Once again a Saturday and a bit of time to write about the past week though it has been frustrating to try to do this. The Internet is being very temperamental as our services have been cut down by our country director in Dar es Salaam because of supposed excessive use and that curtails everything from the Blog to contacting colleagues, and creating appropriate treatment guidelines. Yet it still works albeit very very slowly. I suppose that I should not really complain though I will. In Darfur, the government would shut us down for days on a whim though usually it was when they were planning to do something stupid. So we always had a pretty good idea of when an attack was coming. Anyhoo our field coordinator hopes to have this resolved next week as he,too, can not get his work done.
I spent Monday and Tuesday, getting my work permit/pass authenticated and then signed in each camp. I was given "The Grand Tour" and introduced to many people so that, hopefully, when I did reappear I would be recognized. I spent 2 days in Nduta which is the busiest and most chaotic with about 40,000 refugees and Friday at Kanembwa, which has only about 13,500 at present. Repatriation is ongoing but the number has dwindled down dramamtically as the earlier returnees pass back messages of no services, lost lands and general instability. There have also been some fighting. It is considered minor but, for me, the appearance of armed people is major whether or not shots are fired.
I got more than I expected on my first few days. At Nduta, we were so busy that I had to do rounds on the pediatric ward and I could not observe anyone. There was sadly the usual crowding with 2 children/bed but, by the end of Thursday, there were enough discharges that we did get down to only one/bed with even a few open spots. At Kenembwa, I made rounds with the physician and then spent a bit of time in the OPD with one of the clinical officers, sort of a P.A. by our definition. The task of trying to change things will be Herculean as there just is so much amiss here from basic handwashing between patients to misuse of antibiotics to a general lack of knowledge of pathophysiology and even appropriate diagnosis. The doctor never washed her hands except at the end of ward rounds even after examining a woman with open Herpetic lesions. AT least she did wear gloves when doing a proceedure though one of the midwives was about to start an IV without them when I intervened. I suppose the most comical really saddest sights was the clinical officer trying to get a blood pressure on an adult patient with a pediatric cuff. It kept popping off as it was just too small. I asked him if he had a bigger size. He replied, "yes" and continued on.
I tried to start a teaching program with a session at each camp. They were used to having one on Wednesday at Nduta and on Friday at Kanembwa. I just could not get them together at either camp as they said they had not been given advanced notice. Well I gave it to them for next week and we will see what happens. Unlike Pip, I do not have "Great Expectations".
Saturday, September 29, 2007
Sunday, September 23, 2007
Wednesday, September 19, 2007
That was the week that was.
Once again, a Saturday and the weekend.
Last weekend, my first out here, we went to the UN compound Saturday night to partake of their bar and disco.
My, they do live well here and indeed in all the UN living sites I have been very impressed at the way that they care for themselves. Enough so that I did once inquire about a position. But, as they are mainly administrative, I let that drop.
Sunday we took a long walk to a small mountain called the Mump. Exactly what that denotes, I have to find out. Found out later in the week that it is just a nickname that it got as someone thought that it, sticking up out there, looked like a child with unilateral mumps. Along the way we encountered the usual gaggle of children running out from the little clusters of homes to greet and walk with us as we were the only entertainment about. The children have a unique greeting that I had not seen before. They approach calling "tene, tene" with their fist extended and then touch your fist gently. I startled them by either clicking my tongue when touching or by singing "ding-dong". Soon they were doing it and on the way back they were still doing it. I'll find out this weekend whether I have shifted the culture here.
The rest of the week, I have spent rewriting the outdated treatment protocols. So far diarrhea and respiratory illness have been done and I am now in the midst of malaria. Those are the major causes of morbidity and mortality in all the places that I have been and this is no exception. After that I will start on the less common diseases but I need to get to the clinics to see exactly what is occuring now.
Now another Saturday morning and I did finally get the precious document that will allow me to get my camp pass on Monday after I visit the various offices and officials that abound in every bureaucratic system. With a bit of luck, I might even get into a camp in the afternoon, though I suspect that Tuesday is more likely. As usual I had to threaten to resign to stir things a bit and get this. I had almost gotten in the mindset of knocking on the door at home and surprising Gerda. Not such a good idea at our ages.
I did finish the malaria protocol and now will begin on some others to pass the weekend. Last weekend, I did learn how to use the digital camera that our son, Jan, gave me and to get the pictures onto Snapfish. Now I will try to get them onto this Blog.
That's the way it looks from here.
Stephen
Last weekend, my first out here, we went to the UN compound Saturday night to partake of their bar and disco.
My, they do live well here and indeed in all the UN living sites I have been very impressed at the way that they care for themselves. Enough so that I did once inquire about a position. But, as they are mainly administrative, I let that drop.
Sunday we took a long walk to a small mountain called the Mump. Exactly what that denotes, I have to find out. Found out later in the week that it is just a nickname that it got as someone thought that it, sticking up out there, looked like a child with unilateral mumps. Along the way we encountered the usual gaggle of children running out from the little clusters of homes to greet and walk with us as we were the only entertainment about. The children have a unique greeting that I had not seen before. They approach calling "tene, tene" with their fist extended and then touch your fist gently. I startled them by either clicking my tongue when touching or by singing "ding-dong". Soon they were doing it and on the way back they were still doing it. I'll find out this weekend whether I have shifted the culture here.
The rest of the week, I have spent rewriting the outdated treatment protocols. So far diarrhea and respiratory illness have been done and I am now in the midst of malaria. Those are the major causes of morbidity and mortality in all the places that I have been and this is no exception. After that I will start on the less common diseases but I need to get to the clinics to see exactly what is occuring now.
Now another Saturday morning and I did finally get the precious document that will allow me to get my camp pass on Monday after I visit the various offices and officials that abound in every bureaucratic system. With a bit of luck, I might even get into a camp in the afternoon, though I suspect that Tuesday is more likely. As usual I had to threaten to resign to stir things a bit and get this. I had almost gotten in the mindset of knocking on the door at home and surprising Gerda. Not such a good idea at our ages.
I did finish the malaria protocol and now will begin on some others to pass the weekend. Last weekend, I did learn how to use the digital camera that our son, Jan, gave me and to get the pictures onto Snapfish. Now I will try to get them onto this Blog.
That's the way it looks from here.
Stephen
Sunday, September 16, 2007
Pictures
I have posted some pictures on Snapfish. If you have any interest in them, send me an e-mail and I will forward them to you.
Stephen
Stephen
Wednesday, September 12, 2007
In The Bush
I am finally here in Kibondo. We left Dar es Salaam early in the morning on the 12th. First a commercial flight to Mwanza, a city on the southwestern shore of Lake Victoria. From there we took a UNHCR plane, a Caravan, the bush plane. Room enough for 10 and a bit of lugagge. Fortunately there were two no-shows so that we were able to get a bit extra on board. We were supposed to take only 10 kilos each but I had 22 and still left some back in Dar. Getting on that plane rekindelled my excitement about being here in Africa again, especially as we flew over that familiar landscape. This included a good portion of the Lake which is always breathtaking. We landed in Kibondo and then a 20 minute drive to the compound, again through the landscape that I am so fond of.
The compound here is very large and situated on a hill. I have a bungaloo which faces south. The Burundian border is northwest of us, about 10 kilometers distant. A private shower with hot water twice a day. We arrived shortly before lunch which was excellant and we get 3 meals a day every day. So there goes my African diet plan. This is a bit more like Club Med. and a nice change from other places that I have been.
So far my camp pass that allows me into the refugee camps has not arrived. Hopefully that will not be long as I have been granted (so I am told) my medical license and my exemption which allows me to stay in the country for a year. Those two documents are needed and then the camp pass is automatic. Meanwhile I will review the "essential drug" list and be sure it is accurate. Then, evidently, the treatment guidelines are very out of date and need updating and standardizing so that I should have enough to do for the next few days.
Now it is Saturday, the 15th. and so far I have designed forms for the in- and outpatient departments as well as developed a diarrhea protocol. Actually WHO did that and I creatively borrowed much of it. What remains to do are prot9ocls for malaria and respiratory tract infections. There will be more but these are the most important causes of morbidity and mortality in this setting. What is difficult for me to comprehend is that we (IRC) have been here delivering health care for at least 10 years and this has not been kept up to date.
We went into the "big city" of Kibondo today and it is the same as so many rural African cities. This, being dry season, there was a swirl of red dust every time a vehicle past. You learn to gauge the direction of the wind very quickly. We went into the central market where everything is sold and went to the "supermarket". One room but, evidently, the proprietor just got a shipment of goods, the first in three months. All my favorites were there and I did get a few packages of tea biscuits. The ubiquitous cheese, "la vache qui rie". was there. It exists, like coke. in the most remote places. I even saw a small bottle of my buddy, Jack Daniels.
The weather is wonderful. Cool at night and in the morning until about 1100 then it warms up but not that fierce heat that I have experienced in other places. I have taken pictures of the area and our compound and will try to post them. Hopefully I will get my camp pass in the next few days and be able to be more helpful to all.
And that's the way it looks from here.
Stephen
The compound here is very large and situated on a hill. I have a bungaloo which faces south. The Burundian border is northwest of us, about 10 kilometers distant. A private shower with hot water twice a day. We arrived shortly before lunch which was excellant and we get 3 meals a day every day. So there goes my African diet plan. This is a bit more like Club Med. and a nice change from other places that I have been.
So far my camp pass that allows me into the refugee camps has not arrived. Hopefully that will not be long as I have been granted (so I am told) my medical license and my exemption which allows me to stay in the country for a year. Those two documents are needed and then the camp pass is automatic. Meanwhile I will review the "essential drug" list and be sure it is accurate. Then, evidently, the treatment guidelines are very out of date and need updating and standardizing so that I should have enough to do for the next few days.
Now it is Saturday, the 15th. and so far I have designed forms for the in- and outpatient departments as well as developed a diarrhea protocol. Actually WHO did that and I creatively borrowed much of it. What remains to do are prot9ocls for malaria and respiratory tract infections. There will be more but these are the most important causes of morbidity and mortality in this setting. What is difficult for me to comprehend is that we (IRC) have been here delivering health care for at least 10 years and this has not been kept up to date.
We went into the "big city" of Kibondo today and it is the same as so many rural African cities. This, being dry season, there was a swirl of red dust every time a vehicle past. You learn to gauge the direction of the wind very quickly. We went into the central market where everything is sold and went to the "supermarket". One room but, evidently, the proprietor just got a shipment of goods, the first in three months. All my favorites were there and I did get a few packages of tea biscuits. The ubiquitous cheese, "la vache qui rie". was there. It exists, like coke. in the most remote places. I even saw a small bottle of my buddy, Jack Daniels.
The weather is wonderful. Cool at night and in the morning until about 1100 then it warms up but not that fierce heat that I have experienced in other places. I have taken pictures of the area and our compound and will try to post them. Hopefully I will get my camp pass in the next few days and be able to be more helpful to all.
And that's the way it looks from here.
Stephen
Saturday, September 8, 2007
Still Here
After many perhaps and possibilities, I could not get a flight out to Kibondo as yet. It seems that there is only one airline and one daily plane that holds only 30 people. So I remain ensconced in a rather luxurious hotel. On Friday two more expats came in so I do have company. They will go out to Kibondo with me whenever we can get on the flight.
Saturday we spent droodling about Dar es Salaam (which means, "House of Peace" in Arabic"). We got a tour of the city past the elegant parts where the rich and diplomats live, by the harbor which is lovely, by the fish market though we knew that place about a kilometer away as we were down wind of it and finally through a few of the upscale shopping plazas. We did get to the National Museum which is sad compared to the one in Nairobi. The most interesting parts were the actual skull of Zinjanthropus (Australopithecus Boisei) 1.6 million years old found by Louis Leaky in Olduvai in 1959. Then there were the actual earliest footprints of hominids, 3.6 million years old, found by Mary Leaky at Laetoli. Other bits were a review of Tanzania history from the Neolithic through Independence with the usual panegyrics to the first president, Julius Nyerere. He was a committed socialist who tried to establish collectives though he called them, Cooperatives. That ruined the economy for decades. The idea was excellent but the implementation disastrous. There was also an exhibit of the Duong, a sea mammal somewhat akin to the Manatee that is endangered here. It has the shape of a Manatee but a face more like a pig's. It is evidently the creature that gave rise to the myth of the mermaid not only because of its looks but also as its call is similar to a woman crying.
Our next stop was at the Botanical Garden which was in sad disrepair. The best feature was the myriad peacocks and peahens that were wandering about looking very insouciant. There a bus full of children also visiting and we were more exotic to them than the birds. They were polite and curious except for the one wag, always a bit older and male who would mouth his few words of English, ask for money and then say something in Kiswahili to make the others laugh nervously.
Back at the room at night, I wandered through the 60 or so channels on the TV. Except for ESPN, BBC and would you believe Hallmark Playhouse from decades ago, there were only Bollywood movies, Arabic news and Indian rappers. By happenstance, there was a feature on Stanley's discovery of Livingstone.
Today we will visit something called the Village Museum which has a multitude of traditional living huts as well as music and dancing.
And so the weekend will go and hopefully we can move on tomorrow and start work, the reason I decided to come out here.
Stephen
Saturday we spent droodling about Dar es Salaam (which means, "House of Peace" in Arabic"). We got a tour of the city past the elegant parts where the rich and diplomats live, by the harbor which is lovely, by the fish market though we knew that place about a kilometer away as we were down wind of it and finally through a few of the upscale shopping plazas. We did get to the National Museum which is sad compared to the one in Nairobi. The most interesting parts were the actual skull of Zinjanthropus (Australopithecus Boisei) 1.6 million years old found by Louis Leaky in Olduvai in 1959. Then there were the actual earliest footprints of hominids, 3.6 million years old, found by Mary Leaky at Laetoli. Other bits were a review of Tanzania history from the Neolithic through Independence with the usual panegyrics to the first president, Julius Nyerere. He was a committed socialist who tried to establish collectives though he called them, Cooperatives. That ruined the economy for decades. The idea was excellent but the implementation disastrous. There was also an exhibit of the Duong, a sea mammal somewhat akin to the Manatee that is endangered here. It has the shape of a Manatee but a face more like a pig's. It is evidently the creature that gave rise to the myth of the mermaid not only because of its looks but also as its call is similar to a woman crying.
Our next stop was at the Botanical Garden which was in sad disrepair. The best feature was the myriad peacocks and peahens that were wandering about looking very insouciant. There a bus full of children also visiting and we were more exotic to them than the birds. They were polite and curious except for the one wag, always a bit older and male who would mouth his few words of English, ask for money and then say something in Kiswahili to make the others laugh nervously.
Back at the room at night, I wandered through the 60 or so channels on the TV. Except for ESPN, BBC and would you believe Hallmark Playhouse from decades ago, there were only Bollywood movies, Arabic news and Indian rappers. By happenstance, there was a feature on Stanley's discovery of Livingstone.
Today we will visit something called the Village Museum which has a multitude of traditional living huts as well as music and dancing.
And so the weekend will go and hopefully we can move on tomorrow and start work, the reason I decided to come out here.
Stephen
Thursday, September 6, 2007
I have landed
IT was a dark and stormy night. The wind whistled ominously through the trees as they scratched and thumped on my window as if something out there was trying desperately to get in.
Now this has nothing whatsoever to do with my doings but it seemed to be one way to capture your attention as really today there is little to say.
I did arrive safely after the usual long and tedious flights but, fortunately, nothing unusual happened. The only glitch was waiting at immigration with the several dozen others for close to an hour to get the visa. On the plane, I sat next to a middle-aged Italian man who spoke only Italian and who wanted to chat. So he spoke Italian and I waved my arms about and peppered my English with the few words from different arias and menus that I remembered but they were rather rapidly depleted. Really how many times do risotto and focacchio fit into a conversation.
The plane landed first at Kilimanjaro and most people got off there to climb the mountain and do the safari route. Then another hour and we were here in Dar es Salaam. A drive through the city to the hotel and finally, after 24+ hours, I was able to go horizontal. I did get to see the Indian Ocean this morning on my way to the office and that was, so far, the only highlight. As expected they did not have the permit that allows me to get in the camps. Personnel went over there this morning to try. They have only known about my arrival for 3 months but that is typical wherever I have gone. So I may be here until Monday or Tuesday depending. Then a flight out west to Kigoma and a 200 kilometer drive from there to Kibondo. That can take 4-6 hours during the dry season or a day+ during the rains.
I did see that film, "Away From Her" on the flight and, despite the presence of an older Julie Christie, I was very disappointed as it distorted reality so much. For those who have not seen this film, it is about the deterioration of a woman with Alzheimer's disease and her husband's response to her increasing disability. First she was too highly functional to go to a home unless her husband was truly trying to abandon her as he clearly was not. Then the home's supposed policy of no visitation for 30 days is very difficult to accept. At that point, she had no real idea of who he was and had formed a close relationship with another patient there. There was no mention of possible treatment and when she became extremely depressed, nothing was done to try to help her. It is just too important a subject to present this way.
That's it for now.
Stephen
Now this has nothing whatsoever to do with my doings but it seemed to be one way to capture your attention as really today there is little to say.
I did arrive safely after the usual long and tedious flights but, fortunately, nothing unusual happened. The only glitch was waiting at immigration with the several dozen others for close to an hour to get the visa. On the plane, I sat next to a middle-aged Italian man who spoke only Italian and who wanted to chat. So he spoke Italian and I waved my arms about and peppered my English with the few words from different arias and menus that I remembered but they were rather rapidly depleted. Really how many times do risotto and focacchio fit into a conversation.
The plane landed first at Kilimanjaro and most people got off there to climb the mountain and do the safari route. Then another hour and we were here in Dar es Salaam. A drive through the city to the hotel and finally, after 24+ hours, I was able to go horizontal. I did get to see the Indian Ocean this morning on my way to the office and that was, so far, the only highlight. As expected they did not have the permit that allows me to get in the camps. Personnel went over there this morning to try. They have only known about my arrival for 3 months but that is typical wherever I have gone. So I may be here until Monday or Tuesday depending. Then a flight out west to Kigoma and a 200 kilometer drive from there to Kibondo. That can take 4-6 hours during the dry season or a day+ during the rains.
I did see that film, "Away From Her" on the flight and, despite the presence of an older Julie Christie, I was very disappointed as it distorted reality so much. For those who have not seen this film, it is about the deterioration of a woman with Alzheimer's disease and her husband's response to her increasing disability. First she was too highly functional to go to a home unless her husband was truly trying to abandon her as he clearly was not. Then the home's supposed policy of no visitation for 30 days is very difficult to accept. At that point, she had no real idea of who he was and had formed a close relationship with another patient there. There was no mention of possible treatment and when she became extremely depressed, nothing was done to try to help her. It is just too important a subject to present this way.
That's it for now.
Stephen
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