I love monkeys

MONKEYS!!!   Ever since I moved here I’ve been hearing about monkeys living nearby but I’d never actually seen them.......until today!  This may be the motivation I need to continue running despite the fact it’s now up to 40^oC on some days (not that I’m attempting to go running at midday but it’s still pretty warm in the evenings).  Another motivating factor is the fact that my Tanzanian friend Edina told me I’m looking “lovely and fat at the moment.”  Without a doubt she meant this as a compliment, but there are many aspects of Tanzanian culture I know I will never get used to, and I have started the morning yoga sessions again as a result of her well-meaning comment!  I have also decided to vary my running route a little and rather than just running up a big hill every day to catch the sunset, I am now making it up to the swimming lake a few times a week too.  It’s probably best to make the most of the lake now as, once the rains come, the water turns a chocolate-brown colour and swimming becomes a much less appealing prospect.  Right now though the water is cool and blue and I am joined on my evening swims by swallows swooping down to catch insects or have a drink.  The resident monitor lizards are often to be seen hanging about on rocks enjoying the beautiful evening sun and, despite all that may have happened during the day, it’s easy to remember the good things about living here.

Edina and her youngest son playing bao outside my house

Ndanda swimming lake

This week I had my first experience of the corruption that is allegedly rife in some of the government-run hospitals, as a patient tried to slip me a 10,000 shilling note (about £4 - but to put it in perspective that’s an eighth of the monthly minimum wage here).  Due to a rather extravagant month of spending on my part the money would have been quite useful but I am happy to report my principles remain intact and the money remains firmly in the patient’s possession.  Having not worked in any other hospitals in Tanzania I can only go on hearsay, but it does seem that in many it is standard policy for both doctors and nurses to expect patients to pay them directly for any services provided.  I guess coming from the UK, the idea of accepting hard cash from a patient for just doing my job is a very alien concept; on the other hand I’ve never had a problem accepting the odd box of chocolates from patients  – I'm pretty sure this is different though.   Anyway, I have no idea whether this happens here in Ndanda as the volunteers are generally out of the loop when it comes to the shadier goings on of the hospital.  Despite trying very hard to eavesdrop, my level of Kiswahili is definitely not such that I can follow high-speed gossiping between the nursing staff on my ward!  However, I’ve certainly never seen it happen and I’ve never heard any of the patients complaining about it (though as a general rule Tanzanians don’t complain).    

Makonde plateau

We have also run out of tuberculosis drugs AGAIN this week in the hospital which is very bad news.  This seems to be happening with increasing frequency and will no doubt lead to some frighteningly resistant strains of TB developing for which we will have no treatment whatsoever.  The drugs should be free to all and are provided by the government as part of the National Tuberculosis and Leprosy Programme.  Unfortunately, the logistics of getting these drugs to where they are needed seems to be something of a disaster.  As one of my colleagues pointed out, it is possible to get the latest Harry Potter book delivered to the most remote bookshops in Europe in time for the release date, but getting life-saving drugs to rural hospitals in Africa before stocks run out is seemingly impossible.  I don’t know where the problem lies, whether it is merely a matter of disorganised transport policy or whether there is a more sinister reason involving black markets and people getting rich selling drugs that should be free – it’s not something I am ever likely to know, but it’s made this week fairly awful for both me and several of my patients.

Road to Newala with Makonde plateau in background

Luckily there is a light at the end of the tunnel as the working week is over and tonight we are off to drown our sorrows with 50p bottles of beer and chip omelettes in the local bar – happy days indeed!  This bar just happens to be run by nuns – an unexpected combination in my opinion and something that still makes me smile a little every time I go. 

A nun running a pub

Sunshine, swimming and cornflakes

Having just enjoyed the culinary masterpiece that was chapattis with strawberry jam, I feel ready to give an update on life in Ndanda.  Since the strawberry jam is likely to be the only thing resembling one of my 5-a-day that I eat today I have washed it down with a multivitamin in an attempt to avoid scurvy.  I actually have good intentions of cooking something healthy later in the week and have bought a pumpkin in preparation for this momentous occasion.  However, it will probably take me a few days of looking at said pumpkin before I can summon the energy to attack it with a bread knife or smash it on the concrete floor (depending on how thick the skin turns out to be) and make it into soup (which I will then be able to eat for at least 5 or 6 days).  

I have just returned from a long weekend in Mtwara with several of the volunteers working in nearby hospitals.  Mtwara is a quiet town on the coast and thanks to the fact the Benedictine missionaries build stuff everywhere there is a house that we can stay at for a small fee as a reward for working in one of their hospitals.  The house is literally on the beach and with turquoise water, snorkelling and with the promise of red wine, prawns and cornflakes, these trips are one of my most favourite parts of life here.  The only slight problem is the 4-5 hour daladala ride to get there, which involves taking your life in your hands as the conductor attempts to squeeze as many adults, children and chickens as possible into a bus that isn’t actually designed to have anyone standing.  I think at the worst point there were probably around 45 people squeezed into something the size of a minibus and I spent my time trying not to think too much about what would happen if the bus decided to part company with the road – especially in a country where there is no emergency service.  I may get a little frustrated and ranty with the increasing number of crazy rules and regulations invented in response to the looming threat of litigation in the UK, but I have to admit there are occasions where a few strongly enforced rules might not be such a bad thing.  Hopefully the pictures will help you picture the paradise that is Mtwara.

Work continues to be interesting and frustrating in approximately equal measures.  Last week I was again faced with the difficult situation of relatives requesting discharge when treatment has failed and the patient is quite obviously not going to survive.  It’s not that people shouldn't have the right to die where they want but more that in the UK this decision is taken because the patient feels more comfortable in their own home, whereas here it is usually financial because transport of a dead body costs a lot more than that of a live one.  The luxuries of palliative care teams, Macmillan nurses and social services don’t exist here and quite how these patients make it home at all is usually beyond me.  However, since the only painkillers at my disposal are paracetamol and diclofenac (morphine being unavailable in Tanzania) I can’t exactly offer any kind of effective palliative care, even if they stay in the hospital, which makes the decision to send them home a little easier.  On a more positive note the new nurses on my ward are still wonderful, with one of them even trying to swap his shifts in order to help me with some procedures tomorrow.  It would also seem that my twittering has not been entirely wasted as he not only identified a pleural effusion from an x-ray but also listed possible causes and told me how examining the fluid would help to decide whether it is likely due to TB!  (I realise this last bit will only really make sense to the more medically minded readers but it made me so incredibly happy I had to mention it).

Sunset over Ndanda

I think that is enough for now and my newly acquired copy of the Dead Poets Society is calling me.  On the subject of films though, it would seem American English is not actually the same as normal English - who'd have thought it?  This I discovered while showing Take the Lead to one of the nursing students when she came round for dinner (yes I did actually cook her something – pizza in fact which was awesome).  Anyway, surprisingly enough there is no direct translation for 'punk ass' into Kiswahili and really no way of explaining what it means at all – this term was used A LOT in the film!  I’m going to have to be more careful with my choice next time.

Trip home and the end of the Nutella

So this week has been pretty good.  This may be in part because I know I will be going home for a couple of weeks next month and have been getting excited about all the food and wine I will be able to consume.  Surprisingly, when there is no possibility of wine, chocolate and roast lamb I don't actually miss it all that much, but as soon as it becomes a real possibility, my mind has gone into overdrive imagining going out for dinner somewhere that serves food other than chicken and chips or chip omelette (don't knock it til you've tried it).  It will also be lovely to see the family and friends who I occasionally see via the wonderful medium of skype or get emails and packages from (or, in the case of my grandma, speak to briefly on the phone but have to explain each time that yes, unfortunately I am still in Tanzania and that no, I will not be coming home just yet).

Work has been comparatively wonderful recently as the newly graduated nurses have just started on the wards which means that a) we actually have enough staff and b) the staff we have are pretty keen.  I have surprisingly few patients on my ward, giving me more time to try to understand their more complicated complaints.  Unfortunately this doesn't always help with diagnosis - it would seem I missed the lecture on pain that starts in the right big toe goes up the leg, across the abdomen (where it feels like an animal moving under the skin) and up to the left temporal area where it causes hearing problems.  When this was first explained to me in Swahili I have to admit I gave up trying to understand the finer details and when it was again explained to me in English today (by one of the amazing new nurses that have been allocated to my ward) I decided that multivitamins were probably the drug of choice - I will see on Monday how this has worked out!  When I first came out here I found the uncertainty of everything very unsettling but now I guess I have come to terms with it ...... to a certain extent at least.  Coming from working in UK hospitals where results are available within minutes (ok, so not always minutes but still pretty quick) and x-rays, ECGs and CT scans can be requested at the drop of a hat, rural Tanzania is .......different.  Since patients have to pay extra for x-rays and ECGs (and many of them can barely afford the admission fee) it makes you think really hard before ordering these tests.  This often means that rather than doing the test you give the patient drugs to treat the most likely problem and then wait and see.  It is inconceivable that in the UK you would treat a patient complaining of palpitations without looking at an ECG first or tell a patient they have cancer because they have lost a lot of weight and you're pretty sure that the liver feels a bit lumpy.  Unfortunately this is often the reality here and although I am more used to it now, it's still not exactly easy.

Besides working I have been getting out running most days, though as the weather heats up in preparation for the rains it is getting harder to summon up the energy to do this.  The heat also means that even after being back for 2 hours, having had a long, tepid shower, I am still bright red and sweaty and looking somewhat worse for wear.  However, I clearly remember that this time last year when people were asking me if I wanted to go running I thought they were completely crazy to be going out in this heat so I guess I've acclimatised a bit.  I'm not sure this is going to make England in November an entirely pleasant experience though.

To end on a sad note, the jar of nutella that was brought out to me at the start of the month by a very wonderful friend is no more.  This means I am going to have to revert to peanut butter for dinner on the (many) days when cooking just seems like too much effort.  It was amazing while it lasted though and it is a shame that due to my greediness (and laziness when it comes to cooking) it did not last longer!

A tentative move into the world of blogging

So I've been in Tanzania for a while and since I've forgotten nearly everything that has happened to me so far I have decided to start a blog rather than relying on my somewhat dubious memory.  It may also be nice to let friends and family know what I've been up to while not working hard for the NHS, as I'm not always so great at keeping in touch!  Just to set the scene, for the past year I have been working in a hospital in the south of Tanzania which can just be seen in the distance on the photo above.  The village is called Ndanda and is as beautiful as it appears in the picture.  I should probably also point out that this blog is unlikely to have much to do with embroidery and to be honest little to do with fluffy kittens - unless of course I find myself an orphaned leopard cub which would make me extremely happy and would certainly be worth blogging about.