A great day, but with a healthy dose of reality.

I started today on high, managing to get out for a run before breakfast and walked into the hospital full of enthusiasm. Unfortunately, the hospital meeting brought me crashing back down to reality with the daily death report which included a 12 year old girl that died over the weekend of…. well we don’t really know. She had a positive malaria test, was quite anaemic but also had a very high temperature. Probably severe malaria, but possibly another source of sepsis. With limited investigations and treatment options, what was clear to me was that her chances here were much lower than if she’d been in the UK. All very sad and sobering. Particularly when so close in age to my own children….

Giving presents always provides a healthy dose of ‘Pep-Up-Potion’ and I headed to theatres to present my Christmas offerings for the staff. I had had some theatre hats made in town for the whole team (just 18 in total!). They were delighted with them and that was certainly a boost for me. The smiles and chattering as they sifted through the various designs to choose which one they each wanted was great to watch.

It was then off for a ward round before a few other tasks, then clinic. I was quite time constrained to fit in all my various activities for the day and felt honoured by the way I was treated in such high esteem. In a somewhat professorial fashion, I was whisked around the wards, taken to see just the patients that the team considered required my review – four hernias for theatre this week (two pretty straight forward ones and two biggies), a couple of children, my long stay patient whose wound looks fantastic – still needs a bit more TLC though – and a couple of diagnostic dilemmas). I felt very well looked after and it was quite good fun actually.

I then headed off to my meeting with the pharmacist, who is responsible for ordering all medical ancillaries, not just drugs. In my bid to understand the ‘supply chain process’ for getting ‘African sutures’, I had established that this was a key individual. I believe it is important to work within the constraints of what is easily available in the hospital (rather than, for example, the adhoc supplies from UK visits), but have been desperate to find some alternative sutures. I wanted a suture that was less of a needle-stick hazard than those we are currently using to close the skin. I never imagined that this part of the operation (that is often delegated to the most junior team member for training) would ever cause me such anxiety!

I certainly learned a lot about another process I would probably never be involved in to such detail back home. Whilst many of my questions were not easily answerable through the internet portal we were using (like the cost and availability!), the fact that there were other sutures on the system was very promising. I have provided my wish list of two sutures (2/0 vicryl [the real thing and not the fake vicryl we are being forced to use in the UK!] and something that might be a monocryl equivalent). Watch this space. On the drug front, I also had the opportunity to discuss getting Tamsulosin and Finasteride in stock (good for the patients with big prostates and good for the hospital) and this looks very promising too.

I then had to pop back home to meet some of the Fundi (tradesfolk) who were there to help with some of the unresolved house ‘improvements’. A quick ten-minute job turned into over an hour of sweat, dust and toil as I ended up drilling a new hole for our gas supply to our new cooker. I have been waiting to do this for over two weeks now – the first effort done in my absence had the gas tubing sitting against the hot back of the cooker…. it started to melt. Fortunately it occluded before it exploded…. This task would have been very straight forward if I could have just popped into my own garage to get a suitable drill and drill bit…. Instead I had to struggle with a bit that was far too thin. Grrrr. But being bloody minded (as I can be at times), I eventually got the job done as I wanted it. So hopefully I can connect it all up tomorrow to have a fully functioning hybrid electric / gas cooker. Its only taken four weeks.

Whilst I did skip lunch, a quick shower and cup of tea was needed before heading off to clinic for which I was woefully late. However, I probably did in fact time it perfectly. Forty patients today and all that was left were 11 that they had saved for me. It is not often you get called special (well in a positive way), but today it happened. Whilst it may be one of those slight translational peculiarities, it certainly made my day. However, in follow up to that statement, in no uncertain terms I was told that seeing a Muzungu Surgeon was considered to be the very best possible opinion. When I laughed, the staff made it quite clear that not only was it true, they wholeheartedly agreed. Crikey, I’d never thought anyone would think like that. I have never been the type of surgeon to have a ‘god complex’, far from it in fact. Throughout my time here, I have always considered myself just another member of the team. One that has a wealth of experience not available here in Tanzania perhaps, but certainly nothing more special that that. Humbling. But I would be lying if it didn’t make me inwardly smile. And I’ll take it too. I’ll bank it and use it to help fuel my remaining time here. Of which I am sure I will find many more a challenge.

We also saw four more of the mesh patients for follow up today. They have all recovered brilliantly (including the incisional hernia repair) and are delighted with their surgery. I am delighted with their recovery! A great relief to me and a real boost to our efforts here.

So a great way to close out 2018 – I never thought I’d be here at the start of the year….

Here’s to a great 2019!

Heri ya Mwaka Mpya!

Tank half full?

Well actually, I’m delighted to report that on our arrival back in Muheza, the water tank is in fact almost completely full! For the first time since arriving, we have plenty of water for the house and can enjoy showers, flushing the loo and even rinsing plates under the tap when washing up. Luxury. We will await Monday’s water delivery to see how frivolous we can be for the next week!

Unfortunately the list of fried electrical goods after last week’s power surge has risen to include the kettle and microwave (both of which were almost new). I will have another tinker with them, but at the end of the day, if they are broken we can always replace them.

I too have a (proverbial) tank that is almost full and certainly am ready to seize the next few weeks of work. Having a couple of weeks off really was important, it is only towards the end that I realised quite how much I have given these first two months. I am sure that some of this is ‘the whole package’ of moving to a very different part of the world and trying to settle the family in. But there have been many times when I felt quite overwhelmed clinically. There is just so much need and the complexities of what can, could and should be offered is, on occasion, extremely challenging. There is a song by Avicii that I have grown to love, not least because it is so uplifting,  and there have been times when the words seem very apt, summing up just how I am feeling in those moments; ‘feeling my way through the darkness’, ‘caught up in a dream’, ‘I tried carrying the weight of the world, but I only have two hands’, ‘so wake me up when its all over’.

But for all its challenges, I wouldn’t be anywhere else. It is a real privilege to be doing what we are and to be part of something so very different to anything else I have ever known. I have a number of cases coming up over the next few weeks that will test me (and possibly test my resolve too), but I feel very ready for it. It is a great team here and they could not be any more encouraging for what we are doing nor delighted by what we are achieving.   

Work starts again tomorrow. 

‘polepole’, an Authentic African Experience

Vocab: “polepole” means slowly, not to be confused with “pole” which means sorry

So today’s morning mission was to see if I could get the spare tyre fixed with enough time left to head off to Tanga for our planned shopping and swimming trip. After yesterday’s excitement it seemed especially prudent not to leave without a back-up option! I had some trepidation in this task; did I really know exactly where to go to find the ‘tyre garage’, would I be able to communicate what was required (and safely – whatever that might mean, there is definitely a spectrum to this term I am learning) and would I end up paying a fair price? Mulling this over, I went to pick up the car from the hospital (where it is parked for security every night) and, as fortune would have it, I bumped into the hospital superintendent who was heading that way himself and so came with me.

This fortuitous encounter made the whole process much easier and enjoyable. He stayed with me for the whole experience, turning what might have been somewhat frustrating into a very social and informative event. We were given chairs (broken plastic garden chairs stacked in twos to make something that was surprisingly comfortable) at the back of the ‘workshop’ (a high vaulted tin roof atop four high posts) and watched the goings on. Whilst there is clear process to things, nothing happens particularly quickly and so you just have to accept this and enjoy it! It is amazing to watch people work so effectively with a mix of very basic / improvised tools, pure human determination (of the sort that would never be allowed in the UK – ‘health and safety’ would stop that) but with a smattering of some very recognisable modern tools (the high pressure generator with a cylindrical reservoir over a meter in diameter). Unfortunately, the inner tube (these 4x4s have them) was beyond repair and so a new one was needed. Fortunately, a shop just across the road sold them. Unfortunately, it wouldn’t be open until 09.30 as today was the last Saturday of the month and that means its town cleaning day. All across the country on this day every month the shops do not open until 09.30 (normally it would be between 7-8am) to allow cleaning of the streets to take place.

So we waited watching the goings on of a very busy tyre and high pressure air ‘service station’ (glorified hut really, well actually not even a hut). Trucks, busses, cars, motorbikes all swinging by to get their tyres topped up, or air filters blasted, with the occasional puncture to be repaired. By the end of our wait, I think I had worked out who the boss was, who the apprentices were and who the customers were.

We were also treated to some powerline tree maintenance. Which basically involved one tall tree, two chaps with machetes, one flimsy ladder and a huge potential for death / paralysis / major injury. But remarkably they hacked down the required branches under the watchful eye of the foreman (and the required crowd of onlookers / interested parties) without incident. They made surprisingly light work of some pretty hefty branches.

After this wealth of cultural insight / entertainment for me, the tyre was ready and I returned to collect the girls. It was then off to Tanga for food shopping, lunch and a swim. I was also commissioned by Kate to go to buy a cool box for easier transport of our goods. I followed directions to Barabara Nne (Street 4) in the old new (non colonial) part, where most of the shops are. I am getting the hang of Tanga now and from what felt like a completely unnavigable maze of similar chaos just a few weeks ago, I can now recognise some of the subtleties and make my way around. I’m getting my eye in I guess.

It was then lunch, swim and back to Muheza. A very successful day.

Who needs the AA?

Sometimes it’s great when you’re right. Sometimes it isn’t. This afternoon was one of those times when it wasn’t! 

After a lovely morning, we left our beach resort later than planned (I had suggested 2.30 or 3pm latest, we left at 4pm). We were driving on proper dust roads all the way back to Muheza and also had to negotiate the ferry again. I wanted to ensure we were back well before dark and also had some wriggle room in case of incident. Needless to say, we made a wrong turn on our initial segment only to arrive at the ferry to watch it heading back across to the other side. The mouth of the estuary was in full flood tide and we watched the ferry duck, weave and veer its way across. It then sat for a painfully long time on the other side whilst it was loaded up, including a bus – with all the passengers having to disembark the bus, buy individual tickets and load onto the ferry on foot (although of course I could have misinterpreted this hive of activity in the distance across the river bank). However, it is always interesting to sit and watch the world go by and in Africa there is always lots to look at.

We made it across the ferry and headed back to Muheza. Bumpy, bumpy. Hard work driving on such roads. As well as the multitude of potholes (really hard to see in the shadow), ruts and stones, the roads often have a huge camber (I guess to cope when it rains torrentially). A lot of the time when driving, it really does feel like you might topple, leaning painfully to one side (clearly this statement displays my amateur status as an African 4x4 driver!).

Then as the light was starting to fade, and we were about 10km from home, I noticed that the bumpy, bumpy was more bangy, bangy. Looking behind there was an impressively large dust cloud. Gulp. I ‘pulled over’ (this really means that I stopped slightly to one edge of the road) and had a look round. A puncture on the off-side rear. Great. Well at least I am fairly car savvy and know how to change a tire. First triumph was finding the wheel nut spanner, then actually managing to loosen all the wheel nuts, but then of course the jack was broken. Doh, doh, doh, doh, DOH! But in Tanzania. Help is never far away and as we were just outside a small hamlet, a small crowd of encouraging onlookers had gathered. And then a couple of vehicles stopped. 

Fortunately ‘jack’ is ‘jack’ in Swahili, so even with my limited vocabulary I was confident that the problem was clearly communicated. And in no time someone sped off on a boda boda to find one. They returned and we successfully started to raise the vehicle. Only to find it didn’t go high enough (these 4x4s have an impressive depth of tyre). Off another boda boda sped, again returning a little while later with a second jack. With a lot of help and to the huge entertainment of the local village (I think ‘Wazungu in distress’ (especially with little wazungu) features quite highly on their entertainment ratings!) we got the car up, wheel changed and ready to rock and roll again (quite literally!). 

The onlookers were suitably appreciative of such success and I ensured we remembered the necessary thanks, providing water to wash all the helpers hands and offering a gift of some beer / soda money which was gratefully accepted.  ‘Disasters’ come in many forms, and this one was an absolute joy to be part of. Although I got hot and very dusty / dirty, to have a load of strangers rally to a cause and not be able to do enough to help was a real privilege. This epitomises the Tanzanian culture. Whilst generalisations are always dangerous to make, they are a beautiful people. 

It was dark when we got back underway and the last part of the journey was a bit like a computer game. Unlit boda boda’s, cyclists and pedestrians would suddenly appear out of the gloom, or worse from within the glare of the few headlit vehicles. For every one we missed, I could imagine the positive ‘bring’ of the computer announcing our success, and the stash of coins flying from these obstacles to power up the score bar. But we made it back safely and without causing injury or death (to our knowledge – although a close call for at least one chicken). So all round, this must be considered an absolute result. Certainly an eventful day!

Unexpected links

Today has been another glorious day by the beach. We were very unexpectedly offered a couple of tag along places on a snorkelling trip to an offshore reef and sandbar – known as Sand Island. It just so happens that the friends of one of the families we have got to know here have a house just down the beach and also a beautiful traditional Dhow (imagine a 34’ dark wooden boat with a big white triangular sail). Setting off from the beach, Ruth and I were treated to a glorious sailing trip with a lovely bunch of new friends. It was a slightly bumpy trip (some felt a bit queasy) as the wind was strong and the ‘white horses’ aplenty, but the boat was so solid and seaworthy. For me, sailing on such a vessel was sheer joy. 

All so very basic in many ways, yet finely honed craftsmanship from hundreds, if not thousands, of years of traditional sailing experience. The snorkelling was also superb with lots of colourful healthy corals and beautiful tropical fish. One of nature’s most vibrant playgrounds.

Over the last few days we have met lots of very interesting Tanzanian ‘Wazungu’ (plural of Mazungu – white people, these all now resident in Tanzania) from different walks of life. The Kiwis who manage massive co-operative farms in central Tanzania so big they need a plane to fly between them, French teachers (that is teachers who are French), English / Scandinavian global development ‘consultants’, German hospitality managers to name but a few. And many with young families. Everyone has such fascinating stories behind their presence here. All of them carving out a niche and in doing so helping Tanzania move forward. They all speak so highly of the country and of the people, notwithstanding the many quibbles and concerns that of course are also very apparent.

It was when chatting to another local Muzungu farmer (cultivating sisal, a crop used to make very strong natural fibre threads and ropes) over dinner, that our conversation drifted to what I was doing here. As I briefly told our story, I mentioned the work we have been doing with mosquito net hernia repair. I shared the many frustrations and challenges that we have faced, but was also delighted to follow that all up with our current fantastic success. As I outlined my hopes for sustainability, I mentioned my only real outstanding issue was with regards to sourcing the mesh in the long term. The batch I brought out came from India and whilst in theory it would be possible to ship consignments here, in my heart I have significant concerns that this could derail the whole process.

However, as these things often happen, I stumbled across a potentially very important discovery. He told me of a mosquito net factory in Arusha (run by an Indian family as it happens) where he has just bought a huge amount of netting for his farm. From the rough cost he mentioned, it would be perfect. Per hernia repair the cost would be the equivalent of just pence. If it is of the correct material (which would be very important), it would very much fill this gap. Perhaps providing the final missing link in this project. How very exciting. Ironically, we were in Arusha just last week, but I will have to return to check out this factory over the coming few weeks. Might be able to visit some of our new friends too.

A new contender

We are having a delightful time here at Tides. It is blissful. Sun, sea, sand, shade and a strong cooling wind make it a lovely place to spend some time. Running along the beach, swimming in the sea or the pool, playing games in the bar and eating very nice food are a lovely way to spend time.

A definite contender for most ridiculous boda boda load, 

not least being on the beach!

It certainly brings a smile to the face.

Kristmasi Njema!

We are having a very different Christmas experience. Whilst on the one hand I definitely miss the traditional Christmas experience, being in a hot country has its advantages. The chidlers have roamed freely on the beach, in the sea, in the pool and under the trees, playing very happily indeed. They have found some Muzungu friends of similar ages here, a lovely family from Arusha who have been living in Tanzania for 3 years working on global development projects. We have also enjoyed our family time together opening a few presents. And as parents, we might have had our most peaceful Christmas yet.

I am delighted to say that Santa did find us. There was definite concern that he might not visit Tanzania (as the children at school have no concept of stockings), but perhaps he was drawn by Kates African Stocking efforts and the shear might of ‘chidler power’ willing him to find us! 

We wish you all a very Happy Christmas indeed, wherever you are and whatever you are doing. May it be peaceful and full of joy.

This might be it…

We returned to Muheza for the briefest of stopovers – a night and a morning. After much debate about where to spend Christmas we decided on a beach resort. This was not an easy decision as Hill View has very much become our home and we all definitely sleep best here. However, we thought it prudent to prevent any chance of me being drawn into a Christmas medical disaster (reassuringly, I guess, all four of my lovely ladies seem keen to have me present for the whole of Christmas)! It also appears to be a good decision as a power surge whilst we were away seems to have fried a number of our electrical goods. I will take proper stock of this on our return and begin the process of fixing….

Hospital Decorations!

Unbeknown to me, last night Kate had laid a Christmasy breakfast table complete with African Stockings that she had had made here. A great way to wake up and left me very intrigued as I went out for a run before the rest of the house had stirred. After that, I popped into the hospital to see my one remaining inpatient – a laparotomy from a few weeks ago that had a (predictable) wound infection. In the UK she would have been discharged 2 or 3 weeks ago with a VAC dressing, here the only place we can manage her wound is as an inpatient. There is no such thing as district (or even practice) nurses. She is the lady who had a small bowel fistula following gynae surgery and I am just delighted with how well she is doing (not least because she also had a new diagnosis of HIV). To be honest, she is very lucky to be alive. The wound continues to heal well, albeit slowly, and she is in excellent sprits. I offered her home leave for Christmas, but as a Muslim she was more than happy to remain. My token gift of a couple of packets of sweets brought a massive smile to her face!

Then to pick up the hospice car…. Finding the keys was slightly more problematic than I had hoped – a change of key rings – and whilst my Swahili can just about follow the conversations, it is frustrating not to be more in control of them. Anyhow, eventually all sorted and I got it home. We loaded it up, stuffed with a surprisingly heavy bag of Christmas paraphernalia (credit to ‘Kate-Wife’ again). We gave our housekeeper(s) a Christmas bonus, as well as a number of cards made by the girls which they could not have been more grateful for. I am still a little undecided about the whole ‘housekeeper thing’ but they are beautiful people and moments like these certainly weigh heavily in their favour. They are very much part of the household family now and they adore the children.

Ferry - safe?!?

And so we headed off once again, this time south, to the coastal beach resort of The Tides. It was another exciting journey. Getting to Pengani was fairly straight forward, albeit 42Km on mud / dust roads. But we then had to cross the river on a ferry. I had some reservations about this as we watched it veer from side to side in the current. Up close, it was a bit like a rusted smaller version of the Cornish King Harry Ferry or the Poole Chain Ferry, just without the chains (probably why it’s unstable). I rationalised that we had watched it get to the other side and back safely and it seemed popular and well used so on we got. It was of course absolutely fine and ‘safely’ transported us to the other side! 

Moto-goats

There we found the new holder of the ‘ridiculous boda boda (motorcycle) load’, four goats! Quite remarkable. I am constantly amazed by how much can be fitted onto and transported by these two wheeled wonders (I hasten to add I wouldn’t go near one – the safety record is also widely acknowledged as being decidedly questionable!).

The road from the ferry was fine, until we turned off towards the resort itself. Now, we have subsequently found out that the ‘old road’ has been extensively repaired, should now be considered the ‘new road’, and would have been a much better option. Had we been told. We of course followed the signs – why wouldn’t you! Probably the best way of looking at it was that I got an early Christmas present of a 4x4 adventure. 5km of… I don’t know quite how to describe it, certainly exciting. The track was unbelievably rutted in places and with some massive ‘water features’ to navigate too. The freshly washed hospice car was put through its paces and I certainly earned my beer at the end. Fortunately, we neither got stuck, crashed or broke any parts of the vehicle, which at times felt like quite a close call. So overall, another great result.

And we arrived in paradise. This place is quite something. We have got the resorts ‘family house’, which is massive and luxurious (all the more surprising given the price). I think the food might be better in Peponi (judging by lunch), but this place might just be it. From a family perspective. We have oodles of our own space, a beautiful beach, lots of toys (beach, board) for the chidlers and amazingly friendly staff. What a great way to start Christmas.

Panoramic of our 'mansion'

Our 'room' for our stay!

Returning 'home'

We have had a most excellent time on Safari and loved seeing another side to Tanzania in Moshi. Moshi is certainly much more ‘tourist friendly’ which whilst refreshing for us in some ways, will always have downsides as well as up. Probably the most irritating aspect is how all the prices of goods are heavily elevated for ‘Muzungus’, by five to ten times! This is very different to Muheza where people will occasionally try their luck, but on the whole the price is the price, Muzungu or African. Whilst it is absolutely possible to haggle them down to a sensible price in Moshi, and this may at first be fun, after a while it is exhausting by its repetitiveness. We absolutely want to pay a fair / good price, but equally can’t afford to be swindled. You are also somewhat hounded at times for your custom, again which can be too much with some traders, when they just won’t accept no for an answer!

There are lots of upsides too. Things are definitely more comfortable. There is a greater sense of wealth, a sense that this part of Africa is starting to ‘catch up’ with the west (if that is a good thing?). And it is easy to find whatever you want. Also, being very hedonistic, the food was very good too. We found an Indoitalian restaurant (whoever knew such a thing existed) where their biryani was excellent, as were their pasta dishes (much to the approval of the chidlers).

Countless bus station vendors

So finally it was also time to return to Muheza. Yesterday the bus company had phoned to say that the bus we were booked on had broken down and would not be running. Fortunately, we found an alternative, but the ‘luxury’ was distinctly lacking aircon. It was a very long, hot and sticky 6hr bus journey. The programmes shown on the TVs were also far from age appropriate, with very sexual music videos, a film about a child kidnapping and an extremely violent kickboxing movie. The girls had some insight to resist watching on the whole, but curiosity will always win to a certain extent!

Muheza Bus Station

We eventually arrived in Muheza, very ready to get off the bus! Amongst the sea of faces plying for trade at the arrival of a bus, we were greeted by a friendly taxi driver that Kate had used in the past (to go to school with the girls). A warm smile guided us to his car, and there was no question about the price. Straight down the line, 3,000TS (about £1). Spot on. There was a bit of a hitch in getting the boot open (pretty standard to be honest, you can’t expect the whole vehicle to function all the time – the jury rigged sting in the back-seat to open the boot didn’t seem to work today?!). So we loaded the bags in the back, Kate, Lottie and Beth climbed in, whilst Ruth and I walked. This was a blessing in disguise. A really lovely stroll home together. As we walked back into Muheza, it really did feel like we were returning home. After the hustle and bustle of Moshi, it felt so much quieter (strange when I remember how overwhelmed I felt when we first arrived in Muheza). It also felt familiar, and as we walked the now well trodden path back to the hospital, it felt like we were returning home. Very comforting. It was a very nice feeling.

Life on the edge in a dala dala?!

A view of Moshi from our hotel

We returned to Moshi yesterday and enjoyed a comfortable night in a very pleasant hotel, the Climbers Corner. Whilst still pretty basic in some respects, it more than met our needs. It is cooler in Moshi than Muheza and so we all slept well. Breakfast was enjoyed in its rooftop café / bar offering fantastic views of the town centre and also of the famous Mount Kilimanjaro. I must say seeing it ‘in the flesh’ has definitely upped my desire to climb it. I was already pretty keen, now I am even more so! It is a beautiful mountain. We shall have to see if I can squeeze that in…..

Mt Kilimanjaro in the distance

Dicing with death in the dala dala

Today we arranged a trek through the rainforest to a local waterfall. To save some pennies (and also wanting to enjoy some authentic African experience) we decided to go by Dala Dala - the local bus. These are basically small minibuses, of mostly Japanese makes, rusty, dusty, creaky and packed to the brim with passengers. Sardines in a can. It is quite something. They whizz along at what seems to be break neck speed, the ‘conductor’ hanging out of the window and communicating with the driver with loud bangs on various parts of the vehicle, stopping to drop off and pick up. 

A view forward!

We loved it to be honest (perhaps we are reckless) and it was one of the highlights of the day. The return journey was even more eventful as the driver navigated his way round a traffic jam by undertaking a long line of vehicles, only to be thwarted by a bridge. Not to be stopped that easily, he then drove over the accompanying narrow pedestrian bridge, people jumping out of his way! This was evidently unusual behaviour given the raucous cries of dissatisfaction (or were they approval) from the local passengers. Either which way bonkers, but quite fun too in a sadistic sense.

The trek to the waterfall was just brilliant. We started off walking through local villages which was such a privilege as I suspect it would be very difficult to get such experience on a ‘package’ holiday. It is fascinating the way different villages are arranged, some have road (baked mud track) networks, others – like the ones today – are predominantly paths for walkers / animals through the forest. It really is a very different way of life. Clearly the developed world has ‘developed’ the way it has for a reason, but there will always be drawbacks to that process too. Our ‘commute’ through the villages was delightfully sociable, with our guide chatting away to all the residents, busy with day to day life. When we managed to chip in as well it was greatly appreciated, and we were made to feel very welcome (I was of course eclipsed by the delight when any of the children spoke in Swahili). For a ‘westerner’ there was a slightly uncomfortable feeling to these paths / routes as the concept of property / boundaries is clearly very different. We would not infrequently walk through someone’s garden or past their front door (even through some drying washing at one point).

The waterfall itself was great. A very steep (and probably very dangerous) path down to it certainly added to the excitement. The chidlers were all most excellent. They were all very careful and had absolutely no trouble in navigating it (some of the steps were quite big and Beth was very industrious with how she clambered down and then back up – possibly with a bit of help from dad!). It was well worth all the effort, a great excursion. There is something very magical about water. As we stopped to eat lunch, I found myself quickly becoming lost in watching the water cascade down, the very therapeutic sounds. The stresses of life just seem to slip away…

On our return journey we were treated (or was it slightly sprung upon us) to a trip to a coffee farm. There was an interactive tour, showing us the plants, how they harvest and then prepare the coffee beans. It is a fascinating process involving the removal of three skins (using a massive pestle and mortar), roasting in a clay pot, more usage of the pestle and mortar accompanied by lots of dancing and singing to motivate the person pounding the beans! Whilst I’m sorry to say that I don’t like coffee, it was a brilliant and very interesting experience nonetheless. For coffee lovers this would be a dream come true, you don’t get fresher coffee than that, organic too!

Making memories.

Today we went to Lake Manyara which has a smaller area of accessible Park, so a shorter day before our return drive to Moshi. It was also only just up the road from where we were staying, so we had a comparative lie in. We were all feeling a bit tired today and two days would probably have been plenty for the children. That said, this ‘little extra’ was well worth the visit and thoroughly enjoyed by all. We had a fantastic encounter with some giraffe – much to Beth’s delight – as well as seeing a host of amazing birds, a troop of elephant through the trees and huge numbers of baboons. The landscape was also very different, beautiful rainforest, rivers, swamp and of course the lake itself. Fantastic. No sightings of the tree climbing lions, but we did find a leg bone from an elephant!

As we left, Beth declared that safari was her favourite thing.

Baboons aplenty

Safari Selfie

Beth and elephant leg bone!

Safari is surprisingly tiring!

The road is long…

…with many a winding turn…

We had torrential rain overnight and when we woke up this morning at our ‘safari lodge’ there were massive puddles of water everywhere. It was another early start and as we set off after a regal breakfast (the food has been great) in the mist and drizzle I was wondering if we would suffer a disappointing day at the hands of mother nature. We climbed up the Ngorogoro Crater and to be honest, we could have been in the lake district. The visibility was so poor, all you could make out was green, mist and rain. Except of course that the road was red clay (the soil has changed colour again)! Oh, and I was cold. Something I never thought I would say in Africa! How ironic…. Admittedly we were are 2500m when we got to the top of the ridge of the crater. Things were no better as we bumped our way along the ridge to the descent point. Steady rain, properly misted windscreen, cold.

The descent was exciting however, and lifted things somewhat. A steep narrow track, with massive pot holes and boulders twisting and turning sharply down the mountainside… our guide navigated it superbly. As did our trusty vehicle. And as we descended into the crater the mist began to lift. Slowly, meter by meter of our descent as we crept carefully to our destination. It was quite magical. As we emerged into the crater, we were met by a geological marvel. A collapsed volcano crater creating a bowl of deep green. Mostly grassland with a few lakes, it really did feel like we were entering the landscape of fiction. A lost world where dinosaurs might roam…. 

It was absolutely stunning to be completely honest. Unreal. And the wildlife was fantastic. The weather also lifted throughout the day and on the way out we were treated to the most incredible view of this unique savanna. I really was like being in another world. I half expected to turn my head and see an enormous dipladocus striding along. As it was, we were treated to a plethora of beautiful animals. The highlights for me were a pool of hippopotamus, numerous zebra (which I love for some reason), an astonishing encounter with a male lion that walked around the vehicle (and actually peed on the vehicle in front!) and a long watch of a black rhino – there are less than 2,500 in the world and less than 40 in the crater. We got a really good look at this one as it slowly made its way towards where we were stopped. We also saw another three in the distance as we later left the crater – they are normally solitary, but this was a pair and a calf. Such a privilege. Such beauty. To be found in all of the animals, not just the ‘famous’ ones.

Cheeky monkey, playing around 

post hijack incident!

To top it off, we had a close encounter with a baboon when we were parked waiting to ‘check out’ from the reserve. It jumped up to Ruthies window and was about to climb in to steal some food. I lunged towards it (some natural instinct I think) which sent it scuttling, but not before it had given Ruthie the shock of her life – the tachycardia didn’t settle for at least 30min, bless her. We have all laughed about it over dinner tonight though.

An incredible day.

(Unfortunately, the battery on our camera has died, with the charger left behind in Muheza, so all the good wildlife photos from today cannot be retrieved currently).

Safari!

I will be completely upfront in saying that I have always been a little bit of a sceptic about the idea of a Safari.

I absolutely love being outside and enjoying natures playground. Furthermore, the pull of Africa’s ‘Big Game Animals’ is a strong one. Elephants, giraffes, zebras, big cats are such a thing of wonderment and have captivated a sense of intrigue within me ever since childhood. However, as soon as something becomes a commercial venture, it becomes far less appealing to me. I could spend hundreds of words of prose unpicking this, but will resist my urge. Needless to say, when I saw the actual costs of going on Safari (even though we were already in the country) I had to stop myself from choking and just accept that we were going to do it – we had to do it after all.

I was also a little hesitant about how the children would cope. Essentially, we would be in a car for five days (3 days on actual safari plus the travel) with an 11, 9 and 5 ½ year old. Gulp!

At the end of day one, I can say that it was brilliant! Absolutely brilliant.

It was an early start this morning, up at 05.30 to be in the car for 6am. We had a 3hr journey to the first game park, factoring in a stop for breakfast. We arrived at the entrance to Tarangire Nation Park, all of us very excited. The intrigue increased as having parked up, we walked to reception to register past a number of elephant skulls! There was also a staircase around one of the giant baobab trees. 

When we returned to the car the top had gone up, transforming our mechanical steed into something that was much more fun! There is something magical about driving along with you head in the wind, being thrown about on the bumpy tracks looking around eagerly in the hope of spotting something. I shouldn’t have worried about the children, they loved it. And we were not disappointed. The scenery was stunning and the wildlife breath taking. I can’t resist posting a few photos. So many magical moments but the highlights must be a troop of elephants coming right up to the car at one point, also crossing the road; seeing some lion in the distance hunting and we got a rare close up sighting of three leopards.

Elephants, so close we could almost touch them!

Family Ostritch

Beautiful Zebra

Stunning Giraffe

Lion

Rare close-sighting of Leopard

Our very own Jerry and Zebbe in their native homeland!

Musings on the bus….

We just made our extraction to greet the bus this morning. It was a close call however, with an unusual complete meltdown by one of the smaller team members (who shall remain nameless), almost grounding the adventure for two of us. It was impressive. And whilst as a parent in the thick of it, it is horrendous, a part of you is also quite impressed by the depth of emotional outpouring. Although very difficult not to lose your temper (I might have done a touch…) To be fair, at crunch point (and I genuinely thought I would be staying behind in Muheza), when said team member was presented with a critical ‘should I stay or should I go….’ decision, an excellent choice was made. That out of the way, and despite having to wait anxiously for a very late arrival of the bus, the remainder of our journey was interesting and surprisingly painless.

We were somewhat bemused to be asked to change busses halfway through our 6hr journey, stopping in the middle of nowhere (savannah not far off desert) – we assume so that the drivers can return to their home ‘port’.

There are a number of things I could say about the change of landscape as we ventured north towards Moshi. Firstly, it became increasingly more ‘westernised’. Subtle, but undoubtedly by the time we arrived in Moshi, the buildings were more substantial (several with more than one story, some even multiples!). Also, the shops were more recognisable as shops and there was a definite feeling of an increasing wealth. It made us realise that where we are in Muheza really is fairly rural. Another notable thing was that the mud changed from an orangey burgundy to a brown, more familiar with European soil. Interesting!  

The bus journey also gave me some time to unwind. Inevitably in that process however, there are a number of outstanding clinical things that came to mind from my first 5 weeks of work here…. Has it only been five?!?

As I reflect on these first five week, I am genuinely astonished by how much we have done. It has been massively challenging (how many times will I say that) but also so very rewarding. I have captured much of this in my blogs to date. However, there are many aspects to clinical practice that I am finding hard to work out how to progress. For example, one troublesome condition that crops up on an almost daily basis is BPH, benign prostatic hypertrophy, a big prostate in layman terms. A pathology that usually has a very streamlined pathway in the UK, has very limited options here currently. It tends to present late, frequently with men in urinary retention. Patients often suffering for several days without passing water – gulp! The management at this point is easy, catheterisation. Things start to get a little bit troublesome when a urethral urinary catheter fails, as the technique for inserting the alternative, a suprapubic catheter, is fairly traumatic for all involved (as I have previously described in an earlier post). However, it is from here that things become particularly tricky. Because there is no next step. Most of these patients end up with a catheter for life. Access to medication or surgery is very limited. TURP does not exist here and open prostatectomy (offered in a few referral centres) is very expensive and thus prohibitive for all but a tiny minority. The whole situation is most unsatisfactory. I am currently working with the local pharmacy to see if we can get hold of the essentials of finasteride and tamsulosin. Just getting these basic medications would make a massive difference to the local population. Probably freeing up many from the burden of a long-term catheter (at least for a period of time). Surgical options… well they go into the mixing pot of my scheming mind for the future….

There are other cases too that are pretty heart-breaking. For example, the 19year old girl with sickle cell anaemia who limped into the clinic complaining of hip pain. My concern was that she had suffered with AVN, avascular necrosis, of the hip bone as a result of her blood disorder. Essentially, this is when the blood clots in tiny vessels causing part of the hip joint to die leading to irreparable damage and horrendous arthritis. These concerns were confirmed on x-ray. In the UK this would be pretty devastating news for her as she would need a hip replacement. A big operation for a lady of her age. Here however, the news is horrendous. 

We are not even sure whether a hip replacement is possible in Tanzania. If it is, it would be on a price scale that would be so far beyond the wildest dreams of the average citizen, it might as well not be available. Breaking this news to her and her mother was tough. And there was a part of me that was angry. I was angry that for this beautiful young woman, the life ahead of her was one of pain and progressive disability. She has no options. Compare and contrast that with the many thousands of people who undergo hip replacement in the UK every year. And this doesn’t even touch upon the morals and ethics surrounding causality of disease in these wildly different healthcare systems. Her only hope is that at some point in the future access to such surgery might become possible. But we are a long way from that.

But I must kick back at this point. Release myself from the burden of clinical practice (well try at least) and enjoy a well-deserved break over Christmas.