Safari heaven - a final word!

No neon signs just a simple gate and sign welcoming you to the Serengeti – but what a wonder of delights awaits. Like a child in a sweetie shop I felt like an owl with my head on a swivel trying to take it all in. The name Serengeti translates from the masaai into ‘endless plains’ and it is not hard to see why. On these endless plains ‘piles’ of animals – a new collective noun for a group of safari animals spotted from your viewing platform riding high in the open topped safari jeep.

Animals just getting on with their daily business – a leopard snoozing in the tree with a paw nonchalantly swinging, lions lunching on wilderbeast or sunbaking, elephants taking a dust bath, giraffes chewing and chewing and chewing and chewing some more, hippos playing their tireless game of ‘now you see me now you don’t’ as they dip under the water to keep cool, zebras migrating in their thousands as far as the eye can see yet all in single file across the road like a true zebra crossing….

Every day something different to see, something exciting waiting around the next corner, all wild and unpredictable; a real delight. For me a true treat and a perfect way to round off my time here in Africa. I strongly recommend it to all. Already have a strong inkling that there may be a return trip …. so better start saving hard!

Time now however to fly home and see puss puss my own wild animal, family and friends!

See you all soon

C x

The mentors have left the building!

The day has come to pack up our little house at Kolandoto and wave goodbye to all the friends we have made over the last 3 months – it has been a lot of waving! Folk were at our door from 6.30am this morning; I’d like to think to wave us off, not just to check we were going! Last night Cosmos (our pharmacist) and Mary (our lovely home help) invited us to their church for an hour to say cheerio. Four hours later, after much ‘joyful marching’ down the aisle, we were still there being treated to a full on African style farewell party with all its little customs. A night to remember – particularly as Grace and I were made to strip down to our undies and bra outside the church under the light of the moon in order to try on the new dresses that had been made for us as leaving gifts! We have been spoilt and have some gorgeous tailor made, African outfits to come home with which fills me with girly glee!

I have mixed feelings about leaving. Obviously I will be sad to leave behind some very special people here but I am equally excited to be seeing those people who are special to me back home. We have been living, breathing, eating and sleeping this project and it will be weird to relinquish control and put our trust in others to nurture that which we have sewn. But this is what we must do. For those who have been reading my whiffle over the last few months you will recognise there have been ups and downs and challenges a plenty but I feel very positive about the overall state of affairs we leave behind. I think we are leaving on a really high note having put our heart and soul in right to the end.

In the last week we have set up 6 individual income generating projects for the volunteers using money kindly donated by Grace’s church. The idea is that by providing the volunteers with a small business opportunity you are supplying them with an income from which they can choose to support themselves and their families or their patients or both. It is a motivation tool to try and enable them to continue with their sterling palliative care work. They currently received the equivalent of £1 month which even by Africa standards is insulting and this is likely to stop when the budget ceases. It is our way of trying to induce some sustainability into the project and it feels like a really important thing to do. Pigs and chickens were their request as they breed well and money is generated from selling the eggs, meat and manure. So having purchased 13 pigs and 124 chickens we have learnt a lot about pigs and chickens this week and can now add animal husbandry to the role of a palliative care mentor! If laughter is good medicine I think everyone should be encouraged in their lifetime to round up pigs!

The cherry on the cake for us came on our last day. We managed to meet with the RMO (Regional Medical Officer) and after productive discussion he agreed that adding palliative care to the regional medical budget proposal was both important and necessary. He is meeting with the powers that be within a month and will discuss this further. Inner cartwheels of delight! If this comes to fruition this will be a huge success story for the Shinyanga palliative care project.

It is funny. I looked up mentoring in the Oxford Dictionary – verb; ‘to advise or train (someone, especially a younger colleague)’ or noun; ‘an experienced and trusted adviser.’ From what I know of ‘mentoring’ in Africa I can promise you - it is about so much more than this. And to all those who ‘mentor’ me in life (both at work and home) I thank you. I now appreciate all that you put into the role.

But for now these two mentors are hanging up their boots for a while. You will find them over the next week gawping at animals in the Serengeti and trying to make sense of all that they have seen, heard and experienced over the last 3 months. The final test I think will be saying goodbye to my mzungu partner in crime, Grace, as we go our separate ways at Heathrow airport. It has been a journey in life shared and all the better for it.

Can’t wait to see you all and share with you more stories when home.

Sending some final love from Africa

C x

and then there was Mishepo....

A Royal wedding, Bin Laden no longer and my baby brother being accepted to do a phD at Birmingham University. Go away for 3 months and the world goes crazy! So back to the sanity that is Africa (chortle chortle) and to Mishepo…

An hours bumpy ride on untarmac dirt roads (supportive bra mandatory!) to be greeted by the biggest welcoming committee I’ve ever seen. Oh how lovely thinks I. Except it quickly transpired that this ‘welcoming committee’ was indeed our own outdoor patient waiting area and we were about to do a ginormous GP style surgery. Now I have to be honest if I’d wanted to be a GP I wouldn’t have gone to the trouble of squirming through an interview to become a palliative care registrar. And if I’d wanted to be doing hard core diagnostics in the field so to speak without proper examination or investigation facilities I would have remained a GP!! (respect to all you GP’s out there) But GP I must be this day and thankful was I for my training. I have figured in my time here in Africa that it is sometimes easier to ‘go with the flow’ rather than fight against it! So we ploughed on through various aches and pains, coughs and dysurias, symptoms that had been present on average for 4-8 years, no they had not seen a doctor about it, yes they had tried ‘some medicine’ (who knows what, certainly not the patient!) and we did some best guess medicine and signposted in appropriate directions or handed out painkillers and antibiotics appropriately. Sadly their hope for cure was one thing we could not offer – no magic wand regardless of the colour of our skin. Our efforts were rewarded at half time by a meal of fried monkey nuts, fried chicken (coated in egg) and surprisingly un-fried sweet potato! Prioritising is not a concept readily practiced here in Africa so Grace and I had to interject as we watched the waiting room numbers swell! There was the odd palliative care gem within this bunch of walking wounded; a lady with marked lymphoedema of her leg and arm due to HIV related Kaposi’s Sarcoma and I suppose one could argue that many of those with pain could fall under our remit as there is no-one else looking out for these people in the community.

Day 2 in Mishepo and off to see the really sick people in their homes. Interestingly this is where I received my first marriage proposal; Grace has already had hers! For Grace; a 24 year old lad (we think), local (we think), lives with his grandparents (we think), still at school (we think) with a penchant for bending the truth and a desire to marry a mzungu! On the plus side he makes the best donuts in Kolandoto (sampled and confirmed!) and will offer for her 1 whole goat. For me; a chap who can’t remember his age (not uncommon around here and I’m often writing 70 ish or 80 plus in the notes!), apparently a famous traditional dancer and musician. Has his own house (thatched none the less) and vegetable plot. Sadly also has all the symptoms of probable HIV and this would probably explain the use of the word ‘famous’ – is however willing to offer for me, 20 cows. I will leave you to decide who you think has the best deal!

Bundled into the visiting this week we saw a very interesting chap with fascinating health beliefs. Having had a stroke with right sided weakness 6 years ago he now has the nastiest infected ulcerating foot wound. All of this, he puts down to having been bewitched by a witch doctor at the request of his jilted lover. He has consequently not seen a doctor for his problems as he believes he cannot be ‘cured’ by medicines until the curse has been removed. Despite attempts to convince him that his problems are due to the fact that he smokes like a trooper and has a BP of 170/120 he was having none of it. Really he probably needs his foot amputating but he humoured our suggestions to seek advice from the hospital politely before saying he would think about it. So in the meantime – some pain killers, antibiotics and wound care. This man has not been out of his small bedroom for the past 4 years. Sitting there in the darkened room, lit only by a small window, across which there were bars, I could not help thinking this man was in his own prison both physically and spiritually in light of his beliefs. Talk of mobilising a local pastor to come to his home (as he cannot get to his church) was met with approval and may be his saving grace if he can be cleansed of his curse. In the meantime our wonderful palliative care team will continue to support him whatever the outcome.

It’s a funny world in which we live.

Sending love

C x

Our own royal visit!

The ‘official’ visit went rather well all in all I think. There have been several issues troubling Grace and I relating to the nature of the running and co-ordination of the project (too sensitive to document openly on this megaphone of a blog) - but having Karilyn and Richard visit; with their years of experience of working in Africa, grey hair and an ability to speak Swahili, has been a huge influence and certain issues are now on their way to being addressed in earnest. There are also plans afoot for more work in the area which is very exciting indeed.

Our royal couple were also here for our morphine training day which went exceedingly well (silly choice of word as I am now side tracked by the thought of Mr Kipling cakes…) – so anyway it went tremendously well except perhaps for the moment when I lent on a wonky desk and sent the plastic morphine bottle with its amber coloured gold elixir crashing to the floor. Heart sink panic all round as I frantically scrabbled around on the floor to check the bottle had not smashed and sent our precious morphine everywhere. Thankfully not a single drop spilt so the controlled drug book remains balanced and my character remains intact!

Following this we held our first palliative care team meeting. We have been trying to get a regular meeting off the ground since we started but trying to get Tanzanians to meet all together at a set time is like, as Cosmos the pastor put in in his sermon this weekend, “ trying to get a ‘big horse’ through the eye of a needle!”  Bless him – we have now taught him the word for camel! But anyway the meeting finally took place – I think helped only by the fact that they were promised their ‘incentives’ (pay) on the same day. So the carrot and stick approach worked and the meeting took place and a rudimentary palliative care register was formed and various issues raised and discussed. Whether this continues when we leave is sadly not so hard to predict but a ‘date of next meeting’ has been arranged in part I think to humour the mzungus!

It was also national Albino day whilst Karilyn and Richard were here and Shinyanga this year was hosting the national festivities. It would have been rude not to have gone for a nosey out of curiosity. Albinos are currently lobbying the government for free sunscreen which is very expensive to protect them from skin cancers. I also learnt that since 2008 there have been 15 Albino killings in Shinyanga alone as there is a superstitious belief that having the organs of an Albino will bring you riches. Doctors have even been known to fight over who will circumcise an Albino patient so that they can keep the foreskin remnants….. nasty! So all in all quite a scary prospect to be an Albino in Africa and hence necessary events like this to raise awareness and support.

So - our mission at present is now to devise some sort of ‘exit strategy’ for our departure in 2 weeks time. Our Blue Peter wall has a list as long as my tape worms (!) of things to do between now and leaving which covers things as diverse as visiting those patients on morphine one last time to ensure tight mechanisms in place for follow up when we leave, to making thank you cards, sticking up referral posters in the regional hospital after our final teaching session there on Wednesday, meeting one last time with the RMO (regional medical officer) to fill him with enthusiasm for palliative care and encourage him to include palliative care in his budget plans, to buying gloves as leaving presents, cleaning our house and sourcing pigs, yes pigs! I’ll tell you more about the pigs when and if they materialise!

Anyway - time for bed said zebedee

C x

Gremlins at work - interfering with blogging process! Will post as soon as site fixed. At present it seems very in need of some palliative care! Cx

Morphine delivery - Africa style!

The morphine delivery service continues to function – not always quite as smoothly as we’d hope. The rural service on Thursday arrived spectacularly to the patient’s home; 3 on a motorcycle and straight into a bush! Tears of laughter all round and certainly one way to make an entrance! Cosmos the pharmacist our driver is not always so handy behind the wheel and his gear changes often leave a lot to be desired. Achieving air between you and the seat not always ideal either over the bumpy roads – but all in a days work! The urban delivery service on Friday used public transport to get morphine from Kolandoto to the patient’s home in Shinyanga. So a rather tense journey on the packed dala dala bus (hiace) with a bottle of morphine stashed in my bag but it made it safely you’ll be pleased to know! Both patients are doing well in terms of their pain and have really benefitted from using morphine which we are chuffed about. A few issues with constipation to resolve but we’re working on it. Rather bizarrely whilst buying Ducolax (a laxative) in the local pharmacy we managed to catch a quick glimpse of the royal wedding party which was playing on the BBC world news service. Didn’t get a proper look so will have to catch up on some trashy ‘Hello’ or ‘OK’ snaps or something when I get home!

Interesting ward round at the regional hospital on Wednesday – full of young people with hideous pathology of uncertain origin. The lack of access to basic investigations and basic treatments means people are really poorly managed and there is an awful attitude here by staff that ‘we can’t do anything.’ Grace and I are trying to gently challenge this (particularly when it comes to basic care and analgesia) but we can see also how hard and demoralising it must be, to be a doctor in this country at times, when resources are so limited and people are so poor and cannot afford even the test and treatments that do exist. Do you know, families even take home moribund, imminently dying relatives as it costs 3 times as much to transport a dead person back to the village than a living (albeit only just living) person? To think that in your last hours you could be on the back of a bicycle or in the back of a taxi travelling over bumpy roads is horrifying but a reality here. I have never taken the NHS for granted but for sure will appreciate it a whole lot more when back home. That and running water you can drink from a tap, electricity at the touch of a switch, the privilege of having had a good education and many more things besides….

I will also appreciate

No longer having to stick ‘Mr Men Bite and Sting plasters’ all over my mosquito bitten legs to try and stop the itching. They have been a godsend (thanks mum!) but I do look a bit of a berk wearing Mr Tickle and Mr Bump on my ankles at the age of…

No longer having to light candles at night when the power has gone off using ‘Lucky Matches’ – aptly names because you’re ‘lucky’ not to take your eyebrows off when you strike them!

No longer washing my hands before I eat at the Millennium Social Club (our local in Shinyanga!) where they work on the principle that the water has to be scolding enough to take off several layers of skin in order for your hands to be properly clean…

No longer sitting down after a hard days work with the intention of relaxing or enjoying some quiet time to be greeted by ‘odi’ at the door (the traditional greeting as you enter someone’s home) followed by multiple visitations. You cannot turn people away here! We had 8 visitors the other night – the last one arrived at 9.50pm!! I felt like getting into my pyjamas but I think the subtlety would have been lost…..

Or perhaps I will miss these things? Time will tell.

We have just 3 weeks of work left here in Shinyanga. This week is an important week as we have Karilyn and Richard coming from the UK to meet us. They are key people in the running of this palliative care project and have overseen multiple projects in the roll out of palliative care over Tanzania. So we are on our best behaviour this week!  (It is possible for me to behave sometimes!) The prize at the end of 3 weeks is a long awaited trip to the Serengeti…. I just can’t wait!!

For now sending lots of love as usual. Hope you’re enjoying the bank holiday break.

C x

a few pics at last!

Our humble abode in Shinyanga........and the view from our front door most days!

Out visiting patients with Dr Nzelani - our palliative care champion and a gem!

Grace and I on the ferry crossing Lake Victoria on our way to visit the palliative care team in Geita to gather ideas for our project in Shinyanga...

Enjoying Ugali with my hands!

At the millenium social club (our local!) - great food at really cheap prices once you get over the fact they serve you your lunch in prison trays!!

The 'pied piper effect' Grace and I seem to have with children when out visiting!

Do you recognise the specs?!

A typical African scene....

Group photo at the refresher training we ran for the palliative care team and home based palliative care volunteers

Relaxing in Mwanza!

Just a taster - have loads more where this lot came from!

Has taken me over an hour to upload this little selection one by one but hope it gives you a slight flavour.

Can bore you all senseless with the rest on my return!

C x

An Easter treat??!!

Thought I'd give you something to smile about after my 'cheerful' last post!!
Have managed to upload a pic as it seems Mwanza internet connection abit more speedy than its country bumpkin neighbour Shinyanga!
So this is me and my partner in crime, Grace, dressed up as mzungu dolls at the refresher training a few weeks ago!!
Don't we look like plonkers?!
Hope it doesn't make you feel too nauseous - dont want to ruin your chocolate eating pleasure!!
Will try and upload some more pics if I can tomorrow...
Night night for now
C xx

Happy Easter!

A momentous week - not only is it Easter – happy Easter all (!) but we have dispensed morphine! Three cheers hip hip hooray and all that!

Quite a whirlwind day on Thursday – Grace aptly described it as a delinquents school trip! Our aim to dispense morphine to 3 lucky (?) patients was hijacked on several occasions by various members of the team. Who knew for example it would be a palliative care mentors role to be wandering round a timber yard with running saw mills trying to locate the wood needed to buy the cupboard to store the morphine in safely. Very important - but not on our tight visiting agenda! Neither was the impromptu stop at the cash point - some of the poor hospital staff have not been paid for 3 months but continue to work in the hope they will eventually receive back dated pay and safe in the knowledge God will recognise their efforts. Oh and the ‘quick’ trip to the government hospital for the mzungus to greet some distant relative of someone else who’d had their appendix out… it seemed whenever anyone got out the car we had trouble regrouping and moving on! You really cannot do anything quickly here in Africa! Best laid plans and all that….!

So our first patient – I couldn’t wait to see. Saimon needed morphine. He had end stage HIV/AIDS with TB. He was symptomatic with pain and breathlessness and had pressure sores having not been out of bed for several weeks. He was 40 but looked much younger and had the biggest smile. He loved gospel music. I couldn’t wait to tell him he was special as he was the first patient in Shinyanga to be getting morphine. It was a real shock therefore to arrive and find his family in mourning. He had died the night before our arrival having deteriorated rapidly.

So from the highs of expecting to be dispensing morphine and even having a bottle of morphine with his name on it to the lows of joining his mother and father in their grief was quite odd. The custom here is for the community, family and friends to get together to support each other but the women and men remain separate. So we found ourselves sitting on the floor of Siamon’s family home crammed in with loads of other women and his mother whilst they sung and prayed (hard not to shed a tear) and then sitting with the men outside and his father sharing in a simple dish of rice and greens. I could never have imagined being exposed to such an experience in Africa – sharing in this families personal grief and yet we were made to feel so welcome. It was clear they were so grateful for everything the palliative care team had done yet inwardly it was hard not to feel that we had failed Siamon in some small way by not getting morphine to him before he died. I know that realistically we could not have achieved this as when we first met him we we didn’t even have morphine in Shinyanga but knowing what I know from home and knowing how much he would have benefitted it is hard not to feel somehow sad. Reassuringly his mother told us he died peacefully and I know her perception is all that matters.

So the next 2 patients were a breeze in comparison! Our lady with cervical cancer who we had  managed to get discharged from the regional government hospital and another young lady (36) with leukaemia who looked pregnant but in fact had the biggest spleen I have ever felt. Both got their 100mls of morphine, a little syringe to take it with, education on what dose to take, the side effects and a little hand held patient record to tick off their doses. The team got support in prescribing and dishing out their first morphine and 2 bossy mentors telling them what to do every 2 seconds!!

By 7pm as we were bombing along bumpy country roads in the dark in a pick-up with no rear lights I felt a mix of excitement and anxiety – not just due to the ride home but also due to the enormity of the responsibility of ensuring morphine is used correctly and safely not only now but also when we have returned to our surreal lives back home in the UK!

For now back to Mwanza to celebrate Easter and indulge in the odd chocolate nibble! I hope your Easter eggs aren’t melting in the unseasonably hot weather youre having! Enjoy the festivities whatever you may be doing. I am thinking of you all.

Loads of love

C x

an assault on the senses....

So – the old man died. We reviewed him the day before he died and despite a mosquito net he had been bitten several times by rats and had new wounds all over his body. Heartbreakingly awful. I just don’t know how to articulate how I feel about this….

On more positive notes – lots of good stuff has happened this week:

I am an aunty again J Shame I am not at home but will have to make up for missed cuddles on my return!

We have morphine in Shinyanga – a whole one litre bottle of the stuff! And we have a permit! And we have identified patients who would benefit from it – so we are just in the process of arranging all the necessary paperwork to get it safely prescribed and dispensed! Logistically interesting as starting from scratch – at present there is not even a locked cupboard to store the morphine in, let alone a controlled log book or means of dishing it out!!

The nursing school and regional hospital teaching are both going well – lots of fun!

Patient wise we have had a real success story too this week. We found a patient at the regional hospital; a 38 year old lady with advanced cervical cancer and HIV who has been languishing on the ward for 3 months as no-one knew what to do with her. She had squillions of symptoms yet all she wanted through her tears was to go home. So we waved a wand and made it happen! Seeing her at home, lay outside in the fresh air with her family around with a huge beaming smile on her face was pretty groovy. The plan is to start addressing her physical symptoms now she is at home and the palliative care team will continue to review and support her. A really good case of leading by example and demonstrating palliative care to the team in the hope they will continue the work when we leave.

I have a great photo of this lady to share with you when I return. Frustratingly I still cannot get my pics to play ball and upload. So in the meantime I have put together a wee list of some of the things about Africa that can’t be captured in photos:

The sound of rice being thrown into the air and hitting a plastic plate to remove the stones and chaff before it is ready for cooking

The musty smell of rain drops hitting the dry earth

The dim light that requires the eyes to readjust when entering the traditional mudbrick homes of the patients we visit here

The patients and families warmth and generosity as we perch on handmade stools and chairs as they sit on the earth – all sheltering in the available shade, out of the hot sun

The warm glow from the lightbulb in our bathroom – replaced with a yellow bulb as no clear or white bulbs to be found in the shops anywhere

The sheer delight of being allowed, no, even expected to, eat with your hands

The excitement of riding side saddle in a skirt on a bicycle dala dala through the busy streets of Shinyanga

The tickle on the tastebuds of Tangawizi – Africa’s own ginger beer equivalent

The consistency of ‘mlenda’ – a vegetable dish served with ugali – that most resembles a combination of glue and snot…… but is so very tasty!

The contentment in the simple routine of putting up your mosquito net in the morning and tucking it in in the evenings to keep you safe as you lie by torch light indulging in a few more pages of your absorbing book

The scuttling sound of an insect on the lino in you room as you lie in the dark wondering what it might be… and wondering whether, even though you have your net down, might it just come and get you!

The free evening light show as the thunderstorms perform in the distance

The constant immersion in gospel singing everywhere you go

The ease by which women and children carry babies on their backs and bundles; of various shapes and sizes, on their heads

The new life everywhere you go – goats/kids, calves, lambs, piglets, chicks, babies; which contrasts wildly with the poverty and decay elsewhere

The playfulness and mischievous spirit of the children despite the challenges they may face

The sincerity of the prayers offered for the simple things in life – the food in front of you, a safe journey, health, the chance to meet again…..

Just a few things that come to mind – in the hope that despite the absence of photos you might still get a sense of the place. The other half of the story maybe.

C x

The highs and lows of Africa!

Am I really half way through my trip already and do I really only have 6 weeks left out here in Tanzania? It’s bonkers… time just seems to be whizzing by.

To celebrate the momentous half way mark Grace and I booked ourselves into the Tilapia hotel in Mwanza for a bit of much needed R+R for the weekend. Woop woop!! It is lush…. with a capital L.

I have had my first shower in weeks – yippee! Sadly lost some of my ‘tan’ down the drain in the process and lost the remainder in the swimming pool when I went for a dip this morning but never mind! I feel so clean! Today I ate breakfast in the sunshine looking out over Lake Victoria – buffet affair which was very dangerous as my tastebuds are demanding new flavours and self control it seems is an issue for them… naughty tastebuds!  Pizza, curry, pina coladas, chocolate cookies, tilapia fish, cappuccino all on the menu at various times this weekend – my stomach not sure quite what is happening as no rice, ugali or cabbage in sight!

Last week was interesting as usual. We went to see an elderly chap - the story goes he was relatively well up until 4 months ago when he lost his sight and stopped eating or caring for himself. He could not afford to go to hospital. For the past 1 month he has been ‘bed bound’ and deteriorating and was now very frail. So we enter the barren outhouse where he is lying. ‘Bed bound’ = lying on an empty sack on the earth. He is lucid and in fact more chatty than I expected. He thinks he is 80 ish or so (no-one here keeps track of their birthday). The history gives no clue as to a diagnosis for his deterioration. When the thin sheet that is covering him is peeled back to examine - he is covered in pressure sores. The one on his right hip is teeming with maggots and extends down to muscle. His genitals are grossly swollen and he has dependent oedema (swelling) from where he has not been turned for days, weeks even… Trying to move him it is like he already has rigor mortis, he is so stiff and clearly in pain. When rolled, underneath him is a huge infestation of red ants covering his body. On closer inspection they are up his nostrils, in his beard and in his mouth…..

So the team did the only compassionate thing they could do with the resources they had - they washed him; top to toe with warm water and soap. The ants and maggots were removed and the wounds cleaned with antiseptic and sprinkled generously with crushed metronidazole (crushed in a plastic bowl with a spoon that kept bending!) He was placed on dry bedding and covered with a sheet. An orange was squeezed and the juice given to freshen his mouth. He was left with some paracetamol (morphine would have been nice but as yet we are struggling to obtain) and the community were mobilised to support his on-going care. That somebody cared enough about him to wash him, that somebody reminded him that he mattered – these are probably the biggest gifts that could have been given in the circumstances ….

So from this to the highs of Mwanza and a recharging of the batteries so that we can continue such work on our return to Shinyanga tomorrow…. Bring it on!

Hope you are enjoying the heat wave at home and everyone is well.

Thanks so much for all your messages and emails – it means a lot to hear from you all and it is definitely keeping me going J

Lots of love and some hugs whilst I smell fresh!

C x

Refresher Training Course - Tick!

We survived! We made it through 3 full days of teaching and out the other side relatively unscathed with only a few minor bumps and bruises to show for it! Teaching via a translator is a very odd experience – not always convinced the subtleties were conveyed and often had to rephrase my sentences to make a woppingly blunt point. Seemed a bit stilted at times but no other way round it as my Swahili not good enough yet!! Participants (37 in total) really keen which was encouraging and up for getting involved and doing group work. Team building session was a hoot. We divided the group into teams and got them to build a giraffe in 5 minutes out of two pieces of flipchart paper and a roll of selotape. Lots of laughter and some very odd shaped giraffes (ours included!) whilst the winning giraffe was hotly contested! Most sessions tested our facilitation skills well and truly – particularly when it came to reshaping dodgy ideas! The poverty and social needs of the patients (money, food etc) raised its head several times which is always tricky. Time keeping also interesting – much to do with the fact breakfast and lunch ran late every day and our ‘reliable’ lift often did not get us to the teaching venue on time! Needed to do quite a lot of jiggling on the hoof but fitted a lot in and got some key messages across, which was pleasing. Will be interesting to see when we visit with the volunteers and palliative care team now over the next few weeks whether they are using or practising the skills we taught. Fingers crossed!  

The energisers were fun – I have a groovy little video of us leading a fast round of ‘head, shoulders knees and toes’ and I have learnt to give people ‘hot ones’ – if you’re good, I’ll give you one when I get back! For the last day we managed to get our outfits made which went down a treat! For the princely sum of £10 I have a tailor made traditional African top and skirt made out of groovy material. By the end of the day Grace and I did feel like ‘mzungu dolls’ – you know like ‘African barbie’ that you can dress up in her African style outfit! Comedy! If only I could uploads my pics but either the internet or the computer (I’m not sure which as I’m not computer savvy enough) won’t let me … boo hiss boo! I’ll keep trying…

The closing ceremony was just that – a ceremony. Everybody thanking everybody else, prayers and lots of handshaking whilst a certificate for each individual made its way down the line of ‘officials’ and mzungu dolls before finally being delivered to the joyful recipient! It seems the more mzungus the more prestige as some poor water engineer from Canada who is working in Shinyanga not only had to endure 3 days of palliative care teaching - he also somehow got roped into the official handshaking and certificate presentation ceremony  also!!  Can’t say we’re not delivering our message to as many people as possible!! All in all very reminiscent of school sports day and prize giving…. Happy days!!

Feels great to have got this big bit of teaching done and dusted. We have more teaching planned at the regional hospital, kolandoto hospital and the nursing school over the next 6 weeks but will be able to draw on the resources and sessions already prepared to plan these. As I said before the real test now will be out in the field and whether or not they are using what they’ve learnt i.e. the proof in the pudding and all that….

Mmmmmmmmmmmmmmmm……….……. Pudding!!!!!!!!

xx

A big week ahead!

As I write this it is Sunday evening and Grace and I are living it up in Kolandoto chilling and eating biscuits (ginger snaps if you’re interested) - after a heavy weekend spent planning the teaching for the 3 day palliative care refresher training course we are running next week.

Today is the first Sunday since arriving in Tanzania that I have not been to church. I’m feeling quite rebellious! Last week we were picked up at 6.15am to go to the service at Shinyanga Cathedral which was interesting. At each service Grace and I are required to stand in front of the whole congregation and introduce ourselves and our purpose in life. Difficult enough in English let alone Swahili! So after the laugher stops we sit back down. I am getting to know the routine. Don’t mind the dancing and singing but the hours worth of Swahili preaching I could probably give a miss. We are required to donate to the collection every time also. I’m hopeful I’m storing up some brownie points with the big man…….

Other exciting news – I had a bat in my bedroom the other night. There are some instances where I concede a man can be quite useful and bat removal from bedrooms is one such instance!  I have also discovered a place in shinyanga where I can buy pringles!! What an utter delight – having gone without my beloved savory snacks for almost a month now (a major feat for those that know me!) I almost cried out in joy when I spotted the distinctive green tube winking at me from a top shelf!! Needless to say they were extortionate (4000 Shilling =£2) so they are being rationed! Grace and I have been musing what other things we may have inadvertently given up for lent just by virtue of being here and not being able to get our hands on them!  The usual culprits – chocolate and wine feature but some less so well know; like showers and sitting on proper toilets have also been sacrificed!!

Work continues to astound and amaze. When we arrived we were bursting with ideas to implement. The last 3 weeks of working with the teams and observing current practice has left us slightly shell shocked as the realisation has dawned that we need to go right back to basics. We have tailored and adapted the 3 day palliative care refresher training course this week so that we can not only impart basic knowledge and skills to the team but also help them to identify the current gaps in their service and empower them to develop and improve. I have been in flipchart heaven– being as creative as I can with a black, blue, green and dried up old red marker pen! It’s going to be another busy week but having done the preparation Grace and I are looking forward to getting stuck into the teaching. We have even bought some funky African material and we are having traditional outfits made so we look the part! I can’t wait!

Big love to all as always

C x

A soggy post from Africa!

The rainy season may well have arrived! Having been lulled into a false sense of security with blisteringly hot temperatures (resulting in some mighty attractive teva sandal demarcations on the feet) we have been treated to thunderstorms and rain for the past few days. Good for the crops but less satisfying to be visiting in. When it rains here - it rains. Roads flood and become even more chewed up and bumpy than one could conceive which makes for unhappy bottoms when riding in the daladalas! We hit a record the other day; 18 people in an 8 seater vehicle; 2 men in the boot but no goats as yet…. I’ll keep you posted!

Visiting has been a real eye opener this week. In fact my eyes were somewhat bulging when confronted with the realisation that at present the only palliative care drug we have available to use in the community is paracetamol! Grace and I are on the case to resolve this…..  ASAP! There is money in the budget and we have drawn up an essential list of basic palliative care drugs that we feel should be available here. (A sad little list when I think about the drugs and complexity of palliative care available in the Western world.) Death seems also to be a tricky concept for some to embrace and holistic care dominated by spiritual care which is centred heavily around religion only. History taking and assessment require fine tuning with a rather large spanner. Getting to people is also logistically challenging – 3 on a motorbike not ideal but a necessity if we are to reach people at present. There is work to be done! It seems that every day we uncover some new hurdle or other – to be ungainly crashed into or straddled (!) but by the end of our time here I’m hoping we are jumping over them with ease!

As yet still no giraffes spotted but plans are afoot for a safari trip at the end of our time here. Muchos excitement! Despite the lack of giraffes there remains an abundance of other wildlife passing our front door – cows, sheep, goats, donkeys, the cockerel mafia… Our dinner even arrived clucking and fully conscious through the front door this week in the form of a live chicken which was dully killed, plucked, gutted and cooked in the kitchen. You can’t say it wasn’t fresh!! Some girlie shrieking at the realisation of what was about to happen did occur I’m embarrassed to say – although we heartily tucked in once marinated in sauce!  Not sure what’s on the menu this week??!

Much love to all

C x

the next 2 posts...

internet access remains elusive - I dont blame it!
So I must write my blog when we have power at home (Grace has a wee notebook which is very handy!) and then post en mass when at an internet cafe in shinyanga.
hence the following fairly long posts; one on home life and one on work here....
I'm not good at 'short and sweet' - I'm sorry!
Enjoy ;-)
C
x

a way of living....

Habari Za Asubuhi! (Good morning)

You’ll be pleased to hear the house now has been given a girlie touch and the walls are decorated with cards from all you guys which helps (not that we can see them in the dark when the electricity is out!!) Excitingly we had a flood to contend with the other morning and woke to find the kitchen and living area like a paddling pool. It’s a long story. Anyway it gave the locals lots to talk about as they watched crazy mzungu’s sweeping water out their front door at dawn!

We have decided to pay a local lady to help us with the cooking and cleaning whilst we are here. It is apparently good for the economy to provide work but it feels soooooooo odd. In the long term it is also good for our pocket as she can get a better rate down the local market than us mzungu’s. White skin equals a price hike in most things. That said the cost of living here is embarrassingly cheap for us despite such vast poverty in the local communities. A difficult pill to swallow – I think it will take some time to get my head round this one. Anyway the consequence of having Mary is that I am eating some delicious home cooked Tanzanian food and having joked before leaving that I need to lay down some extra layers I fear I may come home chubbier than when I left at this rate! The staple diet is rice or ugali with veggies (yummy!) and chicken, fish or ‘meat’ – all mostly fried. Having seen the butchers at Mwanza I must say meat is a little less appealing and you need pretty strong teeth for the job!  The fruit is devine here. Ripe mango’s and pineapple straight from the market. None of the cruddy – I’m an unripe mango one minute, turn your back and I’ve gone off rubbish you get in our supermarkets! Oh and ‘soda’ i.e. fizzy pop - They drink buckets of it here. We are going through bottle water like billy-o so are currently in the process of acquiring some rain water for cooking and tea. This girl likes a cup of tea!

In terms of location we are actually based at a remote little place called Kolandoto about 14km (15-20mins by car) outside Shinyanga town which is busy and buzzing. The AICT (African Inland Church Tanzania) hospital is based at Kolandoto and we will be working with the palliative care team here as one part of our role. Getting back and forth to Shinyanga where a large part of our work will take place is going to be logistically challenging. The most likely option is going to be riding in the sweaty armpits of others in a dala dala. A minbus type affair in which I figure the rules seem to be similar to that game ‘how many people can you squash into a mini’! Have resigned myself to the fact that in view of my washing facilities, weather (currenly mid 30’s) and mode of transport to and from work I am going to be one smelly lady for the next 3 months…. Nice!

On that note time to wave cheery bye for now!

C x

progress at work.....

The last few days have been fantastically productive and my head aches a little from all the brainstorming Grace and I have been doing! (We even have an ‘action plan’ wall in the house – it’s very blue peter - I know- we are sad!!)

We have now met all the palliative care team members at both the Kolandoto and Shinyanga sites – a mix of doctors, clinical officers, nurses, pastors, pharmacist and home based care volunteers. How it works here is so different. In fact the void between the UK and here is vast – in terms of structure of service, resources, time management …… everything.

I am slowly getting used to ‘African Time’ – nothing moves quickly here and there are a million formalities that need to be observed to complete even the simplest of task! Saying hello to someone can take 5 minute due to the number of greetings you must share! (longer if your Swahili is as stilted as mine!) Setting a meeting time appears to be a pointless exercise as guaranteed only us mzungus will stick to the observed pre agreed time!!

That said our big meeting on Friday went exceedingly well and we were welcomed once again with open arms and anticipation. From this we have some clearer ideas of the objectives for our time here which will focus predominantly on formal teaching sessions and mentoring via joint visits in the community and work on the ward at Kolandoto. Ensuring morphine is accessible and used with confidence is paramount before we leave. We have also identified that referral pathways into the palliative care team and record keeping needs to be developed and strengthened.

Excitingly we met the chief medical officer at the regional government hospital in Shinyanga and managed to secure his agreement for a regular weekly teaching programme. This is amazing as currently there are no links between the palliative care programme and the government hospital. The provision of palliative care there is poor and they currently do not use oral morphine.  A real opportunity for us here.

So

Whilst there is evidence of some really good work being done there are some gaping holes – some of which Grace and I can try and fill and some that Grace and I dare not even peer over the edge i.e. poverty and peoples need for food supersedes their need for medicines and palliative care in many instances. Clearly this is an issue for the Tanzanian Government to consider but it is a huge problem. I figure we can only do what we can do – and as a wise person often reminds me ‘how do you eat and elephant?’

In bite sized chunks obviously….

a quick update...

So I have finally arrived in shinyanga :-)
But sadly internet access has so far eluded me and is a work in progress (fingers crossed for a working dongle by friday! In the meantime this is a brief update from an internet cafe in town)

I cant wait to show you pictures of my luxury accomodation:
Deluxe washing facilities with shower over squat toilet
Cold water supplied from 7am -8.30am every day only
Electricity off more than it is on
Mosquitotastic.... despite nets and spray, socks and sleeves (I have sweet mzungu blood!)
Pet gecko tolerated but pet cockroach not...!
Free wake up call service - choose either the local mosque (5.10am) or the local cockrels....

That said Grace and I had a fabulous candle lit dinner last night listening to the sounds of the local gospel choir rehearsing their songs till 10pm.... blissful .....

I have met so many lovely people the last few days - the welcome Grace and I have received has been amazing. We are both bursting with ideas for the palliative care team and work starts in earnest on Friday with a big meeting planned. In the meantinme we must meet with all the important local community leaders, church bigwigs and influential sort who will then bless us with their support during our stay and allow our work to proceed...

Wish us luck and I'll keep you posted!

Kwaheri (goodbye in swahili!)
Cass
x

playing catch up: part two!

From Mwanza up the lake and over it on a rather rusty, potentially not sea worthy, ferry (don’t tell mum!) to the dusty mining town of Geita – they say sand gets everywhere. Trust me, in Geita bright red dust gets into places not even I expected!

And so the work begins. Our reason for travelling to Geita? Having established a strong palliative care programme as part of this project and having already benefitted from their mentors input, this was our opportunity to learn from them. To steal ideas for Shinyanga and figure out what went well and what not so!

As well as an all day meeting on Saturday (yes, working on a Saturday!! Note to employers in the UK… I am not skiving!!) we also spent all day Friday doing field visits i.e. visiting palliative care patients in the community and witnessing the good work being done by the fabulous Mary (palliative care co-ordinator in Geita) and her team.

Now I have to tell you – I am not the most ruffty tuffty person in the world but even for those of you who are as hard as nails; to be warmly welcomed into the homes of some of the most sick people I have met and to see the conditions they are living and their poverty, together with the selfless acts of compassion demonstrated by the home based care teams and other palliative care team members is humbling and moving.

(Home based care volunteers; as the name suggests, volunteers (unpaid) who look out for and support the most vulnerable in their community)

I already know I am going to come back from this experience a somewhat different, albeit still recognisable on the outside, Cassy….

x

PS - pics to follow when settled in Shinyanga, not living out of backpack and technical head in gear!

playing catch up; part one!

So - where to begin?

Arrived in Dar es Salaam after a red eye flight (overnight) which was amazingly quiet; so ample seats for stretching out on. Good old BA. Groovy movies too – could have stayed up all night and got me some square eyes! Amazing view of Mt Killimanjaro at dawn from the airplane. Much respect to all those dudes who have climbed it! (you know who you are!)

Dar is busy, noisy, somewhat intimidating and the roads are treacherous so all in all was glad to be flying out the next day to glorious Mwanza – a little oasis situated on the south end of Lake Victoria!

I have got me a buddy too!! Grace joined me in Dar having spent her first few weeks mooching around Uganda catching up with some old friends and colleagues she met when working there 2 years ago. Lucky thing! She and I will be partners in crime in Shinyanga (hurrah) and it is nice to have a fellow mzungu around!! (Mzungu – African term for white person, frequently hollered at me by small children!)

In Mwanza we were welcomed by Armani – a key co-ordinator of the palliative care project here in Tanzania. What can I say about Armarni? He is young, enthusiastic and loves to sing! Watching the sun set from the beach resort at Lake Victoria on my second night in Africa accompanied by Armani’s singing was a real treat!

Enough for now

C x

The first of many posts from Africa to come...!

Jambo!

I’ve made it safe and sound aside from the little travel sickness incident which we won’t mention. (Very embarrassing to learn at the age of 32 you can’t read in the back of the car without loosing the contents of your stomach! Hey ho – every day’s a school day!)

Gosh – I have so much to tell you! Africa is an amazing place – an assault on the eyes, ears and nose! No giraffes spotted yet but plenty of time for that. Only one mosquito bite so far (despite dowsing myself regularly in disgusting Deet which seems to erode everything it comes into contact with – goodness knows what it does to skin!) and stomach holding out so all in all not bad progress!

The past few days have been busy – and I am not yet in Shinyanga; the place I will be living and working for the next 3 months. For those interested I’ll post a separate blog entry on my proposed work out here.  It’s going to be interesting for sure.

Time is limited now. I have dinner with the bishop to attend! I will fill you in on all my adventures over the last few days in the next instalment....

To be continued……!!

Love to all – from a sunny 28 degrees in Geita, Tanzania

Cass x

3 sleeps to go!!

Last on-call survived without incident - tick
Last day at school completed without creating too much mischief - tick
Organised and ready to go to Tanzania - very un-ticked!

Have just 3 sleeps to get things together - there's nothing like a little time pressure to focus my mind. Ha!

Next battle - rucksack vs guff to be packed. I fear for my rucksack!
Ipod tunes sorted; courtesy of the bro and he is furnished with a tidy list of jobs to do whilst I'm away in addition to the mandatory house and cat sitting!

Takeaway on the menu tonight - need to lay down some more fat before I get to Africa! Not sure what delights my taste buds will be exposed to over the next few months.

Anyhoo must get on - I can hear my rucksack calling
Next time I post it should be in Swahili as I will be on African soil!
How excited am I?!!
C
x

2 weeks to go....

Have two sore arms but all the jabs are now complete and I am the proud owner of a shiny yellow fever certificate! Am watching the pile of 'things to be packed' slowly grow and threaten to take over my bedroom floor! Attended a Tearfund training session yesterday so all educated and raring to go!

Will miss this fella:

Just practising how to add pictures to my blog - any excuse to post a cute picture of puss puss and his chistmas toy! Next cat on here will hopefully be of the lion variety :-)



3 weeks to go....

Did I tell anyone I was going to Africa??!!
Nearly a year in the planning and in 3 weeks time I will be sitting on a jumbo jet - destination Tanzania.

The prospect of spotting my first real giraffe (a safari park giraffe does not count!) fills me with grins!
And I approach the palliative care mentoring role (the real reason for going) with a healthy mix of excitement and intrepidation.

Thought this would be a good way of keeping all you lovely people up to speed with the mischief I'm causing overseas.

So here goes....!