Maasai are not at all vegetable eaters, much to the chagrin of mothers everywhere – they live on a diet of only meat (cow and goat), milk, and blood which they take from a cow’s neck once a month. Only in recent years have they also supplemented their diet with ugali, a maize paste which is a staple food in Tanzania.

Me doing a jumping dance with the Maasai

Me doing a jumping dance with the Maasai

The landscape around the village

The landscape around the village

Some of the mud and thatch huts they live in

Some of the mud and thatch huts they live in

The entire collection of huts was headed by one man, with one hut for each of his wives. Traditionally, a Maasai man can only begin to marry once he has tracked down and killed a lion, but in recent years (after the “changes,” as our guide termed it) this practice isn’t adhered to so much. Cows and goats were everywhere, and as we were leaving we saw some of the children heading in for the night with their flocks, holding onto their herding sticks. Children start herding flocks as young as five, roaming for many miles.

On the way back, it was also explained to me that the Maasai village we visited wasn’t just a showpiece; many Maasai still truly do live just like the ones we visited. As a tribe, the Maasai of northern Tanzania and southern Kenya have held onto their culture in a way unsurpassed by most of the other tribes in the area, in part due to their wealth (cattle is an expensive commodity).

When I finally got back to my homestay in the much more urbanized region of Arusha, I could only think about how I couldn’t wait to get back out into the wilder regions of Tanzania.

Mt Kilimanjaro peeking out just behind and to the right of Mt Meru in the foreground

Mt Kilimanjaro peeking out just behind and to the right of Mt Meru in the foreground

Another blog

My friend Conor, a student at the University of Bristol who’s been working with me on the operating table has a really nice blog too, feel free to check out his blog for a more British perspective on the things I’ve been doing in Tanzania!

Third Time’s the Charm

Last Friday (7/3) we made a third trip to Mt. Meru Hospital in Arusha to put into use the skills we’ve been learning in our medical instrumentation lectures and labs. If you remember from the last couple blog posts I’ve made about my times at Mt. Meru, most of my time has been spent working on an operating table powered by a hydraulic lift that wouldn’t go down. Last week, the bed was unfortunately inaccessible due to it being used even in its broken condition, so this week the first thing Conor and I did was check to see if the table was available.

Luckily for us, the operating theater the table had been moved to wasn’t being used, so this week was our chance to finally fix the table. In order to actually move it to a place we could work in, we had to enter the clean area of the hospital, which meant putting on some fashionable orange booties over our feet. The American doctors who had been doing the cleft palate surgeries showed us to where the table was located, and helped us move it back to the original room we worked in the first week.

Along the way I got to see the operating theaters along with some of the equipment we had been covering in lecture, such as the overhead lamps and the anesthesia machines. Seeing open windows inside of an OR was bizarre to see, but sterility had to be compromised to get critical ventilation into the rooms.

One of the operating rooms (with some of the working tables)

One of the operating rooms (with some of the working tables)

Another OR

Another OR

Now that we had the table available, Conor and I felt confident enough to start some of the real work to get the hydraulic jack into the bed. We started with another cleaning of the inside of the tank, which still had a ton of gunk inside. When testing the jack by pushing down the lifting rod, we heard air coming through the outlet and the rod went all the way down to the bottom, making us reasonably certain that any clogs that may have been in the mechanism had been opened.

We used a little brake fluid to clear out the mechanism

We used a little brake fluid to clear out the mechanism

Next, we had to make sure that the brake fluid we had bought at the gas station would work inside the jack – we were a little worried since the brake fluid was somewhat less viscous than the original hydraulic fluid that had poured out of the table the first time Larry and I tried to flip it over. If the fluid wasn’t thick enough, we ran the risk of it leaking out and the bed slowly falling down if any weight was put on it. We needed some kind of platform in order to perform a weight test, and the equipment graveyard we were working in had all kinds of junk to work with.

There was a ton of junk to look through in the equipment graveyards

There was a ton of junk to look through in the equipment graveyards

We ended up finding a box of screw clamps that attached nicely to the rod of the hydraulic jack, and with this we were able to balance a wooden panel and a heavy fire extinguisher on top of it to serve as a stand-in for the real table’s weight. Placing a mark on a broken IV pole and setting a timer let us measure how much and how long it took for the table to settle to see if it was going to be an issue.

Rigging up a little weight test for the hydraulic jack

Rigging up a little weight test for the hydraulic jack

Notice the little black mark on the pole we used to see if the jack fell down at all

Notice the little black mark on the pole we used to see if the jack fell down at all

During the wait, we watched another group as they fixed a broken electrosurgery unit (ESU) and test it. An electrosurgery unit is a machine that uses high voltage to cut through a patients skin just like a scalpel, with the added advantage of cauterizing any blood vessels in the area which lets the wound heal much faster. They used an orange as a stand-in for flesh (nobody wanted to volunteer their arm), and they were able to use the machine to carve the initials “EWH” into the orange for Engineering World Health, along with a lot of smoke.

Testing the ESU

Testing the ESU

After this, we went back to check on the operating table jack and we saw that it had only settled a fraction of an inch in the half hour or so we had left it. Since it was mostly air inside of the jack and the brake fluid would be much thicker, we were encouraged enough by these results to go for the final step of installing the jack back into the table.

The next challenge was locating all the various screws and bolts and getting several people to help us lift the ridiculously heavy table so we could reinstall the jack to the bottom of the table. We poured the 8 cans of brake fluid we had bought the previous week into the tank, making sure not the repeat the mess we had made the first week, and then came the moment of truth – would the table go up and down?

Pumping the table up went relatively smoothly, but when we tried to release the table to let it go back down, it didn’t move, and my stomach dropped. We had cleared any clogs inside the mechanism so there had to be another reason it wouldn’t move. Fortunately, we were saved by a couple of astute observations – Larry, our professor, had noticed that the jack had a really small “sweet spot” for letting us release it when we were testing it outside of the table, and Conor had also noticed a bolt on the foot pedal that adjusted how far down the pedal was allowed to go. Adjusting this bolt a few turns at a time let us find the sweet spot, and finally, the table came down, which was one of the most exciting moments I’ve had in Tanzania so far.

The bolt that was the key to finding the sweet spot in the table release

The bolt that was the key to finding the sweet spot in the table release

Conor and I super happy to see the bed working, with our stylish orange booties on

Conor and I super happy to see the bed working, with our stylish orange booties on

The table was working again, but we still had a couple things to do before releasing it to the floor. We put a little grease on the rolling shaft that held the table up to keep it from getting stuck and cleaned off the top of the table we had gotten pretty dirty. I also used a sewing kit to fix the fabric skirt that prevented things from falling into the mechanism – thanks mom for making me bring that even though I said I would have no use for it!

One of the doctors walked by at this point, seeing Conor and I testing the table, and backed up to do a double take. He called some of the other doctors over to see it working again, and they seemed just as excited as us. They wouldn’t have the bend completely over to do surgeries anymore, which I’m sure made their backs feel a lot better.

After fixing the bed, Conor and I saw some other groups finishing up pieces of equipment too, such as a portable heater and an automated bed lift. Finally finishing a major piece of equipment made me a lot more confident and excited for the next month in Tengeru hospital, where I will be working on equipment every day using the skills I’ve learned this month.

A portable heater another group got working

A portable heater another group got working

A patient lifter another group got working

A patient lifter another group got working

Nkoaranga and Maji Moto

I’ve gotten a little behind on my blog recently, but I’m hoping I can make up for that this week – this post is about last weekend (June 27/28) and the trips I went on then.

On Saturday, one of our OTGC leaders, David (who also lives with me when he isn’t off making arrangements with next month’s hospitals) organized a half-day hike from Usa River up to the village of Nkoaranga, further up the slopes of Mt. Meru. In his words, “we’ll be walking about 12 kilometers (around 7.5 miles) and we’ll rise about 400 meters in altitude.” This seemed like a fun trip to get to know the area a little better, get some good views, and see some of the local villages and farms, so I agreed to go even though it meant another day of getting up at 6:30 am.

We started out by walking along the main road that runs from Arusha to Moshi, dodging the trucks and daladala that seemed way to close for comfort, but soon we turned up a more local road that took us past some rice paddies with farmers walking around spraying pesticide.

Rice paddies on the way up Mt Meru

Rice paddies on the way up Mt Meru

Soon we started hitting some hills surrounded by fields of corn. Something I didn’t expect to see in Tanzania was the huge number of cornfields, which I think of as distinctly American. However, corn is a staple crop here, along with sunflowers, which also grew in spectacular sun-drenched expanses. At this point, we also started passing by some small villages with children playing outside. As soon as one spotted our very conspicuous group, there would be a shout of “mzungu!” which is the Swahili term for white foreigner. This would start a chain reaction of kids running up to join the growing group trailing us, also shouting mzungu, punctuated by a chorus of “hi!” and the occasional “good morning!”

Cornfields interspersed with villages

Cornfields interspersed with villages

All children in Tanzania will learn English in school, but for those that only make it to the primary school level, their knowledge will be relatively basic. Even on my daily walk to TCDC from my homestay in Usa River, I will always get kids shouting “hi!” although I don’t get “mzungu!” so much, seeing as the language school is so nearby.

After a lot of waving and the returning of greetings, we turned around and kept walking with a trail of kids behind us, making us look like some modern pied pipers. They did get tired of keeping up with our pace, so we eventually lost most of our followers.

After walking up the road for a long time, we reached Nkoaranga village and hospital, where one of our groups from EWH will be staying the second month. It was interesting to see the change in climate even on our moderate hike up the mountain; it was much greener and wetter up here than it was in the lowlands. The cultural differences I had seen the previous week between the seminomadic Maasai of the arid lowlands and the agricultural Chagga on the slopes of Kilimanjaro started to make more sense.

We had made it to our destination, but we wanted to see some views of the lowlands, so we continued past Nkoaranga up into the foothills, where the path had a sharp increase in steepness and an equally sharp decrease in navigability. As we struggled up the mountain, we were passed by locals of all ages on their way up and down, often carrying heavy loads of grain on their heads. The people here definitely got in their daily physical activity.

Group picture with the view; a couple local boys decided to join us

Group picture with the view; a couple local boys decided to join us

Passing by more farms and villages that became ever-greener, we often stopped to talk with the local farmers for a minute to greet them and ask them for some directions. Most of the real talking was handled by David our OTGC, who was much more conversational in Swahili than the rest of us. After continuing up and up, we finally got some great views of the lowlands. Cows and villages became more frequent, and we started accumulating more children again who gathered to watch us from the hills on the side of the road.

Walking through the farms in the foothills

Walking through the farms in the foothills

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Spotted a cow through the banana trees

Spotted a cow through the banana trees

After deciding to turn around to make it back by lunch, the return trip started out fairly easy after walking uphill for so long. However, we had covered a lot more distance than David originally said, and some of us (including me) started to get more and more tired of walking. The return trip was much more of a blur, with my legs aching for a break and my stomach longing for some lunch. I perked up a little bit when I heard what sounded like a marching band coming my way, and a wedding convoy with a brass band on the back of a truck with the bride’s family behind it passed us by. Finally getting back to TCDC, I didn’t do much the rest of the day besides relax and eat some lunch – one of the girls on the hike had a pedometer with her, and we ended up covering somewhere around 20-25 kilometers in total (around 13-15 miles).

The wedding party looked surprised to see us too

The wedding party looked surprised to see us too

On Sunday, I was looking forward to a much more relaxing day. The previous week, I had been talking with a local tour company to arrange a trip to a desert oasis called “Maji Moto” (hot water) that David recommended to me. We ended up having most of the group coming with us, around 23 people.

After a 2 hour drive through the arid lowlands and Maasai country, we arrived at the most cliché (but beautiful) desert oasis I could have imagined. Words don’t do it much justice, but the very blue, very clear water was surrounded by palm trees in the middle of arid scrubland with some dry-looking mountains in the distance.

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David and Jaya

We had arrived pretty early in the morning, so luckily we had the place to ourselves for the moment. The water wasn’t exactly hot like in the name, more lukewarm, but the setting was so beautiful it didn’t matter to us at all. After jumping in, we explored around a little bit – the area consisted of a couple of larger pools with a palm tree tunnel connecting the two. Getting to the other pool was somewhat of a challenge, since there was a pretty substantial current running through it, and the water was fairly deep.

Mostly though, we hung around in the main pool by the parking area. There were lots of little fish in the pool that nibbled on my feet and legs, which really freaked me out at first, but turned into only a minor annoyance. After exploring around a little, we started doing some flips and jumps on a rope swing tied to a tree, as well as trying to climb up onto some of the trees hanging over the pool with the monkeys overhead.

The rope swing

The rope swing

There was a small little stand and cooking area where some locals cooked us “Chipsi Mayai,” (French fries and eggs) which according to David is the Tanzanian national dish. After lunchtime, though, more and more tourists and locals started filtering in, and it soon became relatively crowded, which made me glad that we had come a little earlier. It was amazing to see some of the acrobatics the local kids did on the rope swing, hanging upside-down and doing flips as well as climbing amazingly high into the trees. They even swam, without goggles, into the underwater cave where the water was coming from and came out of another hole underwater, something I would have definitely drowned trying.

Some of the famous chipsi mayai

Some of the famous chipsi mayai

We did explore a little around the area, but being a desert oasis, the landscape was pretty desolate and hot, and we soon wanted to go back into the spring. We finally left around 3 pm, feeling a lot better after the previous day’s long hike, ending another great weekend of some Tanzanian tourism.

It was pretty desolate around the oasis

It was pretty desolate around the oasis

There were lots of herds of cows and goats being tended by the Maasai

There were lots of herds of cows and goats being tended by the Maasai

Mt. Meru Hospital Round 2

Instead of making a really long post each week, I’ve decided to split things up by topic – this one is about the second trip we made to Mt. Meru Hospital last Friday.

After another full week of alternating between Swahili classes and medical instrumentation classes in the afternoon, on Friday we made a return trip to Mt. Meru Hospital in Arusha to continue to fix new equipment from the graveyard and hopefully finish up the projects from last time.

I was excited to keep working on the hydraulic operating table lift that we had extracted last time after much difficulty, making a mess of hydraulic fluid all over the floor, our hands, and any tools we tried using to get the piece out of the bed. The first objective for me and Conor, my partner who helped me work on the lift last week, was to find some replacement hydraulic fluid and some grease for the load shaft.

At least it was moisturizing

At least it was moisturizing

We ended up at a nearby gas station in Arusha, and after searching around the shop for a bit deciding which automobile-related fluid would work best, we decided some heavy-duty brake fluid should do the trick. We also picked up a tub of lithium-based grease.

Casually bought 8 cans of brake fluid; no questions asked

Casually bought 8 cans of brake fluid; no questions asked

As we made our way back to the hospital grounds, looking forward to cleaning out and filling the fluid tank again to put back into the table, we got some bad news. While we were gone getting replacement fluid, Larry (our professor) had gone back into the operating room we were working in to check on the table, and was really surprised to find a bunch of doctors in full surgical garb with a patient on the table staring back at him. The table we were working on was nowhere to be seen.

 

Apparently, the hospital had decided to use the extra operating room we had been working in as a temporary location for some American doctors doing cleft palate surgery for the week. They had also taken the table we were working on into another operating room to do other surgeries on, making it inaccessible for the day. Now, keep in mind, last week we had completely removed the hydraulic lift keeping the bed up, so now the bed was resting completely on its base at thigh level. Picturing the doctors bending over so far just to perform surgery really drove home the need they had for this bed – but unfortunately, we wouldn’t be able to finish working on it until the next week. All we could do was hope that the bed would be available by the time we returned to Mt. Meru.

That bit of news put a damper on the day, but I didn’t want to let it get to me too much – setbacks are very common in developing world healthcare. The next items available were a couple of large laundry carts that had loose metal panels due to some broken rivets. A rivet gun wasn’t an easily available tool, but a few screws would do the trick. Back in the US, this would mean a quick trip to Home Depot to pick up some screws, but here in Tanzania, nothing was that easy. Hardware shops were small and spread apart, and the selection at each one consisted of a few boxes of screws the shopkeeper managed to scrounge up – unlabeled and inconsistent. I was on this screw finding mission with Emmanuel, one of the local students at Arusha Technical College, which took the burden off my limited knowledge of Swahili, but we still had a lot of trouble finding these screws.

Me and Emmanuel working on the carts

Me and Emmanuel working on the carts

We must have hit 7 or 8 different shops all around Arusha, taking samples from each, until we found few that seemed like they might work. Then we walked back to Mt. Meru hospital, figured out the one size that worked by some miracle, walked back to the shop, bought a bunch of them, and walked all the way back to Mt. Meru. This ended up taking up much of the morning, and between this and the operating table situation, gave me a taste of the frustration that so many technicians in the developing world face. It really highlighted the differences in infrastructure between Tanzania and the United States, and also made me realize why our medical instrumentation curriculum was so focused on using spare parts and improvised solutions. If finding simple screws took so long, finding more complex parts would be basically impossible.

After lunch, things started going a little better. The laundry carts were fixed, and Conor and I did the best we could on the hydraulic jack to get it ready for the next week. We figured out where the oil intake and outlet were inside the mechanism, and we decided that there was likely some kind of gunk blocking this pipe that had originally prevented the table from lowering under its own weight. We didn’t have a clear idea of how to flush it out if it was still in there – we were worried water would rust the mechanism, and oil was expensive – but we felt a lot more prepared for next week when we would (hopefully) be able to access the bed again.

Conor and I working on the jack

Conor and I working on the jack

You can see the intake valve at the center right by the spring, and thought the closed box in the center had some gunk in it

You can see the intake valve at the center right by the spring, and thought the closed box in the center had some gunk in it

The last thing I worked on was an infant phototherapy cradle. These machines use a specific wavelength of light to help break down bilirubin in an infant’s blood caused by decreased liver function, which could be dangerous at high levels. Some other girls in my group had gotten the lights working, but the mechanism for holding one of the side panels preventing the infant from falling out was broken. We ended up using a couple of pieces of metal hacksawed from the rails of some old cabinet drawers and a bit of epoxy to hold up the panel, making the machine ready to release to the floor again.

Lisa working on the phototherapy unit side panel

Lisa working on the phototherapy unit side panel

Our solution for the broken panel

Our solution for the broken panel

It felt good to finally get a piece of equipment working to end the day, but I felt like it was good to experience the frustration earlier in the day – I’m sure I’ll experience plenty more of it in the weeks to come.

Our after-hospital meeting

Our after-work meeting

The view of Mt. Meru from the hospital grounds

The view of Mt. Meru from the hospital grounds

Karibu Usa River!

After nearly 36 hours of intercontinental travel, lots of airplane food, and not a lot of sleep, I’ve finally made it to my home for the next month here in Usa River, Tanzania. Along the way I never got a real window seat, but I did manage to get a picture of some Amsterdam airport scenery during my connection.

Schiphol Airport in Amsterdam

Schiphol Airport in Amsterdam

I met some other students from the program waiting for the same flight, so the next leg of the journey was a little less lonely. Most of the others were also from Duke, but there were a few from other some other schools in the US. By the time I landed in Kilimanjaro international airport, it was dark – extremely dark, with no streetlights and very little light pollution. I wasn’t able to see Mt. Kilimanjaro on the drive up to Usa River, but the night sky was amazing and I could even see the Milky Way.

After around a half hour drive, we finally arrived at the Training Centre for Development Co-operation (TCDC), a language school founded by a Danish NGO, and is known locally simply as Danish. For the first month here in Tanzania, I will be spending most of my time here taking a Swahili class as well as a medical instrumentation class to prepare me for my second month working full-time in a local hospital near Arusha town.

Here, I was able to first meet my local homestay dad, Nuru, an accountant that works at TCDC, and he brought me and my housemates, Braden and David, to his home a couple of kilometers away in the town. Braden just finished up his master’s degree at the University of Michigan, and David is the OTGC (on-the-ground-coordinator) for this trip, having also just finished up his master’s degree at the Technical University of Denmark near Copenhagen.

Nuru's house

Nuru’s house

Nuru's front gate

Nuru’s front gate

Nuru's courtyard

Nuru’s courtyard

The next morning, I was still pretty tired, but my cold bucket shower (which I have actually started to enjoy) definitely helped wash away any remaining grogginess. TCDC was about a 20 minute walk away, so after a quick breakfast we got on our way. When I walked out the door, I was instantly hit by the sight of huge Mt. Meru (14,977 ft) which was basically invisible the previous night.

Mt Meru dominates everything (when it's not cloudy)

Mt Meru dominates everything (when it’s not cloudy)

On the main road, we were introduced to the Dala Dala vans, that along with the Boda Boda motorcycle taxis, served as the main method of public transportation. The vans often fit upwards of 25 people inside, with people packed in on each other’s laps and sprawled across the seats, but luckily so far the van rides I have had so far were pretty tame, with most everyone able to at least sit down. A ride two kilometers down the road to TCDC cost around 300 Tsh (Tanzanian shillings) – with an exchange rate of $1 for around 2,250 Tsh, this put the ride at around 13 cents. If only Uber was this competitive.

At the main gates of the school, I got a little taste of the local wildlife, with some massive white storks and some small (but very loud) monkeys. Even more exciting was the little taste of high-speed wifi, which was the first connection with the outside world I had so far.

Some white storks hanging out

Some white storks hanging out

Demon eyed monkey

Demon eyed monkey

I got to finally meet my group for the trip, which was an interesting mix of American, Danish, and English students. Mornings at the school were taken up by our introductory Swahili classes – much needed since I couldn’t even really say hello yet, which made for some awkward head nods and smiles at people in the street. It would be slow at first, but by the end of this first month I’m hoping to at least have some basic conversations.

Our classroom

Our medical instrumentation classroom

The Swahili classroom

The Swahili classroom

Twice a day, we stop for Chai, where all the students and staff stop to socialize over some fresh Chai tea. which really highlighted the British influence.

Chai break

Chai break

In the afternoons, we started our medical instrumentation classes taught by our professor Larry Fryda, who has been working on this program for many years and knows basically everything about anything mechanical or electric. Class is made up of both lecture about specific medical devices – oxygen concentrators, ECG machines, ventilators, etc. – and a lab section where we tried out some of these technical skills in the classroom before we did it in the hospital. By the time our classes finished, we had around an hour before we needed to be back home before dark. .

In our medical instrumentation lab

In our medical instrumentation lab

When we got home, Nuru’s nephew Kevin was already there cooking for us. Kevin is a cook for the week-long treks that go up and down Mt. Kilimanjaro, so we’ve been pretty spoiled in terms of food. After dinner, Nuru, David, Braden and I have spent hours talking about culture, and we have unsuccessfully been trying to say the Danish phrase rød grød med fløde, which is basically impossible for non-Danish speakers.

Me and Kevin

Me and Kevin

One of our dinners at Nuru's house

One of our dinners at Nuru’s house

The rest of the week went pretty similarly, with a routine of home, TCDC, then home again. Friday, through, we made our first trip to Mt. Meru hospital in downtown Arusha, where we would get our first hands-on experience repairing broken medical equipment. The OTGC coordinators had already set things up with the hospital staff, so they had lots of machines waiting for us to look at. Our “workshop” was outside in the hospital courtyard, with families waiting at the hospital also in the same location.

Our

Our “workshop” – notice the electrical cables, we covered them with plastic when it rained

The porch/waiting area for local families where we worked

The porch/waiting area for local families where we worked

Developing world hospitals have a lot of issues, but a lot of them relate to the state of the equipment. First of all, many of them lack basic diagnostic equipment we take for granted, such as an X-ray machine or an ECG (heart signal) monitor. Of the equipment they do have, much of which is 20+ years old and donated from hospitals in Europe and the US, a large amount of them have no user manuals or instructions in the local language, making user error frequent. A lot of these user manuals do not even exist anymore, as many medical device companies do not preserve them, or they are unavailable, as the companies want their own technicians to work on them, an unaffordable option for these hospitals. A lot of the machines fail due to incorrect maintenance, and get thrown into a “graveyard” room until a very rare technician gets a chance to look at them. Some machines we can fix very easily, repairing a clogged filter or a leaky tube, whereas other problems, such as software issues, are impossible to fix with the resources available to us. However, often we are able to fix a large percentage of the equipment that was either being used incorrectly or had a simple fix.

The first machine I tackled was an oxygen concentrator, which does exactly that – concentrates oxygen for patients that need a higher amount. After verifying it turned on, we first made sure that the machine was putting out the right amount of gas flow. That part of the machine was fine, so we went to the next test, which was to see if the machine was actually concentrating the oxygen in the air. We didn’t have any oxygen sensors, and neither did the hospital, so we had to improvise, which will turn out to be the main theme on this whole trip.

The innards of the concentrator

The innards of the concentrator

Working on the oxygen concentrator

Working on the oxygen concentrator

We ended up taking a water bottle and lighting a birthday candle inside with normal air, and timing how long it took for the candle to go out. Then, after filling up the bottle with water and bubbling some of the air coming out of the machine into the bottle, we lit a candle inside again and timed it. If the machine was working, we would expect the candle to stay lit 3-4 times longer, but we got exactly the same time, showing that there was something wrong with the oxygen-concentrating system of the machine. Unfortunately, after troubleshooting all day, we weren’t able to find what the issue was – we hope we can figure out what was wrong next week we come back to the hospital, but as Larry told us, a lot of the equipment is simply unfixable with the resources available in developing countries.

Doing our McGuyvered O2 flame test

Doing our McGyvered O2 flame test

Larry bestowing some knowledge on us

Larry bestowing some knowledge on us

After the oxygen concentrator came a broken operating bed with a hydraulic lift, which would go up but refused to come down. This machine turned out to be the messiest part of my day. When we lifted it up to look at the underside, instantly hydraulic oil started leaking out everywhere, a sticky mess almost impossible to get off our hands. After two hours and a lot of paper towels and soap, we finally were able to get out the broken hydraulic jack. Opening it up showed us that there was just a lot of gunk inside of the jack that was probably blocking it. This was really exciting because I think that next week, after buying some power steering fluid to replace the oil, I’ll be able to officially finish fixing my first piece of equipment for some very happy doctors.

Trust me, this mess got a lot worse

Trust me, this mess got a lot worse

The inside of the hydraulic jack for the bed was all clogged up

The inside of the hydraulic jack for the bed was all clogged up

This past Saturday I also got some of my first tourist experiences in Tanzania. I went with the whole group up to Marangu at the base of Mt. Kilimanjaro to a coffee plantation. While we were there, we met “Baba Coffee” and he showed us each step of the coffee making process, from growing, to harvesting, to grinding and roasting.

Arabica coffee beans

Arabica coffee beans

Pounding the coffee

Pounding the coffee

Roasting the coffee

Roasting the coffee

We also went to the nearby Chagga caves. The Chagga are one of the local tribes, and they dug an extensive network of tunnels and rooms underground to protect themselves from the raiding Maasai from the drought-stricken lowlands. The arms race between the Maasai and the Chagga in these conflicts was amazing – the Chagga created very sophisticated systems protect themselves. When the Maasai tried to drown them out, the Chagga created drainage tunnels to the river. When the Maasai tried to smoke them out, the Chagga hung sheets of cow hide in the tunnels and created many vent holes with an indigenous plant over them that would not be touched by the animals. When the Maasai tried to drag them out by force, the Chagga created a complicated system of passwords and mazes. In total, we were told that the Chagga could hide 600-700 people in the caves for up to a month, which was hard to imagine as I crouched through the narrow tunnels.

The entrance to the Chagga caves

The entrance to the Chagga caves

I had to crouch in here

I had to crouch in here

Before we went back, we stopped for some lunch in a Chagga village where they served us the equivalent of like $200 of parachichi (avocados) back in the US, a cheap staple fruit for them. I also met a very confused looking tortoise.

I wish I could get this much avocado at Chipotle without emptying my wallet

I wish I could get this much avocado at Chipotle without emptying my wallet

A very confused looking tortoise

A very confused looking tortoise

All in all, this first week in Tanzania has flown by, and I’m sure the rest of my two months here will go by even faster – I just hope that I can capture as much as I can in the upcoming weeks and hopefully make some real progress in the state of the healthcare system here.