Saturday, August 9, 2008

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

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