The end (for now)

Several people have commented that my last post from Africa seemed like an abrupt end to the story. I had sort of intended it to be that way, since stories like this don't ever really have an ending. I also really thought that I'd get around to posting one last time (earlier than now) with my final thoughts about what I'd learned and the impact that it had on me. That has proven difficult. When I first got back to Seattle I found it difficult to find words to describe how I felt about being back, or about how my summer had gone, or how it had changed me. Did it change me? It must have. I mean, of course it did. But how? That's the funny thing about seeing the world in a new way: when you get used to how you look at things, it doesn't seem new any more. I don't feel like there was any one particular moment or experience or person that changed my world view in any dramatic fashion. All I know is I don't think now they way I thought three months ago about development, Africa, America, myself, working with people, travel, and ginger, to name a few things.

So in lieu of a good wrap-up touching on life, the universe, and everything, here's a short list of how the summer ended: Kiana came to Tanzania. We stayed in Usa River, Arusha, Moshi (on the Mainland), and Stone Town and Kendwa Rocks (on Zanzibar). We went on safari to Ngorongoro crater, Terengiri, and Lake Manyara, hiked on Mt. Meru, Visited Kibosho Hospital and ate lunch with the Dr. Tan and his wife. We explored Zanzibar and enjoyed three relaxing days on a gorgeous beach. Kiana met Joshua, Simon, Ben, and Cory at Cradle of Love. (There were no siafu this time.) Kiana's shoes were stolen out of her bag by the staff at the Zanzibar airport (I should have tipped the x-ray lady) and we made it safely home to the U.S. on August 25. Kiana's bag (which had all the gifts in it) did not make it home until September 10. It apparently got sent to Paris instead of Seattle and had its own two week vacation before deciding to return home. I guess I can't blame it for wanting to see the world.

That's all. Go travel. It's a big world, and you'll be better off if you see some of it.

The End?

I'm writing this post in the computer lab at TCDC. We left the mountain this morning (a bit groggy after last night's farewell vist to La Liga, Moshi's premier dance club/wazungu hang-out) and descended into the semi-arid plains that up to now were just an interesting view from our apartment balcony. It's been warm on the mountain these last two days - yesterday it was actually clear enough that we could see Mt. Meru off to the west, and right behind us, finally visible after a month, the snow-covered peak of Kilimanjaro. After a month of rainy mornings and cold nights in an unheated, uninsulated apartment, I thought a little sun was a welcome change. As we drove down the mountain, my pleasure soon turned to discomfort. It finally feels like Africa now: hot. I'm Norwegian. Norwegians don't do hot. My arm and face got sunburned from riding shotgun for an hour with the window rolled down. At least I'll finally get to use all the SPF 50 I've been needlessly dragging around for the last two months. Our last week at the hospital was quite eventful. By applying a level of persistence that we hadn't been comfortable with during the first weeks we finally found some medical equipment that was listed in last year's inventory but that the staff had been heretofore unable to locate for us. This was particularly frustrating because some of the equipment was broken, and we could have fixed it if we'd known it was there three weeks ago, but instead we have to leave it as is. There were successes, though. We delivered an electrosurgery unit (ESU) that EWH had sent with us to donate. Before it could be used, we had to fashion a reusable part to replace the single-use part that the instrument was donated with. An ESU works much like an arc welder: high frequency, high voltage electricity is delivered to an object (say, your abdomen) by a metal "pen", passes through said object, and exits at a point where an electrical contact completes the circuit back to the instrument. The narrow tip of the pen delivers all the voltage to a single point, cutting and/or cauterizing the flesh. A broad conductive pad at the exit point disperses the current and the flesh there is unharmed. The ESU we brought was donated with one single-use pad. In the West, this pad would be replaced after each surgery, thus ensuring both a sterile surgical field and a healthy flow of cash to the instrument manufacturer. Since these pads are not available anywhere in Tanzania, a more permanent solution was required. The answer was found in a pile of abandoned medical equipment in the operating theater that included, among other things, a non-functional electro-cauterizer unit with a perfectly functional set of re-usable conductive pads. A few minutes' work with a pair of pliers put these pads to good use. Dr. Tan, an M.D. from Singapore who is a full-time volunteer surgeon at Kibosho Hospital, tried it out on a patient and is quite happy with his new toy. He says it's easily the most advanced piece of equipment in the operating theater, and is already planning to use it for brain surgeries that he could never before do at Kibosho. My favorite project of the whole summer was an analytical balance (that's science talk for a really really accurate scale that can measure down to 0.0001 g) that looks like it must be at least 40 years old. We found it collecting dust under a sink in the back of the lab, unloved and unused. The power cord didn't have a plug, which is easy enough to fix, except for figuring out which wire to connect to which prong of the plug. Typical convention is that the "hot" wire is brown or red, the neutral wire is black or blue, and the ground wire is green. The wires in this power cord were black, red, and grey. I figured that since grey, green, and ground all start with "g", grey must be ground. I wired the plug with grey to ground, red to hot, and black to neutral. Nothing happened when I plugged in the balance. When I touched the balance, however, I took 220 V right to the thumb. That really hurt. We unplugged the balance and took a peak at the guts. Turns out the grey wire was meant to be neutral, the black wire was meant to be hot, and red wire, which was meant to be the ground, was attached directly to the metal chassis of the instrument. (I later asked Wilbard which color he would have guessed to be the hot one. He said he would have checked to see where the wires attached before plugging them in. Smart man.) After fixing the plug, we spent a while putting various counter weights back to where they'd been carefully suspended before the balance was tossed about on a trans-Atlantic voyage and stored on its side in a cabinet. Unlike modern balances, this balance is entirely mechanical with an analogue read-out; only the light bulb for the display requires electricity. It's a thing of beauty to a science geek like me. Using it is not at all intuitive, and I couldn't imagine how I was going to train the lab staff. I'd love to take it home with me and just buy them a mid-range electronic balance. Until then, however, this balance is the best they've got; their only other balance is an electronic kitchen scale that can't even measure differences of 0.1 g. I took it back to the lab and conducted a little training session with three of the lab ladies (all the lab techs are female; some of them are nuns). I did the training entirely in Swahili, so my instructions were limited to phrases like Kwanza unahitaji kumfanya sifuri. (First you have to make it zero) and Unahitaji kuona namba hapa. (you need to see number here). It took some doing, but they got the hang of it eventually. The next day I returned and trained a nun/lab tech to use the contraption to weigh out reagent for a staining solution that will be used to diagnose malaria. In addition to being able to speak English, she's pretty smart, so I feel fairly confident that they'll be able to use the balance after I'm gone. Just in case, I taped a card with my email address to the top of balance along with a note that read Shida? Uniandika barua pepe (Problems? Write me an e-mail.) The week wrapped up with a day of paperwork cataloguing all of our work of the last month. The list of fixed equipment feels pathetically short compared to my ambitions for the summer, but I have a feeling that, as is usually the case with trips like these, what I've learned is far more important than what I could realistically have expected to contribute. After all, I'm not an engineer, or even an engineering student - I'm a chemist with good intentions and a soldering iron. Kibosho Hospital is lucky that I fixed more than I broke. What I'm taking away is an education that I couldn't have gotten anywhere else or in any other way. What I've learned about Tanzania and its culture, about hospitals and medical science in a developing nation, about the difference between what's donated and what's needed - this is why I came, and I haven't been disappointed. I can't wait to get back to Seattle and get to work in the lab learning more science and getting my PhD so that I can get to work on the kind of science that will help hospitals like Kibosho. But first: Ninapumzika (I'm taking a break). My wife is in the air en route to Kilimanjaro International Airport as I write this. Zanzibar, here I come. Signing off, A chemist in Africa

One week and counting

I've really started to get used to this place.

Time has a funny way of speeding up and slowing down for me. When I'm dreading a deadline (such as when I was preparing for my 3rd year exam just before I came here) the weeks fly by. When I'm looking forward to something (such as when I would wait for Kiana's visits to Seattle or my visits to Fairbanks during our long-distance engagement) I count the days and hours and minutes and everything drags. When I'm busy, time flies. When I'm bored, time drags. This trip has had all of the above, plus some new factors.

On August 1st, Zev and I both found it hard to believe that we'd spent the entire month of July in Tanzania. I remember July 4th very clearly because it was a rather eventful day, and it seems like a very long time ago. I remember arriving in Tanzania on June 10, how excited I felt and how strange everything was. That seems forever ago. I've only been at Kibosho Catholic Hospital for three weeks, yet it sometimes feels like I've always been here. When I left Seattle, it seemed my return would be in the far distant future.

On the other hand, to realize that I have only 5 more working days at Kibosho comes as a bit of a shock. Have I really been gone so long? Could so much time already have passed? Most of the other EWH students will be home in America inside of 10 days. Before I came, I couldn't imagine what it would be like to be here in Tanzania. Now, I can't imagine what it will be like to be home again. Pole pole (slowly), hamna shida (no problems), TIA (this is Africa) will no longer apply. I'll have work waiting for me when I land in Seattle, work that can fit into schedules and to-do lists and that will require multi-tasking and will not stop twice a day for tea.

Still, I have 5 days. We've got needs finding interviews to do, an inventory to polish off, a few more instruments to fix, some quick start manuals to write in Swahili, and who know what else will pop up? Between all that and having drinks with our Tanzanian friends a few more times, this week will fly by. But that's okay. Kiana gets here in 1 week, and then I get to show her this country I've gotten to know for the last two months. I hope those two weeks that she's here go pole pole.

Getting to work

I'm not sure if I've finally gotten used to the pace of work around here or if I've finally figured out how to make myself useful (probably a bit of both) but for this last week Zev and I have had all the adventures, projects, and learning experiences that any eager volunteer could ask for. It seems that a good deal of the initial work any volunteer faces when beginning a project in a foreign country falls into the category of Swearingen's Three R's of Development Work: Relationships, Research, and Relaxation (feel free to quote me on this - the book deal's in the works). This theme has been running throughout my previous posts, but it's worth repeating here.

• Relationships: who are you trying to help? If you find that the work you're doing is unwelcome or unappreciated, either A) you're unwelcome and unappreciated, B) the people you're trying to help don't yet realize how they can benefit from the services you're offering, or C) you're not offering the services that are wanted and needed. Knowing the people you're living and working with is key to overcoming this first obstacle. Kiana can attest to the fact that I've been a bit petulant lately, wondering when I was actually going to get to do some real work, actually use my skills. But compared to some, I've actually been lucky. There are some Scottish medical students at Kilimanjaro Christian Medical Center (outside Moshi, where some of our EWH folks are working) that tell us they've been in country for 7 weeks and haven't done anything. There are plenty of stories from Peace Corps volunteers who have spent the whole first year of their assignment tilting against windmills. Some of the stories have happy endings. Some don't. I'm not at all sure yet what separates a successful project from an unsuccessful one (my boss says that the key to success is to be able to define the parameters by which your success will be measured), but I do know that all the good work we've had this last week has been the direct result of meeting people on the bus, having drinks with the doctors, or just showing up over and over again until people realized we hadn't left yet and they should give us something to do.
• Research: I already hit on this above - what are the actual needs? When I arrived here, I expected to find a warehouse full of broken equipment that needed my technical expertise. This has been the experience for several EWH volunteers at other hospitals. We arrived to find a competent electrician and several mechanics on staff. For the first week, we thought there was nothing for us to do here. Eventually we discovered that there was broken equipment stashed all over the place, we just had to go looking for it. We also discovered that there were other needs we could meet. We just had to ask around and be available.
• Relaxation: I'm actually kind of serious about this. Zev and I often joke that we are walking the line between patience and indolence. What we mean is that we have yet to do a solid 8 hour's work (all at once, anyway), but that's no fault of our own - that's just not the way things work here. I imagine that if I were to stay here for a year, I would find enough long term projects and develop enough relationships to keep me busy all the time - this was the experience of one EWH student who worked here in Kibosho last year and then spent the next 12 months working at hospitals in the area. But being a 4-week volunteer is essentially a working vacation, or a vocational safari, for all the reasons I've described above. Until I realized this, I was stressed and depressed. Now I'm having a blast, just in time to leave (only 6 work days left!). And I'm actually more productive than before.

Okay, enough motivational material (I'll leave that to my friend Chris Guillebeau - see the link for A Brief Guide to Wold Domination on my link list at the right of the screen). My adventures and activities this week:

• First white people to enter an ancient cave. This has yet to be externally verified, but it might be true. On the dala dala the other day we met a young woman doing a master's degree in archaeology through University of Tanzania Dar es Salaam. She and two other students are studying the defense systems of the Chagga, the tribe that populates the slopes of Mt. Kilimanjaro. We visited one of the sites they'll begin excavating soon, a tunnel ("bolt hole" is apparently the archaeological term for it) that the Chagga could escape into when under attack. Although tunnels like this are known to exist, this one was only re-discovered this year by a farmer digging a pit on his land. We used this pit as an entrance. The tunnel is about 8 feet underground, and is speculated to be several kilometers in length (running from one river bank to the next nears one) although we could only access 200 meters or so due to cave-ins. At its largest the tunnel was no more than 5 feet high, and we had to crawl on our hands and knees to get through other places. There were a dozen "rooms" carved out at certain places, with small indentations in the floor and ceiling that suggest sticks had at one time been placed vertically to create a gate or wall. The archeology students say the tunnel could be as old as 500 years, although we're not sure how they know that. According to the oral histories they are currently taking from local Chaga tribespeople, whole tribes would hole up (no pun intended) for long periods of time, keeping goats and even cattle with them and surreptitiously collecting water from the rivers at the tunnel entrances. There were airholes every 10 feet or so, as well as the occasional narrow vertical tunnel up to the surface so that a spy could check on things above. These openings are so well concealed by rocks at the surface that the students haven't even found them yet. This was only the second time the students had entered the tunnel. When their work is done and they have published a book about the Chagga (which will be the first ever), the site will become the property of the Tanzania government. Until that time, it is only known to the locals, three grad students, and us.
• Zev gets electrocuted. There are two examination chairs in the dentist's office, and two weeks ago we repaired the lamp on one of them. This week the lamp on the other chair quit working, and Wilbard told us to check it out. The problem was simple: a burned out fuse. But why had the fuse burned out? It could have been just a power surge (normal around here) or a bigger problem. Wilbard advised us to check it out. In order to measure the current, I devised a tool I've taken to calling the Swearingen Device. Basically, I used a screw driver, some wires with alligator clips, and a bunch of electric tape to make a tool that I can stick into the fuse socket. When the gator clips are attached together, the circuit closes and the lamp works. I can use the gator clips to put a digital multimeter in series with the circuit and measure the current passing through the fuse socket. We had the Swearingen Device in place on one of the chairs, turned on the power, and saw that the lamp worked. Zev then grabbed the gator clips in order to disconnect them from each other and put the multimeter in the circuit. He hadn't turned off the power yet, so each of his arms became multimeter leads and he became the multimeter, measuring 220 V AC right across his chest. He jumped pretty high. He seems to be alright, but now he has a new respect for electricity and an irrational fear of dentist's chairs.
• I become an electrician. There are several construction projects going on at Kibosho Hospital these days, including a new wing for the nursing school. As with construction projects anywhere in the world, this one's running behind schedule. The problem is, the grand opening's on Sunday (the Bishop is coming to bless the place) and 4 days out they still didn't have the lights up. So, rather than fixing scales and dentist's chairs, Zev and I have spent the last two days playing apprentice to the electricians, which mostly involves pulling wire and handing tools up to guys on ladders. It's not exactly biomedical engineering, but it's been fun and (I think) we've actually been helpful.

We've also tinkered around with ancient medical equipment, watched a few surgeries, attempted to translate a sonogram manual from German to English, and started a poker game with some British Medical students. Good times.

The man on the mountain

Hello! Back in Usa River, regular internet access allowed me to post regularly, which really helped me to process my experiences as well as keep a journal for posterity. Now that I live on the side of Mt. Kilimanjaro my internet access has been quite limited. I've rather missed these exhibitionist soliloquies. I'm in Moshi at the moment, enjoying the hottest day I've yet experienced here, letting my poor mzungu skin get a rest in a cool, dark internet cafe...

I have no idea what to write. My world view has pretty much completely changed since my last post, and I'm at a total loss as to how to transcribe even a portion of that into any sort of intelligible paragraph within the next 14 minutes of my purchased internet time. What follows will be free-form and chaotic. My apologies.

Patience, patience, patience. One must be patient when working here. I knew this, I was told this, I was ready for this. I'm not a terribly rushed person, I enjoy working at a leisurely pace...but seriously! I nearly went insane after the first week as we attempted to complete an inventory of the hospital's medical equipment. We'd be told "come back later", and when we did, we'd be told "come back tomorrow", at which point we'd be told "come back later". We'd make appointments which wouldn't be kept, wait two hours for someone who wouldn't show, come back again and again and again until we felt like we were just being obnoxious. Lesson 1: multi-tasking doesn't work in a world with no schedules.

But this is their home, not mine. I've met several volunteers here from all manner of NGO's. The cranky ones are those who thought they could teach the folks here a thing or two, who thought that if they were persistent and kept showing up from 9 to 5, the Tanzanians would eventually start to as well. Cranky volunteers, these. The happy volunteers, like the nice Irish teachers from Kimmage University Dublin who have been coming back to teach NGO governance classes for the last 15 years - these folks are patient. They try to teach the Tanzanians values like fair pay for fair work, financial transparency, and respect for those under you (a big task in the face of the values system instilled on this country by a century of German and British colonization), but they don't force. The know that you can only teach someone what they want to learn. This is universal. If you don't believe me, ask a math teacher. Lesson 2: You can only help someone who wants your help.

Kibosho hospital is beautiful, a beautiful campus in a beautiful country full of beautiful people. A reward for patience is developing relationships. Among the many things that I was told before coming and thought I understood but realized how much I didn't when I got here: you can't just parachute into a hospital on the side of a mountain on the other side of the world and just start kicking butt and taking names, thereby single-handedly reversing the tide of poverty, oppression, and inequality in public health. I guess I thought that I would walk into the hospital on Monday morning and find a giant pile of broken equipment that I could fix as easily as that Shop-Rite scooter back in Arusha. For one thing, they've got a pretty good electrician at Kibosho (Wilbard) who fixes most of what they bring him. For another, there is a NGO medical equipment repair shop in Moshi that fixes what Wilbard can't fix. What really slowed us down, however, is that the hospital didn't tell everyone (or anyone?) "The Americans are coming, please bring out the dead instruments so the amazing wazungu can make your life better." It turns out that the needs actually were there, but we had to go looking for them. The staff here have gotten quite used to making do with very little, and broken equipment is not rare, so in order to find things to fix, Zev and I and our poor Swahili had to go looking and returning later (and returning later and returning tomorrow) and talking with people and making friends until we found the secret stashes of broken, 1950's era medical equipment that had been given up for lost. Lesson 3: you've gotta make friends.

What we have accomplished so far: finished most of our inventory (still coming back tomorrow for a few departments); repaired an infant scale by fabricating missing linkage pieces from Coca-Cola bottle caps (with the help of our new friends in the work shop); refurbished and repaired an ancient electric aspirator pump (the type used for sucking fluids out of baby lungs and surgical openings); and repaired the wiring on a dentist's chair, thereby doubling the number of available chairs at the hospital (from 1 to 2). And now that we've demonstrated our eagerness to fix things, our list for Monday is looking pretty good: we've been asked to (attempt to) repair and train the staff in operation of a sonogram, an anesthesia machine, and an electrosurgery unit. Lesson 4: be careful what you ask for.

Random crazy story: Second or third day here, we're trying to do the equipment inventory, frustrated and stymied by language barrier. We'd been scheduled to do maternity earlier in the day, but they got really busy when a woman began having complications with the delivery. We heard someone say "C-section". Wilbard finds us, offers to take us over the the main operating theater and help us out (he speaks English pretty well). We walk through the main door and see 3 nurses and a small, still baby. The baby is laying on a brightly painted wooden table under a hand written sign reading "resuscitation table". They chat and laugh as they use a foot operated suction pump to remove fluid from the kid's lungs, then proceed to perform CPR. The baby starts crying. I guess it'll live. We look through a large window into the OR - they're sewing up the mother from which the infant has just been extracted via C-section. Wilbard waves in to the head nurse, motions for her to come out and see us. We protest, already feeling like we're invading some place we're really not supposed to be, but he ignores us. The head nurse comes out, introduces herself (Lucy), checks on the newborn, and cheerfully tells us that she'll be right out as soon as they finish with the mother. I stare into the OR. I never realized how much, ummm, "stuff" they have to cut through to get a baby out that way. I've never seen anything like that in my life. I'm not sure that I need to again. We've been invited to scrub in and observe a surgery next week. Zev wants to do it. I'm going to go hang out in the lab. Lesson 5: don't look through the window.

Rest assured, dear readers, that I am keeping a detailed log of my exploits here and taking plenty of pictures which I will happily force upon you when I return home. Lesson 6: if you want someone to go away, feigning interest only encourages them.

Hospital on the Mountain

This is as high as I'll make it up Mt. Kilimanjaro on this trip to Tanzania. Zev and I arrived at Kibosho hospital on Saturday morning. The trip only took a few hours, less than I had expected. We dropped off 4 EWH students at Kilimanjaro Christian Medical Center (KCMC), a huge Lutheran hospital complex at the edge of Moshi. We soon left the paved tarmac and bounced up the mountain side. The weather was noticeably colder, as was the reception: the people at Kibosho didn't realize that we were to arrive that day, and they weren't quite sure what to do with us. We found Wilbard, the technician we're supposed to stay with. He didn't have a room ready for us yet, so he took us to meet the head nurse to see what she had in mind. She welcomed us warmly, then informed us that there would be a $USD50 "registration fee" that she had "forgotten" to tell the EWH organizers about. We called Michelle Garst (the on-site trip organizer) to tell her about the situation. She didn't sound the least bit surprised. Apparently, this is par for the course around here. TIA.

They found us a room in a dormitory that is currently empty, but will next week be full of nursing students. It's a concrete structure with high ceilings that feels very European, not least because the only decoration is German movie posters (though mostly for American films). The acoustics are nice and echo-y, so I spend a lot of time playing my guitar and enjoying the reverb.

Yesterday Zev and I took a daladala down the mountain to Moshi. It's a good 20 minute trek down the steep mountain side to reach the actual village of Kibosho, then an hour-long ride in the van, packed as usual with ~25 passengers. The ride was slow at first; the driver didn't even turn on the engine, preferring to roll down the bumpy dirt road. Gas here is more than $USD6/gallon, so it seems like a good way to save money. However, when a competing daladala started to gain on us from behind, the driver turned on the engine and began hurtling down the road as fast as we could go. It became a race to pick up as many customers as we could before the competition could pass us and start stealing fares. The passengers sensed the urgency and were quick to load, I suspect because they knew if they got stuck on the daladala behind us that wasn't getting any fares, they might end up sitting somewhere for a while, waiting for new customers to show up. That's the nature of public transport around here: full cars go fast, empty cars wait until they're full. And full means really full. You won't even start moving until you've got at least 22 people in the van.

Moshi is nice, a bit less hectic than Arusha. The touts are just as aggressive, but there's more room to breath, and the tourist district is smaller. I'm back in Moshi again today, writing at an internet cafe. I haven't tried the interent at the hospital yet, but Joanna (the EWH student who worked at Kibosho last year) said it's the slowest she's ever seen in her life. This morning we met the staff and then came down the mountain to bring a broken sterilizer back to the shop where it was repaired. The shop turns out to be where Joanna worked all this last year after her initial EWH stint at Kibosho. It's a small shop on the grounds of a Lutheran radio station. Wilbard says it services hospital equipment from 4 states: Tanga (on the east coast), Kilimanjaro, Arusha, and Manyara. I'm told they are never lacking things to fix.

We're back up the mountain now. I don't know if we'll get around to fixing anything today, but that's alright. The more important task is to get to know the staff and the grounds, get a feel for how things work in our new home, and start making plans accordingly. Hamna shida (No problems).

Into the woods (and out of contact)

I leave tomorrow morning for Kibosho Hospital. I don't know much about the place - google maps shows it as a dot on the side of Mt. Kilimanjaro. I'm told that the hospital itself is a compound outside of the community of Kibosho, and that it's fairly large by Tanzanian standards. I and one other student (Zev) will be the only EWH students there, maybe even the only Westerners in the whole region. We'll be staying with Wilbard, the hospital's lone technical staff. I'm also told that internet may be slow or non-existent at the hospital. The nearest internet cafe is in Moshi, about an hour's drive away, so this will be the last post for a while.

I'm ready to go, I think. I wish I knew more Swahili, and I certainly don't feel like a qualified biomedical engineer, but I feel like the instructors have taught us as much as they can. Now it's time to get my hands dirty.