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.
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.
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.
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.
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.
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.
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. .
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.
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.
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.
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.
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.
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.
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.
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.
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.