jjvinnicombe

[jjvinnicombe]

Things that have happened

First of all I have left Kilimatinde! As I write this I am sitting on a bus to Arusha in the North. Not that the last 6 weeks has been hard work but now begins the holiday part of my trip; 9 days of safari and Zanzibar with Ro and then 5 days in Uganda seeing all my friends on a whistle-stop tour! In the last few weeks a fair few notable things have happened so I'll just flesh a few of them out here... One morning Ollie and I went in to do the paediatric ward round and found Mwaja (one of the Clinical Officers in the middle of a medicine degree) ready to do some minor surgery on a poor ten year old girl. Basically she'd managed to get a bit of wood buried in her leg and it needed to come out. Anyway, Mwaja being the top lad that he is got Ollie and I involved. I got a pair of sterile gloves and Ollie was in charge of shining the torch and dousing the wound with saline. Mwaja topped her leg up the brim with local anaesthetic and then I had a poke around inside with the forceps. However after a good poke I couldn't find any wood in there so Mwaja had a go. He found a couple of bits about the length of a match and four times as thick and when he drew them out the poor girl was hating it. But it wasn't over, Mwaja said that she could feel something right at the back of the leg too (the wound was next to the shin) and he thought he could feel something else with the forceps (but we couldn't see it). So he's probing away, manages to grab something fairly wide about 3 cm inside and starts to pull. Now this girl is fully crying and her mum comes over to, at first, comfort her, but then restrain her as Mwaja starts to pull harder. He's pulling and pulling and the girl is screaming now. I say "Mwaja, are you sure you're not pulling bone?". "Yes, the X-ray showed no fracture" he says as he pulls harder. And then suddenly, and this is no joke, a piece of wood about 1.5cm wide and 10cm long is being held in midair by Mwaja's forceps (I will upload a photo). Ollie looked like he was going to be sick and actually turned away and my forehead was covered in sweat. This little girls leg wasn't even 10cm in diameter, the piece of wood had travelled obliquely or it would have punched out the other side. Anyway Mwaja cleaned the wound out with saline and gauze, we packed it with iodine soaked gauze and that was that. (Well I say that was that, but we had to clean that wound and pack it with gauze everyday and fair enough she hated it everytime)  Something sad happened. Earlier that week Ollie and I were doing the paediatric ward round and then we heard a sound which triggers a running-to-have-a-look reflex in all humans but 1000x more in healthcare professionals. It was the sound of stridor - the sound you get when you are trying to inhale but your throat is too closed up to get a proper breath in. We rounded the corner and it was two kids, one baby and one two year old. In the UK this would be a proper emergency - at least 5 doctors would be working on each. These kids just had Ollie and I and a copy of the Oxford Clinical Handbook on Tropical Medicine. Top causes of stridor: something is pressing on the trachea (like a tumour) but unlikely in children; something is stuck in the trachea (like a piece of food) which is very likely in children but not two separate children at the same time; or a serious infection has caused the tissue around the trachea to swell up and close off the airway. This had been going on for a week, they hadn't swallowed anything, it had to be an infection. A mixed blessing because at least it was something we could do something about, but we had no way of working out which infection it was.  So we examined them as best we could but even this is fraught with difficulties because if you upset the child and they start crying then that can completely occlude the airway and that's death basically. In between coughing and gasping for air the two year old wasn't too bad, he was sitting up and eating rice and his vital signs weren't terrible. But the baby wasn't good at all, didn't have much of a stridor but that's a bad thing because it means they aren't able to take decent breaths anymore. Also the mum said they hadn't been able to breastfeed in a couple of days. We still didn't know and would have no way of finding out the cause. We had no ability to do bacterial cultures and some causes of this presentation are viral anyway. So we started broad spectrum IV antibiotics, gave them steroids to try and reduce the swelling in their throats and help them to breathe. Because the little one was so dehydrated they got fluids too. We came in the next morning and the baby had died overnight. And now two more children from the same household had arrived with the same condition. Their arrival was at least a little bit helpful because with them the underlying disease was easier to identify. Cough, cough, cough, cough, cough, cough, cough, loud inspiratory stridor. It was whooping cough. So we checked over the new kids and got all three of them started on erythromycin - there is no cure for whooping cough but that is the best we've got. There is a vaccine for whooping cough, it's the P in DTP (Diphtheria, Tetanus and Pertussis) and they have it out here too - I've been making babies cry with it for weeks now. But unfortunately this family live deep in the Rift Valley and hadn't managed to immunise their children. (As I left this morning all remaining children were alive and improving) Okay I'll end on something a bit, well alot lighter, but forgive me if it's just too an awkward juxtaposition to the above stuff. The boys from Leicester left me last week so I've been hanging out with the Germans girls every couple of days since then. On Saturday we went to find the centre of Tanzania! Sounds like it would be an epic journey from the 1800's but actually it was just ten minutes drive down the road. But it was more than that haha. Because the point that marks it is a stone marker on top of a massive rock on top of a hill covered in forest. So it ended up being another waterfall style trek; fighting our way through trees and undergrowth, scrambling up huge boulders and finding out own way. At one stage we lost sight of the marker for ages and so scrambled up another huge boulder to look for it and have lunch. This boulder had a full thickness crack along one side and what should we find living down there but hundreds of bats! Bats again I know, I'm obsessed with bats, but it was really cool seeing them in the daytime and so many of them! Anyway we saw where we had to go and with another half an hour of trying a couple of routes we finally made our way to the rock with the marker on top! Unfortunately there was no actual way to climb that huge rock, just to sheer and smooth. And so in the end we had to settle with being next to the centre of Tanzania (I mean it's pretty convenient the centre of Tanzania is on top of a rock and not say just in someone's mud hut, so who's to say we weren't on the centre).  Also Monday 1st May was a bank holiday here too. So to celebrate yet another day off I went to the village party at the local secondary school. Normally these events are incredibly dull. There is always a special guest, there is always the same formality of a dozen long speeches and lunch is always served really late when you're bored and starving. Luckily Monday was an exception, there was a special guest sure and lunch was late but the speeches were few and short in length and the morning was very interesting! It basically ended up being some sort of bizarre adult sports day with workers from the hospital versus the school staff versus the villagers. My first event was downing a beer which, as anyone who has seen me try, is something I cannot do. I was 5th out of five for that one. I also jumped on the hospital team for tug of war, finally an event I've been winning since Year Four. We lost that one too. Other notable events I didn't join in with were: chasing a chicken (felt bad for the kuku but the video is hilarious) and a race where you run the length of a football pitch, thread a needle and run back again (love the imagination with that one). I also had a laugh when the special guest arrived, they were just a representative from the local district authority. The workers wrote signs in swahili - "Welcome to Kilimatinde", "You are very welcome", etc. And then at the end - "When will employers stand up for workers rights?" Haha! Preach it brother! I'm planning to write another blog post called "Realities" but if you can't face another quite frankly fairly depressing entry then someone let me know.

[jjvinnicombe]

I possibiltise the impossibilities to be possible

Laurent (Kilimatinde Hospital Administrator)

[jjvinnicombe]

Kilimatinde Hospital - pretty beautiful I reckon (note the washed surgical scrubs drying in the sun)

[jjvinnicombe]

Trekkin'

At risk of this blog going the way of all my other communications from abroad - i.e. boring - I vowed not to write again unless something awesome happened! Cool, fun, enjoyable and interesting things have been occurring but nothing I could justify writing a whole blog post about. Finally we did something to enable to me to break the silence.  Yesterday we (meaning Your Humble Narrator (I read A Clockwork Orange over Easter) and the three Leicester lads - Adam, Chris and Ollie) set off to find the waterfall. We read about it in this little handwritten guide by previous elective students and Laurent (the hospital administrator and all round great guy) agreed to take us because he'd never seen it himself. So Laurent got the rough directions off a mate and about 10ish we set off into the woods. This wasn't as easy as it sounds. Sure we started on a dirt road, which then gave way to a dirt path but this soon degraded to worn grass and then no clear path at all. Plus we were constantly having to duck down and squat walk under thick spiky bushes which ripped our clothes and skin. The good news is we saw some monkeys! The bad news is that Laurent couldn't find the right way to the waterfall and so by half eleven we were back at the house.  Hang on a tick, that's not very thrilling. Correct, I enjoyed it, but definitely not blog worthy. But wait, because we set off again. This time we started at the dam and followed the river - pretty decent way to find a waterfall tbf. And when I say we followed the river, we literally walked the length of the river to find the waterfall. This is dry season but only just so it had rained pretty heavily a couple of days ago. This left the riverbed in a particular treachous state of seeming like solid ground but infact being deceptively deep liquid sand. This caught all of us out a few times, sometimes you could run across it like some sort of mad lizard/Legolas like character but in general we soon learnt to stick to the solid river banks. However this had us fighting with the spiky bushes again and to traverse some sections we had to leap between the more solid patches of riverbed or use long sticks as a third leg to lean out into the river with our feet on the bank. Occasionally we would reach a big stretch of boulders and have to leap from stone to stone. That was super fun and sketchy (especially if you forgot to bang the slippery mud off your shoes from the previous section). At one point Chris was slightly ahead, just about to jump down a particularly high sheer stone and then he literally dropped out of sight. He had fallen over two metres but somehow his phone (which smashed against a rock) and himself were completely fine! Ollie wasn't so lucky, didn't hurt himself but still had a fall a bit later on. Basically the river pooled and we had to scramble over some rocks to either side of it to get around. Ollie was standing on a rock in the middle of the water, about to jump to one of the sides but he thought he better get rid of his walking stick first so he threw it on ahead and the momentum carried him clean off the rock and into the pool. Turned out the water was chest deep! It was hilarious but all of us held back the laughter until Ollie laughed first. Poor fella was soaked in slightly grimy water but he didn't hurt himself or damage his phone or anything.  This is where the trekkin' started to get really fun. It's incredibly hard to put into words and I don't think the photos do it justice. But basically after a while it stopped being mostly muddy riverbed and a few rocks and changed into lots and lots of progressively larger boulders. We were having to find our own path, try one way and then climb back if there was no further way down and go the other way. We were doing larger and larger controlled jumps down onto whichever rocks looked flattest below (by this I mean sitting down, legs dangling and sliding ourselves off to minimise the distance to the rock below). At one stage we had to do a controlled 5m slide down an over 45° slope; the whole time just guessing this was the best route. Eventually we climbed over some rocks and saw the Rift Valley floor peeking out ahead. We had actually trekked to the edge of the valley. The sun was glaring, we didn't have much water and this is where the route got really really really steep. But to go back would probably be impossible and take ages. So we pushed the collective thought that "a broken ankle here would take about 24 hours to make it to an orthopaedic surgeon" out of our heads and we pushed on with the trek. It soon became blinding obvious that not only had we found the waterfall, we were literally climbing down it. That's right, we were climbing down a dry waterfall. Some bits were so steep that we had to lie flat on our stomachs and feel down the rock with a foot to find a purchase and then scramble down like a ladder before directing the others to the same foothold. But slowly but surely, spending longer and longer choosing a path each time we made it carefully down the valley wall. Towards the end it ended up being a bit of a race against time as the boys started to feel fairly dehydrated and the water had dried up a while back. Once we hit the flatter end part of the trek we marched pretty quickly to the house at the bottom of the waterfall. Conveniently this was owned by Laurent's mate and he extremely kindly went off on his motorcycle to fetch cold water and soda for us. Then Laurent got the hospital ambulance to come and pick us all up so we wouldn't have to walk via the long winding road back up to the hospital.  Yesterday's experience was one of the best treks I have ever done in my life. The terrain we crossed was incredibly challenging and the views constantly breathtaking. But the biggest part for me was the fact we had to constantly choose and reevaluate our own path. Once we hit the riverbed Laurent was just as clueless as us about the route. But we worked together and made our way to the valley floor. As I said before the photos won't quite do it justice, but maybe you'll be able to imagine just how big the boulders were and how steep some of the scrambles were.  PS - we saw a baboon at the waterfall!

[jjvinnicombe]

Just a couple of Jebson looking cute enjoying his chai and chapati breakfast

[jjvinnicombe]

Our waterfall adventure

[jjvinnicombe]

Adam, Chris and Ollie in the market enjoying some beers

[jjvinnicombe]

Views from the watertower

Second from the top = path back to our bungalow (it’s top centre on the left)

Bottom = Adam halfway down the rusty ladder (doubly incontinent at this stage)

[jjvinnicombe]

Spirit by the sachet (has to be sold like this really as people wouldn't be able to afford a whole bottle)

[jjvinnicombe]

7 things from the weekend

1) Friday was a bank holiday in commemoration of a Zanzibar President who was shot. Resultantly we didn't have to go to work, so we lay about all day and then in the evening sat on the porch and got drunk on beer and some old sachets of spirit we found in the house (that's right the spirits come in sachets - I will post a photo) 2) Good news, the little baby girl from last week made it to her referral in Dodoma! Unfortunately we won't be able to find out how she is getting on or her diagnosis but at least she is still alive! 3) We have an inside flushing toilet (posh I know) but it doesn't take solids if you catch my drift. So we also make use of a long drop (think squatting over a hole built over a pit) outside, which in fairness is a concrete structure with a door and concrete floor (so pretty posh too). Now the interesting thing about the long drop is that it's also home to a bat. Normally when you open the door it's either already down in the hole or it swoops down their pretty sharpish. Basically one of the other medical students, Adam, went to use the long drop. He opened the door but there was no swooping so it must have already been down there. He squats down and proceeds to get on with it. But then suddenly the bat swoops through the window and is desperately trying to get down the hole. It's landing on Adam's back, wings flapping, just trying to get home. But then eventually the poor fella just gives up and flies out again.  4) A note on Swahili time. Interesting isn't it, how language is based upon the culture and environment it is used in. Swahili is mainly a mix of East African languages from groups such as Bantu and Nilotic and about 40% Arabic because of the historical coastal trade which happened in this region. As a result the religion of Islam spread and it influenced the Swahili language - today (despite Christianity being the dominant religion) the days of the week start on Saturday; with Friday being the holy day and thus last day of the week. The word for Saturday is literally Jumamosi meaning the first day and Sunday is Jumapili meaning the second day and so on. As for time, we are close to the equator so the sun more or less rises and sets at the same time everyday. As a result the start of the clock is at 6am (dawn) and all the hours are counted from there. So therefore 8am here is "saa mbili", the second hour of the day.  5) On Saturday we went to Manyoni to get some money from the ATM and buy some food at the market. Despite Friday night we ended up sitting bang in the middle of the market, drinking beer from a cool box and sharing a BBQ goat leg. It was awesome. You basically have to go and choose which cut of the meat you want yourself and so I went for leg, correctly banking on it having the least amount of entrails (which, including goats head, was being roasted everywhere you looked). Then they cover it in loads of salt, squeeze lime juice all over it and cook it up for you. When it's done they cut it up into bitesize chunks and serve it in a black carrier bag - lovely. 6) Oh yes also over the weekend we went to another viewpoint over the Rift Valley called "Flat Rock". It was about 20 minute walk away but really cool and amazing views. As the name implies it was literally a huge flat rock (see photos for details).  7) Apart from the trip to Manyoni the weekend was mostly spent with us all just lying around chilling and reading really! But we did have another little adventure to break the weekend up - we went and climbed our local watertower. By watertower I literally mean a 10m tall stone structure used for storing water. And by climb up I literally mean using the rusty ladder bolted by rusty supports situated about a metre and half off the ground. Adam had to boost me up because (to my shame) I lacked the necessary arm strength to pull myself up the first few rungs and then it was just a mere pretty sketchy climb up the dodgy ladder to the top. The views from the top were absolutely amazing, turns out the hospital is basically surrounded on all sides by a huge forest. That goes some way to explaining all the monkeys (I have only seen one so far) and apparently one leopard (which I really really want to see)!

[jjvinnicombe]

Five goats, just chilling.

[jjvinnicombe]

Sunset views at "Flat Rock"

[jjvinnicombe]

Medical outreach by AIRPLANE!

Yesterday I got to join the Kilimatinde staff on a medical safari by plane! Needless to say it was absolutely incredible.  They came to pick me up in the ambulance at 7:15 whilst I was literally just about to shower and completely unprepared. I had to throw everything I thought I might need into a bag and get dressed in record time - didn't even have time to brush my teeth and definitely none to grab any breakfast :/ Also that morning the fellas and I had gone to check out the sunrise over the Rift Valley and we had literally only just got back so I was lucky not to miss my opportunity to go entirely!  Anyway feeling a bit grimy and hungry we set off on our drive to the airfield. It was over a two hour journey, but through some awesome terrain like a vast plain of flat dry mud stretching for miles and a load of sandy river beds (we got stuck in one). Plus we stopped for breakfast and I had a chance to brush my teeth (thank God)! Eventually we arrived at the "airstrip", literally and I mean literally a dirt track about 2 metres across at its widest point. It had grass either side and a couple of bushes on the strip itself. And there waiting for us was this little plane and our South African pilot. The plane and pilot were provided by a charity called MAF which operates out of Arusha (Northern Tanzania) and does missions all over East Africa. In Tanzania they mostly just support hospitals like Kilimatinde in doing medical outreach to places which are just a bit too far away or too inaccessible to drive to. But they also do humanitarian work in the other countries, delivering goods and equipment to refugee camps, etc. Anyway the important thing is I got to fly in one, it was absolutely incredible and the views over the Rift Valley were obviously absolutely amazing (see photos for more details)! We were only in the air for 25 minutes but it was really cool. I got to sit in the co-pilots chair and tried hard to keep my legs and arms tucked away from all the pedals and controls! All the panels and consoles were so rudimentary, no autopilot or computers or anything - just a very old first generation GPS system. I spoke to the pilot about it and despite being less complex than a big transatlantic plane it was definitely harder to fly. Which made it all the more impressive taking off and landing on these tiny dirt strips!  Anyway at the other end all these kids mobbed the plane and helped offload all the stuff and then it was just a regular outreach session tbh apart from the fact we were in the middle of nowhere and right next to the "airstrip". It's really interesting these monthly sessions though because clearly they are used as a bit of a meeting point for lots of mums and there were loads of entrepreneurs that had brought loads of stuff to sell to a captive audience! Food, baby clothes, torches, etc. Plus there was some preaching going on too. Because only five of us could go on the plane we were a bit stretched and so I more or less ended up weighing like 200 babies alone; they were working me for my ride on the plane! Plus I did the usual assortment of drawing up and giving vaccines too, all good fun. Then today I did something a bit different at the hospital and went to see patients in "outpatients". I put that in inverted commas because in the UK outpatients is an area in hospital where people see specialists but here it's kind of a mix between GP and A+E. Basically it's where patients come if they are ill in anyway; whether it's an emergency or not serious in the slightest. Oh wait, so it's just like A+E then. Anyway so with the help of Benjamin, another one of the clinical officers, I got to take histories from and examine a load of patients and work out what investigations I wanted and how I thought they should be managed. It was fun but under the influence of Benjamin and myself not really knowing how things are done here there was probably a lot of misdiagnosis and overtreatment that just wouldn't fly in the UK. I did get to see one old man with probable TB and pregnant lady with a new HIV diagnosis, so that was unfortunate but interesting. Sorry that the blog is usually loads of blocks of text and then a load of videos and photos and not very well mixed up or ordered! I just have to get the media up when I've got decent internet whereas I can upload text as and when! I hope I'm getting the point across that I'm having a truly fascinating, eye-opening, varied, enlightening, fun, interesting and fantastic time out here! Can't believe I got to go in a little biplane for free and have such a unique experience!

[jjvinnicombe]

Sunrise from The Point this morning

[jjvinnicombe]

Managed to catch the bats on film by lighting up the watertower up close and attracting insects for them to eat!

[jjvinnicombe]

Our sweet ride got stuck in the mud

[jjvinnicombe]

Taking off - making use of a "runway" about 2 metres across