Pole, pole

This is what people yell at me when I go running. It means slowly, slowly. "Pole, pole, mzungu" (slow down, white person). The little kids run after me yelling "how are you?, how are you?" over and over. I don't think they have any idea what it means.

I just have to vent first about my blogging frustrations. Besides that my internet doesn’t always work, I have a hard time with the format because it looks different in Mozilla and Internet Explorer. I use Mozilla so if you’re using IE, you’re not seeing the blog the way I intend you to see it. I’ve been without power since the Thursday morning and it’s now Sunday evening. At least my water still runs when I have no power and my stove is propane, but my water is heated electrically so I’ve been taking cold showers.

My friend Kent's guard tortoise, Oscar

I had a fun weekend with the fam. I went to Erik and Bernice’s for dinner on Thursday with Dean and Elaine Peterson from Bonner’s Ferry and their youngest son, Mike, and his wife, Lisa. It was fun to see the Peterson’s in Africa and they send their love to the Rowberg family. They told lots of stories about their time out here with Mor mor and Mor far (my grandparents) and Erik pulled out a book that Mor mor kept of all the money they spent beginning in 1948. It was interesting to see how much they paid for food and clothing back then, but the Tanzanian shilling was also worth more back then. Now the exchange rate is $1 US to 1,270 Tanzanian shillings.

Erik and Bernice's house

I went back to Erik and Bernice’s on Friday and we went out for Ethiopian. Bernice had to leave early Saturday morning for 2 weeks in South Africa so Erik and I took Nashesha and her play-mates to “Fun Fair” at her school. It was a school carnival with games, food, and a hay ride. The kids threw darts at targets for prizes, jumped on inflatable bouncy castles, bobbed for apples, and had their faces painted. There were also singing, dancing, and acrobatic performances. I ran around with the kids while Erik and Steve Cunningham (his girls go to the same school) sat in the shade and drank beer. Steve and his wife, Fatuma, have 2 very cute little girls that Nashesha plays with. We all went out for pizza after the festivities.

A picnic lunch with Nashesha and her friends

Nashesha helping mow the lawn

Ever wonder what to do with your old shoes? Tie them to your backpack and they’ll sell like hotcakes. My roommate, Eric, and I play soccer with some people our age when we’re able and one day we were wandering around town before we headed out to the soccer field. I had my tennis shoes tied to my backpack so I could change into them for the game and I had 4 people want to buy them or trade my tennis shoes for souvenirs. I’m planning to leave the clothes and most of the shoes I brought here, but maybe I should just sell them all before I go.

There are many smells in Africa. Some good, some bad. I showed pictures of how dusty it was last week, but it’s raining again this week and it smells good after a fresh rain. There are beautiful and fragrant flowers here to balance out the trash lying all over the place that smells less than nice. In the evening, the smell of cooking permeates the air. Along side every road you will find women frying fish and meat and roasting corn to sell for dinner. I really like the ears of roasted corn. It tastes like popcorn on a stick.

Erik and I eating some tasty treats off the street

More from the hospital:

This last week an orthopedic surgeon was visiting from Sioux City, Iowa. He’s also been volunteering at Selian for 10 years, coming twice a year for a week or two. He founded an organization called STEM-Sioux area Tanzania Education Mission that sponsors 600 children to go to school. He’s also working on buying some land to build an orphanage. Dr. Meyer brings a group with him, but not of physicians and nurses. He works with the Tanzanian nurses and surgeons and brings people to work on the education part of his mission here while he operates. This time, he also brought a representative from Stryker, a company that manufactures surgical equipment and implants. Sharon went through the stock room and took inventory and was able to get her company to donate money and supplies to Selian.

Sharon with one of the kids pre-op

x-ray of clubbed feet
and the patient who walks completely on the dorsal part of her feet

Dr. Meyer used to do mostly repairs of bowed legs in kids due to fluorosis. Many water sources here are too high in fluoride and it causes bones to bow and teeth to turn brown. Due to public health measures and teaching people where to take their water from, the incidence of fluorosis has greatly reduced. We did have one case of a little girl with bilateral genu varus secondary to fluorosis and did bilateral femoral and tibial osteotomies to straighten her legs.

A less severe, unilateral case of a clubbed foot

He also does plenty of club foot cases, congenital talipes equine varus (CTEV). It’s amazing how kids adapt and walk with one or even 2 clubbed feet. The operation is a Turco talectomy +/- cuboid decancellation depending on how badly the foot is everted, but this operation requires lots of follow-up. These kids need to be recasted and their feet manipulated every 2 weeks for some time and they require lots of physical therapy so that their feet don’t go back exactly as they were.

One patient pre-op and post-op bilateral club foot repair with Dr. Meyer

We did one total knee replacement and cleaned out a knee of a little boy with TB in that joint. There were many fractures we set as well. People here often don’t have the money for an operation when they fracture a bone and so come back after they’ve put together then money and they get their plate, rod, or screws. I scrubbed in with Dr. Murila (Selian’s orthopedic surgeon from Kenya) for an open-reduction and internal fixation or a distal radius fracture and he had me put in 4 of the screws for the plate. They actually do have a battery powered and an electric drill for the screws, but I used the hand crank and although you can’t tell it from the picture, I was sweating from the heat in the room and using my muscles to drill through this guy’s bone.

Someone asked me about the cost of medical services here and the hospital does charge patients for their services. About 60% of the hospital funds comes from patients and the rest from the Lutheran churches in the US and Tanzania and from private donors and organizations. Services are much cheaper than in the US though. I think an x-ray costs about $10, an upper endoscopy about $30, the club foot operations about $70, and a total hip replacement about $2,000.

Spending 2 weeks in the operating room, I’ve seen one patient many times. He’s a young man who sustained a burn to 40% of his body and he comes to the OR every other day for dressing changes. I went to see him in the ICU and he has a pseudomonas bacterial infection and now I know what it smells like. It really does have an odd, grape-like smell, but in a bad way.

Every Tuesday is continuing medical education and this last week I gave a talk on diarrheal illnesses. It came out of the 2 cholera patients I saw and also because I felt that every person who comes to the hospital with diarrhea was getting antibiotics, and it’s usually not needed. So I tried to clear up for myself and others what the recommendations are for antibiotics and diarrhea. Diarrhea is one of my favorite topics of conversation, especially at dinner. My mom loves that.

The church that I attend is interdenominational, with services in English.

And the Arusha Town Clinic is across the parking lot

One of the many geckos we have living in our house. They're cute little guys, and hard to catch.

A toy car little kids push around made of old plastic jugs.