5 September 2010 (Sunday) The ride home from Mikumi National Park was anticlimactic and fast. Joshua, my guide was anxious to get me back to home base so he could get back to Dar Es Salaam, his home so he take a shower in his own place, eat his own food and sleep in his own bed. Mmmm…that is the same thing I want to do but all the way back in the good ol’ USA, not just CCS home base. We drove one more time through Mikumi to sort of say good-bye to the animals that had given me such a fabulous experience the day before.
The watering hole where the elephants bathed that I inserted in the previous weeks post was totally dry. I guess between the heat of the day and all of the drinking, the water was gone. No more Hippo lounging in the water. Just empty and all the animals gone, kind of freaky.
I asked to stop at the lodge where we had eaten lunch the day before (inside the animal park) to see if the gift shop was open. My fellow volunteer, Claire and I have been looking for post cards to send her grandkids, everywhere! None. After all it’s not like the village of Bagamoyo is a hotbed for tourists. So I figured since all of game reservations are “tourist-type” places then maybe they would have postcards. Yeah! I scored. I bought 3 postcards for Claire and one for a souvenir for me. Of course I had to shop in the gift shop as well but it truly was just “touristy” stuff. I had seen many types of baskets at vendors alongside the road on our trip to the park. My friend Susan collects baskets from all over the USA and the world, so I did find one made in that region of Tanzania to give to her. As I mentioned, Joshua was in kind of rush to get home, so I was pretty sure I would not be able to get him to stop at one of the roadside vendors and then wait for me to haggle down the price in my broken Kiswahili so I made the purchase while I could.
Back on the road again. The time went by quickly. The last hour of the trip back to home base was on a “short cut” on questionable roads. Let’s say I would have preferred to have had a sports bra on for all of the jarring and assault from this road. It did make me glad to reach CCS home base!6 September 2010 (Monday) Today’s course content was to review what was presented last week by myself as well the student presentations. Remember they learn best by repetition. At least this time all of my flip charts and lecture notes were already done, so all I had to do was review the content and then get to my favorite part asking challenging questions!
I had picked up the lecture notes turned in from the student presentations from the faculty office as the list of students for each group was on the lecture notes. Ah-Ha! Now I could call out the names for each group to know exactly who presented and which questions I could ask them and feel relatively confident that they could answer without losing face. Great!
Needless to say this was much easier on me but I think very stressful for the students. I did want them to be held accountable for the content they presented by being able to answer questions on the topic their group was responsible for. I wanted to make sure it was not just the speakers that knew or understood the content but their whole group. And in turn by repeating information known by the individual groups teaching the remainder of the class the content as well. So I had everyone in the first group stand up. Slowly and painfully I finally got all 8 members to stand. Then I started out asking questions, almost too easy of questions. No one was answering because they could not believe the questions were so easy – they thought I was tricking them. Not so! So I made the questions a little harder. One timid little hand at the back of the class room volunteered to answer the question. She got it right! Yeah! She got to sit down and be put out of her misery. Pheww! I asked 3 or 4 more questions of this group. With each answer they got a little more confident. So I allowed them to sit down. I moved on to the 2nd group. Now they were getting the hang of it – easy questions are asked first – if one answers a question one gets to sit down and hide in ones seat. So this time I had more ready volunteers to answer questions. But this time I didn’t stop with just 3 or 4 questions for the group, I made sure everyone had a question to answer. They did it! Yeah!
Group 3, had not listed their names on the presentation notes so I had the whole class stand up! Oh they hated that – being made to stand up. The classroom is 95°F, nearly 100% humidity, you would think they would beg to stand up and try to cool off. After much encouragement, they were all standing, listening intently for the question that would release them to the safety of their seat. I had a great amount of difficulty conveying the concept of diffusion of gases. I couldn’t decide if it was my English or the lack of their English or the way I was explaining it to them. So I kept trying different ways to demonstrate diffusion and then asking questions to check comprehension. I posed the question “What is the process of a gas in high concentration moving to an area of low concentration called?” Silence. I asked the question again. And just when I was starting to get a cramping pit in the middle of my stomach that no one was going to answer the question, 4 hands timidly were raised. I was smiling inside. One of the young men, Simoni, was first to raise his hand so I chose him to answer. In a very quiet voice he answered: “diffusion”? I just about did jumping jacks of joy! I told him to say it again, louder. He said it so loud I had to step back. I cheered and clapped. And said he could sit down. I looked around the room and saw that many others would have guessed correctly and said “if you had the same answer, you may sit down”. Nearly the whole class sat down! Good I think…The rest of class session went much smoother with more questions and answers, building their confidence until it was time for tea break – time had just whizzed by!
When the students returned from break I brought out another way to quiz them – flash cards. I so wish I had done this sooner because it was extremely successful. I had been listening to the volunteers who teach young children and how successful flash cards are. So I thought I will make my own medical terminology, respiratory system, clinical questions flash cards. They loved them, so much that they wanted to keep my cards to use during studying. I said they must be shared with the whole class not just the person that held the cards. They agreed.
An interesting note of our routine, after every lecture the class leader would come to the front of the class with a notebook for me to sign stating how many hours I taught. She would write in the hours, I would sign. What I found disturbing was she would only log hours where I was actually presenting a lecture not the time I was asking questions or writing on the board or reviewing vocabulary. Hmmpf! I felt like all of what I did was teaching and some of the best learning on their part was when I asked questions. Oh well, it’s not like I was getting paid by what was in the book but it still bothered me.
In the afternoon, I was planning to go pick up my skirt from the tailor, Pili. Sarah, one of the other volunteers said she would go with me but she forgot and went after her placement instead of coming back to home base to escort me back down the road. I had only been there once with Claire and was not sure which turns to make in Pili’s neighborhood to get to her house so I didn’t go. I get too tired in the heat and humidity to be wondering around in the wrong direction. I had wanted to wear my wrap-around skirt to the last day of classes the next day. Oh well, maybe I can wear it during clinical later in the week.
I think I was still quite tired from the busy weekend at Mikumi, and everyone else seemed tired too, so I laid down for a short nap. Ahhh…sleep…then all of sudden, doors slamming, building alarms gonging – what the heck! The alarm technicians had finally shown up from Dar Es Salaam to fix the short in the security system. Oh for Pete’s sake – I thought it was fixed! Nope, the guards just had not been turning on the alarm at night. Just locking us into the house after we went to bed and unlocking everything before we got up. Kind of scary, to be locked in and no fire department if we caught on fire. But oh well, I guess we could have pushed the mosquito screens out of windows to climb out if needed. So no nap!
I got out my little laptop and fixed up my lecture notes so I could finalize the files and store them on the CCS home base computers for future use if needed and to make hard copies to give to the school. I could print one copy at CCS but if I wanted more I needed to have them copied out in the community. The internet café near CCS did not have a working printer so I asked Sarah, where there was another Internet café. She told me near CCS Summer house. During the Summer when there are more volunteers than can fit into the home base house or home base and the annex across the street (where we were staying) then they open up Summer house down the street about 4 blocks. So Sarah walked me down to Churchill’s Internet Café for my printing needs. What a nice young man! He had a printer but it was not a copy machine. So each copy had to be printed one at a time, very tedious and right in keeping with TFT (Tanzania Flexible Time) – after all “this is Africa!” The electricity went out in the middle of my print job so we talked awhile to see if maybe the electricity would come back on. Churchill is originally from Kenya, hence why his English is better than most I had met so far in Bagamoyo. But he admitted his Kiswahili was not very good. He said in Kenya they tend to speak more slang and in Tanzania they speak “proper” Kiswahili, but he was learning. So we spent some time quizzing each other. The electricity returned and he resumed printing my materials, one page at a time. By the time I was done it was nearly dinner time and the sun was setting. We (volunteers) are encouraged not walk alone nor walk at night. If it is dark we are to catch at Bajaj (a sort of a pedal cab) or an approved taxi to get back to home base. Well I had not brought my list of phone numbers with me and it was more light out than dark so I started walking back. It is considered rude to not say “hi” to people you meet along the street. As I walked back to home base I practiced my greetings: “Mambo”, “Hujambo”, “Harbari za jioni?”, “Mchana”, Most people responded with one word answers: “Poa”, “Jambo”, “Nzuri”, “Nzuri sana”, as they should. But there is always some young man who wants a longer conversation in partial English and partial Kiswahili that the ultimate goal in the conversation is to seek a relationship. Which just makes me walk faster. Hmmm, it’s the same all over the world, nothing new, it’s just tiring.
The remainder of my walk was uneventful. I watched children playing alongside the street and playing soccer in an open field of stones and dirt. The soccer ball was made out of cloth, left over remnants of kangas (a length of fabric used to wrap around the waist to form a sort of skirt) and such. How adaptable kids are! I finally made it back to home base for another great meal and relaxed. 
7 September 2010 (Tuesday) My last day of classroom time with my 57 students. I was little sad, still wondering if I have made a difference in their lives. I know I feel different but have I in some way improved their lives, their education by my short interaction with them? I may never know but I hope so.
The faculty had requested I teach CPR with a particular focus on bag-mask ventilation for infants, children and adults. My tools offered were two baby dolls, 3 self-inflated ambu bags and 2 masks. Everything had been cleaned up for my use but the dolls were not CPR manikins so all I could do was demonstrate position and troubleshooting airway problems. I had them return demonstrate airway position, opening the airway, face mask position and reviewed normal respiratory rates. We talked about chest compressions but they could not imagine doing CPR on anyone in the hospital and definitely not out in the community. If someone was dead – you leave them dead and get on with life. Not mean just a fact of life. So the question “why teach them all this?” begs to be answered. After all I was trying to teach an 8 hr class in 3 hrs and struggling with this concept of “why do any of this?” So off I went to the faculty office (a room next to the classroom) and asked “when would they use this information?” I was told that children are often inadvertently over medicated with morphine so one may have to provide manual breaths until either a reversal agent can be found and given or until the medication wears off. Okay good to know! Another clinical situation would be during surgery, if a local anesthetic is used or surgery needs to be performed quickly, there is not always another physician to manage the airway so a nurse manages with manual breaths. Can you imagine doing a whole surgery with only bag-mask ventilation! Exhausting! And flashes of my early transport years before transport ventilators were available having to give manual breaths during the whole transport. Back into the classroom again to reinforce manual breaths and what situations they would use manual breaths.The last hour of class was spent on learning the Heimlich maneuver or abdominal thrusts to clear an obstructed air way. I had made a couple of posters reviewing CPR and the “Helping Babies Breath” program but ran out of flip chart pages to be able to draw choking and abdominal thrusts. But these young people have a fantastic memory so no worries. This was hilarious to teach as well as to watch! I think everyone was able to do it. While I was checking each student as I walked around the room, 4 creative students decided to get imaginative and create a Heimlich maneuver chain. One student was giving the next student an abdominal thrust while she was giving the same procedure to the next student. I wanted to take a picture because we were all laughing so hard watching the 4 of them all chained up doing the Heimlich on the next person. But they all seem to shy away from photos so no picture for ya – you just have to take my word it was hilarious! I was so proud of them for finally feeling comfortable enough with me to be silly and show off! Maybe I am making a difference…
We ended the class about a half hour early. We cleaned up and put the equipment away. I said good-bye to the class as a whole, a little sadly. But no one left, the students just sat there. I should have been suspicious. It was the last day of classroom time with all 57 students. I would have my 9 to 15 students in clinical but this was the last chance to see the group. I was a little sad that they weren’t a little more involved with saying good-bye. So I was feeling “poor pitiful me”, my students don’t even want to say good-bye to me. I went into the faculty office to give over my copies of lecture notes for their files, and have a mini exit interview. Again I should have been suspicious; all of the faculty were in the office including the principal (I never saw them all in one place before). I told them all the equipment is put away and was going to go stand outside for my ride back to CCS. They said wait. Okay….
The class leader stood and said a formal good-bye in her very rehearsed English. Very sweet! Then another student had written a song to say good-bye and thank me for teaching about the respiratory system, CPR, Heimlich, positive pressure ventilation, vital signs, etc. Amazing! Then another rocking out song – they had voices like a choir – it gave me goose-bumps! Fantastic! And finally some parting words from the principal, my mentor faculty member, Veneranda and then I was encouraged to speak and say my good-byes. I gave them words of encouragement in their studies, their education and for their exams planned for next week. I hoped that they got something from this experience – I know I did. They stood and clapped for me! Very heart warming. And when I thought the good-byes were over – parting gifts were brought out! Oh boy! They gave me 3 meters of batik fabric in my colors of royal blue, purple and mint green (absolutely gorgeous!) and another length of fabric with zebras all over (great!). The wrapping was an empty page from the flip chart (uh-huh(!) the missing page I needed to draw the choking poster on!) *grin*The best compliment I could give them for my gift, was I immediately and genuinely threw the batik fabric around my waist into a makeshift kanga (wrap skirt). They loved that I loved their gift! I was warm and fuzzy feeling all over! Sigh….
I shared my day with everyone at dinner that night. Everyone expressed their sadness about my pending departure but that was still 4 days away so don’t say good-bye yet. I am seriously thinking of coming back some day. It would be great if I could swing coming back while this particular group of students are still in their program. Veneranda shared with me she would like to retire within the next 3 years, so that is something to consider as well, as we got along so well. Maybe…some day…
8 September 2010 (Wednesday) Today was another day on the pediatric ward. I was excited to go as now I was feeling more comfortable with the staff, routine, and my students. I knew Madame Veneranda would be making a surprise visit to start assessing what the students had learned in their first month on the wards. I was nervous for them but I was sure they would do well if they stayed calm. The week after I leave will be their big exam covering the whole semester. The students started firing questions at me in their franticness to remember everything they think they will be tested on. Thank goodness I was able to answer everything – eek! After all its been many years since I attended my first nursing classes.
We only had one patient in the whole ward; A child quite ill with malaria and severe anemia who was just finishing a transfusion. Most of the kids from last week had been discharged home and some had died. So with only one patient and 9 students, it was decided to clean everything in the ward; curtains, bed stands, beds, mosquito netting, equipment carts. One by one each piece of equipment was carried out side on the covered walkway between wards, water hauled in and everything soaped up and rinsed off. Once dry, each piece was returned to ward after the floors had been cleaned. What a process but very thorough!Since we had CPR the day before I decided to review the emergency equipment available on the ward. There is one corner room which is air conditioned where equipment is stored and where admission exams and procedures are performed. We pulled down the emergency box, sort of like our crash cart, but in a giant tackle box and began reviewing all of the contents and what the purpose was for each item. While we were in the exam/admit room, my thirsty students asked if I knew how to operate all of the equipment in the room. Yup! (thank goodness) So one by one we reviewed each piece of equipment, how to turn it on and off, what it was used for, how to clean it after patient use, where it was stored, what types of patients would need this type of equipment, etc. While I was reviewing all of this, 2 new interns from England who were going to meet Dr Paul (pediatrician) to begin their orientation to this area came in the room. Thank goodness they arrived because many of the meds in the tackle box were British, so even though I could guess at their names and uses, it was nice to have them confirm I was guessing correctly. The interns elected to stay and listen to the review of equipment and meds, knowing they may have to use this room some day when they start working. They thanked me for including them in our review. And my students respected me a little bit more for sharing our knowledge with strangers. At least that is how I interpreted their behavior.
9 September 2010 (Thursday) My last day of work, tomorrow is a holiday. I presented myself to the Matron (Aeisha) who in turn escorted me to the maternity ward. The nurses were still in report for change of shift. It had been a busy night. They asked if I could wait an hour or so before I did the in-service on resuscitation. I left to return to my students on the pediatric ward. They were genuinely pleased to see me. I told the Matron I would continue working with my students until someone came to retrieve me to teach in the maternity ward. She said that would probably be the best use of my time.
3 patients had been admitted overnight. More malaria and another burned baby. Ouch! My students and I got to work, taking vital signs, preparing for a dressing change and talking about complications of the medications our patients were receiving. They are so much more relaxed with me now, comfortable asking questions and doing some tasks independently. We were busy so I did not even notice the maternity ward staff never came to get me. I walked back over to the maternity ward before I left and everyone was busy with lots of mothers in various stages of delivery. I reported to the Matron I was not able to teach a modified “Helping Babies Breath” program. She told me since I did not meet my objective – I would have to return some day to teach. Maybe I will…
An interesting note about ID of infant and mother. When a mother is admitted to deliver, she brings 2 or 3 kangas with her (the wrap skirt fabric, I have mentioned before). Each kanga has 2 halves that are identical. When the mother delivers she cuts the kanga in half, she wears half and the infant is swaddled in half. So at a glance one can match up a baby with their mother by the color and pattern of kanga. Great! This is done in the pediatric ward as well. The mother brings sets of kangas so if her child is sick, swaddled or covered with a kanga, the mother wears the same thing so everyone knows who belongs to who. Colorful and efficient!
In the evening, the Imams saw the moon which heralds the end of Ramadan. So Friday is now an official holiday. Eid al Fitr. No clinical. No placement. No work. Sad, as I would have preferred to work up until I left.
10 September 2010 (Friday): Got to sleep in a little. So conditioned now, really couldn’t sleep. And my stomach woke me on the dot for some of that good CCS breakfast.
Packed my bags. Sorted out clothes I would not need back home to leave with CCS to donate where they see fit. Donated my remaining teaching supplies to the CCS resource center (where the volunteers get supplies to teach or train at their placements. Checked in on the internet or tried to for my flight but because my final destination is USA, I was not allowed to check-in on line. What a pain.
Mama Thea our Program Manager for the country of Tanzania took all of the staff and volunteers out for Eid dinner. We went to a hotel restaurant along the beach. It was quite windy but it was great to eat close to the water. There were a couple of craft vendors on the beach. Of course I can not pass up one more opportunity to shop. Took a look but nothing that interested me – ho hum…
We finished our lovely meal and all piled back into the CCS van, kind of looking like one of the local daladalas (minivans that get backed to gills with passengers going short to medium distances. Sometimes with chickens, children, men, women, bags, fruit, etc until everyone is overflowing out the windows).
The daladala vehicles are saturated with countless people. I never saw an empty daladala. Seats would be filled and still more would be loaded into the aisles, windows, tops of van. Daladalas house an array of people, with children in their school uniforms sitting alongside of business people in more formal attire heading out to their jobs, alongside Muslim women heading to market. The driver never seems to interact with the passengers, yet there is a conductor of sorts that hangs out of the open door taking exit requests and fare money. At every stop along the way whether for traffic or a stop, hands would protrude from each window offering peanuts, fruit and scarves from the nearest marketplace.
Various daladalas traveled in front of our home base but I never saw the same one twice. Everyone seems to know where they are going and which one to catch. It seems pretty efficient but a lot of chaos!
I watched the busy-ness of Eid celebrants up and down the street and realize my time is almost done. I wonder if anyone will remember me. I hope I can keep all of my memories, feelings, values I have gained from this experience intact. This blog helps. I wonder if I have made a difference for my students, the hospital staff, the orphans I have played with, the women I have crafted with and the CCS staff that will remain long after I am gone. I have been honored by my students, the NTC faculty, the nurses and doctors at Bagamoyo District Hospital and even passers by in the streets. I don’t know if any of it is real but it all makes me feel like a better person for coming here and interacting with another culture. Maybe I have made a difference…
No comments:
Post a Comment