Highs and lows and the countdown to leaving

I will start with tales of last weekend because it was very wonderful and I want to make use of the lovely pictures I have stolen from the people I was staying with.  My last New Year in Tanzania was very pleasant as I spent it sitting on a rock on top of a nearby hill with great company, a lot of stars and some Amarula.  Since I totally failed to do any advanced planning this year with regards to New Year celebrations it was kind of lucky that it all worked out so well in the end.  I decided to make a final trip to Mtwara and thus boarded the daladala on the Friday evening hoping for the best.  My plan mostly revolved around the people staying in the beach house allowing me to sleep on the floor since there is nowhere else quite so lovely (affordable) to stay in Mtwara and I already knew it was fully booked.  Luckily they had an even better idea and I spent my final weekend in one of my favourite places in Tanzania in a mosquito-net tent looking up at the stars, smelling the sea and listening to the wind rustling the leaves of the coconut trees above me.  Admittedly the wind did pick up quite significantly on the first night around 2am just before it started to rain.  As you can probably imagine mosquito-net tents are not totally suited to this situation and my perfect night was somewhat disturbed when I had to evacuate the tent rather quickly and then do battle with the wind to get it and myself under the veranda before we both got soaked.

View from the breakfast table - I think I might miss this quite a lot!

Mtwara market

Looking down over the harbour, fish market and random half-sunk ship

A very colourful collection of people waiting for the ferry

The tides were also in my favour this weekend and I managed a night-time swim both evenings with a slither of a moon and a sky-full of stars above me as I floated around with the sea to myself.  On the Saturday I was joined by some other volunteers that are working in Tandahimba Hospital (significantly more remote than Ndanda) who were far more organised than me and had rooms booked and everything.  They also had extravagant ideas for a New Year BBQ and as can be seen from the photo below we ate pretty well (including fresh fish steamed in banana leaves with ginger, chili and lime).  I mostly chopped things, mixed mayonnaise with pasta and tomatoes and turned kebabs.  All the complicated stuff was managed by the others who did an amazing, amazing job and it was surprising that I could float at all that night after the amount of food consumed!  It was a lovely weekend, with great people that I have been incredibly lucky to get to know at that I will miss greatly when I leave Tanzania.

Slightly healthier and more varied than my usual diet

Breakfast - I suspect I'll be less excited about cornflakes once I'm back home

Coming back to work after a weekend in Mtwara is usually a bit tricky and my motivation is not always what it could be.  However, my first ward round of the week included a conversation that went along the lines of:

"So you've stopped vomiting for the first time in a month - that's great!  Any other problems?"


"Well I lost one of my front teeth over the weekend because the crazy patient in the side room decided to fight me and knocked it out"

"Er right. Sorry about that. Erm would you like to see the dentist?"

"Not really, my mouth hurts quite a lot but I'd like to have permission for discharge today."

"Oh, er, right.  And you're sure you don't want to see the dentist?"

"No, no and I'm very grateful for all your help, thanks so much"

"Right, I don't suppose you know whether she's still crazy and likely to knock one of my front teeth out do you?"

It is possible that some of the conversation got lost in translation but I think it went something like that.  There was definitely no mention of suing the hospital, the doctor or the other patient; but then I don't think the "where there's blame there's a claim" adverts have quite reached rural Tanzania yet.  Luckily, whilst the patient responsible for the tooth loss was still less than lucid, she didn't feel the need to punch me in the face at any point and the drugs kicked in half way through the week so all is now a lot quieter on the ward.

The week unfortunately didn't end on such a positive note as one of my very few regularly attending diabetic patients passed away this morning.  She had been admitted to my ward for a long time after some mouse bites on her toes became infected (mouse bites and diabetic feet not being a great combination).  She sadly needed to have one foot amputated and I have to admit to feeling pretty proud of myself for managing to arrange this despite some fairly significant difficulties in the surgical department recently.  She had initially been doing fine but I was called to see her a few days after the operation as she was 'not quite right' or at least the Swahili equivalent of this heart-sink phrase that is used regularly in the UK.  It was obvious that her speech was altered and soon became apparent that she had lost the use of her left arm and leg and in fact didn't even acknowledge that they existed.  This is pretty much as bad as it gets in terms of a prognosis considering it was her right leg that was amputated and I guess the final outcome was the best thing that could have happened.  The problem is that I still haven't managed to get used to the way that Tanzanians tend to express grief - very vocally with a lot of screaming, wailing and often collapsing to the floor.  I always find it incredibly distressing as I have no idea what to do or say, where to look and I have to admit that the rather more understated way people grieve back home is much easier to deal with as a doctor.  The nurses have to reassure me every time I witness this that it is a completely normal way for people to react here and that the relatives don't hate me and hold me totally responsible for the death of their loved one.  I'm fairly sure that even if I was here for 20 years I would still struggle with this particular cultural difference.

Just to prove that I do actually do some work and don't just go swimming in Mtwara

Baby weighing Ndanda style