Don't Scratch

I think I could feel the mask slipping down my face. I tried to wriggle my nose to keep it in place, but I may have been making it worse. With my hands resting against my chest, I tried not to move and touch anything, including the itchy patch of my head just above my right ear. The itching was the worst part. I had never had to just stand there, not scratching. But it was going to be well worth the uncomfortable minutes.

The Monday started out pretty normal for a day at Machame, except for the two other Cornell students, Jenny and Danielle, who had come to pay me and Brenna a visit. They were dying to see a birth, and had ventured to the labor and delivery ward around 10pm Sunday night, hoping to catch a woman in labor. Disappointed, they returned at 5am Monday morning, only to just miss a woman who had to undergo an unsuspected c-section. I had seen my share of births and stayed tucked under my blankets to avoid the chill of a Machame dawn.

After the morning devotions, the Patron of the hospital stood up to tell everyone about a woman in the ICU who had an extremely low hemoglobin count due to internal bleeding and would probably pass if she did not receive a blood transfusion. There was only 1 pint of blood in the blood bank that matched her blood type. Things didn’t look too good. Jenny, one of the other Cornell students, mustered up enough courage to donate blood for this poor woman. As O+, Jenny is a universal donor and the woman’s body should accept her blood. I thought about donating, but was unaware of my blood type and the thought of African needles, although I had seen them in their sealed packages, still frightened me.

The rest of us left to get Jenny some more sugar so she would be fine in the upcoming surgery that would start around 10am. We brought her some sugary, fried dough from the hospital canteen and then returned to the guest house to eat as well. Finishing up around 10 (things don’t normally start on time in Tanzania), we met Jenny and headed to the sterilization room to change into scrubs so we could watch the orthopedic surgeries that day. I thought I had heard the morning report mention another child that was to be prepared for a cleft foot operation, and two young men who were to undergo hand surgery. One had fractured the proximal phalanx of his left index finger, and the other had a severed the extensor tendon to his left index finger. A bad day for left index fingers I guess. I remembered this last case from the surgeon’s orthopedic clinic the Thursday before, and as we approached the orthopedic building, I pointed the girls to their changing room and went to put on my scrubs.

We were a little late for the first finger surgery, but our tardiness didn’t stop all of the staff from greeting us warmly. As I began to hover over the operating table, I could see Dr. Lyimo begin to put a wire through the proximal phalanx into its corresponding metacarpal bone. With the wire in place, the two fractured pieces of bone should fuse and the man should heal in a few weeks. I looked around during the surgery to make sure Jenny and Danielle weren’t feeling bad or on the verge of passing out, as Lauren had done the previous week. They were feeling fine and as Dr. Lyimo began to sew up the man’s hand, they began to ask Brenna about the time. As they could only stay at Machame until the early afternoon, they wanted to check in on labor and delivery one more time. Brenna agreed to be the martyr and walk them to ward and I stayed to watch the anesthesiologists try to bring the unconscious body back to life. I think they had over-sedated him because it took a very long time for the guy to breath on his own.

I decided to leave the operating theater and go and sit with the nurses outside. After joking about Brenna’s lack of rhythm, one of the nurses, Margaret, asked me why I had never scrubbed in and assisted in the surgeries. I responded that I had never scrubbed before and didn’t really know what to do. Instead of taking my response as an indicator that I was under-qualified to assist in surgery, she told me that she would ask Dr. Lyimo if I could assist. I didn’t think he would agree, but I hoped that he would while she walked over to talk to him. After a minute or two, he called to me and said it was fine if I assisted with the next surgery, the same case I remembered from the orthopedic clinic.

Finally it was time to scrub. Margaret and I walked to the two sinks and she began to describe the hand and arm washing technique. Fives minutes of washing elapsed and then I walked with my hands aloft into the theater. She then directed me to the sterile, metal container which contained my gown. Unrolling it, I timidly put my hands into the sleeves, trying to only touch the interior of the gown. Without any gloves on, the exterior of the gown was cleaner then my thoroughly washed hands. Margret then described how I had to hold the cuff of each sleeve with my thumb as I slipped my hand into the glove. My first attempt failed and the cuff slid down to my wrist, with the glove’s elastic base conforming around the cuff. I asked if I could try again but putting on another would contaminate my hands and it wasn’t worth starting over. I succeeded with my second attempt, with the cuff resting just below the base of my thumb. Then I was told to wait with my hands across my chest. Margret had to help set up all the utensils and it wasn’t yet time to don the second pair of gloves.

This is when things began itch. First it was a spot right above my right ear. Then it was a spot right under the mask, on my nose. Helpless, I stood waiting, twitching slightly so that my hands remained where they were but enough skin would move so that the itch would go away. I tried to direct the itch with my mind to at least move to my feet and legs, where I could shift my weight and scratch with my surgical boots or step on my own feet. Thinking back, this period of waiting seemed longer then the actual surgery itself. But after enough waiting, I was assisted into my second pair of gloves and the surgery began.

Making an ‘L’-shaped cut around the left index finger knuckle, Dr. Lyimo exposed the inner workings of the man’s hand. At this point, it was time for my first and major roll in the surgery. I was handed a small metal instrument that had very sharp, little teeth that were curved under and back toward the handle. Using this distorted fork-looking tool, I held open the skin while Dr. Lyimo worked. My left hand rested on that of the patients, holding everything steady. His skin was remarkably cold under my multi-gloved hands and it shocked me at first. I looked up to check the blood pressure, but I realized it was just the tourniquet halting the majority of blood, silently doing its job. After some quick flicks of his wrist, the surgeon had exposed the two separated ends of the tendon and began to suture them back together.

My next task was to flex the index finger so that Dr. Lyimo could see how his sutures were holding. With a satisfied little hop and a sigh, he took the patient’s hand and moved the finger back and forth, noting how the tendon moved. From my incredibly close viewpoint, I could see the small black markings of the sutures on the tendon move forward and aft along with the finger’s movement. His work under the skin was done and now it was time to sew up the dark outer covering.

Removing the tourniquet, the man’s flesh began to retain its red and pinkish hues. Observing that there were no capillaries to cauterize, Dr. Lyimo asked from another suture set and began to tie the skin back together. With every puncture of the skin a little bit of blood would ooze out, creating another job opportunity for me. Accepting gauze from Margaret, I dabbed at the cohesive liquid and allowed Dr. Lyimo to continue with his work. With the last suture in place, Dr. Lyimo tied off the strands, cut the lines, and asked the anesthesiologists to bring the man back. Allowing the medication to taking its time, the doctor began to take off his scrubs and hinted that I should do the same. Alas, my time in a surgical gown was over.

Although I did make another small mistake and took off a glove when I wasn’t really supposed to, I was able to help form the patient’s cast. Holding the limp hand in the air, Dr. Lyimo was able to use both of his hands to maneuver the Plaster of Paris bandages and create a smooth, white cast for the Tanzanian. Even though this part of the operation wasn’t quite as exhilarating, I still got a kick out of helping beyond my normal duties (tying gowns, wiping off aprons, getting gloves, etc).

I am not sure if I should have been assisting in an orthopedic surgery or not, as I have received no formal surgical training, but it was awesome actually scrubbing in and holding instruments while the doctor performed his magic. It is just beginning to dawn on me that this is my last week in this incredible country, and I may have reached a high point on that Monday afternoon in the orthopedic theater of Machame Hospital.

Machame Hosptial

     After returning from Zanzibar, I spent one final night with my host family in Moshi and then was driven to my internship placement at Machame Hospital in Machame, Tanzania. Only about a 30 minute drive from Moshi, Machame is a collection of villages on the slopes of Kilimanjaro. At roughly 10,000 feet, I now am always wearing pants and the one bright green Patagonia fleece I brought with me.

            It was a sad goodbye leaving my host family in Moshi. Although at times I felt like I was an intruder and completely out of place, it now feels like a home and I think I would be warmly welcomed back when I return.

            The Machame Hospital is a very different organization than KCMC. When I had my stomach rash (which has now subsided altogether), I walked through a very busy regional hospital that was constantly filled with patients and had clearly distinct wards. Machame, a private hospital set up by Lutheran missionaries in 1904, now beds about 50 – 60 patients, of which the majority are women preparing for childbirth. I often feel like there is not a lot going on, especially when there are no surgeries. I expressed this sentiment with one of the newer doctors, Dr. Garrison, and he said that when he first came to Machame, he felt bored because he had finished all of his work by about 1 every day.

One cool aspect about Machame is that it caters to the Maasai women from all across northern Tanzania. Many will walk for days to get to admitted to Machame, spend a month or two before the delivery, have their baby and then walk home. “Typical” Tanzanian life (cooking, clean, farming, childrearing) is hard on women, especially the Maasai because of the environment in which they live, so the month or two at Machame before childbirth is often a much needed break.

            Another interesting aspect that I have had to deal with is the daily morning devotion. Every morning, at about 7:45, the majority of the staff gathers in the hospital church located at the very bottom floor of the building, fairly close to my house. After about 20 minutes of singing and a small sermon, all of the non-medical staff are dismissed and the nurses and clinical officers (like a Nurse Practitioner) that were on duty the previous night stand up and state new cases and give an updated total of the patients in the hospital. Often, the doctors critique the nurses and clinical officers for their diagnoses or try to get the staff to get in the habit of stating all the necessary information regarding a certain patient.

It is during this time that I find out if there are any interesting surgeries that day or if a person has come in with a new sickness. I also use this time when all the doctors are together to ask if I can follow a particular doctor around on his rounds to the wards or if I can accompany them in surgery. I have spent most of my time in surgery but am hoping to spend these last two weeks seeing other aspects of the hospital, including the pharmacy, laboratory, and radiology departments. I find the orthopedic surgeries the most intriguing so if a particular surgery comes up, I may sneak back to the surgery theaters. So far, I have seen: two c-sections, a re-circumcision, a screw/plate removal from a woman’s ankle, two pins put into a fractured elbow, a pin placed into a dislocated finger, a hysterectomy, and a cleft foot operation. I think the hysterectomy and the cleft-foot operations where the coolest so far.

I think the hysterectomy surgery was technically an incomplete hysterectomy because they did not remove the woman’s cervix in addition to the uterus. The entire uterus was removed because of benign tumors that were causing internal hemorrhaging and pain. After its removal, the doctors noted the size, which was about the size of a soccer ball when it should have been the size of your fist.

A cleft foot is a condition found in about 1 out of every 1,000 births in which the tendons and ligaments on the medial side, or inner arch of the foot. This makes the foot point inward and the person becomes very pigeon-toed. To correct this problem, Dr. Lyimo, the orthopedic surgeon, sliced the ligaments and tendons down the middle, cut one of the strips closer to the foot and then cut the other closer to the leg bones. By tying these two strips together, he was able to lengthen the ligaments and tendons and with a cast, correct the issue.

Spending so much time at a hospital and around patients has really affirmed my desire to go to medical school. Seeing surgery, I constantly want to learn how I can perform these operations and help people. I feel useless a lot of times because I see someone with a distinct predicament but I don’t know how to fix it. Hopefully now, with a lot of hard work, I’ll end up at a medical school.

A Little Bit Of Tourism

 Although I have been mainly focused on the class that I finished on June 24^th, I have been able to spend a little bit of my time in Tanzania as a tourist. Two of the other Cornell students were placed into a host family in which the father, Bwana Chuwa, runs a Tanzania tourism company. Bwana Chuwa must know everyone there is to know in Tanzania, because he hooked the group up with an awesome safari and trip to Zanzibar.

            Maybe not quite as densely populated as the Serengeti, the Arusha National Park had a decent amount of fauna including a lot of giraffe, zebra, water buffalo, baboons, and colobus monkeys (they look a little like skunks but with really fluffy white tails). At one point during the safari, we got out of the car and climbed up a hill to an overlook from which you could see a crater from a collapsed volcano. I was a little upset that I didn’t get to see any other big game, like lions or elephants, but the safari was worth the day’s travel.

            The Zanzibar archipelago is located off the eastern coast of Tanzania and is composed of many islands of various sizes. Technically, the name of the country in which I’m currently volunteering is the United Republic of Tanzania because back in the day, the mainland, Tanganika, and Zanzibar were two different countries. When they decided to team up, the president of Tanganika became president of the United Republic and the Zanzibar president became his Vice.

            If anyone can afford to go to Zanzibar on a holiday, I would definitely recommend it. A two hour ferry ride from Dar Es Salaam places you on a beautiful island that feels entirely different then the African mainland. With about 95% of its inhabitants Muslim, the island definitely shows off its Arab influences. This was also the first time I had completely immersed into an Islamic culture, although I’m guessing that it would be very different to be a tourist in a Middle Eastern country.

            Walking through the small corridors of Stone Town, the prominent town in Zanzibar, I felt as if I was back in Europe, walking through alleyways that have endured countless generations of people. One difference between Stone Town and it’s European counterparts are the elegant, carved wooden doors of the Stone Town buildings. Each door is said to symbolize the wants and desires of its original owner, and some are older then the buildings in which they live. Many also have metal spikes protruding from the doors, additions borrowed from India that were once used to prevent elephants from breaking down the buildings.

            Like Moshi, Stone Town also has a very lively outdoor market, but with a complete different set of staple foods. Zanzibar, once the spice capital of the world, offers an enormous variety of spices to the public. The fish market is also a sight to see, and a smell to experience. Like the fish section of Wegman’s on steroids, I had never seen so many types of fish on display. I will admit that the smell was a little strong for me so I couldn’t stay in the market too long.

            With pristine white sands and turquoise water, the beaches on the Northern coast were incredible. Like pictures on the Discovery Channel, the scenery included small wooden Dhows (the name given to Zanzibari boats) dotted the horizon as they fished for local fare. After lunch, five of us decided to trust a local entrepreneur and went snorkeling out on the nearby reef. Although it wasn’t the most colorful, we were still able to see a good amount of wildlife. I have taken a lot of pictures from this beach day and I’ll try to make an album on picasa soon.

            Leaving Zanzibar on possibly the worst 9 hour bus ride of my life, I was a little disappointed that I couldn’t continue my tourism and see all of the other incredible sights Tanzania has to offer. I would really like to see the inner region of the country, as that is where the majority of the population lives and I would really be able to see the livelihoods of these warm and welcoming people. I guess that’s another reason to come back.

            

It takes a village

            The electricity is out again. The family had brought in a woman trained in the art to lead the ceremony. With the help of the house girls, they all surround Catie, my young host sister of 6, carefully picking at her head but still cautious not to block the candle light. Every few seconds, the two blades of the scissors come together with a resounding “click”. I sitting a few meters away on the couch, trying to eat dinner. As the steam rises off of my meal, I am mystified. I had wondered about the actual actions, but this was my first time witnessing anyone getting extensions.

            My first day walking the streets, I was a little shocked to see that almost every single child under the age of 10 had a very short buzz. My only clue to the sex of the kids is their school uniforms: shorts for a boy, a skirt for a girl. Slightly puzzled to why the girls have short hair I tried to come up with an explanation. Only later did one of the other Cornellians explain that everyone keeps their hair very short so they do not get lice. To make up for the lack of natural hair, a lot of the women and girls get extensions or put their natural hair in tight braids that run along their scalps in varying directions.

            What captivated my attention the most from the extensions process was the way in which everyone chipped in to help. Although the house girls could have spent this choice amount of free time relaxing, they both decided to help the woman with Catie’s hair. This helping sentiment seems to be prominent throughout Moshi.

            Lincoln, the 1 year old, can be a handful at times. However, this doesn’t stop the whole household from taking care of him. And by whole family, I mean the two house girls, the parents, young daughter, and even the guard. I would expect, and hope, that a child’s immediate family would take care of their blood, but I wouldn’t really expect this of a man whose sole job is to watch the property for thieves. This Saturday, when I came back from town, I was greeted by the guard who was bouncing Lincoln on his knee.

            I was trying to express how everyone in the house cares for Lincoln when one of my peers in Tanzania stated that the same thing happened in her house with a young child named Ibu. I have met Ibu before and he looks like a 2 year old version of Jay-Z (Brenna has a picture of him with her sunglasses on and he looks incredible). Initially I thought that Ibu was another child of Brenna and Kathy’s house mom, but it turns out that Ibu is living with his grandmother, who resides in the house directly behind Brenna and Kathy’s. Although Ibu isn’t directly related to their host mom, Mamma Grace, this doesn’t stop her from feeding and taking care of him. I would expect the same from an American mother who has a neighbor roughly the same age as one of her children, but Ibu is 5 years younger then the youngest in Mama Grace’s family.  

            I wonder if it is the hardships these people go through that draw them closer, or they are just generally nicer and more caring people. Whatever the cause, I’m happy that there are multiple sets of eyes looking over Lincoln and Ibu so that one day, they can become the next leaders of Tanzania. Hopefully then, they won’t have to live their lives continually contracting malaria, an infection that my house father and Brenna and Kathy’s host father have contracted over the last few weeks. 

Lincoln & Catherine.... But Mainly Lincoln

Hanging with the kids

Tanzanian Vittles

African food. Try to conjure up that image. I had no idea what I would be eating for two months this summer, but now I am very familiar.

My first experience with Tanzanian cuisine was actually at Cornell toward the end of the spring semester. I was taking a semester-long prep course for the trip and we were all invited to eat lunch one Saturday at our professor’s house. Lunch was prepared by two Cornellians who spent 13 weeks last summer volunteering at the Weill-Bugando hospital in Mwanza, Tanzania. They cooked ugali, a polenta-like paste made from corn, a shredded collard greens-ish dish, and an egg dish that had red peppers and cheese. Unfortunately, I haven’t had this egg dish yet.

Unlike the variety of foods that my incredible cook of a mother makes, and the interesting dishes the infamous Deb produces, I have had basically the same meals every day. During my first breakfast with my host family, I was greeted by a large spread of hard boiled eggs, hotdogs (this seems to be a morning food item), tea, natural orange juice, bread, butter, and jelly. I poured my self a cup of the tea, let it cool, and then tried the jelly. The first wave of flavor was intense. I think the closest description would be to take a fruit medley jelly from the U.S., add a cup of sugar and Gatorade’s Fruit Punch ready-mix powder. I continued to eat the jelly for a while, until I felt like it was eating the enamel off my teeth. I starting bringing a jar of peanut butter to the table, and it eventually made it into the breakfast rotation. I really enjoy hard boiled eggs, but two every morning are starting to take its toll on my taste buds. I am thinking about waking up early to cook myself an omelet or some scrambled eggs.

Unlike the U.S. system of 3 meals daily, the Tanzanians have added half a meal in between breakfast and lunch, known as Tea. One thing that I am not sick of is the Tanzanian tea. Locally grown, the flavor is unlike anything else I have tasted. Most of the locals drink it with whole milk but I prefer a cup with a spoon of sugar. With tea, it is common to have some form of fried dough. It’s pretty interesting to note that at one of the most respected medical campuses in Tanzania, there are no baked or boiled goods sold at the campus Canteen. The one healthy alternative is a bowl of fruit salad that is not always available.

For lunch, I have had some form of banana and / or rice every day. The lunch places make a dish called “pilau”, which is seasoned rice and beef that tastes pretty good. Ndizi is another dish that I like, which is cooked bananas, covered in a somewhat salty banana sauce and beef. With one of these meals comes a form of vegetable, sometimes the collard green that I mentioned above, or often shredded cabbage. There is also a complementary piece of uncooked banana which I think is the highlight of the meal. I have never tasted such good bananas. The Chagga, the prominent tribe in the Moshi area, are known to make most of their essentials out of the banana plant (food, beer, houses, etc) and I think they have perfected the art of banana growing.

Dinner everyday is basically the same. The meal is usually rice covered with a sauce, vegetables, and a meat. The meat is either chicken, fish, or beef, but most often beef. The fish is… interesting. I think the first time I had the fish was about two weeks ago on a sunny Wednesday. As I was walking back from KCMC, I passed a woman sitting on the side of the road selling whole, roasted fish about 6 – 8 inches in length. I’m not much of a fish person and but I wasn’t the first to say that these fish did not look very appetizing. I thought about the lack of local water sources in the area, and then tried to dispel the thought of eating the animal. That night, atop my heap of rice was one of those fish, cooked in some type of spice. Not to upset my hosts, I ate as much as I could, but did not come close to sucking out the eyeballs as did my host parents. It actually wasn’t as bad as I thought it would be, but I would rather eat as little of it as possible.

To me, the highlight of dinner is dessert. Where as Americans most often enjoy foods like ice cream, cake or cookies for dessert, the Tanzanians choose to eat fresh fruit. Although they have many more seeds then the fruit I normally eat back home, I think the fruits I have eaten here have more flavor and possess a natural sweetness that I don’t taste in America.

Overall I have enjoyed all the foods I have eaten so far, but am looking for a change. I look forward to Thursdays when the Cornell students go to our professor’s house and she bakes us some sort of American dessert. The first time we had cookies, followed by strawberry shortcake, and then last week was chocolate-zucchini cake. I am hoping this time it will be cookies again, or if I had my choice, Popsicles. I also heard that one of the Cornell girls brought some Gatorade mix, so I’ll have to investigate that. Hopefully, next weekend’s trip to Zanzibar will bring out some new dishes.

Additional bracelet. I traded the coffee bean one for this one. Technically #5

More Pictures

As per a request, here are some pictures of my living quarters

The family room

My room / bed

Front of the house

Host family's banana trees

Pathway to my host family's house

New Bracelet. Aquired in deal for other gifts