Sugar, soap and snails

With the arrival of Christmas in Ndanda comes some lovely hospital traditions.  I made a rare visit to church this week in order to see the nursing students re-enact the story of Christmas.  I have no idea what they were saying as the rain was pelting down on the roof so hard it was impossible to hear anything.  However, this didn't actually matter too much as a) I do kind of know the general gist of the story and b) I really only went to see the sheep who stole the show last year and did not disappoint this year either.  The students given the role of sheep make the most of having their identity hidden by a sheet over their head as part of their costume and thus their movement up the aisle is accompanied by some fairly loud and alarming sheep noises, a lot of jostling and at one point what appeared to be a fight between two sheep that had risen up onto their hindquarters and were butting each other.  The shepherds also took their role quite seriously and used their sticks liberally to try to keep their classmates/sheep in order.

Another hospital tradition is the giving of gifts to all patients who will be admitted over Christmas.  Apparently in the past the gifts were pretty extravagant and came in large containers from America and Europe.  Unfortunately the containers have ceased to come and hospital funds are tight so each patient now gets a bag of sugar and a bar of soap.  However, whilst the gifts may be less exciting, the gesture is still lovely.   The wards are all decorated with leaves and bright flowers and the nursing students accompany the doctors and senior nursing staff through each ward singing and beating drums.  It's like nothing you could ever imagine happening in England and whilst the pictures don't really capture the atmosphere they may at least give an idea of the scale of the event.

My ward - all flowery and clean

Singing and dancing in the rain

In less Christmassy-related news, the recent rains have heralded the arrival of the giant snails once more to Ndanda.  Having passed many of these fantastic creatures when running recently, I decided to set off on a walk today together with a camera and the objective of getting the perfect black and white picture of a snail.  This was admittedly quite a specific task and after walking for a long time it started to seem like the snails were deliberately hiding just to spite me.  However, just as I'd given up hope and started to head home there he was, the size of a guinea pig slithering across the road.  I have no doubt that the locals thought I was even more crazy than usual as I crouched down and moved around him trying to work out how best to capture him but it was well worth it in my opinion.  I have included two pictures as one is clearly insufficient to capture his awesomeness. 

I hope anyone reading this has a lovely Christmas.  I will be mostly eating Christmas pudding and being on-call.

Diabetes and Dar

This week I’ve decided to return home a little earlier than planned which means I have just over a month left in Tanzania and a bit of time to mull over my time here.  When I first decided to come out to Africa for a year, it seemed like a long time – as a junior doctor in the UK I changed jobs every four months so twelve months working in one place seemed like ages.  Fifteen months have passed and now I totally understand what people were saying when they told me that a year is not long enough and that you need to live somewhere for several years if you have any hope of ‘making a difference.’  I didn’t have any grand ambitions of ‘making a difference’ when I came out here so I didn’t really listen to them!  In fact, I can’t really remember what my motivation was for coming, it was just something I’d always planned to do.  I think I mostly just wanted to live somewhere different, experience a different way of life and see some interesting medicine.   As it turns out, it is very difficult to live here, to see just how unfair life can be, and not want to change things.  It then becomes difficult not to feel frustrated/angry/upset when it becomes apparent just how difficult this can be.  On the other hand when progress is made, no matter how minimal, you start to think that if you stayed longer maybe the impossible would become possible. 

Just before I left Ndanda this week to come to Dar for a meeting I decided to discharge two diabetic patients from my ward.  These are young women who need insulin and in the UK would be offered all manner of support to help them understand and manage their condition.  Here they are usually just given some insulin and sent away with little explanation about the disease, no follow up, no way to check their blood sugars at home and no explanation of what to do if they become unwell.  We therefore decided to have a counselling session with these girls and their relatives before they left and so myself and two nurses from my ward sat down and tried to explain a bit more about the disease.  It was amazing – probably one of the best things I have seen since I’ve been here!  I hardly had to say anything (which is for the best as I would have likely confused the situation more with my dubious Swahili) as the two nurses took over proceedings and did a fantastic job of explaining and answering questions, advising about diet and managing hypoglycaemic episodes.  The patients and relatives actually asked questions (this is a VERY rare occurrence here) and were so incredibly grateful at the end that they all left grinning and shaking hands vigorously with me and the nurses, wishing us all a good day.  It turns out that one of the relatives was convinced the patient had HIV as she had lost so much weight and had thus been hiding her at home in case the neighbours started to talk!  They have promised me faithfully to come back for follow up and I really hope they do (going on past experience of managing chronic diseases here, I won’t be holding my breath).  They still have a terrible prognosis, with no means to test sugars at home they will likely develop complications of the disease much earlier than they would in the UK and they could easily die from a hypoglycaemic coma if the family fail to recognise the problem and act quickly enough.  However, when they left the ward I felt happier than I have for a long time, partly because they were so happy but mostly because it was so lovely to see how well the nurses managed the situation.

Mtwara airport - I think the sign may have been put up a little prematurely!

Someone asked me how big the airport is - not big as this picture is taken from the departure lounge

I’m now back in Dar staying in a massive conference centre run by nuns (they really do get everywhere) which means proper meals for the whole week and the chance to catch up with volunteers from all over Tanzania.  Dar is not my favourite place in the world – big cities not really being my thing, but it does seem to get undeservedly bad press from many quarters.  We receive various emails warning us of the dangers of travel around Dar and the training we receive on arrival in Tanzania is pretty intimidating to say the least.  Yesterday the Tanzanian receptionist warned us that walking around near where we are staying was totally unsafe with muggers and kidnappers lurking on every street corner.  This luckily turned out not to be the case and I had a very pleasant walk along the nearby railway line with one of the other volunteers, joined occasionally by a children who greeted us not with the usual ‘mzungu’ (white person) but with shouts of ‘mchina’ (Chinese person).  This was surprising since neither myself or my friend look even remotely Chinese, but since it is virtually impossible to go anywhere in Tanzania without children (and often adults) feeling the need to remind you loudly and quite insistently of your skin colour, the new word made a welcome change.  I’m not quite sure what has led to the confusion but I suspect there must be some Chinese workers somewhere nearby building a road.  I haven’t had to spent that long in Dar while I’ve been living in Tanzania and have only ever needed to go to a limited number of places (mostly those that sell ice-cream).  This means my knowledge of the Dar public transport system and geography of Dar in general is fairly limited.  However, so far this has not been a problem as people are usually helpful when it comes to directions and I suspect a passable level of Swahili does make things a fair bit easier.  Today as I tried to negotiate the daladalas to meet up with a friend I was taken by the man sitting next to me on the first dala to get the next dala – a walk of ten minutes or so (and as far as I could tell quite out of his way), warned about the dangers of thieves and then, after various enquiries to different drivers, put in a dala to the right place with instructions given to the conductor of where to tell me to get off.  This guy didn’t seem to expect anything in return for his help and I was annoyed with myself that this surprised me so much – I guess I believe the bad press more than I care to admit and had half expected to find myself lacking my camera and wallet at the end of our journey!  Unfortunately I’m not quite brave enough to risk taking my camera out too often when I’m in Dar so I only have a few pictures to show what it’s like.       

Fairly typical housing on the outskirts of Dar

The only train I've seen in Tanzania

Sunset over Dar taken from my hostel

The view from Slipway - basically a little bit of Europe dumped in the middle of Tanzania (including ice-cream parlour)