Yesterday, we went with the nursing students to a local church to help with a palliative care clinic. The clinic was free, and ended up being less about palliative care and more for locals who could not afford health care costs at any of the nearby hospitals. When we arrived, some of us were sent to the pharmacy (a table of donated drug samples) where we packed unlabeled pills into plastic bags. Patients came to us with the doctor's prescription, and we did our best to find the pills they needed (though I recognized maybe an eighth of the drug names). The clinic went fairly smoothly. Patient's blood pressure and vitals were taken by a nurse outside, and then patients, one at a time, entered the church to see the twenty five year old doctor. The doctor was helpful, translating patient complaints and asking the nurses what they would prescribe. This was until he received "bad news" from his girlfriend via text, which we all think was a virtual breakup. From then on he granted each patient about thirty seconds of his time, prescribing most brofen (ibuprofen) or multi-vitamins. At one point, a women came in holding her throat and in about eight seconds he sent her away with the diagnosis: tonsillitis. When one of the nurses asked if he maybe should look at the women's throat, he laughed off the comment and went on to the next patient.
It was an interesting experience because, on one hand, these patients were recieving free care. But, in treating their symptoms, they were likely being diagnosed incorrectly. But then again, just to flip the coin once more, an accurate diagnosis may n0t make much of a difference when these patients dont have the resources to seek care for, say, cancer. We are hoping to help with a similar clinic next Thursday.
Today, we are at KCMC for an information session on obstetrics and maternal care in Tanzania. After, we are staying in Moshi for the night, going to a culture club called the Watering Hole to listen to music. Tomorrow, we are planning one day in Arusha. Hopefully, funny stories to come.
Friday, July 10, 2009
Saturday, July 4, 2009
First Week at Marangu Hills
We officially finished our first full week at Marangu Hills. It is absolutely exhausting. We are, for the most part, teaching a class every period (8am. – 4pm.). Sometimes teachers will ask us to help with their class, and apparently help means for us to teach while they get some shut-eye in the back of the classroom. But we are happy to relieve the teachers once in a while. The students are fascinated with us, mostly the color of my hands and the texture of my hair (probably the only place where my hair is considered beautiful).
As Emily and I are getting used to this style of teaching, I think we are starting to really make a difference. At first students thought they could spend the entire class period asking us questions about America or singing for us, but now they are viewing us more as teachers. We are writing our own lesson plans and finding ways to teach them things so that they will remember it. The teachers are impressed with what we can do with the children. They say that the “phobia” of Westerners makes them listen and absorb the lessons we are teaching them. It may be that or they know that we aren’t going to hit them if they ask a question…
On Friday, we went to the funeral of a local pastor. There were about one thousand locals (not an exaggeration) crowded around this church. Lining the hills were people, dressed in their most colorful cloth, standing among the gigantic greenery you find in rainforests. If it was at all socially acceptable, I would have taken a picture. We unfortunately drew a lot of attention, but it was an amazing experience to be there.
As Emily and I are getting used to this style of teaching, I think we are starting to really make a difference. At first students thought they could spend the entire class period asking us questions about America or singing for us, but now they are viewing us more as teachers. We are writing our own lesson plans and finding ways to teach them things so that they will remember it. The teachers are impressed with what we can do with the children. They say that the “phobia” of Westerners makes them listen and absorb the lessons we are teaching them. It may be that or they know that we aren’t going to hit them if they ask a question…
On Friday, we went to the funeral of a local pastor. There were about one thousand locals (not an exaggeration) crowded around this church. Lining the hills were people, dressed in their most colorful cloth, standing among the gigantic greenery you find in rainforests. If it was at all socially acceptable, I would have taken a picture. We unfortunately drew a lot of attention, but it was an amazing experience to be there.
Arusha
We spent the weekend in Arusha and on safari at Ngorongoro and Tarangire with the Duke Engage LTP (Literacy Through Photography) students. They are doing really amazing things with kids in Arusha, and definitely gave us some good ideas of how to engage our students through art and expressive thinking.
Glad to return to Marangu where things are quiet and we are familiar faces. I finally felt comfortable enough to go on a run through town. It was incredible. As I ran through central town kids started running with me, mamas cheered me on, and the taxi drivers yelled my name. I am reading The Unheard, a story about a deaf author finding home in a rural African village. I am finding that I can really relate to his experiences and those initial feelings that you are being welcomed in a village or culture so different than your own.
Glad to return to Marangu where things are quiet and we are familiar faces. I finally felt comfortable enough to go on a run through town. It was incredible. As I ran through central town kids started running with me, mamas cheered me on, and the taxi drivers yelled my name. I am reading The Unheard, a story about a deaf author finding home in a rural African village. I am finding that I can really relate to his experiences and those initial feelings that you are being welcomed in a village or culture so different than your own.
Marangu Hillls Academy
Today was our first day at Marangu Hills, though the students were busy with their monthly examinations. We were able to meet once with the girls and have our first counseling session. We spoke to them about HIV, puberty, and coping with a changing body and changing feelings about yourself and others. We are having some trouble getting the girls comfortable and willing to ask questions. The culture here, especially at the school, is not very conducive to moving outside of your comfort zone and asking questions, so we spent the majority of the time lecturing. It is also difficult because girls here seem to not only develop more slowly than in the States, but many of them are at radically different stages of development.
The school was a little apprehensive about teaching extensively about HIV. I think they fear that speaking to girls about condoms or sex may provoke behaviors that such a Christian school condemns. We are going to try to work with the teachers to develop a curriculum that deals with HIV/AIDS that is informative, creative, and won’t put ideas into their heads about what is expected of them at their age.
The school was a little apprehensive about teaching extensively about HIV. I think they fear that speaking to girls about condoms or sex may provoke behaviors that such a Christian school condemns. We are going to try to work with the teachers to develop a curriculum that deals with HIV/AIDS that is informative, creative, and won’t put ideas into their heads about what is expected of them at their age.
Change of Plans
As we had expected, our original plans for what we would do here have changed. After several days of shadowing at the hospital, we started to realize that we were probably getting more in the way than we were helping. Patient traffic is not overwhelming, and so the hospital really just needs trained doctors and money. It’s a humbling experience when you travel abroad, expecting to change the world, only to find that you yourself are very limited in what you can offer. We had originally planned on creating a method for taking patient information by creating a computer system for the hospital to operate on. But unfortunately, or fortunately (however you look at it), the hospital already has a fairly complex computer system in place.
And so we looked for someplace we could make a real difference. For the next four weeks, we will be working at Marangu Hills Academy, a boarding school in Marangu. Here we will mainly be teaching physical education and providing counseling for the older girls several times a week. We are trying to create room in their education to learn about healthy behaviors and inform them about health-related issues they may not have heard about before. The challenge will be to inform and engage these students, especially within such a rigid and conservative education system. In our free time, we will be assisting in the classroom, teaching English, Computer, and Mathematics.
After four weeks, we will be working with the ABSN nurses at a hospital in Kilema for one week and assisting with Marangu Hospital’s home-based care project for the final two weeks.
And so we looked for someplace we could make a real difference. For the next four weeks, we will be working at Marangu Hills Academy, a boarding school in Marangu. Here we will mainly be teaching physical education and providing counseling for the older girls several times a week. We are trying to create room in their education to learn about healthy behaviors and inform them about health-related issues they may not have heard about before. The challenge will be to inform and engage these students, especially within such a rigid and conservative education system. In our free time, we will be assisting in the classroom, teaching English, Computer, and Mathematics.
After four weeks, we will be working with the ABSN nurses at a hospital in Kilema for one week and assisting with Marangu Hospital’s home-based care project for the final two weeks.
Marangu
Considering Moshi was fairly urban and busy, we could not have expected what was to come in Marangu. We drove through town, windows down enjoying the Kilimanjaro breeze, only to be bombarded with bananas as women desperately tried to make drive-by sales. And as we moved further into the village toward the hospital and our compound, the market turned to farmland. This is the kind of place where soccer games are interrupted by the occasional grazing cow. Our house is on a hill at the base of Kilimanjaro. We pass over a waterfall each day on our way to the Hospital. The weather is cool and completely unsuitable for our wardrobe, but we will make due.
Marangu Hospital is a small, under-resourced, but clean and quiet place. Wards are contained in individual houses with waiting rooms that are rarely full. Parts of the hospital are construction sites, as they are desperately trying to finance a pediatric ward and a nursing home. We sat in on the morning report, where doctors who were on call the night before review the patients they saw. Some of the attention was on an eighteen year old girl who was bit in the cheek by her brother, but most was on the number of surgeries or patients that would have to wait because medication or equipment was scarce. The wheelchairs here are made of lawn chairs (the plastic white ones) mounted on bike tires. The incubators look like 1950’s jukeboxes.
We visited Marangu Hospital’s AIDS clinic, which was unfortunately very busy. The building was partially funded by PEPFAR, which explains the constant George Bush praise we hear everyday. I had about an hour conversation with the Hospital’s Administrative Director, during which he praised America and their foreign policy, something you don’t hear very often.
Marangu Hospital is a small, under-resourced, but clean and quiet place. Wards are contained in individual houses with waiting rooms that are rarely full. Parts of the hospital are construction sites, as they are desperately trying to finance a pediatric ward and a nursing home. We sat in on the morning report, where doctors who were on call the night before review the patients they saw. Some of the attention was on an eighteen year old girl who was bit in the cheek by her brother, but most was on the number of surgeries or patients that would have to wait because medication or equipment was scarce. The wheelchairs here are made of lawn chairs (the plastic white ones) mounted on bike tires. The incubators look like 1950’s jukeboxes.
We visited Marangu Hospital’s AIDS clinic, which was unfortunately very busy. The building was partially funded by PEPFAR, which explains the constant George Bush praise we hear everyday. I had about an hour conversation with the Hospital’s Administrative Director, during which he praised America and their foreign policy, something you don’t hear very often.
The Oranges Here Are Green
At long last. The blog is up.
Our first night in Moshi.
If nerves weren’t enough to keep me up last night, I owe the 3am wakeup to the roosters and goats chatting outside my window (all night long). This morning we visited KCMC (Kilimanjaro Christian Medical Center). We toured the hospital with two Duke graduate students, who are researching the effect meditation has on the performance of orphaned children.
KCMC was nothing I have ever seen before. The wards were overcrowded, mattresses (if you can call them that) were scattered about the hallways, which were coated with last night’s rainfall. At one point, we were stopped before entering the delivery ward because our shoes were “contaminated”. Meanwhile, dirty water was dripping from the ceiling, despite a continued effort to mop it up. Patients were dressed in their normal, colorful African attire, while nurses wore what we consider patient gowns, ones clearly donated from overseas.
But even with the tremendous number of patients that come to KCMC each day, the hospital remains one of the most capable in the region. People were excited to hear we were from Duke, they definitely appreciate the collaboration.
What most struck me today was the size of Tanzanian “mamas”. Women here, and I say this respectfully, are heavy. It is apparently customary for a woman to take three months after she delivers a child to stay home and care for her baby. While the woman cares for the child, it is the community, especially the husband, who is responsible for caring for her. If the woman emerges from her home months later and is relatively thin, it is interpreted that the husband and the community could not properly care for her. Obesity becomes a sort of right of passage into mama-hood. [I can think of a mother or two who would appreciate this custom in America…]
Tomorrow we are off to Marangu, the rural village we will be spending the next eight weeks at. Our project, though we expect to see some changes in it, is to help Marangu hospital by assisting with community-based care, developing health education materials, and revising the hospital’s method for obtaining patient information.
Our first night in Moshi.
If nerves weren’t enough to keep me up last night, I owe the 3am wakeup to the roosters and goats chatting outside my window (all night long). This morning we visited KCMC (Kilimanjaro Christian Medical Center). We toured the hospital with two Duke graduate students, who are researching the effect meditation has on the performance of orphaned children.
KCMC was nothing I have ever seen before. The wards were overcrowded, mattresses (if you can call them that) were scattered about the hallways, which were coated with last night’s rainfall. At one point, we were stopped before entering the delivery ward because our shoes were “contaminated”. Meanwhile, dirty water was dripping from the ceiling, despite a continued effort to mop it up. Patients were dressed in their normal, colorful African attire, while nurses wore what we consider patient gowns, ones clearly donated from overseas.
But even with the tremendous number of patients that come to KCMC each day, the hospital remains one of the most capable in the region. People were excited to hear we were from Duke, they definitely appreciate the collaboration.
What most struck me today was the size of Tanzanian “mamas”. Women here, and I say this respectfully, are heavy. It is apparently customary for a woman to take three months after she delivers a child to stay home and care for her baby. While the woman cares for the child, it is the community, especially the husband, who is responsible for caring for her. If the woman emerges from her home months later and is relatively thin, it is interpreted that the husband and the community could not properly care for her. Obesity becomes a sort of right of passage into mama-hood. [I can think of a mother or two who would appreciate this custom in America…]
Tomorrow we are off to Marangu, the rural village we will be spending the next eight weeks at. Our project, though we expect to see some changes in it, is to help Marangu hospital by assisting with community-based care, developing health education materials, and revising the hospital’s method for obtaining patient information.
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