A culture with 1000 greetings

I finally feel comfortable here in Dar. I know the streets, the shortcuts, the bus routes. I know how much I should pay for a candy bar and where the locals buy the best fruit. I know where its safe to go on a run and how to politely tell people I don't want to purchase any of their products.
Sometimes in Dar I feel like an animal at the zoo. As we walk to work in the morning, the air is filled with people yelling "Mzungu" and asking in very high pitched english "how are you my baby?" "where are you going my baby" "can I take you to my house my baby"
People who I have passed every single day, twice a day, for five weeks still seemed shock to see me. But when I get the chance, I stop and answer their questions and take a few moments to get to know the people around me. A man on the corner sells oranges, he also owns rents a taxi everyday to pick up some more money. However, his three kids that sit with the large orange mound while he is driving the taxi, seem to wear the same clothes everyday and eat very little. The woman who works at the small shop closest to the hospital, she smiles and doesn't call out. I buy my phone minutes from her and she always calls me dr.mzungu (as I am usually wearing the white coat when I pass by).

Inside the hospital, I have met some of the nicest people in Dar. The nursing students are so excited to get to know us and so modest when we ask questions back. This week I spent my time in the woman's medical ward. I have come to feel almost at home in this ward, as the head nurse has started to assign me specific jobs everyday when I arrive. Shamim is a nursing student who was assigned investigations with me on Tuesday. She is nineteen years old and in her 2nd semester of her first year of nursing school. She is very sweet and was very excited to teach me the responsibilities of investigation. This entails drawing blood and urine samples and taking them to the lab. At first I was slightly scared to have this responsibility as I had yet to draw blood on my own. Shamim talked me through the whole process and with my first try I successfully drew blood!

This patient has severe malaria, hyperglycemia, and swelling in her legs due to a muscle infection. I got to see through out the week as her legs began to return to normal size, her blood glucose lower, and her parasite count go down below 100. It was very rewarding to check her vital signs everyday and see,slowly but surely, as she returned to good health.

I started off this blog with intentions to talk about the culture here in Dar, but I have such a hard time summarizing what it looks like here. The streets are filled with trash, the air is so thick with pollution, and the people are so full of life. The city is like the new york city of Africa. There are roughly 6 million people living in Dar, which is only 614 square miles. Skipped by most tourist, the attention that the color of my skin gets is something I like to call backwards racism. People push us to the front of lines. Taxi drivers see us and try to push us into their cars. When they see me opt to walk or ride a bus, they laugh and are confused.

I miss the comforts of home, the simplicity of getting into my own car and driving it wherever I want with very little traffic and other silly things. But I will miss the greetings, the handshakes, the warmth of the people here. I have perfected the Tanzanian handshake. Unlike american greetings that are usually stiff and last a few moments, Tanzanians shake hands and then continue to hold hands for the rest of the conversation. At first this felt awkward to me, now I love the closeness I feel just holding a simple conversation with one of the doctors. A culture with 1000 ways to say hello and no way to say goodbye.

Halfway

I can't grasp that I have been there for a month already and that I only have less than 4 weeks left.
Every day here brings new surprises.
But for this blog post I will focus on my working experience thus far in greater detail.

As I have mentioned before, I am assigned a weekly rotation that says I should be "working" in a certain ward each week. It also says a doctors name that is suppose to be supervising me. This, however, is not true. I have met only 1 of my supervising doctors since I have been here, in five different wards. The wards I have been assigned to so far were surgical, labor, and pediatrics. I learned very early on that there is no one to check in with or to report to at any of the wards. So if I go to a different ward, it doesn't matter. This might sound odd, why wouldn't I want to go to a certain ward? Well read my post about the labor ward...I have yet to return to it and was suppose to stay there for 2 weeks. The other thing effected by the lack of authority is how the nurses view the volunteers. They seem to see us as annoyances that are in the way of them doing their work. However, most of the time the nurses are sitting at a desk shouting out to the student nurses to be doing the things they should be doing. Basically, in order to be of any help or learn anything I have to walk up to a student nurse in the ward, introduce myself and tell them about projects abroad and why I am there. Then I follow them around for a little bit, asking questions and reading files to fill in the unknowns. If I am lucky, they are super excited to show me stuff and have me assist in whatever they are doing. If I am unlucky, they speak no english. The doctors are, in general, willing to take the time to show us what we should do, but only after we ask and assert ourselves.

Though I have only been assigned to spend time in three wards, I have spent a good amount of time in the mens and womens internal medical wards. As I have mentioned a few times before, these wards are mainly patients suffering from malaria, TB, and other infectious diseases. The days spent in these wards I was shadowing my friend Ben, a nurse volunteering from sweden. Since Ben is already a registered nurse he knows so much more than the student nurses here and sometimes even the registered nurses. He is so great! He has showed me and talked me through placing IVs and giving medications, reading patient files, and placing catheters. I am scheduled to spend a week in internal medicine at the end of my stay but this is Ben's last week here so I will spend this week in internal medicine instead.

Another ward I have spent a few days in, is the minor theatre. This is where people come as outpatients to get wounds dressed or redressed and cleaned, stitches, and the most shocking, circumcision. This is where I did my first stitches as I described previously. This ward is usually where you feel like you are actually doing the most. TO explain the conditions of this small room would never paint the right picture. Patients have to bring all of their own supplies, the only supply the hospital provides is the stitches and the iodine solution. So patients come in with unsterilized gauze and cotton and it is placed in a sterilizer for less than a few minutes, so its not actually sterile. Its just very overwhelming to wrap my head around the inability for a hospital to provide proper supplies for something so simple as cleaning and wrapping a burn wound.

Regardless of which ward I am assigned to, each wednesday I have gone to major theatre (surgery). This week, I watched a man's last three toes get amputated down to his tarsal bones. It was absolutely horrendous. They don't have bone cutters so they were literally using surgical blades that kept breaking inside his foot. The man has gangrene from diabetes and as we left the surgery, the surgeon explained that they would most likely have to come back and amputate his entire foot....so then why didn't they just do that this time...I have no clue. The same day I got to assist in a removal of a hernia. Assisting means I got to hold the tools that were clamped to the skin and to cut the sutures. Afterwards the head surgeon dictated as I wrote in the patient file what happened in the surgery. I came to Tanzania with a few goals, and one of them was to figure out what I might want to specialize in. I think it has become more and more clear that I thoroughly enjoy surgery.

I wish I could explain things much better, but words don't explain the smell, or the constant film of dirt on everything, the yellow of the patients eyes that are dying from cerebral malaria, or the sound of a mother crying for her child. 

LIONS AND ZEBRAS AND ELEPHANTS OH MY!

The sun is beginning to set. The ten foot grass reaches above the car as it whips into my face. The bright clay has begun to plaster on my arm. The car jumps up and down, up and down, as we go through the rough terrain. Then suddenly, as if out of midair, a lion crosses the Safari car. We stop dead in our tracks and watch as it disappears into the grass.

This weekend I went on a 3 day safari to the Mikumi national Park along with 9 other volunteers. It was a 5 hour drive from Dar to Mikumi and well worth every penny. The first day we went on a game drive and saw Zebras, Giraffes, Elephants, Impala, Wildebeest, and Hippos. The best was when were about five feet from a group of elephants.

Elephants in Mikumi National Park

After a five hour drive through the park, the sun began to set and we drove a few miles down the road to our hotel. Woke up early and returned to the park, this time with our hearts set on seeing a lion. However, this is very hard since they are probably one of the most stealth animals and blend in perfectly with the African grass. After driving for another five hours around the park looking at everything, we had given up. When all of a sudden, like I described above, a lion crossed the road! After this one we saw 3 more, getting within 10 feet of them!

We left and drove 2 hours to Udzungu national park. We checked in to our hotel and met our guide from the park, he took us to a small waterfall about 1/4 of a mile into the park. Then we walked 20 minutes down the road from the park entrance to visit the local village. This was so different from Dar. The people saw us and stared but no one tried to sell us anything or put us into their taxi. Instead the locals shouted "Mumbo!" and smiled as we toured. Small children ran through the streets behind us and the smell of roasting chicken filled the air. Now this is the Africa I envisioned. We returned to the hotel to have dinner. Our guide bought us a round of wine and Konyagi, a locally stilled gin that is very inexpensive but pleasant to drink. The wine was also from a local winery called Dudoma. It was nice treat to sit and enjoy the company of the 9 other volunteers. Our conversation always turns into comparing the different countries we represent, on this trip we had Denmark, United States, United Kingdom, Sweden, and Australia. We laughed and talked until we were all too exhausted.
The next morning we woke up early again to begin our day of hiking. We climbed 3.2 km to the top of the 500 foot Sanje Waterfall inside the national park. It felt truly amazing to stand and look out on the beauty of this country. I loved this hike especially because after spending the last three weeks feeling fairly distant and lost in the crowd, it was so amazing to feel at one with God and his beautiful creation.

We then hiked back down to the base of the waterfall and did some swimming and jumping off rocks. It was absolutely the best weekend of the summer so far.

I have experienced so much at the hospital these last two weeks as well. I wish everyday was spent as happy as I was standing on top of that waterfall but the reality is, work the last week was especially saddening. I was scheduled to work in the labor ward this past week. On monday I reported to the ward and dawned on my scrubs to prepare to help with the miracle of birth. My expectations were soon crushed when I realized the majority of the time in labor is spent sitting around waiting for the women to be ready. You would be sitting or checking dilation stages, feeling somewhat bored, and then the next five or six woman would all have their babies at once! But the standards of the hospital don't allow for all the woman to have ultrasounds, as they pay for them out of pocket. In the five hours I was in the labor ward, two babies were born with their cords wrapped around their head and were unable to breathe for too long. I have never been so sad so quickly. In america, they would have had an emergency Cesarian section birth and the babies would have been born completely health. As well another baby was born a month premature and his lungs were not developed enough. He entered the world only for a few moments before returning to our creator. As if this was heartbreaking enough, after the babies passed away, they were wrapped in their blankets and simply placed in a container that was kept under the weight station while their mothers recovered. I couldn't stand working there knowing this. I left the ward and excused myself to an early lunch. The next day was a lot of the same. By Wednesday I was too sad and couldn't face another day of labor. So I returned to the major theatre, surgical ward. I watched and helped assist in six surgeries. Right before we left for lunch though, a pregnant woman came to the surgical ward to have a Cesarian section birth after being in labor for 3 days.When the baby was pulled out, it was wrapped in its cord as well. After 2 of the longest moments of my life I watched as he took his first breathes and began to breathe on his own. I realized that this was something I could not run from or hide. Death is a natural part of this world and it hurts us who remain here after. But laying in bed that night I realized how amazing it was that these babies would never known the pain, sin, and evil that is in this world, they will only know the glory of God and the beauty of heaven.

To contrast all of this, I had the great pleasure to miss work on thursday to do a volunteer outreach day with the other Projects Abroad volunteers. One of the girls, Kiera, works at an orphanage about 30 minutes outside of Dar. We took her orphanage to the beach and it was the most rewarding experience I have had thus far. The kids didn't want anything from us other than our attention. They clung to me and were happy just being held. So we swam, ran, jumped, ate lunch, and basked in the sun. No language barrier could keep us from sharing joy together. This was the perfect way to start my long weekend on Safari and a great reminder as to why I came to here.