This is probably my last blog entry before I return to the States for the Holidays, because I'm on the way to Southern Tanzania tomorrow. I went to Dar Es Salaam last week. I bought a bunch of paintings, so I'll have an awesome apartment when I get back, and I bought a bunch of gifts. I also got to spend some time on the beach on Friday and Saturday, which made me feel a bit smug, since I hear there was snow in Iowa and Minnesota. Yesterday and the day before I was in a small village called Mang'ola for drug shopkeeper training. I'm starting to be able to understand more Swahili so it's easier to understand what's happening at the training and if people are enjoying the training and finding it helpful. I got to interview some of the women at the training to help Karla with her article too, which was fun, they seemed to get a lot out of the training, although it's hard to tell for sure because Tanzanians are too polite to say otherwise. That's about all that's new here. I'll see you all pretty soon.

The past couple weeks have been marked by some sadness for MIHV. The district medical officer, who happens to be the uncle of one of our staff, passed away this week. The sister of another co-worker passed away this week as well. For the wake and burial I wore traditional African clothes. I thought everyone would get a kick out of it, so some photos are below. Wakes in Africa last for several days, day and night, and women are responsible for cooking, so I learned how to cook dishes called pilau and kichumbali.

Other than that I continue to work on preparations for drug shopkeepers and MAISHA training. I am also excited to help Karla with a newspaper article for her class. I am hoping she can publish it somewhere and people can hear about some of the cool stuff we're doing here. I'm leaving for Dar Es Salaam tomorrow to go to a friend's graudation and see the sights. After I return I'll be going out into the field to a village called Mang'ola Barazani for drug shopkeeper training. Then I'll be travelling to Southern Tanzania to visit a hospital and school that are "friends of MIHV" and see if the hospital is a good place for medical volunteers to work. On our way back from Southern Tanzania we will visit Zanzibar for a few days. That will get me pretty close to time to come back home for a while, but if there's time I'd like to climb Mt. Meru as well, we'll see how it goes.

I've been working in the office and at the hospital for the past couple weeks, so I don't have any new photos, but I've been keeping quite busy. I've been working on arranging things for our next drug shopkeeper training and beginning to design a curriculum for MAISHA (maisha means life in Swahili) training, which is a group of taxi drivers that we want to train in basic emergency response and community health so they can educate their customers and families. One nice story to follow up our first drugshopkeeper training: Jolene, our Country Director, had a bit of a stomach bug, and sent one of the MIHV staff to a drug shop to try to buy a partial dose of the medicine she needed (she already had a partial dose from when we had done a survey to see if they would sell them before training) and they refused to sell her the partial dose. So apparently, the eduation is having an impact. Today, I am doing a presentation on chronic diseases for my co-workers and members of the District Council Health Management Team.

This week, I was out for a bike ride and I saw a large crowd by the side of the road. I stopped to see if I could help. A woman had been hit by a car, and her arm was badly broken, but other than that she was ok. I couldn't do much to help so I made her a sling and helped carry her to a car to get her to the hospital. We then saw her in the hospital the next day, but had to send her to Arusha for surgical repair of her injury. Other than that events at the hospital are about the same as usual, but I've been trying to learn as much as I can about prevention and primary treatment of rheumatic heart disease. I'm not sure why I found the prevalence of this disease so much more surprising than other infectious diseases. I guess because I thought all it took was a little amoxicillin and the problem was solved, which is pretty much true, but as with everything else, somehow it gets more complicated here.

I have a busy month and a half before I come home. I'll be helping build a school this weekend. Next week I'll be continuing to prepare for drug shopkeeper training and MAISHA training. Next weekend, I think I'm going to Moshi to do some hiking around the base of Kilimanjaro. After that, I'll be going to southern Tanzania to visit a site that would like to host international medical volunteers, then back to Dar Es Salaam for my friend Eveline's graduation. Then drug shopkeeper training. In December, travel will keep me busy. I plan to climb Mt. Meru and then relax in Zanzibar. I found out that I can climb Mt. Kilimanjaro for free in April, so that's pretty exciting.

Much has happened since last I wrote. MIHV started a drama troop event at market day to help spread messages about malaria, pneumonia, and diarrhea. It was a lot of fun. The performance mainly consisted of singing and dancing.

The next day I began working at Karatu Lutheran Hospital. The first day was quite a challenge for me. I saw a lot of difficult cases, including a young man whose hand was crushed and he had to have two fingers amputated and a young HIV positive mother with a complicated C-section. Over the next few days there were many interesting cases, a young woman with very high blood pressure (we're still trying to figure out the cause) and a young woman with very severe anemia (the same). Most of the issues I am facing in the hospital are not unexpected, but it is certainly challenging to balance the realism of accepting things are they are and the idealism, that it is not the way it should be. For example, we were unable to give the woman with anemia a transfusion because they had no blood reserves. They could not get blood from the hospital 3 hours away because they did not have a cooler to transport it. The doctor I worked with and I offered to donate blood, but the bags were expired and in bad condition.

Last weekend. A Peace Corps volunteer and I went on a bike trip. We had planned on going through the Ngorongoro Conservation Area, a cool mountainous region with many Craters and a lot of wildlife. However, the trip fell through because we found out we needed a guide, but obviously we could not provide him with a bike. Instead we decided to bike from Lake Natron up near the Kenyan border back down toward Karatu. This was a bit more than we bargained for. The road was almost entirely sand up to 6 inches deep, and we ended up travelling at a rate of about 2 miles an hour during the day before we gave up on the idea of biking the rest of the way home. The experience was still very enriching though, as we got to see Oldonyo Lengai, an active volcano, which is currently smoking, we spent two days in Engaruka, a Maasai village, where they were quite welcoming, and we saw some ruins from a settlement from hundreds of years ago, that were quite impressive and interesting.

Now I'm back in the office for a while, another thing I've been considering doing is teaching 1-2 periods of chemistry each day at the local secondary school, but I'm not sure it will work out. Other future travel plans include climbing Mt. Meru, visiting Dar Es Salaam for my friend Eveline's graduation, and travelling to southwest Tanzania to see if a hospital in the town of Njombe will be a good place for medical volunteers to visit.

This past week I travelled to Lushoto, which was very beautiful. I continue to have a bit of bad luck with travelling though. The guide I hired tried to take a shortcut through the rainforest because we had walked 36 km (~22 miles) the day before. He ended up getting lost and we found ourselves in very thick forest where I fell and twisted my knee a bit, then had to hike out about 10 km because there weren't any roads any closer than that. I decided to forego other hiking plans for a bit after that and I think I'll plan beach vacations until after I complete my climbs of Mt. Meru and Mt. Kilimanjaro. Hiking 36 km through the mountains again would probably kill any desire I had to climb anything.

Rainforests aren't quite as exciting as I had expected. Of course, I expected technicolor flowers and monkeys 10 feet away, which wasn't exactly realistic. In fact they're pretty much just like other forests, but the surrounding mountains were beautiful and the people were very kind and friendly. I also learned that it was easy to make friends with local kids by taking their photo and showing them the results, which was really fun.

The next things on the agenda are starting work in the hospital on Monday, making a reference book for local drug shopkeepers, and a bike trip though the Ngorongoro Conservation Area up to Lake Natron, which promises to be incredible, if for no other reason than I'll get to spend almost a week on my new bike, which is super sweet and came with an awesome bell that will be returning with me. I'm hoping at the end of October, beginning of November to head to Mt. Meru, then to Pangani to lay on the beach. The photos are from my travels this past weekend.

Here's a photo of the people I work with, we are on a trip to Ngorongoro Crater.

This past week I completed my first project in Tanzania. I developed training materials and helped coordinate training for women who work in drug shops. As I've mentioned before these women are very important people in the health care community and often prescribe important medicines including antibiotics themselves, without any consultation with a physician or pharmacist. These women do not have health care experience, so giving them some insight into proper prescribing and when children are critically ill will hopefully have a big impact. We are planning on using secret shoppers in six months to see if the training was effective and what areas we need to do further training.

The other fun this weekend was a trip to Ngorongoro Crater, which was incredibly beautiful. I didn't see quite as many animals as I did on last weeks trip, but the more beautiful surroundings more than made up for it.

There was also some humor on this trip. We got out of the park and parked at the gate for everyone to stretch their legs and get checked out of the park. There was a baboon walking right past our cars so I walked up as close as our second car, about 15-20 feet away and shot some photos of the baboon. Then the baboon started walking toward me, which made me a bit nervous since I had heard they're quite mean. So I started backing away from it, until I had backed my way into the back seat of our car. The baboon jumped through the window into the front seat of the vehicle, which was quite a shock for me and quite hilarious to everyone else in the group. Soon the baboon jumped back out the window, no harm done, but I was pretty concerned for a bit. Hopefully I can include a photo of him above.

Quite a bit has happened since my last post. The first was working at the eye clinic. It was really great. I worked with a British doctor, Dr. Savage, who has been working in Tanzania for 10 years, and a Tanzanian woman, Dr. Kombo, who is doing something like an Ophthomology apprenticeship with Dr. Savage. It was a really great experience. I learned a ton. We saw many, many cataracts and performed about 15 cataract operations over two days. We also saw some people who had some problems with their free cataract operations. I saw a woman who had a retinal detachment, a girl who lost her eye to shingles, and several other interesting cases that only nerdy med students would care about. I'm still looking forward to participating in other clinics and working in the hospital, but unfortunately the man I need to meet with, the district medical officer has been in the hospital with pneumonia almost the whole time I've been here.

The other project I've been spending quite a bit of time on is creating training materials to teach drug shopkeepers about how to prescribe drugs correctly with full doses, proper instructions, and according to the government protocol. There are a lot of system wide problems with regulation of pharmacies and some problems with the quality of health care providers, that make it seem more worthwhile to go directly to the drug shops, rather than seeing a clinician. The training will occur this Thursday, so I'm hoping we can get it translated before then.

I went on my first safari this past weekend. The game drives themselves were very good and I have some amazing photos that I hope to post soon, but the rest of the trip was a bit of a disaster. The car broke down on the way out to Lake Manyara. Then I joined another group for safari at Lake Manyara,after that we left to go to Tarangire Park, where I was supposed to have a luxurious tented camp waiting for me, but it was full, so I ended up staying in a guest house that cost about $3, you can guess about how nice it was. It was actually very tidy and had mosquito nets so it was fine, just not really what I was expecting. Then on the ride home we ran out of gas. I'm still haggling over price with the guy, but I think I'm going to have to pay full price for the trip. So I have decided I will start a small scale smear campaign against Fun Safaris. The next travels are into the rainforest. I'm setting it all up myself and I'll be camping, so I know exactly how luxurious it is.

To be honest, there's not too much new here. We finished up our health facility assessments this week, and found that not many kids were going into dispensaries and health centers, which those facilities claimed was because there weren't sick kids, but after checking in with local drug shops we found they were treating many kids, so people were just skipping the doctor step and going straight to the pharmacy. Many of the people in the office will be travelling to the village of Mang'ola this week. I've elected to stay in town because some doctors from out of town are coming in to perform an eye clinic and surgeries, which I am hoping to at least observe, if not participate in. The next big plans are travels to Tarangire NP and Lake Manyara NP next weekend, and travels into the rainforest two weeks after that. My mom wants some photos of people, so a few more photos up above, this is Rose and Halima looking at some baby clothes we bought as a gift, while at market.

I'm starting to get settled into what I'm supposed to be doing here. We began some health facility assessments this week in health centers and dispensaries in the area. Though they are not far away, the farthest was 50 km away, the roads aren't paved and they wind through the area, so the 50 km drive took about 3 hrs. Seeing the clinics were interesting too. Since the clinical officers have five years of post-secondary training (including their internship) before they are out practicing on their own, much of their practice is based on protocols. This takes away a lot of the art and detective work of medicine and may result in missing something important, because often these clinicians don't even examine the patient. They hear the word cough and reflexively prescribe an antibiotic for pneumonia. In the circumstances where people are traveling for hours to reach you you might think better safe than sorry, but antibiotic is becoming a major issue as pharmacists give out antibiotics without a prescription and may not give a full course, even if parents get a full course of antibiotics they often stop taking it as soon as the child is feeling better. It is my opinion that antibiotic resistance in Africa will be an even bigger problem in Africa than it currently is in the states because most people won't be able to afford the new antibiotics we use to treat resistant infections.

Last night, I went out for nyama choma (barbecue)with the staff at MIHV, we had a great time. The staff here is very kind and friendly and they are helping me a lot in my quest to learn Swahili. Though sometimes they forget I don't speak it until they see the blank stare on my face.

I'm using my free time this weekend to look into some options for travelling. In September or October I'm hoping to climb Mt. Meru, fortunately last night I met a man, who works for a Canadian NGO, who grew up right by there and his brother is a guide. It sounds like he will be able to help me find a good deal and a great trip. I am also excited for a trip I'm planning to Tarangire National Park. It's one of the few big parks that has most of its wild life during the dry season, so I hope to take advantage of that and see an elephant migration. Some other trips in the works are a trip to Zanzibar and a trip to Madagascar once I've done a little more research.

This coming week I'll be going out into the field again to continue the assessments before we start training community members in recognizing signs of severe childhood illness. I might go to Arusha to pick up a cell phone (so I can stop mooching off the office phone) and I hear they have last minute safari deals, so I might try to find a good deal on those as well.

Here's some of the gorgeous scenery around me:

Here's my room:

Here are some photos. My house:

I made it

My travels to Tanzania were pleasantly uneventful. I arrived Saturday and I'm getting settled in. I went to a bbq today which was quite fun. I hope to have several photos up shortly. I was supposed to have a 15 h layover in Ethiopia. Luckily Ethiopian Airlines put us up in a hotel and gave us dinner and breakfast, and I made some friends who were climbing Kili along the way. I'll post photos of all the beautiful scenery, my surprisingly nice accomodations and the gang in Ethiopia when someone else is not waiting for the computer.

Welcome

After many requests I decided to establish a blog about my trip to Tanzania. I'm not there yet, but I thought I'd start posting information on this so you can find it when I get there.

Sijambo means "I'm fine" in Swahili. I chose it as the title since I've heard inferences that some people are worrying about me more than they should. That, and surprisingly the Swahili word for togetherness and the Swahili word for dancing and drumming were taken.

I'll be arriving in Tanzania on August 24. While I'm there I'll be working with Minnesota International Health Volunteers (MIHV). I'll be splitting my time between working in hospitals and clinics and helping with a public health project to improve early childhood survival in the Karatu district in Tanzania.

I also plan on doing some tourist stuff. Hopefully, I'll have time and money to climb Mt. Meru as a warm up for Mt. Kilimanjaro. I'll also be living about 5 miles from Ngorongoro Crater, which is one of the premier sites for safari in the world. There are many other safari sites nearby as well. I hope to have a chance to travel to a few other countries in Africa, as well. Regardless, I look forward to having great photos to share with you all.

As I've told many of you, I'd love to have some visitors on this long adventure, especially anyone interested in sharing a Kili climb before all of the ice melts. So even though I know that my friends and family who happen to possess both time and money right now are few and far between, know that my door will be gladly open to you.