Ilula Medical Group

Photos and Faces of Idunda

2011-02-17T08:53:00.000-08:00

Departure?

2011-02-17T06:50:00.000-08:00

After hugs all around, the big group has gone. Gary, Carol, their daughter Jennifer and her friend Julie took the Land Cruiser and the luggage and left with Dennis driving. Peter drove the Cruiser with only Don and Eunice, but the group will swell to 14 when the other travelers are picked up at Chilinze. The new arrivals left Arusha where they were stranded because of the explosions here in Dar. Their plane will arrive here about 10 PM (without them), mine about an hour later, still more or less on schedule, only 25 minutes behind last I checked.

Joseph will be picking me and another woman up at 8:30 PM to go to the airport. He will pick up Kelsey in the morning for her 9:30 AM ferryboat ride to Zanzibar. She will meet Amy Schulz and her two friends in Zanzibar for a little end-of-the-trip R&R. For us, this marks the end of the medical adventure. Kelsey and I spent some time debriefing the experience. I think it is safe to summarize saying we both loved it, adventures and all! She has some thoughtful comments on future rotations, which we will use. I have great hope for our developing connections with St. Kate’s, IMER and Concordia.

For lunch we all went to “Steer.” The receipts have “Magic Kingdom” written on them. But I do not know if it is a subsidiary of Disney or not. Could be! The place is a collection of fast food restaurants in an American style. There was an Asian one, a MacDonald’s style burger place, a bakery and a pizza place in this building. On the outside were the usual street vendors. Inside US, outside TZ.

The traffic was bad; no, horrific is more accurate. It took 2 and ½ hours to get to the place. We dropped Dennis off first at Wama. I have no idea what that means. The name of the business, I think. It is where BkB buys their vehicles. Two congregations have bought motorbikes for their partners and Dennis was hoping to get them shipped by truck to Iringa. Unfortunately, they were buried far back in the container and will take several men to unload enough to get at them. He felt thwarted.

Dennis has been our steady pillar. He is reassuring when we need it, confident when we need it, always wise, smart as a whip and widely experienced. Dennis was adopted by Benjamin Ngede when Benjamin married Dennis’ mother Sarah. I deeply respected and admired Benjamin Ngede and no less his son.

It is now 5:40 PM our time, 8:40 AM yours. I am not sure just how much if anymore I will be able to write before I get home. It has been fun keeping a little record of this month-long adventure! I look at the ground below my feet, then at the palm trees here at FPCT and the Indian Ocean and realize I am very far away from home. Very far. It is a surreal experience, life changing in so many ways. It isn’t just me that wants to share the stories. My experience is that everyone who comes here wants to do the same. The stories are endless, many tragic and heartrending. Others are heartwarming and hopeful. I can’t help but think I am a better person for having been here. I hope you will come and see for yourself!

For me, departure tonight now seems highly likely. In the mean time, follow Amy and friends and Kelsey at http://safarinjema2011.blogspot.com/

Ken

Update

2011-02-17T03:09:00.000-08:00

Some good news. The seminarians are found, alive and well, but wandering around aimlessly near Arusha, not knowing what to do with themselves and totally unfamiliar with Africa....

Nope. They are a resourceful group and reached Jo at the Lutheran Center, who contacted Don. Now bus travel is being arranged to meet the Tantanca bus at Chalinze, half way to Iringa. Our group will leave to meet them at the rendezvous.

It is now 1:50 PM here. The airport has re-opened. I will go there tonight and hope my flight will actually take off. Last night's flight will get in at 9:55 PM and should have left about 8:30 AM. The KLM site doesn't list the actual departure.

My flight is still scheduled and has left Amsterdam. It is 25 minutes late, but I will suffer through that without complaint if that is the extent of it. There was another blast this afternoon, but our understanding is that it was a scheduled detonation of a remaining bomb. The tweets and news wires say there were 32 people who died in the blasts. Reuters has a little story and says 20 are dead.

We are all well. The Iringa folk will be leaving soon for a wait at Chalinze until the Augustana people arrive. More breaking news as it happens!

Ken

Dar Mall of Tanzania

2011-02-16T23:30:00.000-08:00

Bombs Away!

2011-02-16T21:49:00.000-08:00

We are safe and sound in Dar. It is around 9 PM. However, there have been explosions for the last hour at a munitions dump about 2 km from the airport. It is now closed and Don’ seminary classmates are stranded in Kili likely until tomorrow’s flight to Dar. Of course, I hope things are back to normal by then since that will be the flight I take back to Amsterdam. Apparently the government had been warned to move this explosive dump, but failed to do so. One report said the fire that started this was from a thunderstorm. Not so. There is not a cloud in the sky. The first couple explosions were really loud like thunder claps close by, but I immediately noticed they were not preceded by lightening. It took a short time for me to realize the moon is almost full and there is not a cloud in the sky. From some areas the eerie orange glow of the exploding bombs could be seen. We are on the outskirts of the 10 K (6 mile) radius they have evacuated. There have been some exceptionally loud explosions, but many, many less substantial ones. Much of the info we have learned by watching “tweets” on the internet. Instant news.

Regardless, now at about 10:30 PM, the explosions have been fewer and further between in the last 15 minutes, but still not finished.

It is now 12:30 AM, Feb 17. There are no further explosions and the tweets have slowed. I am not finding any new news on the web.

It’s morning. The group stepped into my office for an update on the flight, the airport and the explosions. We found this website: http://tinyurl.com/4c2rolu that tells the story, photo and all.

My office, you ask? The wireless does not reach to my room, so my office is a chair on the sidewalk in line of sight of the office where the wireless originates. I charge astronomical rates for my consultations, absolutely outrageous! But hey, I have a captive audience. Unfortunately, everyone has paid on credit for Tsh, so I am not holding my breath. “The check is in the mail.”

I may write more about the pleasant day we had yesterday, but it pales in comparison to last night’s fireworks. After breakfast we went to a shopping center. Not quite the Mall of America, but big competition for the Burnsville Center. We got a flat screen TV for the Lutheran Center, a new phone for Don, a pair of steam irons and more! Lunch and shopping at Slipway were high-lights, and a very good dinner at a Thai place in the New Africa Hotel. We did have a great time, but how can that compete with explosions?

I am hoping I have a ride to Dar airport when we go to pick up the classmates. We'll see how that coordinates. By the time you wake up in seven or eight hours, much will have been determined and likely I will be at the airport waiting for my flight. I can only hope!

Ken

The view from Idunda

2011-02-16T07:03:00.000-08:00

Goats

2011-02-16T07:01:00.000-08:00

The car doesn't tell the story. The view does!

2011-02-16T06:56:00.000-08:00

Sunday in Idunda

2011-02-16T06:41:00.000-08:00

We awoke to the sounds of morning, roosters crowing and dogs barking - and a radio blaring. The plan was to get up, go to the dispensary for a tour of it and the unfinished nurses’ residence and to deliver the medicines and supplies we had brought. Next we would eat breakfast then go to church. After church we would have our partnership meeting with the elders and leave promptly by 1:45 PM. This way, we could stop at the secondary school where the Idunda students St. James supports attend. Dennis said the way he came was faster and the road was better. We would go home that way. Unfortunately, this would preclude going to the school. I had hoped to deliver the 80 letters our confirmation students had written to their contemporaries at Lutangilo Secondary School. It was not to be. There were another 25 letters or so written to the people of the Idunda congregation by adults and younger kids. Many of the kids drew pictures to express their love and messages to our partner congregation. The adults told about themselves and their lives at St. James. I settled on giving the Lutangilo letters to the District pastor who could deliver them. The other letters and the one from Pastors Walt and Will to the congregation I gave to Deacon Letson Chusi.

Before we went to the dispensary, Dr. Saga took me out to see the parsonage/guesthouse wall. One end of the building had collapsed. For those who have been there, it was the end facing the church, not the one with “St. James Idunda” inscribed on it.

The visit to the dispensary went well. There are two beds in small but separate rooms and a gurney in the main room. The town fathers had been using one room for an office, but had moved out. Nurse Annaliese had full control of the space. All appreciated the medicines and supplies we brought. We walked down to the residence, ample for two nurses. Unfortunately, it was unfinished. The roof and trusses had been kept and the mud walls had been removed, brick walls replacing the mud. It still needs its outer coats of cement and all the interior work before it can be used. The outdoor kitchen was a shell, awaiting the traditional mud wall treatment. Progress had been made in the last two years, but minimal. It will take 3.5 million Tsh (about $2500 USD) to finish it. One alarming construction defect abounds and was obvious in Idunda. Contractors might be told to make the ratio of cement to sand 1:6 (US would be 1:4), however, sometimes the contractor skimps on the cement to increase the profit and may use 1:10 or 1:12. This cement quickly crumbles, as evidenced by the wall of the pastor’s house. Dr. Saga impressed on them how important it is to monitor the construction of the building process so this doesn’t happen. The floor in the church is crumbling too due to the same construction flaw. It was poured in 2006 before Leann and Eric Benson were married there. I told them in our partnership meeting that a floor done properly should last a hundred years. I saw they understood my disappointment in their use of gifted resources. In their defense, if it was done intentionally to stretch their resources, you can understand their desire to stretch the capital as far as possible. I hope they have learned this is a false economy.

Church started 45 minutes later than we had planned, but for no reason that I could perceive. This is Tanzania. Once again, the choirs were stellar. There was dancing. You simply must be there to appreciate this marvel! At first the choir nearly outnumbered the rest of the congregation. As the liturgy began, people trickled in. This week, all four preaching points came to the main church. When it began to rain, the numbers swelled to standing room only. I counted about 80 kids up in front sitting on the floor. Total capacity is about 250. I am certain there were twice that many.

And it did rain. At times, the rain was so loud on the metal roof it was impossible to hear the pastor who was nearly yelling. It continued to rain. I could not help but think about our upcoming travel back to Iringa. The rain did not bode well for us.

Near the end of the service, after we had introduced ourselves we gave our gifts and received gifts in return. I offered the books Holly and Miriam had put together, the crosses from Bob and the shirt from Pastors Will and Walt. We received beautiful kangas and lovely small baskets, not to mention four chickens and a huge bunch of bananas.

All four of the preaching points had brought goods for the post-service auction. With the downpour the auction was not going to be held outside! So an auctioneer from each preaching point began. One of the very talented auctioneers danced as he worked the crowd. I got a couple more baskets.

Before the service, the pastor’s wife had offered an array of baskets for me to choose from. We like Idunda baskets. We probably have enough of our own. Oh well. So I said, “Mama will be very unhappy if I fail to bring her this basket,” pointing to the largest of the array. “And my daughter will be very unhappy if I don’t bring her this one. And my daughter-in-law needs this one.” So I bought the whole bunch. Then I had Msigwa translate this: “If mama is not happy, no one is happy.” The pastor’s wife smiled broadly. (Sorry Sweetheart. It was humor at your expense.)

Unfortunately, as we were about to leave some other baskets appeared, but we simply did not have time to deal with them. When we come back to Idunda, I propose we ask the women to make baskets for us to buy, so they know in advance we are interested.

Eunice said this was the largest auction she had seen after a church service. Like the service, it went on for a long time. Ultimately, we chose to leave before the end of the auction. We still had lunch and a partnership meeting to attend. While we were eating, I managed to print some of the photos I had taken. The little printer I brought was a worthwhile gadget.

The partnership meeting was fine. We reviewed the projects, the dispensary, the cement quality. The pastor did say this. “We thank you for the five bicycles you gave us. We asked you for eight, but the five you gave us are working well.” Hmmm. I felt a little twinge of something at this apparent ingratitude. I said, “So tell me about the motorbike St. James gave you.” There was a brief silence as the turn-about-is-fair-play kicked in. I didn’t mean to be vindictive. “We still own it,” he replied. Hmmm, I thought, still ”own it”? “It is very old, six years.” Hmmm, I thought again. I didn’t think that was very old. “It isn’t working,” he said. Then Msigwa said, “I still have the letter requesting 800,000 Tsh ($560 USD) for repairs.” They had not been maintaining the motorbike since it was brought to them. Understand that Idunda is a long way from anywhere, not so many kilometers, but winding, slippery, hilly roads. Still, there is a reason to get things maintained. This is not resolved for them. I don’t know what will happen at this point.

Finally, we were ready to go. Still raining and over an hour later than our scheduled departure.

Since you are reading this, you can assume we are all well. You should know the trip home was harrowing. Don eventually got used to the chorus of “Go slow, go slow,” especially from the Tanzanians who knew about the steep and slippery curves just ahead. They are so polite though you could barely hear them. I was white-knuckled much of the time. We did get stuck three times, twice on uphill slopes, once in the drainage ditch. Once I slipped getting out to help and got muddy head to toe. Nothing hurt, uh, except maybe my pride. Naaaah.

We arrived home, safe and sound, and with great relief. Trish Bloomquist prepared another of her several tasty meals for us. We recounted our thrills and went to bed. The next day, we spent a long while cleaning up Gary’s Toyota Land Cruiser and prepared for our departure to Dar tomorrow morning.

Idunda and Dennis the Hero!

2011-02-14T06:53:00.000-08:00

Saturday

It was touch and go even yesterday, but the sunshine broke though on a beautiful Saturday morning. What could go wrong?

First off, it rained all night. The area needs rain. It’s a blessing, but another day or two of dryness would not be disastrous for the crops and environment.

Second, Dr. Saga’s meeting, scheduled to start at 9 AM and end at 10, did not. He was specific and adamant that it should, but the others involved arrived at 9:30, despite his admonitions. Dr. Saga is an Assistant to the General Secretary of the Diocese. This is an important position. The fact that those others were late is more a cultural matter than one of disrespect. He had said if they needed work on, he would leave the meeting in charge of someone else, which he did. Our departure was to be 10:30 sharp and we did get going about 11 AM. Not bad!

We were loaded! That is, the vehicle was loaded. We were all high on life. We stopped at Ipogoro, a small village on the outskirts of Iringa. Consider it a suburb. The schedule was to stop at Lulanzi, photograph the dispensary being built, lunch at Idete and on to Idunda. The paved road ends abruptly outside Ipogoro and from there, except for a 2 km stretch which is paved for some reason, the road is gravel or less….

We got to Lulanzi and took photos. The original footings still showed the error. The contractor had made them about double the expected square footage, if I got this detail correct. Inside, Dr. Saga noticed one of the doorways was out of square and ordered it to be repaired. He is an astute man, well versed in many things. He served as general contractor (and bird-dog) on his own home. (He is also an excellent physician, for whom I have deep respect.)

To our surprise, dark clouds were sneaking up on us from behind. We got in the car, but rain quickly followed. The road to Idete is “hapa, hapa,” which I believe is Kihehe for “bouncy, bouncy.” The rain picked up. We know we would get to Idete, but that would be a decision point. We arrived at Idete about 2 PM, no problem. Lunch was waiting, rice, chicken, beef, sauce or “soup” and ugali if I remember correctly. Eating is always preceded by hand washing. One of the women pours warm water on the hands over a pan. It’s always drip-dry. Dr. Saga and I paid attention to the recommendations I made in my brief talk on diabetes. We ate less rice and less in general. Good for us! The rain shower stopped and the sun shined. We picked up District Pastor Patson Lubawa and started out again

The road to Idunda, well, road is a huge exaggeration, is long, winding, muddy, steep and not all that much fun, especially in rainy season. We got stuck in the mud twice. Both times, we got out with a little pushing. Some parts of the, uh "road" are covered with grass, with barely visible trails. Going was slow. Even so, in one grassy area, the trail disappeared for a moment. Suddenly, we found ourselves sliding off the bank and hung up on the steepest slope you can imagine. An inch in either direction would have determined whether we noticed nothing and kept on moving or instead toppling down the mountain slope, end over end, rolling about 15 times. This happened so fast, I didn’t even see my life flash before me. Of course, I’m old, so that takes awhile. Thanks to Don, we remained safe. We got out. The angle of the tippage was frightening. We were completely unable to move the vehicle. To our advantage, we had a winch. Also, there was a strategic tree to anchor the winch hook. (Don calls this serendipity a "God thing." Be thankful for God things.) Unfortunately, even with the winch we were stuck. The truck was overheating, so we wisely shut it off. Unfortunately, we could not get it started again.

As it happened, late the night before, the General Secretary, Chavala, called and canceled on us. We were supposed to have two vehicles since there were so many scheduled to go. We would have had five and four in each vehicle, instead we had seven in one vehicle.

We were stranded. There was no cell service where we were, several km from the nearest village. Lubawa headed off to the village with Msigwa when it was clear we needed help to get out of our predicament. Crazy wazungu! We sat for an hour. In the mean time, we had another shower, so we climbed back in the car. About 6:15, Eunice was tired of waiting so she walked down the road to try her cell. Amazingly, she got Gary! (Consider it another God thing.) Gary called Dennis, Dennis returned the call and said he would leave in fifteen minutes. He did. He said he would fly. He did. We knew it would be 3 and 1/2 hours. Msigwa returned first with some boards we could use to dig away at the dirt we thought was the key to escape. We needed a hoe or a spade. Eventually, about 18 men and several young onlookers arrived to help, with hoes at least. They dug away. It looked helpful. We needed a battery charge; the battery having been drained with the winch did not have the power to turn the diesel over fast enough to start. Someone on a piki piki (motorbike) retrieved a six-volt battery, which did not work. I think we were all crestfallen.

To our surprise, Dennis arrived at 8:20. After three more hours of digging and fussing with the batteries, it looked like we were ready to try pulling the vehicle out. Finally, after several false starts, we were able to pull the vehicle from its one-foot-in-the-grave status without rolling it down the hill, potentially end over end. Of course, it still needed resuscitation. A tow chain was hooked to it and we pulled it to get it started. Whew! What a relief when the lights came on and we could hear it roar!

By now it was midnight. Don led the way with Dennis following. It was winding, steep, muddy, slippery and treacherous. We arrived in Idunda to the cheers of many, including the inhabitants of the two vehicles, at 1:30 AM. We were bushed. Even before we got out of the vehicles, one of the pastors prayed a prayer of thanks. Naturally, he had prayed for our safety before each leg of our journey. Members of the congregation danced and sang. We ate silently. We all slept in our clothes.

Last Night and Today

2011-02-11T06:29:00.000-08:00

Leaving Ilula

2011-02-11T06:25:00.000-08:00

It is Thursday evening here, 9 PM. The guests have gone home and I should be packing. But I will write for a bit first.

Kelsey and I found a new watering hole since the Peace Garden has not been open since the big group left. It is called Namanga Grocery, after a region bordering Kenya and Tanzania. I know the gang would have liked it too. We first went there with Dr. Mango and found the store is owned by one of the nurses at the hospital, Georgiana. Somehow we told her about guacamole, one of the few recipes I know by heart, and told her we would make it for her. We gathered the ingredients with the help of an acquaintance of Anna’s, our caterer. Esther came running out to greet us, so for the price of a soda, she and her son Dominic helped us make the correct purchases. We invited them, Anna, Tura and Lucy, the housekeepers, to our guacamole party. We also ran into Dr. Mango at Georgiana’s Namanga Grocery. Of course out of politeness we joined him for a beer. He informed us that Georgiana was out of town, laying the permanent gravestone for her father, a custom to signify the end of 40 days of mourning. She was to be the guest of honor! So we invited our friend Dr. Mango instead. Why stand on ceremony?

The guacamole was excellent and most liked it (not Esther). I brutalized myself when I sliced my finger fighting with an unripe avocado. I hate it when I do that! The other doctor, Kelsey, repaired it with plastic surgery technique. (A steri-strip from my first aid kit. I didn’t need the morphine.) I have a dirty bandage on it with tomato stains (no blood). In the morning I will trade the bulky bandage for a BandAid, supplied by Anna, my own supply decimated by other minor emergencies over the years and never replaced. Wow! That sounds like Africa!

We had a great time. Sadly, we will miss Anna, charming, attractive and a good cook.

Tomorrow we will say our formal goodbyes at devotions and morning report. Sometime before noon, we will go to Iringa and spend the night. We will leave for Idunda in the morning with a big troupe. (As I write this, we had a big lightening strike and the power momentarily went out. I think Idunda may still be questionable.)

Kelsey and I were chuckling about how we have adapted. This morning I said to her, “Now there’s something you won’t see in the hospital at home.” It was a chicken walking around the hospital wards. The walls need patching and paint. There are no screens on the windows, some of which have broken glass. The only imaging equipment available to us is ultrasound. Thankfully, Dr. Saga reads them well. There is an x-ray, but simple as it would be to flash the film, it is not legal without a certified technician. We have no hemoglobin reagent (coming tomorrow?), so our clinical assessment must suffice, crude as it may be. We can test for HIV and malaria, contenders for diagnoses 1 and 2 in incidence. We use syndromic patterns for most diagnoses, like Typhoid and acute watery diarrhea.

Friday afternoon at Neema

We have left Ilula. We had many goodbyes this morning, several repeated several times. All the people at Ilula were gracious and helpful, tolerant of our lack of Kihehe and Kiswahili, the local languages.

The drive to Iringa is beautiful. We arrived safely. At one of the phamacies, Kelsey and I put in an order for drugs we are taking to Idunda in the morning and cabbed the two big boxes back to the NSSF apartments.

Tonight it is Roger Bloomquist's birthday and 11 are going out to dinner with him. We still won't match any Tanzanian choir in our "Happy Birthday" song. Our present to Roger (and Trish) is our presence at their apartment over night and Monday.

I am planning on having Monday in Iringa to do a little shopping, for what I am not quite sure. Then Tuesday already we are tagging along to Dar es Salaam and the final leg of our trip. Kelsey will be meeting Amy and friends to spend a few days in Zanzibar and me, home.

If you have read this far, you surely saw the photo of Kelsey dangling off Gangalonga, but don't worry Gail and Vance, you also probably guessed we rescued her! Of course, it was a cliffhanger, as you can plainly see. To know she is well, simply look at the Isimila photo, taken after Gangalonga.

It is now raining a torrent. This is much needed, but only tomorrow will we know if we can get beyond Idete. (This is a lot like the end-of-the-season shows on TV isn't it? So stay tuned....)

Cliffhanger

2011-02-11T06:06:00.000-08:00

In Ilula, February 6-9

2011-02-09T05:23:00.000-08:00

Sunday Feb 6

The last several nights we have been without electricity for several hours. It goes out about dusk or before and comes back on around 11 PM. I believe these are planned outages. Tanzania relies on hydroelectric power and without rain, no rivers, no electricity. So this way they conserve. All of TZ is in the same time zone, so there is no rolling across the country. I do not know if all the cities are treated the same, e.g. whether or not Iringa goes out to at the same time Ilula does. Last night was unusual. Off at dusk, yes, but off all night. This is not good at a hospital. Currently, no pun intended, the hospital generator is offline. It has been sent to Iringa for repair and should be back in a day or two. I understand that the hospital will get another electric line to satisfy the growing need for power on campus. That will be good, but not without emergency back-up.

We watched Jeremy Rifkin on my MacBook, downloaded last spring, if I remember. It was very interesting, indirectly answering the question, “Why are we here?” Not the existential question, but just why in Africa doing what we are doing. It has to do with empathy, but read the book or watch the video on iTunes (Jeremy Rifkin, “The Age of Empathy”). It is worth an hour.

One of his over-arching ideas is that we (the world) need to have distributed energy instead of the centralized carbon-based energy sources we have. Of course that means solar, geothermal, maybe wind in our backyards. It would solve the problems in the poor countries, since development of a grid could proceed and isolated places like Idunda and even Ilula would be less dependent on the wait for the power grid.

Sunday

What does a Tanzanian do for fun on a Sunday afternoon? In general, have no idea. But I know what we did today. Kelsey and I skipped rounds this morning because I had promised to take photos and offer a greeting at the 8:30 service. I have promised that I will take the message back to their partner congregation, Chisago Lakes. My understanding is that no one from Chisago Lakes has visited Ilula. They support one student, Felix, a nephew of Pastor Muyenze. Felix just passed his Form Four. Many, many students did not, especially at the public schools. As an aside, a criticism of American teachers teaching here is that students are taught "to the test." Profs teaching at Tumaini U report the inability of students to think critically, a consequence of teaching to the test. Sounds like a criticism we hear from teachers at home.

The Ilula Lutheran Church wants their companion to know about them (and visit). They have plans to enlarge their church and finish the pastor’s residence (100 bags of cement for the house).

But the big deal this Sunday was that their youth choir was having a fundraiser to buy guitars, an amp and a mixer, 2,000,000 Tsh (about $1350 USD). At 2 PM we went to the District Office, near the hospital and the church for this celebration. The choir sang many songs and there was a featured guest speaker. She is a professional singer, I think originally from the church. Then there was an opportunity to contribute. After that, an auction for a special cake. Between the two, I emptied my wallet. I still didn’t win the cake. (Don’t worry Sweetheart, there wasn’t that much in my wallet at the time.) The woman who did win, Rita, a nurse at the hospital, donated it to the party and everyone had a little taste.

We were served lunch. This is the way in Tanzania. By about 6 PM, the party was over. Our caterer, Anna, found a locked door at lunchtime since we were gone, which meant she had to make a second trip, which she did without complaint. I know she likes us, but she is gracious to a fault!

Tomorrow we have visitors from BKB so we will accompany these wazungu to Image school.

Monday

I have a haunting image to share. But I have decided not to upload the photo of a baby with end-stage HIV. The mom brought the baby to clinic with profound malnutrition and deadly dehydration. If the baby has HIV, so does the mother. The infection may be passed in utero, but also in mother’s milk. So she needs drugs during pregnancy and after if possible, if the baby is to survive. Sharing the photo would be an effort to bring to you the reality of this devastating disease, but you will need to take my word for it on this one. The infant died about two hours after admission to the hospital. Can you imagine the anguish of the parents? First the emaciation, then profound suffering and finally death.

On a happy note, the wazungu arrived. The first stop is always the administrator’s office for a history of Ilula District Hospital. Dr. Mango is always gracious and hospitable. Next I got to lead a tour of the hospital campus. Despite being a small group, I gave them the full load. Pastor Marty Ericson had several along from Como Park Lutheran and others from Immanuel or friends of Immanuel: Dick, Jim, Barb, Phyllis, Terry, Al and Sue. I think I got everyone’s first names. Friends, pole sana about your last names. (At least two who were planning on coming were rerouted from Cairo to Europe, then back to the US.) We had box lunches they were kind enough to bring and Kelsey and I accompanied them to Image School. Terry stayed with Dr. Saga. She is a nurse who practices healing touch.

We had great conversation on the bus to and from Image. They dropped us off and were on their way to River Camp near Iringa for dinner. Speaking from experience, they will enjoy it! Thanks for coming to Ilula folks!

Wednesday, February 9

Yesterday it rained all afternoon. It REALLY rained. None of this brief little shower business. The 5 gallon pails the staff collects rainwater in to boil for coffee were filled in minutes. Of course that’s run-off from a roof, but it rained hard. The rain is badly needed for the crops. I am thankful for the rain, but it raises a cognitive dissonance. If there is rain in Idunda, we may be unable to go. It is simply too dangerous. The mountain roads and sheer slopes can swallow a vehicle. When we were in Idunda in 2006, we had some wet roads and even got stuck on the way home. We simply need to be prepared not to go if they have had rain for three days before or if they have one rainstorm like we had here. It means the medicines and gifts may have to wait. The pastor at Idunda called Dr. Saga this morning to report the roads are good, but I am quite sure Dr. Saga was not convinced. We will see what the weather brings us in the next two days. Both Kelsey and I would truly miss the opportunity, but there is real danger.

The bishop was here for a meeting yesterday (lasted several hours), but had no need to greet the wazungu. I think the Bibis (my mom and Nona, the Bibis) were the main reason we had audience with him in 2008.

This morning I delivered a short lecture presentation about Diabetes 1 and 2. I made the Power Point from memory (I was glad to realize I know some stuff after feeling so lost the past couple weeks).

The Tanzanians were certainly engaged and asked good questions at the end of the talk. It was very fun. Today rounds went well with Dr. Sevelo, who is a good teacher and patient with the wazungu. I delivered a short bedside treatise on a common fungal infection. I couldn’t help myself. I finally knew about something! (Ok, it isn’t quite that bad.)

Early this afternoon, Kelsey and I walked into town. A woman named Esther, who I thought was all of 16, recognized us and introduced her son of about that age. For the price of a Coke, they helped us find the makings for guacamole, a recipe I know by heart, but the Tanzanians are unfamiliar with. It was to be a demo for one person, but now we will invite a few others to try it out. It will be close to a wazungu party. An African party would surely include music and dancing.

Isimila Stone Age Park

2011-02-05T06:54:00.000-08:00

Ilula

2011-02-05T05:18:00.000-08:00

Feb 1

It is evening. I am sitting on the Guesthouse porch, looking out across the savannah to the very old mountains. It is warm here, about 85 F. The clouds have been rolling in, there is thunder in the distance too, but this has happened several times the past two weeks without bringing the rains. I have developed a favorite mountain, though I am sure to the mountain it hardly matters. There are gray clouds above it that earlier blended with the mountaintop. This time of night, nearly dusk, that mountain looks like a blue screen with the mountain projected onto it. It’s north and the road to Image school and village heads toward it. In the west, the clouds have mostly cleared, but the sun sets far enough south that the view of the sunset is blocked. It has been hot today and just now cooling a bit. In the air is the scent of burning grass. I don’t think it presents any danger. The view is spectacular. The only thing marring the view is the satellite TV dish directly in front of me. Africa is a place of contrasts and contradictions.

Earlier, Tura and Lucy, the housekeepers, who speak mostly Kihehe and Kiswahili, were watching a Spanish soap opera dubbed in English. They were rapt. I didn’t laugh but seeing this over-done soap performance I found quite comical.

Kelsey and I walked to Anna’s café to buy some water. She had a couple of singles, but knew we needed a couple boxes. She walked us to the duka that had the water, we paid for it and she insisted on carrying one of the boxes – on her head of course. So I tried my, uh, head at it too. I needed both hands. Then she called to one of her young friends. I think she has daughters the same age. The girl, form 4 in school, is named Esther (hi mom!). Of course, she grabbed the box, deftly hoisting it to her head. They walked us all the way back to the Guesthouse. There is no arguing with beautiful Anna. She and Esther left, so I thought it was safe to wash my handkerchiefs and my sandals. Nevertheless, I felt guilty and hoped I would not be caught!

The contrasts and contradictions do not stop with the ancient and the modern. Dr. Saga went to Iringa today, so Kelsey and I made rounds with Yunfwa Sovelo, MD. He apparently is finishing his internship and today was his last day at Ilula for nine months, if I have the details correct. I think he was sponsored in medical school, so the hope and contract (unenforceable) is that he will return. He is highly knowledgeable and a great teacher. I hope he sees the light and will spend a few years here.

Today we saw pellagra, a vitamin B3 deficiency that causes dementia, diarrhea and a terrible skin condition. The elderly man had lived on pombe too long. We saw Kwashiokor in a child about nine months, with a swollen round face, swollen legs and deteriorating skin. Yunfwa said this could be corrected in three weeks with proper nutrition, which the child will get here in the hospital, but will take three months if his mom can afford the formula and uses it, since he will be discharged before he is better.

We saw a very old man actively dying. His devastated son asked Kelsey if there was something we could give him to ease his pain. They have morphine here, which is what we would give him at home. The situation is subject to the “double effect.” That means that in giving him enough to make him comfortable, we might give him enough to suppress his respirations. I do not yet know what the cultural norm is here. We will ask Dr. Saga. At home, this creates terrible cognitive dissonance. Doctors often fail to give enough morphine to alleviate the suffering for fear of legal repercussions. Think of the fear mongering surrounding “death panels,” so feared by some.

Kelsey saw a normal vaginal delivery, but the umbilical cord stump was swollen and hemorrhagic. Was it simple cord trauma? This happens. Or was it a sign of intrauterine infection? We started antibiotics.

We were worried about a 12 year old with peritonitis. As it happens, she was too sick for the surgery she would have gotten in the US. She died today. It’s complicated. No malaria smear, highly unusual. No hemoglobin – ran out of reagent to perform the test. We suspect she somehow had a perforated bowel. This could happen with appendicitis or a parasite and even typhoid.

Now in the quiet, we reflect on the above cases, intellectually, pragmatically, compassionately. Never forget that despite the terrible stories we write about, these are caring people, doing the best they can with what they have. We can best help by working shoulder to shoulder, helping with incremental improvements. Above all, be thankful for what we have at home.

Ken

Feb 2, my birthday

And memorable it was, too. After all, I am in Africa! Of course we did rounds this morning. In fact, it was consultation rounds with Dr. Kawono, Dr. Ndipisi and Dr. Saga. We have been pondering a 48 year-old woman with ascites (fluid in the abdomen). Unlike the Pellagra man, she does not imbibe, a common cause of ascites in the US. The main other differential point would be cancer at home. There are heart causes and liver causes too, but they are not in this picture. TB is, however. She is already treated with standard antibiotics, so it likely is not Typhoid. Now a dilemma. We have no tests to determine what she has. Even doing an open biopsy won’t help, since the nearest pathologist is in Dar. We cannot culture, we cannot image. She cannot afford to go to Dar. Ultimately, she was committed to a course of anti-tuberculosis drugs. They are toxic to liver, but it seemed the best choice. The only choice for her.

Dr. Mango, DDS, MPH, and his dental staff did a nice presentation on complications of pulling teeth. They are doing a week-long series on dental problems for the medical staff.

Birdie spilled the beans about my birthday and Don Fultz called to wish me and sing me happy birthday. He has a good voice.

Later Dr. Mango kindly brought me his last week’s worth of English papers. He took Kelsey and me to get today’s edition and then bought us a beer. His family is in Dar and he only sees them every two months. So we had a party of four. Georgiana, one of the nurses also runs a little duka, which supplied the beer. This time, Kelsey, the only one I had told, spilled the beans about my b-day. So they sang happy birthday to me for the second time today. No cake though. I think I will ask for a chocolate devil’s food cake with Bunny’s boiled chocolate frosting when I get home.

Feb 3

The porch again. I napped nearly an hour and a half this afternoon. My favorite blue-screen mountain is back today. We did get a little rain yesterday. It wasn’t an all-dayer unfortunately, just a teaser, but real rain, not just sprinkles. Kelsey was reading, trying to figure out a patient from rounds. I joined her and read a couple hours from “Tropical Infectious Diseases.” Interesting reading, but there is definitely stuff the average person doesn’t want to know. It’s fascinating reading about things we are seeing daily here that I literally haven’t thought about since med school. On rounds, Dr. Christopher Mbata asked me how long I had been practicing medicine. “Thirty-six years,” I answered. “But I am a baby in tropical medicine.”

There are many questions we do not ask. They fall into several categories: 1) questions we cannot ask because we do not have the equipment or tests (gee, I wish we could get a CT scan), 2) questions of curiosity where we won’t use the information in treatment (at home it’s “Doc, should we get an MRI?”), and 3) questions we do not want to know the answer to. A version of this last question is nevertheless asked frequently, “PITC” or Provider Initiated Testing and Counseling: Rapid HIV test. The docs are very careful about this test. You can infer it is ordered surreptitiously. Important as it is clinically, it is also stigmatizing. Unlike the US, where we give information very directly, as Dr. Saga says, here the results are given obtusely. The HIV positive patients are members of the CTC Clinic (Counseling and Treatment Clinic), where they receive education and Anti-HIV medicines, provided free by the government. The ratio of M:F is 1:1.4 overall, but in 15 – 25 year olds, it is about 20 times more prevalent in women. Some of those young men get around! It is 95% heterosexual transmission if you are curious.

A huge concern is that possibly 35% of Tanzanians are HIV positive. It is important to see HIV as a chronic illness that can be controlled.

Kelsey and I fretted about a child with pneumonia and wheezing. They do not have the inhaled meds we use routinely at home. They still us aminophylline, which we essentially abandoned 30 years ago, due to narrow therapeutic range (toxicity) and low effectiveness. In general, with some obvious exceptions like this one, the national Tanzanian formulary has most drugs equivalent to drugs we have, just not the massive variety the US has.

We finished rounds and attended the dental education session being held daily this week. After the conference, we attended the Perinatal Mortality Committee meeting, where every maternal and newborn death is discussed, with attention to what could be done in the future to avoid similar problems. As an example, on infant died after mother’s uterus ruptured. She had had a C-section for her first baby. She went into labor and did not come to the hospital as she had been instructed. In the US, we do many vaginal deliveries after C-section, but they all must be in the hospital and observed closely to avoid this problem. She likely would not have lost the baby had she come to the hospital. The Ilula staff is very capable at doing C-sections.

Ken

Church in Iringa, Isimila and Guacamole

2011-01-30T05:20:00.000-08:00

Sunday, January 30, 2011

Lat night Amy, Kelsey and I had a great time with the Fultzes and the Langnesses, talking smart and laughing a lot. Following some wine or beer and popcorn, we had dinner where Gary and Carol lived a half-dozen years when in Iringa. They sold it and now it is a small guesthouse and a big, great restaurant. Oh it’s nice to be on vacation!

This morning, I went to the Lutheran Cathedral church in what to me is downtown Iringa. But then, I consider Tumaini in the ‘burbs. When I got back, Kelsey asked me, “How was church?” “I don’t know. It was in another language.” Well, I did figure out when the offering was occurring, at least the first time. I also did OK with communion, recognizable in many languages, I am quite sure. Here is another problem with my Swahili. Even when I have the correct words, they are virtually incomprehensible to the Tanzanian on the street, even when I say the words louder. These people are so polite, they rarely smirk at me.

The church is very beautiful, not exactly in a St. Peter’s Cathedral in Rome way, but definitely compared with the several rural churches I have been. Interestingly, though the Cathedral choirs were good, the rural churches have no equal! They are enthusiastic, in tune and have their music memorized. I certainly do not wish to take anything away from the big church. Consider this an endorsement of the rural churches.

We went to Isimila this morning – church was 7 – 9 AM, so we went around 10. It is just as astounding this time as the first two. The massive spires are yellows, reds and rusty oranges. There are stone-age tools, knives, scrapers, spear heads, chisels, hammer stones and round rocks for slinging that were fashioned 300,000 to 400,000 years ago. The University of Chicago had a team out here in 1957 or so. Ah yes, I remember it well. It is definitely on the list of must-sees, unless you are over 80 years old or fossilized. There are some parts of the trek that are a bit treacherous. No untoward events befell us, however.

Coming back from Isimila through the Iringa suburb of Ipogoro, the escarpment is obvious. This reminded me that I should say something about the road up the escarpment. They were working on it in 2008 when we were here. It is now complete. It is a great new road. The trucks, cars and pedestrians aren’t any different, however. They are where Steve Martin got the idea for “wild and crazy guys,” I’m pretty sure. We had a good cab driver, “Jay 4.” There’s a reason for his name, but I cannot remember it.

We got the fixings for guacamole, so we are going to invite ourselves over to D&E’s for happy hour. Hasty Tasty ran out of chapatis, so we are chipless. We will improvise.

It is back to Ilula tomorrow and work. It will be good after this little respite.

Ken

Iringa

2011-01-29T06:14:00.000-08:00

Jan 26, 2011

Amy, Kelsey and I left Ilula for a few days for Iringa before Amy is off to her Arusha adventure. She will be meeting two friends for safari in Ngorongoro Crater and Serengeti. We will go to Neema Crafts to see how Beatrice does therapy and perhaps go to the regional hospital for a tour also. I have some emails to catch up on and the blog you are reading.

The rest of the big group leaves Ilula for Dar tomorrow and then home. They will attend the devotions in the morning, catch up on a couple patients and head out when Becky and Lamont Koerner arrive in the bus.

We said our good-byes tonight, with appreciations for all. It was a pleasure and a treasure to have both David Page and Scott Lien with us representing Global Health Ministries (GHM), even for a short time. Scott is Director of Operations. David, who was CEO of Fairview Systems retired in 2007 and is now devoting time and energy to GHM board work. Scott is doing a whirlwind tour of many of the hospitals GHM supplies. They bring with them passion and an infinite depth of kindness and caring. We heard from them after they arrived in Dar – going out to dinner at some swanky hotel.

Friday, January 28, 2011

Yesterday, the three of us went to Neema Crafts and were given a great tour. When you visit Iringa, you must eat at Neema Café, buy stuff at the craft store and possible use the Internet services. But more than that, seeing 100 Neema employees at work is the most important. Each employee has a disability. Some are significantly crippled, some are deaf. All work. I have seen others like the man who walks on hands and buttocks, dragging his lame legs from a seated position. He is not without his flip-flops when moving. He wears them on his hands. In the craft area, actually a small factory, they make elephant dung paper (don’t worry, they boil the fibrous dung before it becomes paper), paper beads (long wedge-shaped papers wrapped and glued around a wire, then dyed and strung), beautiful woven fabrics on variously sized looms and, among other crafty projects, beautiful lamps. I will have to try to get a lamp home somehow.

In the afternoon we hiked up to Gangalonga Rock. There is a reason it is named. It is a huge landmark. We climbed it and stood over-looking all of Iringa. Although I have been there before, two things stand out. First, I am older and still made it just fine, although I think it qualifies as a maximal cardiac stress test. Second, it is just as impressive the third time as the first and second.

We had a delightful dinner at Lulu’s with other wazungu: Roger and Trish Bloomquist, Don and Eunice Fultz and Carol and Gary Langness. I am pretty sure I didn’t let anyone else get a word in edgewise, since it was such a relief to be understood. The food was satisfactory, but the orders seemed mixed up and unfamiliar compared with the US versions of same, like Mandarin Chicken. Hmmm. To top it off, they ran out of rice. You read correctly, ran out of rice! Don’t worry, we did not leave hungry.

This morning, I went with Gary and Carol Langness and Amy (she’s from Huruma) to pick up new sweaters for the kids at the orphanage. Then we went to Huruma where I got to meet Mama Chilewa.

That was fun! I took some video.

In the afternoon, we had a tour of Tumaini U. Gary Langness gives a great history of the school. I took a lot of video and basically got the story on video. There may be a happy medium in how fast one pans from one scene to another. I remember my dad’s efforts with the Super 8. Zip – zip – zip! I did some zipping myself and on the other hand some verrrrry slow panning. Peter Harrits has nothing to fear from me!

Saturday, January 29, 2011

I tried to call home a million times this morning, about 5:30 AM here and 8:30 PM there last night. Birdie said the call registered, but nothing happened, highly consistent with my own experience. But I got charged for each and every failed connection. I have no idea.

To give me a little positive reinforcement, I went to see Don and Eunice to see if I could get their Magic Jack (MJ) to work right. We managed to get it straight eventually. Couldn’t fix a couple computer things. Oh, well. It did hurt my ego, but my foot is sorer than my ego (from booting the thing).

Some things in Tanzania are EXACTLY the way they are at home.

Ken

Maasai kids

2011-01-29T06:12:00.000-08:00

Lame elephant? Nope. Just showing off!

2011-01-28T03:09:00.000-08:00

Tungamalenga and Ruaha

2011-01-28T03:01:00.000-08:00

Saturday.

It was a pretty long day. We started by getting Dr. John off to the bus to Dar. We heard later he arrived without a problem and I am guessing now, 9 PM and after a nice dinner at Sea Cliff, he is at the airport, awaiting the 12:30 AM departure.

We went into Iringa and had time to go to the internet café, then a nice lunch at Neema Crafts. We had hoped to get drugs for the dispensary at Tungamalenga, but were unable to. Also, our intent was to survey a few large pharmacies to find out what kind of resources they have and what education they provide their customer-patients. That didn’t work out either. Perhaps Kelsey and I will be able to do that in the next couple weeks.

It is easy to live here for a few weeks with the inconveniences our Tanzanian brethren live with every day, all the time. Ilula has electricity and they will be getting another line in sometime in the near future (African time). The water is cold for showers and the drinks are warm. Much of the cooking is done over charcoal fires, so they live with smoke. The food is just fine, though limited in variety: rice, cabbage, plenty of fruit, a few veggies and lots of potatoes. The meet dishes are mostly chicken, some pork, although we have had mostly beef.

Tonight we are at a “camp,” although we haven’t seen any campers. It is a hotel with tent spaces. Dinner was fine. See the menu above! They charge quite a bit for what you get (we think), what the wazungu market will bear I suppose.

We went for a walk through the small Tunga market and several of us tried pombe, a local fermented brew from corn and perhaps millet. Tasty! Well, it did have the faint odor of beer, call it more an odor than a “bouquet,” and gritty. A beer a real man could get his teeth into. There was a place that sold hors d’ourves to the, uh, drinkers. They would come to the take-out, order a kilo of pork, which then was sliced off the leg or shank (I’m not familiar with the butchery terms). The client pays, then the pork is chopped into bite-size pieces and barbequed on the spot. When the customer is sated, it’s back to the club for more pombe.

It is Sunday now. We had a leisurely morning, with a nice Spanish omelet, a sausage of some kind and fruit juice. We put in some practice time on the song we knew we would be expected to sing, “We are Marching.” To add even more humility to our endeavor, we sang a verse in Hehe, the local dialect:

Ndigendela lumli lwa mtwa,

Ndigendela lumli iwake

Worship was very nice. We kept expecting to see the Augustana bunch arrive. We thought we were racing them to Mwagusi Camp. As it turned out, we met them coming away from the camp. They had spent only one night here and were leaving. They had spent some time in a park in the north, perhaps Serengeti.

So after a round about trip, we are now here. We had a tasty and filling lunch: beef strips, chips, guacamole, tomatoes, tossed salad, cold fried eggplant with honey, soda pop, including “Coke Light.” This camp is nearly heaven. Spend a few days here as soon as you can! Chris Fox is a wonderful host and the staff is top notch.

Momentarily, we are off to the afternoon game drive, so I will close now and gush about the animals when we get back.

Whoa! I did not think we would be able to beat the previous drives I have been on, but I think we did. I don’t intend to catalog the animals on the blog since it would take all day. I will include a few special photos, so you will believe my stories when I get home. We found ourselves with no one else on the drives. In the Serengeti, sometimes queues line up for an hour to see two lions. We saw five or six from twenty feet. This is the place to be. Explore the Mwagusi web site!

At dusk, we got back to camp for another delicious meal, this one on the dry river bed. They do need rain here, so I wouldn’t mind if it did; like in the BWCA, rain is the dues you pay for the wondrous pleasure of God’s earth.

Wow! Another couple of game drives! I think I will try to impress my grandson with a couple. We were 10 feet or so away from the lions, maybe 15 from elephants. Giraffes are beautiful but not as plentiful as I remember. Becky Koerner wanted a photo of a Dung Beetle. We have them in action. She will make several enlargements for her office day, including the Dung beetle as a pictorial representation as to what kind of day it might be. Sometimes you’re the bug, sometimes you’re the windshield.

David Page and Scott Lien have joined us. We picked them up at Ruaha International Airstrip and they stayed with us on the game drive. To our delight, we have another game drive in the morning, then back to Tunga to pick up Amy and Randy, then Iringa and Ilula. They stayed back to be around Tunga. Amy wasn’t feeling well and it was her birthday too.

She is recovered now. She had a good time in Tunga, if disturbing in some ways. She is keeping a blog too, so visit: http://safarinjema2011.blogspot.com/ , she’ll tell you more!

Beth, Pr. Samson Mkemwa (head pastor) Pr. Makongwa (asst. pastor)

2011-01-27T08:17:00.000-08:00

Makungu

2011-01-27T08:14:00.000-08:00

Today, Ken and I made the journey to the village of Makungu, about an hour and a half drive from Ilula. The Makungu parish is the companion congregation to my home church of Abiding Savior Lutheran, in Mounds View, MN. Our congregations have been linked for several years, but I was the first person to visit.

We left at about 9:00 am with Pastor Yusto from the Iringa Diocese and headed out on the dirt road toward Ilula. The drive was beautiful as we wove our way into the mountains. The road was narrow and steep, and covered with potholes and craters from the rain.

We arrived safely in Makungu, and were welcomed by the pastors. They welcomed us into the parsonage, where Rev. Samsom Mkemwa (the head pastor) lives. His wife prepared us tea with snacks. We had chapattis and a savory banana dish. I drank a cup of tea that was brewed in warm goat’s milk. While we ate, members of the congregation began to gather outside singing, dancing and playing instruments. They sang songs in both Swahili and Hehe, and did the traditional Hehe dance that we’ve come to know well.

The congregation escorted us into the church, where Ken and I were ushered to our seats at the altar. Rev. Mkemwa expressed his thanks and appreciation on behalf of the congregation. They had waited many years for a visitor from ASLC. Although we had been planning this trip for two weeks, the congregation did not find out about our visit until yesterday. They prepared a beautiful celebration for us on very short notice. After Rev. Mkwemwa finished speaking, it was my turn to speak and do introductions. I introduced myself in Kihehe then switched to Swahili for a sentence or two before turning to rely on Rev. Yusto to translate for me.

I sent warm greetings from Abiding Savior, and thanked the congregation for the very warm welcome. I assured the congregation that the people of Makungu have always been in our prayers, despite our lack of communication over the last few years. I told them how we looked forward to renewing our partnership and moving forward together. There were no hard feelings, as people clapped and cheered.

Next came the exchange of gifts. Rev. Mkemwa presented us first with African clothing that had been made the night before for us. I received a dress, Ken received a shirt, and Rev. Mkemwa also put on a shirt of the same fabric. They then presented us with several more gifts: woven baskets filled with passion fruit and eggs, pineapples, and home-grown coffee beans. The fresh food is for us to bring back and share at Ilula, the rest is to bring home to remember Makungu. I then presented the gifts sent from Abiding Savior: a photo album, several prayer shawls, a quilt, calendars, and the many toothbrushes and toothpaste we had collected.

Pastor Lisa had written a letter to Makungu, which I read on her behalf, and also sang to them our weekly benediction “As you go on your way, may Christ go with you. May Christ go before you to show you the way. May Christ go behind you to encourage you. Beside you to befriend you, above you to watch over, within you to give you peace.”

The choir then sang for us, and people started doing the Hehe dance in the aisles, which I joined in on. Finally, after the dancing was done, we went back to Rev. Mkemwa’s house for lunch. His wife had prepared rice, beans, chicken, and a tomato sauce. After lunch, we took a few pictures with the congregation before heading back to Ilula.

Beth

Even beautiful creatures have their awkward moments!

2011-01-27T08:08:00.000-08:00

Aussie blog

2011-01-27T08:01:00.000-08:00

When we, “the Aussies,” first planned this trip, we had no idea what we were in for. Never would we have expected the array of medical, cultural and social experiences we have had, which we shared we both the Minnesotians and Tanzanians.

The hospital here is very small yet services a huge population in neighbouring areas. We were shocked to see the lack of resources, yet impressed and inspired with the important work done by the staff at Ilula Lutheran Hospital with so little. Our infectious diseases knowledge has grown immensely. Coming from urban Sydney we had only seen one case of malaria between the three of us. It took some time to adjust to a place where ‘fever and diarrhoea’ signify malaria until proven otherwise and was treated empirically whether or not the blood smear was positive or negative. Similarly, the exposure we have had to HIV medicine has been a great supplement to our prior knowledge from Australia; here, we were frequently seeing the consequences of AIDS, including opportunistic infections and malignancies.

One of the busiest areas of the hospital is the maternity unit and we’ve loved attending natural births, ceasarean sections and checking up on the mothers and their infants. The staff at Ilula have all been so helpful and have really made the visit wonderful. The relationships we’ve formed with them and the local people in Ilula have really cemented the visit and made us feel a part of the community, not just visitors to it.

We’ve also very much enjoyed the cultural side of things at Ilula. Thinking we’d be able to get by on the (very) minimal Swahili we crammed before we left Australia, we were a little bit disappointed to hear that most people in Ilula actually speak the tribal language, He He. We were up for the challenge and with our secret weapon (He He guru Mwa Moody) on board, we were introducing ourself in He He in front of the Lutheran congregation at church in no time! There is so much to talk about in terms of culture here; from the food, language, customs of greeting and introducing people, gender differences, all the way through to watching the kids walk to school balancing hoes on their heads to practice skills for working in their shambas.

As a treat at the end of our trip we took the bus to Tungamalenga, a village just outside Ruaha National Park. One evening we took a tour of the village and were stopped by locals in order to try some of their “pombe” (bamboo juice). The next morning we sang in church (in He He) and then headed of for a two-day safari stay in the park. Needless to say the hot showers and beautiful accommodation were much appreciated, as were the safari drives for some light relief after the past three weeks.

Overall, there have been ups and downs in all areas of our trip but the most important thing is that we have achieved what we set out to do: experience medicine in a developing country in order to start us thinking about what our roles can be in the future to aid in such endeavours, to form lasting relationships with the people we work with and above all, gain an understanding of the culture and lives of the beautiful people of Tanzania.

Chantal, Sarah and Trish

2011-01-22T01:37:00.000-08:00

The Aussies - Chantal, Trish and Sarah

An exotic flower we named Audrey

Asifewe's two daughters

The baby

The Ilula Medical Friends

Is it Jan 19 already? Or 20? Or 21? 22 maybe?

2011-01-22T01:06:00.000-08:00

Time is flying. Gary Moody is going home in the morning, leaving for Iringa at 6 AM. We spent time tonight debriefing the day after rounds in the morning, a visit to the dispensary and school at Image (ee-Mah’-gee, not Im’-ij). The dispensary needs to be replaced. There is land set aside by the community. Now all the need is, you guessed it, money. I wish there was more to say, but there is not. Birdie and I visited the school in 2006 on our first trip to Tanzania with the St. James group. The Headmaster was Ngogo. I remember how impressed we all were with his vision and leadership. But all that was there was a set of three buildings, a few foundations and a lot of strings outlining the future buildings. They had students, but I do not remember how many. Now there are many buildings completed and 840 students! After the tour, the kids sang for us and danced for us. I can confidently report that “a good time was had by all”! When I get home, I may post a little video, but not now because the internet is too slow.

Randy has developed some discussion topics that have produced some lively conversations. No conflict, just some thought provoking ideas, like how do we suggest change without offense. We need to be especially careful of not practicing “knowledge paternalism,” i.e. thinking all our answers are right. Some pretty high faluting ideas came forward. Randy is thinking how culturally contextual the term “corruption” is. Compare our individualism with African collectivism. In the US we may see a manager taking a chicken home to his family as stealing or embezzlement. Here the same action might be seen as sharing the wealth. It is difficult to get one’s head around in one sentence. Each culture defines itself in its social context. I think a relativistic question we can pose to any culture is “How does this practice (insert social norm, more, behavior, custom, etc.) advance its society?”

Tomorrow we have a group of US visitors touring educational and health facilities touring the Ilula District Hospital. They are from Augustana College! What a treat it should be. Well, at least one of our group is looking forward to it!

Ken

Jan 20, 2011

First, happy birthday from Africa, Mom (Esther W. Olson)! The temperature here is about your age, Mom and in Minnesota, I presume about the ages of your great grandchildren.

Dr. Moody left this morning. We had goodbye appreciations for him last night. We miss him already and have been calculating where he might be since he left.

Several of the students had opportunity to go to an outreach clinic this morning and one is a little sick. Our Augie groups will be a little larger than we originally planned, but all will be well.

There is a newborn (NB) we have all been fretting about, especially Sara. We feel helpless. The NB came back at 4 days of age with lethargy and jaundice. We cannot measure NB bilirubin. Clinically, the jaundice spread down the body, even to the feet. We also know the baby is quite anemic and we suspect a hemolytic (blood breakdown) process. We cannot test for that either and if we could test for it, we would be unable to treat it (think exchange transfusion). So we watched as the baby got sicker. The baby got an IV, but without an IV pump we have had easy access to in the states, we would have had to drip it (counting drops per minute). This was standard in adults when I graduated from residency. But with infants, it is too easy to fluid overload. We resorted to small, intermittent fluid boluses, until a nasogastric (NG) or orogastric tube could be placed. (A very skinny plastic tube is placed in the stomach via nose or mouth). We saw the baby get cooler and cooler, heart rate drop, go from poor suck to no suck and become ashen gray. He is on antibiotics and we have nothing else to offer, except continuing the same regimen. We expected the worst. Gave up? No. We have been carefully checking morning and night, primarily Sara.

Amazingly, this morning, the baby seems warmer, has a weak suck reflex and seems less jaundiced. We never would have predicted that. He has hiccups. Could be natural, like every NB; could be related to NG position, or worst, could represent brain damage from kernicterus, as a result of the bilirubin being substantially over 20. My grandson Sawyer got to 13, maybe a little higher. When this happens at home, everyone scrambles and we have these marvelous lights to use. Here we have a 60 watt incandescent bulb and we cannot really have the baby undressed for prolonged periods due to worry about hypothermia, so effectively there is no therapy. So, as miraculous as the improvement is, assuming it continues, there is still a high likelihood the baby has permanent brain damage. If he does not die, we will likely never know the outcome. I think this baby will haunt us. I will upload a photo of this sweet boy and his mom.

My gadgets have been useful. The photo of the baby (and many other people), I have been able to give to the human subjects, thanks to the little photo printer I brought. The people have been very grateful for them. We have taken many photos, but except possibly for a brief electronic peek, they never get to see themselves.

We have used my palm-sized projector a couple times. It works great (at night)! What did you expect? It is the size of a deck of cards! Hooks up to the computer well.

Now I have a phone that works in Tanzania. My iPhone works fine – for its non-phone functions. No, I am not playing the games on it. Well, not much anyway!

The students were here. It was great! There were many from Augustana, several from St. Thomas and a lone Gustie. They seemed pleased to be here and Chery Feinstein, Julie Ashworth, Augustana professors, and Kari, the liaison from the trip planning group seemed thrilled to have been here. I have a mild bias I suppose, but our students were professional in every way. They made a fine presentation to students who were extremely interested. See Randy’s story below. I definitely want to connect with someone in the nursing department.

Ken

DEVELOPING A “CULTURE OF LEARNING” AT ILULA

We officially opened the Peter J King Family Foundation Medical Education (and future nurses training center) last evening with the opening honorary guest lecture, “HeHe Proverbs,” given by Dr Gary Moody. Gary has a list of HeHe proverbs: he and our students have had fun this past week trying to think of American synonyms for some of these proverbs then finding photos to match and placing them in a power point presentation. Example “Roar within your stomach like the cow does” might mean “keep your problems to yourself; “The lead cow drinks the cleanest water” likely means “the early bird catches the worm.” We then had our students give us a power point presentation about the cases they had seen this past week: malaria in pregnancy, malnutrition and malaria, an ultrasound diagnosis of a ruptured ectopic pregnancy, a case of large bowel volvulus that was operated on etc. Several of the students have delivered babies with the help of Tanzanian nurse midwives; one of the mothers named her baby “Sara”, after our student, Sara Tonsager who participated in her care. Sara and Sara are now “soul sisters.”

We have made a point of telling the staff at morning report this morning that the new Education Center is theirs. It is for all of the health professionals at Ilula, from the medical attendant students, to the nurses and midwives to the doctors and clinical officers. It is also for the people of Ilula: for the secondary school teachers to gather and learn health information that they can share with their students, for education of community health workers, and for pastors to gather to learn health information to pass on to their congregation. We talked about developing a “culture of learning”, how when students challenge and ask questions, that it actually improves the care of patients. After that talk, we all observed a noticeable change in how ward rounds were conducted: a great start!

We hosted a group of 29 college students from Augustana, St Thomas and Gustavus this morning. They are on a 1 month J term trip learning about health and culture in the area and stopped by the hospital. We broke them all into small groups and had our students give them all a tour. Afterward, our students presented their lecture on cases they had seen here at Ilula.

We have an educational theme of nightly discussions going on here at Ilula that hopefully have engaged the students. The focus culminates in trying to understand the meaning of partnership and discussing principals of how to partner well with our Tanzanian brothers and sisters. “How to help without hurting.” Pre-course work included reading a book, “The Fever” (Sonia Shah) about how a disease, malaria, affects a culture. They also read, “Africans and Americans, embracing cultural differences” (Joseph Mbele) to give them a better understanding of cultural awareness. We move on tonight to talking about definitions and causes of poverty and complete our discussions tomorrow with “how to partner well.”

Randy

January 21, 2011

Today is my last day here, and my first post. Ken would not let me procrastinate any more. The day started with some great presentations by our medical students to the entire hospital staff. The presentations covered DKA, diabetic neuropathy, and hypertension. The hospital staff appeared to be very interested in the content of these lectures as well as the process of didactic education, American style. Next we went to a small house in Ilula to visit a patient who had had a stroke. She had been a nurse, but now is unable to work due to being hemiparetic on the left side from the stroke. She continued to receive PT (Amy) and OT (Stacey) treatments in her home. Next I went to visit the CTC (Counseling and Treatment Clinic) where HIV patients are monitored and treated on a monthly basis. They have a great system of record keeping and monitoring the patients to deliver antiretroviral medications according to protocols. Finally, I spent some time with Nixon Mdegella in the outpatient department. He is a clinical officer who has been at Ilula for 10 years. This was pretty much one of the highlights of my trip since, as an emergency physician, this acute care was right up my alley. We saw lots of malaria in addition to trauma (fractures, head injury), infections (hand infection, foot infection from thorn into foot), and assorted sick kids, abdominal pain, and chest pain.

I had to say my farewell to the staff at morning report today. It was a bittersweet moment for me. I told the staff that I wanted to thank them for all the help, learning and hospitality they had extended. I also told them that, having seen how well they took care of us, how well they take care of each other, and how well they take care of their patients, I will be a better doctor and a better person when I return home. The graciousness of the Tanzania people will stay with me for a long time I hope.

John

I spent a little while in the Out-Patient Department (OPD) with Dr. Saga today. I assume I will do this often in the next couple weeks. We saw some memorable cases too: one man brought his chest x-ray which showed a pneumonia (pneumocystis) commonly found in HIV positive people, fortunately easily treated with a common oral antibiotic; a woman came with a whole body rash – Stevens-Johnsons Syndrome. She was checked for HIV (PITC is “provider-initiated testing and counseling”). There is still a stigma being HIV positive. The government supplies drugs for free. The stigma may be changing. One young woman came to the outreach clinic and wanted to be tested. She had been coerced into not telling or being tested by the male who could have infected her. She was of course worried, but when she was tested and despite her fears was positive, she was relieved because now she could be treated.

We went for a walk to the river, currently a trickle, despite the rain we had a few days ago. Today was beautiful with a few scattered clouds and bright sunshine. We walked the travelled paths along the plowed fields an I keep wondering about the ag project and whether they are using any of the practices taught at Tumaini. The soil does not appear to have much humus. I will have to ask.

After the walk, the hospital administrator came to get me to take the photos I had promised to do at the church. Pastor Dani, Alum and I strolled around the church and took some nice photos. There was beautiful singing inside and perhaps a Friday afternoon service. They even allowed me to take a few shots inside.

The Ilula church is partnered with Chisago Lakes. So far no one from there has visited Ilula. I think I have picked up on one possibility, which may or may not relate to the Tanzanian concept of Chisago Lakes. Chisago sounds like Chicago. “Are you close to the Great Lakes?” Alum asked. About 150 miles, I said. Now I am wondering if he may have seen Chicago on the map, next to Lake Michigan. I hope I have the opportunity to show some photos to Chisago Lakes.

This evening we went to Dr. Saga’s home where Dora prepared the best meal we have had. (And our food has been great.) She did tease us a little telling us she had forgotten to make ugali. It was a wonderful night of visiting and eating. As you might guess if you have met the Saga at all, they are truly gracious hosts.

In the morning, we are on the way to Iringa, then on to Tungamalenga and most of us to Ruaha. More after that adventure!

We got word that one of the tour students got a cut with a razor blade, not his own while at a night club. Though his risk is extremely low, he will still be on HIV prophylaxis for a month. I did not like it when I had to take it after a splash in the eye with a patient's blood some years go. It was nerve-wracking, even for the few days.

Ken

January 17 an 18, for sure

2011-01-18T07:11:00.000-08:00

Hurry up and wait.

We have meeting about the Nursing School today at 10 AM. It is 11 AM now. (The meeting finally started at 1 PM, but only because one of the Diocese board members died and details needed attention.) This is an important planning meeting, including many important people, not only the Wazungu, but diocene, regional medical officers and Ilula people. Getting all together is challenging. Visions for the school will be discussed. My understanding is that in addition to nursing training, other CME, e.g. dispensary personnel, doctors and medical officers, will be planned using the Peter King Medical and Nurses Training Center. Later in the evening, we went to the IPO orphanage and school. I cannot remember what that means, however I do know Randy knows Barrett Skare, the Norwegian woman who started and shepherds this amazing place. They are building a high school that will be outstanding. The building has up to date hardware and utilities. I am not sure when it will open. The IPO has the most beautiful garden, maintained by a gregarious comedian named Elesha.

We all ran out of gas in the evening, but through a complicated spreadsheet managed to calculate the in-country transportation bill and collected the funds. I may make it easier if I ever do it again for a big group, as in “Gimme $200 bucks apiece up front and I might give some back.” It was just tough to plan for. We have had the luxury of transport at our beck and call, though we have paid for it.

Jan 18

Today, some did rounds, some other things. Stacey, OT, met a young woman nurse stricken by a stroke only two months after starting as a nurse at the hospital. Initially, she could not walk. Now she can walk but still has left hemiparesis and is developing a little contracture in the left hand. Staci did a stellar job making a neutral position bivalve hand and forearm splint for her (under my tutelage, ahem!). She has the theory, I have the experience. But she did all the work, if I might have gotten a little plaster on my hands too. Our steadfast Bella is a marvelous interpreter and a game assistant as well. Our semi-pro photographer Beth caught it all on, uh, electrons and Stacey will produce the Power Point. Be sure to see it at the local OT training institution near you!

We are on our way to Iringa so a couple of us can get our work permits (first time ever needed by volunteers at Ilula). The immigration officials did not respond to any explanation or reasoning. This is a new way to spend a $100. So the second wave of us decided not to tempt fate (and potentially stir up a firestorm for Dr. Saga and are on our way to voluntarily pay up. I wonder if a Tanzanian jail would be like the tales of Mexican jails? Guess I will try to continue wondering. It took the first group over 4 hours. It’s a PITA! But it took us about 1/3 as long. Smaller PITA.

Randy

We have met a number of amazing young people here: ones that want to “grow up to be doctors and lawyers and such”…teachers, business people, those that can help this community progress and prosper. After working in the pediatric ward at Ilula, it strikes me that these children have such a gauntlet that they need to surpass in order to achieve these dreams.

First, you have to hope that you’ve been given a mother that is sufficiently well nourished to carry you to term, allow for good cognitive development and without complications such as malaria…and that she has access to a hospital that can safely deal with any complications that could occur at delivery. You need to hope you get a mother that does not have HIV and a family that can provide enough nutrition for appropriate brain development. You need a family that can afford to send you to school and hope that the school has competent motivated teachers that can help you excel. You need to make sure someone puts you under a bed-net when you are under 5 years old to prevent malaria and hope that you have access to clean water and sanitation. If, and only if, all these things go right, you might have a chance to compete in this country, a chance to be part of the change that this country is hoping and waiting for.

Ken again
We met the Augustana College education group. Randy bumped into them and directed them to me while I was looking at my email. They will be touring the Ilula District Hospital Thursday or Friday. I suppose I will wear my blue Augie shirt both days. Don't tell.

I got to talk to my lover for a half hour. Boy! I like Magic Jack. Broke up a little, her voice, that is the electrons did. She sounded fine!

Don't know when the next installment will be uploaded. I will try to get the others on paper too, like Randy did. Count your blessings!

Jan 13, 14, 15, 16, I think

2011-01-16T06:54:00.001-08:00

Amsterdam

Here we are at Amsterdam, Schiphol Airport. I have no idea how that is pronounced. I think the pilot pronounced it “Sky’-pul.“ You would think he would know. I also heard “Ski’-pole,” likely a displaced winter enthusiast. It was raining on our arrival, 45 degrees F. I didn’t see any snow, but then again, it was dark. Lastly, I heard someone pronounce it “Skip’-ul.” There is no schwa on my keyboard, which should replace the “u” in “ul.” It doesn’t seem likely I will walk up to a Dutch person and ask. We will see. But I did! Ski-pole.

The flight was uneventful. However, Randy’s article on medical issues on commercial flights reports a study with incidence of 46/1245 (3.6%) developed DVT, all high risk and compared to a cohort wearing compression hose. That extrapolates to 10 of the 300 people on the flight, if we were all high risk. Wow! None of us though!

Amy capsulized how we all felt on the flight. “I was too tired to read or even watch a movie.” As I write this, I am too tired to make corrections, almost too tired to be clever.

I am looking forward to connecting with the Augustana College people. They will visit Ilula one day. On the flight I overheard a young woman say she was from SD and Augustana. I wanted to ask her more, but it was fleeting. She got off at Kili. I am guessing it is natural to want to connect with the familiar experience. Contrast that with my reticence to ask how to pronounce Schiphol.

Kili Airport, Dar and FPCT, Ilula

We made it! No mishaps. It was late to Free Pentacostal Church of Tanzania, 1 AM or so with arising at the B-C of dawn (very early). We left by 7 AM and arrived in Ilula just before 5 PM. For me, after three times, that drive has become a little familiar. Seems to me there is a fair amount of new construction that looks like modern industrial and commercial building on the outskirts of Dar. The vegetation is lush after the rains have begun. Driving across the gorge is harrowing. Kulwa did a wonderful job of driving. I did a wonderful job of dozing. So I am not sure if anyone was white-knuckling. Amy reports all the rest of us were sleeping, but she was not white-knuckling. We have now had a beer, dinner, and heard some stories.

The others have had an eventful 9 days: breech twins, one not salvageable, mom and the healthy babe left 8 hours after delivery; Mom was happy, having lost two previous babies; large bowel obstruction, repaired; wound dehiscence and repair; several normal deliveries: lots of malaria, including in a pregnant woman (with malaria it’s “shoot first and ask questions later”), primarily because of its prevalence. None of the above are criticisms. They do the best they can under the circumstances. The med students have been doing a great job. Quickly they realized they needed to limit the number of cases they would follow or be overwhelmed.

Besides all of us, we have three Australian med students too, Chantal, Sarah and Trish. Two ESL teachers are with us from Morogoro. (Becky Peterson and Alice Kellgren, both of World Teachs into their one-year commitment, seven month.) Yet all have been and will be busy. Some went to the HIV outreach clinic, the maternal and child outreach clinic and Bella and Latifah taught a class of form six men students on HIV prevention. (Form six students are often 19-20 years old and would be about US 11th grade equivalent). They were asked to come back and give it to some of the girls at the school. Of course there is more, but I am tired. Plans are formulated for tomorrow. We will attend church Sunday and… wait for it… we will be expected to sing. The women have worked up “We are Marching” in three languages: Hehe, Swahili and Marekani. It’s gonna be over by the time you read this, but surely if there is an earthquake Sunday morning, you will know why.

Jan 16

Church is over, but not before lightening rounds at the hospital. And rounds were interrupted by a blessed event: twin boys, almost 14 pounds together almost equally split. They were delivered by C-section, because one was breech (and both large). The health of these two babies is contrasted by the 1.9 kg (about 4 pounds 3 ounces) 15 day-old infant with jaundice and rigidity. We saw four men all acutely ill overlying their chronic wasting illnesses. A father looked on as his delirious son in the bed was unable to speak. All of the men had malnutrition. One had malaria but was not yet responding to quinine. Because of the C-section, I missed them on rounds this morning. But then, I missed the c-section too. Some supplies are precious. The adage is “hold on tight.” I could hardly refuse when the surgeon asked for my OR cap and I trudged back to the house for another one. By the time I returned, the twins were out, ably managed by the nurses as Kelsey and Amy looked on. Sarah (Aussie), is going into OB, so it was her opportunity to shine assisting Dr. Saga and Dr. Moody and helping Dr. Moody close as Dr. Saga got back to more lightening. Sarah got to meet proud papa too.

Church is always such a treat. The choirs are astounding. They use beautiful harmonies and rhythms in their songs. It’s another area where we can learn from our friends in TZ. We were all given opportunity to introduce ourselves of course, but not in either of my fluent languages (“American” and pig-Latin), but naturally in Kiswahili. Pastor Lamont Koerner delivered the message, a good one, mostly in English. He also gave the benediction and his wife Becky and I both thought it was the end, but it was not to be for another twenty minutes. The choirs marched out singing rousing hymns and sang for the congregation as we trooped out too.

Now we are on our way to Iringa for the afternoon. All want to get to the internet café for email, of course and me so I can post this, but more importantly so I can talk to my wife! Al I have done so far is a brief message to say I arrived all right.

Tomorrow

2011-01-11T17:37:00.000-08:00

It is finally here. Seven more of us will be off to Iringa and Ilula. We will have several more suitcases full of gear to bring with us thanks to Global Health Missions. Also, thanks to Park Nicollet Eagan and Susan Erickson who graciously allowed me to pilfer a few sterile gloves, masks and a million gauze pads.

It appears I will be able to get all my gear into the gigantic roller duffel we used last time. I could actually ship myself in it, but I would be over the 50# weight limit. Birdie has a care conference for Dad Degner tomorrow, but I need to be at MSP early enough that it won't interfere. At first I thought I might have to "tuck and roll," but she has enough time flexibility to actually stop to let me off.

Stuff to do, dinner to eat, etc. More from MSP and more from Amsterdam.

Ken

Packed, more or less

2011-01-10T08:05:00.000-08:00

Still "abunchastuff" to do, but last night Amy, Kelsey, Randy and I got our heads and hands around packing. Every one is under the 50# limit, although since I have not put my personal gear together, I am mildly concerned. I could really ramp up my worry by waiting until Wednesday AM to finish. Naaaaaah. John will get two suitcases from Global Health Ministries and Lamont will haul one of those. Two other friends will be in Tanzania while we are: Dave Fuerst, St. James member, who works for Lutheran World Relief and Scott lien from Global Health Missions. A group from Augustana College, Sioux Falls will be there too!

Thanks to St. James for several (many) things. We are bringing nearly 400 toothbrushes, most from St. James. I have read a few of the letters. I know the students and people at Idunda will love them! I will pull some of them for the congregation at Idunda, distributing the rest to the students, likely each of whom will get four letters!

Bob Nastrom: The crosses are wonderful! Pastors: Thanks for the clergy shirts (Friar Tuck brand! You will each have to put on some weight before we can start calling you Friar Tuck....) Miriam and Holly, terrific work on the books for Idunda. Thanks to my sister-in-law, Jill Christopherson for funding the project.

I learned my Grand-daughter Parker, 11 months, still spells reading "reding" and nuggets "buggets." Actually, she pronounces nuggets "buggets" too, so that isn't so surprising.

Ken

Packing

2011-01-08T10:16:00.000-08:00

Departure is getting close!

Some of the group will meet at my home to pack the extras Sunday evening. This probably won't take more than an hour. We will have stuff to distribute. I don't expect we will exceed the two-bags-fifty-pounds-each-plus-carry-on limit, but we will have stuff! I will have a bunch of electronics in my carry on, including an extra laptop Wayne Hayes from Roseville Lutheran is sending with us.

Dr. Gary Moody and half the group are already in Ilula. Gary has requested us to bring some additional things, like scrub suits. Scott Lien from Global Health Ministries has graciously offered to pack them and other supplies for Dr. John Kvasnicka to pick up and so, he will be bringing his carry-on and two bags with 50# of scrubs and supplies from GHM. We will redistribute as necessary before check-in at MSP. Check-in is always an adventure, making sure we are not over the 50# limit. The first time we went, I think the big bags of M&M Peanuts for Dennis Ngede were pulled from the checked bag and stuffed in Sandy Thibault's carry-on. Only later did we learn we could have aggregated our group's baggage and avoided the anxiety.

I have a few books, some Hospice kits, some old style “Midwife kits,” now renamed and redesigned as Newborn kits. I don’t know if we will be able to re-package them as the new form or not. I may seek some volunteers spontaneously at St. James tomorrow or at the cluster* meeting later in the afternoon.

I have a box of 500 tongue depressors. (So we won’t have to use the same one over and over like I do in the office. JUST KIDDING! I hardly ever do that!) I have the toothpaste.

Sounds like I will have a million toothbrushes from St. James too. One large basket is overflowing now and I expect members to bring more tomorrow!

We decided to have the confirmation classes write some letters to the 25 students we sponsor at St. James who attend mostly Lutangilo and Pommern Secondary Schools. Pastor Will took charge of this and it has me nearly in tears to say we already have 85 letters and 25 crayon pictures (from kids too young to write)! Wow!

Phil Larsen is going to be at our Adult Ed and Coffee Hour at St. James tomorrow (about 9:45 AM) talking about the Ag Project. We may pirate just a little time from him to have others write more letters.

Peace!

Ken

*Cluster is a subgroup of churches administratively grouped. The full cadre of 70 SPAS churches that have Tanzanian companions is divided into five clusters. Ours meets tomorrow afternoon.

Whirling Dervish.... A mystical dancer who stands between the material and cosmic worlds. His dance is part of a sacred ceremony ...

2011-01-04T08:04:00.000-08:00

Things are now going dervishly fast and I am whirling! Perhaps I am in the cosmic. Everything is slightly blurred (blood sugar's OK).

I am picking up some medical kits this morning from Don and Eunice Fultz, also whirling, leaving today with a group from Luther Memorial, I think.

Still seeing to details for our collective needs in TZ, like transportation. It will all come together (I pray).

Peace!

Ken

Departures and arrivals and waiting....

2011-01-03T19:12:00.000-08:00

Sunday, January 2, about half the group left for Tanzania, the rest of us with a few more days to gather things to bring for ourselves and our colleagues. They should be in Irninga now. The rest of us are waiting and will be leaving MSP January 12. I am getting excited for departure, still mentally organizing what I need and how much space will be left for gifts and supplies for our friends in TZ.
Next Sunday, January 9, at St. James ELC in Burnsville, we will have an adult ed forum (coffee at 9:30 AM, forum at 10:00-10:45) on the Ag Project, with an opportunity for folks to write letters to our students and the congregation at Idunda, St. James' TZ Partner Congregation. It will be fun! If you care to bring a new toothbrush or two for our public health students' project, feel free!