3 weeks later...

I admittedly have been slacking on keeping a written account of my travels. My last week in Africa was the most inspiring and intriguing in the hospital... and the most memorable. Every day something exciting or tragic happened. Everyday I learned something miraculous about humankind or perseverance. And so, there was little time to sit and write. But I will try to catch up.


Day 15- playing tourist

Today I had a rough day in the clinic and in the labor ward. There was little to do and I suspected because of the rain very few patients came in. So I left early so that I could play tourist with a couple of Swedes. We took a dala dala into Marangu, a village somewhere on "the mountain," and explored the Chagga caves. These caves were home to the Chagga people years ago and provided an interesting insight to how they lived. There are 2 main tribes in the Kilimanjaro area- the Maasai and Chagga. The Maasai are your quintessential Africans draped in red robes carrying a herding staff, known for being fierce lion killers and cattle herders. The Chagga are the peaceful counterpart living in harmony with "the mountain." The two tribes were rivals to say the least. And that folks is your superficial and brief history lesson, less detailed than a quick google search and probably with false information. So after the caves we explored a waterfall and drove to the gates of the Mt. Kilimanjaro National Park. We ended our tourist day sharing a huge jug of banana beer on the side of the road, our taxi driver in his pink disneyland sweater joined us, and eating a delicious meal of bbq meats. Goat included of course.

Day 16- a day in the OR

Before coming to Africa I had this romantic vision of what being a nurse in a maternity ward meant. I imagined groups of women supporting the laboring mom, a natural progression of labor and delivery, and most importantly an environment that embraced natural childbirth. Well, I was wrong. I saw more cesareans than vaginal births. And I saw a cultural disconnect between patient and caregiver.

I watched a tubal ligation during one of the c-sections today... that means she got her tubes tied. This woman was on her 4th c-section and wanted to call it quits. Understandably so. Ironically, this extremely fertile woman had only one obvious ovary and one obvious uterine tube. Dr. Awesome searched and searched and just couldn't find the second set of sex organs. So, he tied up something that may have looked like a uterine tube and called it a day.

I learned a very important thing that day, a physician- at their own discretion- can opt to perform a tubal ligation on his or her patient if they have had more than 3 c-sections. Controversial? Oh, yes. Discuss. This practice is very telling of many things. Ethics, or lack there of. Hierarchy and position of health care providers. Population management. The struggle of... fill in the blank.

Day 17-

During report the nurses and physicians had a lengthy discussion regarding a patient who had decided to leave the hospital against medical advisement (AMA). Something that one of the head nun said struck me- he, the patient, has to truly love himself before we, the healthcare team, can do anything for him. I can't remember the last time I heard a nurse or a health care provider express concern about a patient loving oneself.

Today was a whirlwind of emotions. I was joined by another volunteer, a pre-med student fresh out of high school from Denmark. We walked into a very busy maternity ward and I was immediately drawn to a little bundle wrapped tightly in a kanga laying on one of the newborn warmers. I poked my finger to touch his precious little cheek and my heart dropped. No, it sank. This baby was dead. My first reaction was not something I am particularly proud of but I recoiled. I snapped my finger back feeling like I had just intruded on a secret. I turned to the Danish girl and whispered "that baby is not alive." I didn't know what to do. I wanted to hold it but at this point no one was giving any attention to this bundle. All hands were on deck for two other laboring mothers. We had mom #1 on the left writhing on the delivery table buck naked quietly begging for someone to help her. I, still being in shock about the baby, went to her side and just said the only thing I knew how to say "pole sana," which roughly translated means "I am sorry you're going through this." It is the thing I hear the midwives say the most. And on the right we had mom #2, screaming and refusing to push. It was a scene I had seen before. Midwife, nurse, doctor all at her side yelling at her to push. There was no monitor but it was obvious that with everything happening the baby was probably not faring well. Mom #1 makes some more noise and the doctor decides to check her. Three minutes later baby is crowning and is delivered. Mom #2 continues to refuse to push, yells that she doesn't care about the baby... wishes it were dead. (All of this obviously translated to me after the fact.) Nurse hops up onto the delivery table and straddles mom... pushes with all her might on the fundus. She is pushing with so much force the delivery table is shaking. Midwife is giving an episiotomy. Meanwhile out of the corner of my eye I see someone take the dead baby to the room where they... take out the laundry. And doctor, after having just delivered a baby scooted on over to stand at the end of the delivery table and barked orders. Finally... Finally, the baby is born. He is pale and still. Dr and nurse rush over to the warmer that 5 minutes ago had a lifeless baby on it and commence CPR. "Oxygen!! Oxygen" the doctor yells, it takes two people and about 10 minutes before they get a cannula and tubing that was patent. And what struck me the most was the excruciating lack of urgency. The staff, nurses and doctors, could not find tubing that would work with the oxygen concentrator. It it seemed like no big deal. I stood mortified and terrified for this baby's life. He was so limp. They suctioned, performed chest compressions, and artificially breathed for him for what felt like 45 minutes but was probably only 15. Still, 15 minutes of continuous CPR and I really thought this baby was gone. When he finally cried I was in awe. Did this really just happen? Holy crap. I helped to warm the baby and wrapped him up in a dry kanga... he was so flaccid. He had no tone. But, he was alive. A half hour of some supplemental oxygen later he was slapped on the butt before being delivered to his mother in the recovery room.

The day ended with a c-section. Aside from the poor mother laying naked on the delivery table waiting for the doctor and the OR team for an hour, it was a routine surgery.

Day 18- last day, mostly sad goodbyes.

I did very little today except for say goodbye to everyone and take some pictures.

Day 19-21: travel. travel. travel. home.

An exhausting 45 hour journey home with a 13 hour layover in NYC where I experienced the antithesis of African life.

Hospital and Safari

Day 8-14

St. Joseph Hospital. Moshi, Tanzania.

My first day at the hospital began with a stomach full of butterflies, but actually every day does. I stumble around not knowing really where I am needed, what needs to be done, and who to work with. Somehow my blue scrubs from the goodwill stand out so vibrantly amongst a sea of brightly colored kangas. I ward off constant staring with a smile, a wave or a "habari" and I'd say 90% of the time I get a smile or a neutral "nzuri." The other 10% are hard blank stares.

Fellow nurses- imagine your first day on the floor not even really knowing how to spike a bag of fluids or where to get a pillow. But, on top of ALL that you can't talk and you are deaf. How the hell are you going to do anything or learn anything. Well, you manage and adapt. I have things like a cheat sheet with very specific Swahili phrases. My worn down paper has phrases like "lie down" or "take one at night" or "PUSH!!." But other than that I have almost zero form of verbal communication. I try to talk with my face, my eyes, my hands. The biggest lesson learned here is how darn important communication is in the healthcare profession. The language barrier between myself, the staff, and the patients is less of a nuisance and more of a road block. The importance of communication has been darn well drilled into my head during nursing school but was just really hammered home during my stay here in Tanzania. I have to admit, I was naive and quite ill-prepared for this.

I spent most of my first day playing with pregnant bellies. Measuring fundal heights, palpating for fetal position and using a fetoscope to measure fetal heart rates. It is simple work but a foundation to caring for preggos. And, it is an amazing thing to connect to a living baby within another person. I almost feel like I am intruding on a special relationship when I listen for the baby's heart beat. I worked with two nurse midwives and saw upwards to 60 patients. I also gave a ton of vaccines to newborn babies and expecting mammas. I'd say that was a solid first day... except for getting lost on the way home. The hospital is about a mile and a half away from my accommodation with a total of three turns, somehow I missed turn #2. I befriended a little school girl named Janet and in exchange for some pocket change she led me to my home. Sweet girl.  I walk to and from the hospital every day past houses, motorcycle taxi drivers and a few shops. There is always the same house bustling with 5-6 young toddlers half naked yelling gibberish at me. As soon as he sees me coming one little boy, with out fail, twice a day runs to the edge of his driveway waving his hand screaming "yayayayayayayaya."  

The next day was mostly observing. It being my first day in the labor ward and not actually being a midwife AND not being able to talk to anyone led to a day of feeling like a useless pile. So I did what felt natural, I carried babies when I had no idea what else to do. As soon as I walked into the labor ward someone was being carted off to the "theater" for a cesarean section due to prolonged and obstructed labor. This was my first c-section to watch and what a treat for it to be in Africa. One of the more moving moments of my time at St. Joseph's Hospital was when this baby was pulled from the horizontal slit made in a young mother's lower abdomen. Eyes squeezed shut and mouth gaping the baby was silent and for just a little too long. The physician (from here on called Dr. Awesome) picked up the baby and started to stroke him in a downward motion. I, slightly teary eyed and in complete emotional awe, looked at the scrub nurse who was talking me through the operation and interpreting bits of swahili. He said, not yet. Not yet? Don't sigh with relief until you hear the baby cry. A few more moments passed and finally, the first cries of this baby immediately breaks the tension in the room. Dr. Awesome closed his eyes in silent prayer for what was probably only 2 seconds but as I watched him it seemed like eternity. It was such a slight gesture but in my eyes so incredibly moving.

It would be an understatement to say that the health care system and hospitals are different than those of the developed world. I would say try to imagine what health care and hospital wards would look like in the 1950's and put mud and dirt all over everything. No judgment, just observation. It is an antiquated system here speckled with technology and modern practices. The waste produced here is LIGHTYEARS less than that made in an average US hospital. All of the drapes used during surgery are cloth and can be seen drying on a clothesline outside the operating room prior to getting autoclaved. Everything is sterilized and reused, even the nasal cannulas. No one gets a bandaid after a shot. Every glove, every dollop of alcohol sanitizer and every piece of cotton or gauze is used with special care and consciousness. Nothing is wasted as there is little to waste. However, there is a definite disconnect in infection control but a definite lesson to be learned in resourcefulness.

During my time in the labor ward I wondered... with no name tags, no wristbands, how the heck do the nurses and moms know whose baby is whose?? Well, African women live and breath the Kanga- the multi colored cloth one would imagine the quintessential African woman to have wrapped around their body. Kangas are used as clothes, as a receiving blanket, as a carrier for an infant, as a sheet to put over the examination table in the clinic, as a peri pad wadded up placed in their underwear literally 5 minutes after popping out a baby. The kanga and how a woman uses or wears it gives them a way to express themselves and define their personality. And with their newborns? They know exactly what patterned kanga they own... very seldom are two alike. Newborns are swaddled in a matching Kanga to the mother or the grandmother. Ingenious and pretty fool proof I'd say.

Safari- Tarangire National Park and Ngorongoro Conservation Area

My first and only weekend in the Kilimanjaro area consisted of riding in a bumpy jeep, craning my neck to see out the window, standing in a jeep, snapping hundreds of photos, having a good time, and trying to sleep in a bouncy jeep my head bobbing to and fro like never before. I did a two day safari in Tarangire National Park and the Ngorongoro Crater, a collapsed volcano with tall walls encasing a menagerie of animals that seemingly live harmoniously together. I managed to see four of the big five- Lion, Buffalo, Rhino and Elephant. Among many other spectacular creatures. My favorites were the warthogs, giraffes, and zebras. The terrain just looked like where the dinosaurs would have roamed and it was equipped with gigantic beings like rhinos... slowly lumbering, placidly chewing grass. I was lucky enough to view this animal as they are extremely endangered and there are only 26 in the crater. Deeper in the jungle and at higher elevations I drove in the jeep feeling like I had just jumped out of Jurassic Park. A t-rex was just around the corner.

After the first day I did some luxury camping equipped with a five course meal and scotch with scots... although I recently learned that "scotch" is an American butchering of what really is whiskey. I, not really being a drinker, knew none of this and made a fool of myself. I joined a father and son duo from Scotland on the safari trip and had a blast with them. The son was quiet but kind and his father quite cheeky and fun. Both are doctors, the son doing TB research and the father doing primary care visits in the Bush of Zambia.

When someone thinks of a safari I imagine topless jeeps, khaki outfits and telephoto lenses. Well, Scot Sr. nailed it... minus the cheesy safari hat. And surprisingly about 80% of the other safari goers had their all khaki/telephoto camera outfits on too. I had no idea it would be this stereotypical. Nonetheless, standing in a jeep and peering out the top while driving through rough roads and trying to spot animals was extremely fun! It was like a disneyland ride for 8 hours. But, by day two I was done. My back ached from the uncomfortable seats and bumpy ride and I was exhausted. Am I getting old?

Everyone in Africa moves with a sort of grace that is just not seen in the US. The people here move deliberately and purposefully. Women walk along a busy street with 50 pounds of bananas on their heads as cars, buses, and motorcycles rush by. I bring this up because on my jeep ride to Ngorongoro crater at 6AM I saw two african men running. Running... what?? I haven't seen anyone run since I saw a tourist go for a morning run on the beach in Zanzibar. People don't even run when they cross a street and a bus is 5 feet from hitting them. Well it is ironic. The best runners in the US are black... but after two weeks in Africa I finally see someone running. Probably a Kilimanjaro guide.

I'd say my first week at the hospital was a success. I managed to help people but also sit back and observe a lot. There is much to learn from watching. I see what people view are important and what can be let go. I saw babies saved and mothers give birth. I've seen bravery and the tolerance of pain that I have never seen in a US hospital. I've seen women survive the most gruesome births and I've seen midwives use their gentlest touch. Aside from this environment I've seen much of the Tanzanian countryside. From my walks to and from the hospital to driving to the national parks. I've seen majestic animals and just the craziest looking creatures. Huge trees 800 years old and a pride of lions lazily napping in a field of daisies. I have seen children herding goats and old men playing what looks like checkers but probably isn't. I have seen a lot.  

I have much more to say about the healthcare system here and about my time in the hospital but this post is long enough and you are probably bored ;)