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.

Mumbo!!!

Hello world
I am sorry it has taken me so long to be able to post but I have very limited Internet access. I'm typing this from my roommate's iPad. I'm working on getting a portable modem to use with my laptop in the next week.
Let me paint a picture for you: you are walking down a road that is made of potholes and as you pass people they're eyes are locked on you the entire time. They mumble and sometimes shout "mazungo" which translates to "white person" or "European" and they're eyes do not leave you even when you are out of sight. The main road is full of busy busses that are old 12 passenger vans turned into public transportation filled with 50 plus people at all times. As you walk out to signal you wish to get on, the  people are shocked. A few stops down you yell out "shosha" (stop) and suddenly the stairs triple because no one expects you to know a word of Kiswahili.
This is called 8am.
The hospital I work is called mwanayamala. Translated this means "baby don't cry" ironically as it is always filled with crying babies. The level of sanitation is probably the most concerning aspect of the hospital. There is only a few air conditioned areas so the rest of the hospital is cooled by open windows, which allows the many flies to contaminate the wounds that are left open between nurses caring for the hundred or so patients in each ward

In the last week and a half I have learned so much. On my first day at the hospital I did rounds with the surgery medical students. There is roughly 30 of them that are completing a part of their rotations at the hospital. During rounds we go to each patient in the surgery ward and go over there condition and treatment. However this means undressing their wounds and leaving it undressed for up to a hour. The patients are cleaned and redressed after all of rounds are completed.
During this I met two UK doctors that are here doing an elective. During lunch break we decided to go down to the minor theatre, which is where patients with minor wounds and issues are seen. The nurse working had a list of over 100 patients he was suppose to see that day, which didn't include the emergency patients that came through. After the qualified UK doctors were willing to assist the nurse, he left us to run the ward ourselves. We went through all 100 patients and 5 or 6 emergency patients. The one patient that remains in my memory is a man that came in at noon with open gashes covering his head. He had a gash on his lip that was so deep, the septum under his nasal cavity was open. All three of us worked on him for over a hour. I did my first stitches on his head, directed by the UK doctors.  He was drunk and couldn't afford to buy a syringe for us to inject some local lidocaine, so I was literally pinning him down to prevent him from moving everywhere.

On Wednesday and Thursdays they do major surgeries. So clad in my scrubs and crocs, I watched surgeries for 6 hours each day. Many removals of hernias and Caesarian sections, and two thyroid removals. The surgeons are very willing to teach during the surgeries and let us scrub in to assist whenever we want. The atmosphere is light and happy, many of the surgeons wanted to know a lot about me as we worked.  The anesthesiologist first told me I was old and should be married already. But the next day he told me we were getting married and now calls me "my baby" every time I see him! But I think his true intentions is for me to give him my scrubs when I leave, as they were all auctioning them off.

Next week I am working in the labor ward which should be very exciting and apparently very hands on.

My family is AMAZING. My sisters are Careen (age 10) and Carol (age 6). The speak very good English. Which is very fortunate because the grandmother who takes care of the hours doesn't speak any English. When I first got here my house mother wasn't here because she is a doctor at a hospital very far away. But she came home about 6 days ago and has really been the most welcoming person I've ever met. Her food is really good compared to the food many of the other volunteers. I have struggled with being a picky eater my whole life and I made a promise to myself I would eat any thing in front of me. As I've done that, I've eaten eggs for breakfast most days which I've struggled my whole life to like. Three days later and I woke up craving them! Lunch is mostly rice, beans, a meat, and vegetables. Dinner is similar. The fruit is amazing though because it is always so fresh. I eat fish off the bones most meals which I would normally never wold have eaten in America.
We now have 3 volunteers staying here and l am so thankful for them because traveling and doing all of this with someone else is much better.

Today I went to the beach all day. Just a little taste of home. The other volunteers range from places all over, many from Denmark and England. I'm one of the older people here because many of them are on gap years after high school.

There is still so much to say but I'm hogging the little Internet we have. Next weekend I'm going on safari and will for sure have a post after that. Hope everyone is well in America and soaking up their summer. Oh by the way, I had a woman tell me I looked like I had lived in Africa for much longer than two weeks because I was much tanner than most "mazungos"....best compliment ever.

Today is the Day!

wow! Today is actually may 12th.
In 10 hours I will get on a plane and start my 24 hour trip to Tanzania.
I leave Jacksonville for NYC, NYC to Istanbul, Istanbul to Dar es Salaam. I will arrive in Dar at 2:45am local time. which, by the way, is 7 hours ahead of Jacksonville time. I will then be transported via the Projects Abroad staff to my host family home.
I have to think this way, in facts.
The plane ride to NYC is 2.5 hours, to Istanbul it is 10.5 hours, and to Dar it is 8.5 hours.
All I know about my family is this: "Agata works at Ministry of Helth. Lives with her husband Basil who is a business man. Their Daughters Careen and Carolyn."
All I know about their home is this: "The house is near the Projects abroad offica and Mlimani city,shopping and cinema centre of Dar Es Salaam.It is about 30 minutes to our office."

There is still so much unknown.
I am ready to start this journey. I am ready to learn a language I have never heard. I am ready to learn how to aid the people through medicine. I am ready.

Standing Between Me and Dar

Only 14 days stand between me and Dar es Salaam. Needless to say they will possibly be the most stressful 14 days of my life as 4 final exams also stand within these days. BUT here's the beauty of God's plan, "Dar es Salaam" literally translates to "The abode of peace." So of course I am stressed and currently surviving off of free food and caffeine. Of course I am worried about 4 exams and their importance in my career. I say of course because I know I am being prepared to see the world differently. I wonder How different I will see the world from the Abode of peace?

The other day I watched a beautiful movie by HBO called "Mary and Martha" about a woman who leaves her husband in America and takes their son to Mozambique for 4 weeks. While there he contracts Malaria and dies within a day of showing symptoms. This of course destroys her life and but she returns to Mozambique to find her peace. While there she runs into a woman who lost her 22 year old son to Malaria. As the story goes on the woman work to help raise funds to buy mosquito nets and malaria medication for thousands of people in Mozambique. There is a line in a the movie that states "Did you know that if you take every single person killed in a terrorist act around the world in the last 20 years and you add to that all the lives lost in the middle east since 1967 and you add to that every American life lost is Vietnam, Korea, and every American engagement since then (Iraq, Afghanistan) and then you multiply that number times two - that is the number of children that die of Malaria Every Single Year."

If this fact doesn't hit you somewhere in your heart, you might be a lost cause.
Wondering what you could do to help? http://www.malarianomore.org/ this is a great cause that the movie was based on. we live in a world where 660,000 children are dying from a treatable virus and I'm worried about an exam? whats wrong with this picture.





A lot of people ask me if I'm scared or nervous to leave this last week. and this made me realize I'm more afraid of not going. That sounds weird and I don't know exactly how to explain it. I think what I am trying to say is that I am afraid of not being fully in the moment while I'm there, that a part of me will want to be back here. I've never traveled or been completely off the grid before and I just want to take full advantage of completely letting go of here. Caring about exams, about rent, about what I will eat next, about boys or lack their of. I want to find peace, I want to fully thrive in the abode of peace. 

I write all of this while studying at a local cafe sitting across from my beautiful friend Melanie Rose who just made me cry thinking about all of my friends that I will miss while I'm gone :(

Vaccines and Grace

Woke up this morning with an allergic reaction to my Yellow Fever vaccine. The site where the shot was injected has raised and literally looks like Africa on my arm. After getting it checked out the doc said it was okay that I just needed to watch it for a few days. Meanwhile the oral typhoid fever vaccine is running its course through my body and causing wreckage.
 But here is the upside: Most people in Tanzania have never been vaccinated for ANY disease while I am able to get vaccinated for diseases that kill thousands of people yearly. We have a vaccine for THE FLU, while 53,689 people died of the flu in Tanzania in 2011 alone. So like my dad always taught me I "suck it up" and remind myself that my discomfort is considered a luxury in most places.

 This brings me to my other point: Grace. On Sunday April 1st, I was baptized again. I was baptized when I was an infant in my Lutheran church in Jacksonville. And in no way do I undermine the importance of this baptism. I thank God my parents had faith and chose to have me baptized and raised in an awesome church. Lutherans believe baptism signifies the water cleansing an infant of the natural sin we are born with and entering them into the church family. I think the most beautiful image God has set for us is when Jesus chose to be baptized by John the baptist. A man perfect, without sin, chose to be cleansed to show the world that the living water is an image of eternal life through him alone. When I was baptized as a baby, I was rescued from what I didn't even know yet:sin. I think baptism is a reminder of what it is like to be an infant, clean and pure of the worldly ways. Recently I have come to understand my faith in an entirely new light. I have called myself a christian my entire life, I devoted my life to Christ in 10th grade at Young Life camp, but it wasn't until God called me into my darkest hour to show me that I wasn't walking a life with him. I was asking God to come into my life, but why would I want someone perfect to come into my messed up life?! why wouldn't I want to walk with him, holding hands down a path only he knows. Why wouldn't I want to show the world that my imperfect ways are cleansed and I am made new life an infant DAILY through Christ. God has showed me IMMENSE amounts of Grace over the last 5 months. He has filled my life with friendships that show me how he intended for us to love one another. He has showed me that I put another human above him and that I needed to put him above the rest. He has showed me that to walk with him is not to be perfect but to stumble and fall but admit that he has rescued me from this and not my own doings.
Over this last semester I have found refuge in God. I came running to the lord with all of my issues, but I never let him take them away. What drives God insane is continually repenting for the same sins over and over, HE HAS THEM SO LET HIM TAKE THEM. I keep returning back to the same sin because I haven't forgiven myself, or let his Grace BE GOOD ENOUGH.
So, I am washed clean. I am an infant with nothing but a future ahead of me. With nothing but eternal life to look forward to.
Thank you Jesus for new life.

also Thank you for my dear friends Alex, Mel, and Forrest for being there to be a testimony to my life. You guys have been god's hands and feet in my life, showing me daily that I am worth loving and what true friendship is: love.