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