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