Adventures of my 2nd week in Tanzania

30 August 2010 (Monday) My first day to start teaching to the nursing students at Bagamoyo Nursing Training Center. They are at the end of the first semester of nursing school. Today we started the end of their anatomy and physiology class with the Respiratory System. It was a struggle to provide a college level course with flip charts, hand written notes and some computer generated notes. I realize how dependent I am on technology when I teach with Power Point presentations instead of back to the basic tools but I managed. It is very time consuming to write, draw and detail everything on flip charts. I was so worried I would not be ready in time for class as I had limited access to the Internet with electricity outages and server outages. I took my little laptop with me that has a basic word processing with me to Zanzibar so that did help me get a lot done. I was lucky enough to find an unsecured server on Zanzibar to be able to pull some clip art into my lecture notes. When I was done doing my 4 lecture classes, I made copies for the faculty to keep on file along with the flip charts. But just in case faculty change or the notes get lost, their is a digital copy on the CCS computers under my placement. I offered to make a hard copy on a CD but they really do not have a reliable computer to be able to access it so that was the best we could do for them was to give the paper copy.

Around the classroom they have commercial posters of the various systems they have learned about during the semester. The nervous system, the gastrointestinal system, the musculoskeletal system, etc. A poster for almost every part of the anatomy except the respiratory system. So I got approval to send back a wall posters with the parts of the anatomy they do not have yet. Before I return to work I will shop the University of Utah medical book store and get those sent off so the students so the posters should arrive by the time they start their 2nd semester. I have approval from CCS and the principal of the training centre.

I admitted at the beginning of class that it was going to be a challenge for them to understand my English with an American accent. They agreed! And since the students are from all over Tanzania I would also have to take my time to train my ear to listen to their English with the various accents their tribal languages lend to their speech and pronunciation.  Working together we would hopefully both learn together. I encouraged them to ask questions whether it was related to the lecture topic, nursing or not. After all we are to be sharing our cultures with each other. They are so shy with me, quite fragile. I am a little nervous about pushing them with questions as I don't want them to lose face but I also want them to be interactive.

57 nursing students in one hot classroom!

Apparently the style of learning from Primary school on is rote memorization and learning info in particular order. Students have a great deal of difficulty answering questions out from the order of how the content is presented. The other volunteers who teach the younger students said the same thing about teaching the ABCs and 123s, etc. They can say what something is in English if you ask them in order but ask a question about the alphabet out of sequence and there is a problem. So at college level I was having the same problem. So after each lecture we would have a verbal quiz to help the students stretch their minds and check and see if they truly understood their readings and my lecture. At first verbal questions surprised them and stressed them but by the end of my time with them they were getting the hang of it - it became quite fun! The best help in this style of reinforcing learning worked best when I introduced flash cards. That way the students could read what I was asking and not have to deal with my accent - perfect! I finally got the students to be competitive wanting a turn at answering questions!

After placement, we (the volunteers) were taken to the art center. Dickinson trained us on making our own swatch of batik fabric, drumming and making our own woven bracelet. Great fun! The time went by fast. I met woman sewing a dress together for one of the kids without a pattern on a manual sewing machine. I had one of the artists speak to her for me about I sew as well. She just beamed a smile at me. So I asked if I could take her picture while she was sewing. Yes! At this artist compound there was the usual array of wandering chickens but these were blue! I thought well they do belong to artists that is probably why. But no, they died them so that predator birds do not recognize them as food! How smart is that!

                  

    

Hot all day long, wears one down and builds quite an appetite. Headed back to CCS for another fabulous dinner!

31 August 2010 (Tuesday) Today the students were responsible for presenting the details of the respiratory system. Monday I have presented an overview. The 57 students were broken up into 7 groups with me finishing up with the nervous system control of the respiratory system. Each group of students had 8 to 9 students. Most designated one speaker which was too bad because I thought I would hear from everyone. The remainder of the students must have contributed to drawing the illustrations to accompany the spoken part of their presentation. The drawings were phenomenal! Granted they were copying the illustrations from their text book but they were making them poster size - no easy task! Wish I had thought to take some pictures of some of their work but I think that would have embarrassed them.

I ended the class with more spontaneous questions about what they had just presented. It was still kind of a painful process but at least I was starting to get volunteers to answer! Yeah!

In the afternoon our cultural experience was to visit a traditional healers house / office. I was excited about this as I am always interested how the past health care influences the present. I thought it was quite interesting! So interesting I forgot to take a picture of the Dr Id. He is 74 years old and still a very active practitioner. Most of the younger volunteers thought of him as a little loco but one has to look past the verbiage used like "being made ill with a bad genie" is really the same as mental health can influence your physical health and wellbeing. So he not only treats the physical symptoms but is a counselor for the behavior or mental health issues that are contributing to their illness. I think he is just like conventional medicine just goes about it in a different way with age proved "herbs and medicines" instead of our scientific proved methods. He gets the same results, sometimes better!

Mama Christina our Kiswahili teacher

We have Kiswahili lessons for an hour 3 times a week for the first 2 weeks. I love languages especially when they make sense. I do not like learning the grammar though, I just want to be able to speak and get around and not be so dependent on others speaking English. We learned this week about time, numbers, etc but I think I explained that in an earlier post. Kind of confusing but at least that explains why there is sometimes confusion about what time we are supposed to be someplace.

Dr Ponza, pediatrician

1 September 2010 (Wednesday) I was dropped off at the Matron of nursing's office for her to take me to the pediatric ward to meet the staff and make sure I could find my way. Matron Aisha is quite a personable person. She is friendly and supportive but she can also be stern and directive when the situation demands. Her presence demands respect and everyone leaps to their feet when she enters the room. It was like I was in the military all over again!

            

Grace, Monica and Sara

My first clinical day with my students on the Pediatric ward. I am dreading this as well as looking forward to it. The hospital is very bare and basic but still have to deal with life and death issues. Its a good thing I have been in the military and have had to "make do" with minimal resources before and that I have a head for "figuring" things out. I figured there would be 3 or 4 students assigned to the Pediatric ward but no their were 9! There was more staff and students than there were patients! There was one patient recovering from pneumonia, another being admitted with pneumonia, 2 with slowly recovering from malaria, 2 with acute symptoms of malaria in the isolation area (due to diarrhea). Both the patients in isolation were severely dehydrated and nearly unconscious, very sad. The last patient was a little 2 year old with healing burns. Most family meals are prepared over an open fire with children playing near by. Very scary! One of the older children was pouring porridge from the boiling hot pot into her bowel when she lost control of the post and the whole pot of porridge poured down the front of this child. How painful! She had to go through painful dressing changes every day with only a little oral morphine to take edge off the pain. Apparently there is too many problems with respiratory depression if too big of dose is given so they tend to under dose. Sad!

I was a little overwhelmed with severity of the patients and how basic the conditions but they all seemed to take it in stride. My job with the students was to help them apply what they had learned in class to their clinical setting. So we got to work with practicing taking vital signs on each other, listening to normal then obtaining vital signs on the patients. Vital signs need to be recorded before the physician starts rounds. The physician mostly does sit-down rounds and has the mother bring the child to the desk. Yup with IV fluid, dressings and all. No poles for the IV fluid either. These are truly multitasking moms. They just sling the child up on their front or back and carry what ever is connected to them and sit down in front of the doctor. The doctor asked the mother if there is any improvement or concerns not the nursing staff! I kind of think it should be both! The doc will write orders in his or her notes and then one of the nurses transcibes the orders into a log book so everyone knows what needs to be done for the patients. That first day there was a lot to do for me and my students. We started an IV, drew lab work and helped admit new patients. One patient got to go home, which was exciting!

All of this done with a minimal amount of sleep for we had been woken up with the building security alarm sounding "whoop-whoop-wa-wa-wa-whoop-whoop!" At first security thought it was a cat or something on the fence but it ended up being a short in the system but that was determined after trying to reset it several times hence the little sleep! Another adventure in Tanzania...

2 to 3 September 2010 (Thursday and Friday): More time on the wards with my students. I thought I would have the same students but no some students rotated to afternoon shift and some rotated from afternoon to day shift. I thought how am I going to learn anyone's name if they keep changing who I am working with so I decided to take pictures of 2 to 3 students at a time and list their names so I could start learning their names. I did pretty good with this method which in turn helped me know at least a few of them by name in class. The students that I would remember their names would just beam at me. The men were the easiest to remember as there are only 9 men out the 57 students.

Sania, James, and Hadija

The little burn patient had to go through another dressing change and I was asked if I had any ideas on how to make it more comfortable for her - you bet! Its so much nicer to be asked than to barrel ones way into a situation dictating what needs to be done. After all who am I to say do this different when this is the way that has worked for them for so long. So I demonstrated how to soak the dressings off more thoroughly by squirting with a saline bottle than just splashing bath water up on her dressings and then I demonstrated how to layer the new dressing without lumps and to secure with ties instead of copious amounts of tape that made it eventually more difficult to remove the dressing (having the layers of tape not the way I showed them how to dress the burn). The mother could see right away that this was going to be easier on her daughter and she bowed to me and called me little mother in Kiswahili! I almost cried. The charge nurse I think respected me better as well because so far I had not shirked any task she had tossed my way. I felt very good about how the week was ending.

I do have to interject in my jubilation that there was also some great sadness. Every day there would be at least one child who died. So sad because it was often so unpredictable. It was not always the most ill child. I think the random death was one of the hardest things to deal with and sometimes interfered with my concentration on what I should be doing with my students. Extremely sad. The illness and death rate for children under 5 years of age is extremely high and unfortunately I got to witness this fact daily. The  mothers are fractured by the death. The staff seam to leave the mother to her grief rather than do any consoling. I don't know if this is their culture or is it because the nurses are pediatric nurses and do not know much about taking care of adults and adult grief. But it is my culture to give my condolences so on one child who had died just before I arrived for the day, I went to the mother and hugged her and said how truly sorry (pole sana) I was for her loss. She knew I was genuine and hugged my hand in response. I can still feel the wetness of her tears on my hand - so very sad...

Thursday afternoon we got to cook with our chef Chiku and her assistant Edna. We were allowed to pick a couple recipes we wanted to learn. I was tempted to decline and offer to teach some Mexican food but I really wanted to learn how to make Chipati (Indian flat bread but made the Tanzanian way). So I requested the Chipati recipe and experience and one of the bean dishes. Claire and Michael requested to learn one of the veggie salad type of recipe. We all worked together while learning. It was great fun! Just what I needed after a stressful day at the hospital.

Chiku, one of our fabulous Chefs



Michael (fellow volunteer) following the recipe



Yes they let me use sharp objects! Amazingly trusting!



Joshua, my personal safari guide





3 to 5 September 2010 (Friday afternoon to Sunday afternoon): Mikumi National Park Safari! I almost did not book this trip because I was exhausted emotionally and physically! But I called our travel contact Kennedy to see if he could book be a short notice safari. Yes! He came through for me! Since I was the only one going and only going for a short safari we had haggle over the price but finally came to a compromise. He would provide a guide and driver all in one and we would use his own car a 4 wheel drive Toyota. Worked out great! Joshua was my guide/driver. A very nice 34 year old young man. Being the only two together all weekend and on the long drive we talked about everything. Work, school, family, travel, languages, opinions, etc. I had a great time.

Smile Twiga!

When we reached the entrance to the park on the way to the lodgings, we saw all of the animals I wanted to see, giraffes, elephants, zebras, impalas, snakes (well I didn't really want to see that but we did), warthogs, and baboons! Amazing! I thought if I see all of this so close to the road right away what was I going to see the next day on entry into the park? Well it was even more amazing!! I saw lions, more baboons and tons of giraffes and zebras. But probably the very best was sitting at the watering hole watching the hippo and then the elephants come in to have a drink and a bath. Fantastic! They were so close I could smell them, hear them probably could have touched them if it had been permitted. I will try to put the video in of their bath. The elephant bath ended when the bull elephant decided we were too close and postured for us to leave by stomping feet and flapping his ears. So needless to say we booked on out of there! Thrilled with the experience!

Bull Elephant ready to charge!