Ketumbeine

I just returned from spending a week learning about rural medicine in Tanzania and I had a fabulous time! First I just have to brag that after coming home today to empty cupboards and fridge, I went shopping in town and went to the market for produce all by myself. I've only been with my aunt, Bernice, or my roommate, Eric, and I did very well today with talking to people and not getting too overwhelmed at the crowdedness. Now on with the exciting week.

I spent the week with the Fribergs who live in Ketumbeine. Steve is trained as a pediatrician, though practices very broad spectrum out here and he and Bethany have 3 delightful children. Nyika and Zaka are twin boys and Shalai is the only girl. They're from Minnesota, but Steve grew up out here as a missionary kid and his parents were friends with my grandparents and Bethany grew up as a missionary kid in Nepal. They're quite amazing people who really feel a call to service and live a simple life among the Maasai.Mtu wa mbu hospital

The week began with Steve and me in his land cruiser full of Maasai patients. He brings a car full from Ketumbeine to various places each week and this week we dropped a couple people off at the Arusha Town Clinic to get x-rays, a couple people off in Monduli where there is a Catholic rehabilitation center, and a couple people went with us to Mto wa mbu for ultrasounds. Mto wa mbu is a small town that is pretty touristy because it's at the entrance to Lake Manyara National Park. The name literally means "river of mosquitos." The hospital is a nice building and has about 12 beds, a lab, a pharmacy, and an ultrasound. They also run an ARV (anti-retroviral) clinic for patients with HIV. I saw patients with the Tanzanian doctor who works there and watched ultrasounds preformed by Steve. By the end I was starting to be able to recognize body parts of fetuses by myself. We stayed the night in Mto wa mbu and saw more patients the next day. One girl had come in during the night after being stung by a scorpion.

Lake Manyara

One really fun thing about Mto wa mbu is the baboons that are everywhere. Any down time I had I spent outside watching the baboons play.

We left Mto wa mbu and drove back through Monduli to pick up one of the kids we had dropped off at the rehab center. He is 17 and has a form of muscular dystrophy and was having difficulty walking so they gave him some leg braces and new tennis shoes and he's now smiling again. It was fun to see the rehab center and I saw some kids I remembered as patients from the past couple weeks with the visiting surgeons from the US. They all looked great. We ran some errands in Arusha before picking up the people who had x-rays and brought everyone back to Ketumbeine. Ketumbeine is in the middle of Maasai country and is very rural. The drive to Ketumbeine alone was beautiful. In the week of driving, I saw lots of cows, goats, donkeys, and camels, but also ostrich, impala, Grant's gazelle, a dik-dik, a jackle, zebra, giraffe, and a couple elephant. I was crammed in the car with a bunch of people so I didn't get any pictures, but I'll go on safari in a couple weeks and you'll see pictures after that.The Friberg's home

Ketumbeine is a small village with a church and the dispensary that Steve built. He has a few beds and 3 employees: a nurse, a clinical officer, and a guard. He can do a few very basic lab tests, but has no imaging. He treats a lot of malaria, TB, GERD, reactive airway disease, pneumonia, and nutritional and vitamin deficiencies including rickets, scurvy, and pellagra. I saw a woman with an old cutaneous anthrax infection, the flattest feet I've ever seen on a young boy, and an old woman with old scars on her head and arm from a fight with a lion when she was younger. What a cool old lady who had a fight with a lion and lived to tell about it.
The other interesting thing that happened while I was in Ketumbeine was news of an outbreak of Rift Valley Fever. It's a hemorrhagic fever (in the same family as Ebola) caused by a virus and it is transmitted by mosquitos who bite infected livestock or from the blood of livestock. There have been over 100 deaths in Kenya and a few in Tanzania too. People in the Ketumbeine area were being told not to slaughter their livestock and to cook meat and boil milk very well. There is also a vaccine for cattle being distributed by the government. I'm very thankful for mosquito nets and DEET.

An "ant hill" which are actually made by termites

The Fribergs live next to the dispensary and since there is no phone service in Ketumbeine, people knock on his door day and night asking him to see patients or to drive out to bomas to pick up very sick patients who cannot walk into the dispensary. I rode along to a couple bomas to pick up patients and got to take some pictures. The roads are pretty terrible anywhere you go out here and when it rains, they wash out. One trip, we had to stop a couple times to fill a washed out area with rocks so that we could drive across.
Maasai bomas are a group of houses surrounded by a fence. A typical boma has a few brothers living there with all their wives. The Maasai who are Christian only take one wife, but polygamy is still very common in the Maasai culture. Wealth is determined by the number of cattle and goats each boma has and the wealthier you have, the more milk you have to attract flies so I went to one more wealthy boma and when we left we must have had about 1,000 flies in the car. We couldn't even open our mouths to talk or a fly would get in. It was quite comical. A Maasai diet consists of goat and cow meat and milk and maize flour. They don't eat chicken or fish. It sounds as ridiculous to them as eating a rat sounds to me.

Shalai and me at one boma

Bethany helps to run an organization of Maasai women who do beadwork. These women are widowed or abused by their husbands or otherwise need a way to make some money and be more independent. Traditionally, Maasai women are treated as property and have no way to support themselves and their many children without a husband. The Maasai Women's Bead Project teaches women not only to do very nice beadwork (I bought a bunch of stuff to bring home), but also teaches women self respect and how to function independently. I went to where they work in the village with Bethany and sat around watching the women bead and sing songs.

One of Shalai's very cute little friends

I went to church on Sunday morning and their local Lutheran church has 2 services. One in Kiswahili and one in Kimaasai. I can't understand either, but since the Fribergs speak Swahili and not Maasai, they go to the Kiswahili service. The singing is so beautiful and seems to happen spontaneously whenever there is silence. There were 2 offerings during church and afterward they auctioned off some food for additional offering. The pastor for their church covers about 15 small congregations so they have other evangelists who preach when the pastor is at another church.

I was lucky enough to be in Ketumbeine for a celebration at a local boma and was invited to go. Nyika and Zaka accompanied me to the boma and we were served chai and goat from the 3 they slaughtered that morning. The celebration was for a little girl that was circumcised that morning. Yes, I said little girl. Many Maasai still circumcise both sexes, though some, especially when living closer to big cities, are getting away from female circumcision. There were many people gathered and they were all dressed in their best traditional clothes with plenty of beads. The men processed in and out of the boma a couple times and then men and women made circles and they sang and whooped. The women shake their shoulders so that their large beaded necklaces shake and the men take turns in the center of the circle jumping as high as they can with very straight bodies. They can really jump! It was so fun to watch and it wasn't until today that I realized I could have taken a video with my camera, but I didn't think of it at the time. So you'll have to use your imagination with the pictures because I won't be able to imitate the noises for you. The men can make a very low-pitched sound as a background hum and then other men whoop so high-pitched it doesn't sound human. The women all sing and everyone looks like they're having a great time.

The procession of men

Even the smallest girls are decked out in beads.
One man taking his turn jumping
A Maasai sandle with the sole made from old tires

I really enjoyed being out of the city and seeing the stars at night. The Fribergs were very gracious hosts and I had so much fun playing with the kids, learning some new recipes from Bethany, and getting some IV practice with Steve.