An X-Ray for Ilula

7Feb19

An X-Ray for Ilula

Since I arrived, a large portion of my personal time has been devoted to the x-ray need at Ilula Lutheran Hospital (ILH). Read on if you are wondering about why a hospital might need an x-ray machine.

I will start with a bit of history of which I was only vaguely aware. Over the years since I started coming to ILH with learners, I knew there was an old portable machine around. Once I saw it in the hallway of the old general ward, pushed to the side and looking forlorn. But I lost track of it. Until this year when I was in the “new” x-ray area. The room is about 5 years old and has been slowly made acceptable for a new installation. There sat the old machine! Dr. Benjamin Chota told me that it had been used as recently as 2012 when the Tanzania Atomic Energy Commission condemned it or at least shut it down. Dr. Benjamin said that in 2010, 500 x-rays were performed. I hope neither patient nor operator were harmed! He thinks a few more exams were performed in subsequent years. We brought our first students here in January 2011, but I do not recall seeing any x-rays.

An estimate of the number that will be performed in the future is somewhat difficult to forecast. A couple years ago, we tallied the number of patients that were sent to Iringa for x-rays. There were 169. We made some estimates generalized from that. With changes here that, we believe, is a severely understated number. Think traffic. Many more cars, trucks, motorcycles and now bijajis on the road with a concomitant number of increased accidents. This is only part of the issue. Many more medical patients are being seen, including 120-150 outpatients per day. Two years ago there were 7800 admissions and over 15,000 bed-days.

So how does a hospital work without an x-ray? I dunno. Shoulder to Shoulder has been working hard to raise the $100K+ to buy one. We are working with Rotary International and are hoping the Iringa Rotary Club will be the host club as we work with Rotary Clubs at home to raise funds for matching grants.

Leslie Pratt and Steve Moburg accompanied me to the Iringa Rotary two weeks in a row, once for an introduction and a second time to present our case to the club about having Iringa Rotary to be the in-country host for funding through Rotary International. The prospects look good. They graciously listened to my pitch and seem genuinely engaged and are willing to work on the project. The one objection they offered is that the Rotary International process takes a long time.

I am confidant the x-ray will happen, but it has been a long time coming!

CTC (HIV) Mobile Clinic

Thursday, February 7, 2019

Once a month the Ilula Hospital team conducts mobile HIV clinic rounds. The primary purpose is to provide medication for and check the welfare of those HIV positive patients who live too far away to attend the weekly HIV clinic at Ilula. Mostly these are poor people who live more than an hour away from the town and who cannot afford transportation to get to the Ilula HIV clinic. Mobile HIV clinic goes to two sites, each in mountainous villages south of Ilula. The setting is beautiful, with mountains and rolling hills and lush green forests as far as the eye can see.

The team all piled into an Ilula hospital ambulance for the ride to the villages. There were 11 of us in back and 3 in front. The rooftop carrier was piled high with boxes of antiretroviral drugs for distribution. HIV drugs are provided by the Tanzanian government and are free to all who need them. We travelled along dirt roads, bumpy and rutted from rain, up and down steep hills, around sharp turns, across bridges. The ride was something akin to a roller coaster. When we arrived at the first village half of the staff poured out of the ambulance to set up the clinic, while the rest continued on to the second village.

At the first village there were many people already waiting for us. More people were walking to the clinic along the road. There were no vehicles to be seen, everyone arrived on foot. Women were dressed in there most colorful African clothes with babies cleverly tied to their backs with a piece of fabric. Men were there too, but were far outnumbered by the women. The morning began with a speech by the local medical  officer followed by a speech by one of the Ilula nurses. Then we set up a weight station, a prescription station, and a drug distribution station inside the community center building.

There was a long line of people waiting to be helped. The people were serious, there was not a lot of chatter or laughter, quite unlike other gatherings of Tanzanians where people are talking a mile a minute and laughing and joking and enjoying one another’s company. The queue was very orderly except one old man who was protesting loudly and tried to budge. The others just ignored him. There were no angry words or  pushing.  Probably the villagers know this crotchety old man and know just how to deal with him. As each person entered the building, they were weighed at the nursing station and the weight was entered into the paper chart (No electronic medical record here!). Each proceeded to the prescription station where the chart was reviewed for signs of weight loss and a brief series of questions about how they are doing. If there were no new problems or symptoms the patient proceeded to the pharmacy station where they were given a 2 month supply of antiretroviral therapy. Almost everyone takes the same 3 drug regimen combined into one daily pill. Only those who have failed to respond go on to second line therapy. 

We saw 104 patients, 101 of whom were doing well, no weight loss, no symptoms of opportunistic infection, going about there daily business like the rest of the people in their villages. Three people had an acute respiratory illness, one of whom needed further evaluation. There seemed to be so many people with this condition. The line of waiting patients seemed endless. It was hard to remember that although 5% of the people in Tanzania are HIV positive,  the vast majority, 95% , are negative. 

When we finished with the clinic, we all piled back into the ambulance for the ride back to Ilula. On our way we stopped to do home visits for 3 patients who were too ill to attend clinic. These were people, who, for a variety of reasons, were non compliant with taking their antiretroviral drugs. Each of these patients was very ill, lying in a dark mud hut, on a mat on the dirt floor. The suffering of these people was almost palpable.

We new comers came away with some very deep impressions. 1. Medication compliance is absolutely critical. People living with HIV can have long and productive lives if they take their medication. They are much less contagious if compliant, which is so important in reducing the burden of this illness on Tanzanian society. 2. Those people who are non compliant or non responders, endure terrible, really unspeakable, suffering. The mobile HIV team does a great job in ensuring that the most HIV positive  people are taking their meds as prescribed, and are working and productive members of their community. 

Deb Mangham MD

My Role in Ilula

Leslie Pratt writing today. I am a Maternal Fetal Medicine (high risk OB) physician who is now mostly retired. This is my third trip to Ilula. I first came in 2014 at the prodding of my daughter (Laura Hanson) who was a 4th year med student at the time. I was here as clinical faculty and was a bit unsure of my role. I observed rounds, participated in a few Cesarean section deliveries, presented a talk at the 1st annual MN Ilula medical conference and tried to impart a few words of wisdom to our students. And I was overwhelmed by the volume of patients and the lack of resources I saw.

My second trip two years ago was focused on participating in the medical conference which by then was so well attended it was held in a lecture room at the Health Care Institute in Iringa (an hour away). That year I felt I was not only contributing to our students education but importantly to the medical education of our Tanzanian colleagues.

This year the 6th annual Minnesota Ilula International Medical Conference was attended by 130 participants, the largest audience yet. It was held in a new and even larger conference hall. Over the two days of this year's conference we heard presentations not only by members of our group, but importantly by several of our Tanzanian colleagues.  

I have spent most of my time at Ilula hospital doing ultrasound this trip. Perhaps the most meaningful part of this year's trip has been spending several days introducing two of the new Ilula physicians to ultrasound. I have now discovered what my role is here. And why it is worth 26 hours of air travel, 12 hours of bus travel, countless meals of beans and rice, and having to always sleep under mosquito netting. My role is to help these very dedicated men and women take care of their pregnant patients with the most knowledge and best resources we can give them in a part of the world where a woman’s risk of of dying in childbirth remains unacceptably high.

Today is the last day of the Ilula-Minnesota International Health Care Conference, and I present today. I have never spoken in front of more than twelve people and I heard the conference hall echoes, so it has to be a large space. Walking up to the building I see a journalist snapping candid photos, a registration table with colorfully dressed participants huddled around it and as I walk inside the building I feel a sense of disguised anxiety or excitement bubble inside me. The conference hall has rows of tables covered in brightly patterned fabric with Tanzanian nurses, accountants, laboratory technicians, doctors, nuns, pharmacists and hospital administrators sitting attentively waiting for the the conference to begin. As Dr. John introduces the day’s schedule, my mind wanders out the big bay windows and I forget about my talking points and feel immensely present under the tin roof and hum of shuffling chairs.

My conference “job” for the day is to be the photographer. So, I tried my best to be a chameleon in each room I pop into. I sat in on everyone’s talk for at least 5 minutes, trying not miss any memorable moments such as Sarah’s debut as a pregnant pre-eclampsia patient.  For the most part it was our Minnesota group that was presenting on topics.  While I learned about chronic kidney disease and intimate partner violence I wanted to hear more from our Tanzanian colleagues. Three talks were happening at the same time. I shuffled between buildings, scurrying away from the beating sun and by the time I knew it, it was my turn to present. I was nervous.

I wondered how relevant me harping about the devastating consequences hypertension will be.  Will I convince anyone that blood pressure control is important? I worried that my minimal clinical experience will disengage people before I reach my second slide. I felt unprepared to answer questions about medical management of strokes in Tanzania. While, two weeks in Ilula Hospital provided context to the health care infrastructure, I didn’t know what resources and training the participants had in order to be “helpful”. Nothing is worse than wanting to know the answer and hearing “I don’t know”. I, myself am still trying to get comfortable with the idea that we actually don’t know a lot about how our bodies work. 

I stand up tall, trying to not think too much, and begin my “schpile”. Before I know it, I was done talking and was relieved to hear another voice fill the room. A doctor in the front row asked a very relevant question about whether anti-retro viral therapy increases the occurrence of strokes. This shocked me since this question did not remotely cross my mind, albeit incredibly relevant. Another doctor asked how to tell the difference between ischemic and hemorrhagic strokes. I prepared a slide about relevant symptoms to each, but blanked when he asked me. I knew he was making me aware of the fact that CTs and MRIs are not a common tool here. I felt a little ashamed that I did not prepare my talk for my audience well enough. It was clear that Tanzanian health care workers had challenges with available resources. 

As the conference was coming to an end, birds began scratching at the tin roof and Randy motioned at Sarah flapping his arms and pointing at the barn doors. I chuckled, as Sarah without protest and a gentle smile walked outside to clear the commotion. We wear many hats here in Ilula! The conference finally finished on a very high note with a “special” song, that I doubt anyone on this trip will forget.

After the conference, Minnesotans and Tanzanians from Ilula Hospital boarded the bus, and we drove to Mama Iringa’s for dinner. The Italian eatery was a welcome change from our fried food diet.  Don’t get me wrong, I love all the food Anna cooks for us, but who doesn’t miss a Neapolitan pizza.  I was sitting between Dr. Malala and Dr. Benjamin, shoulder to shoulder. Of course, Dr. Malala ate some pizza but it was clear that pizza was not as appetizing as umgali with a tomato sauce. Dr. Benjamin, commented that in medical school after long days of studying he would order a pizza. At that moment, I felt very connected, either by experience or by eating together. To end an already great dinner, Dr. Saga brought himself and the whole table to tears with a rendition of our “special” conference song. We laughed, squealed and cried to the point of silence. I couldn’t be happier that night.

Day 15 Ilula Blog/Monday/28Jan19/

The Ilula Hospital area bells rang as usual at 0500, 0545, and 0600. That sound usually signals the sleeping runner/walker members of our group to take a jaunt before the sun is up, but not today. After tea/coffee and one of Anna's fritter balls, the packed coaster bus of 30 (some hospital staff and those staying with Dr. Saga included) left the compound at 0636 for the ride to day 1 of the Sixth Annual Ilula-Minnesota International Healthcare Conference in Iringa (at the Primary Health Care Institute).  Edyta, Kat, Kari, and Michaela however, separately taxied from the compound to an all-girl Maasai school and the Ilula Orphanage Program for I.T./electric circuitry initiatives. Alas for today, we had no church service and morning report.

The conference bus arrived at about 0750 and the group quickly set up the registration table, audio-video equipment, and computer connections for the 0800 start. The King family group, a major meeting sponsor, welcomed us and attended part of the meeting. 

The 2-day meeting agenda may be available on another document for those interested. The conference seating was full with over 120 attendees including presenters. Overall today’s meeting was well received and participants averaged about 3 questions (asked in the usual African respectful and quiet way) in the limited time after each of 12 presentations. There was also a separate afternoon breakout session on preeclampsia/eclampsia for those interested.

The return bus left Iringa at 1745 and arrived in Ilula at 1850. Anna and her kitchen assistants provided our evening meal which included the usual yellow rice, spaghetti, a meaty red sauce, a mushroom sauce dish, pineapple and mango pieces, and a spinach dish. And we were very hungry after a long day….

The fields and hills around Ilula appear bountiful and verdant (the rainy season has started) and common crops seen are corn, beans, and tomatoes. 

Some trivia:

Price of gasoline: 2359 Tz shillings/L

Exchange rate: (100 USD bill): 2300 Tz shillings /1 USD

Common bottled water brands: Kilimanjaro, Udzungwa

Common beer brands: Kilimanjaro, Serengeti, Safari, Tusker

The Ilula hospital has not been able to do x-rays, ecg, and serums for creatinine, albumin, sickle cell testing, iron, or liver function….HIV-RNA now is being processed regularly (sent to Iringa), but cd4 not so much

Michael Madalon

Monday and Tuesday were devoted to presenting our sixth annual Ilula Minnesota International HealthCare Conference.  This conference brings us together with our colleagues from across southern Tanzania to learn together, share best practices, make friends, and develop quality improvement plans that teams take back home to implement at their hospital.  From each of 28 hospitals we invite one doctor, one nurse and one pharmacist and one administrator.  They come as a team and together develop quality improvement plans based on what they learned.  This is a great way for us to leave a lasting impact even after we return home.  All our presenters did a great job and all the healthcare professional teams that attended gave positive feedback.

Our first course was presented in January 2014 with 30 attendees.  Based on extremely positive feedback from the initial conference, our partners in Tanzania encouraged us to significantly expand the conference to offer this educational experience to a much larger audience of caregivers.  As a result, we expanded the 2015 conference to include all 28 Southern Zone Lutheran Hospitals and hosted 100 professionals.  As the conference has grown we have included staff from local nursing schools and local medical authorities.  Again this year we hosted over 100 Tanzanian health care professionals at the conference. 

Our conference is based on 5 principles:

1. Lifelong Learning.  We believe all professionals should contribute to a culture of learning and continuously learn to improve our practice.  We include students and residents in preparation and presentation of the conference. 

 2. Interprofessional teamwork.  We include nursing, pharmacy, administrators, and physicians in both the attendance and presentations.  We emphasize teamwork throughout the conference.  We each bring unique knowledge and skills to share; specifically Tanzanian presenters emphasize tropical medicine and HIV, American presenters emphasize the growing global problem of chronic and non-communicable diseases.

3. Mutual Respect.  We emphasize the ability for all our participants to teach and learn from each other, in spite of our differences in practice setting, culture, and socioeconomic situation.  We include local leaders in planning the conference and select topics based on feedback from participants.  Presentations are delivered by both US and Tanzanian professionals.  We adhere to the highest international standards in the preparation of the educational content and accreditation of the program.  The program is based on a foundation of a longstanding and ongoing relationship.

4. Continuous improvement.  Learning should drive improvement in practice.  We include planning sessions for participants to complete planning documents based on learnings to institute improvement plans upon returning to home hospitals.

5. Sustainable Impact.  We believe that education and improvement are some of the most valuable ways to promote a sustainable positive impact on the health of our partners’ communities.

Our conference is accredited by the Education Department at the HealthEast Care System to provide participants with CME credits for participation in this program.

Funding for the course is provided through generous contributions from several foundations and individuals including Global Health Ministries and the Peter King Family Foundation.  All funds raised go entirely to hosting the conference, and support for local Tanzanian staff to attend, including meals, travel and lodging expenses.  We want to sincerely thank all our donors, without their generosity, the course would not be possible.

Overall the conference was a great chance to learn together, build relationships, and plan together to improve healthcare in Tanzania.  I hope we can do it again for many years to come.

Jan 27, 2019

By week two, most of us have settled into our groove in Tanzania. Just in time to welcome the second half of our group to Ilula! After a long treacherous bus ride, complicated by a flat tire on the way, our new friends arrived yesterday evening. It’s been fun welcoming Ken, Birdie, Cari, Steve, Norm, Deb, the Dudeks, Leslie and Chandra (sorry if I butchered anybody’s name). I look forward to getting to know them all better in the coming weeks.

We had a very busy Sunday, including long church services and meetings with the King foundation and hospital administration. I think the highlight of my day was going to Dr. Saga’s house for dinner. He shared many stories with us about his family and upbringing in Tanzania. As one of 10 children of a farming family, prospects of getting a higher education looked grim when he was growing up. But Dr. Saga was determined and continued to pursue opportunities to go back to school. He started out as a clerk helping to Swedish missionaries treating patients in Ilula. At that time, only a few decades ago, Ilula was a very rural village with only 4 houses! Overtime he worked his way up to assistant medical officer. With some help from friends abroad he was able to help transform Ilula Hospital into what it is today. It was a good reminder for me to never take my education for granted. I am so lucky to have had the opportunities in my life to pursue a career in medicine. We truly have amazing jobs!

Volunteering at Ilula has been a wonderful and eye opening experience. Apart from all of the medicine I’ve learned on ward rounds, Witnessing the beautiful relationship that Ken, Randy and others have formed with our Tanzanian colleagues has been truly inspirational. It gives me hope that through hard work, collaboration and faith anything is possible.

January 26, 2019

Two weeks ago a group of strangers or near strangers gathered at MSP to begin a Tanzanian adventure.  For some a routine trip, done over many years, for others an adventure of a life time.

Within days folks from highly diverse backgrounds meddled into a warm, supportive family.
Different continents, levels of training, age, professions created a group motivated to learn, share and have fun.  I mention age because I’m really the outlier in the bunch. It turned out not to be a problem at least I don’t think so. Maybe others have a different opinion, hopefully they will keep it to themelves(kidding).

It has been extremely invigorating to be around young, enthusiastic, bright young people on thresholds of great futures.  People, whose lives will undoubtedly have been inriched by the time spent in Ilula.  I do remember my first overseas adventure after medical school in a country crushed by poverty and war.  Coming from the States it was easy to be critical of what was available and how things were done.  After a few days reality set in and time to get to work with what you had.

I did not sense that with our family here.  All got immediately into the rhythm of Ilula with joy and flexibility.  Flexibility—-the key to success in any new situation.

Our Tanzanian hosts have been more than welcoming graciously allowing us to participate in OB/GYN,   General wards and peds which has been very rewarding to the residents, pharmacy and meds students as well as seasoned physicians and pharmacists. In HIV clinic and OPD got to see what high volume care looks like.

Other highlights for me were the visits to the orphanage and palliative care rounds out in the village.
Patients with tough problems living with meager resources yet appreciative and accepting.

And finally, the spiritual component floods all of the care that happens here with daily devotions as well as prayer with palliative care patients.


AS

WE SPEND OUR DAYS IS HOW WE LIVE OUR LIVES

Road trip to Image and popcorn

Oh goodness, oh for cute, the whole kit-&-kaboodle!

Today started with a handful of us taking on the foggy dirt road for our usual morning run, which ended with my chatting with a group of local students who were interested in my running watch and my goofy dance moves.  I was eventually saved by a group of women who dispersed the kids off to theor school day.

My morning was spent in the OB ward where I helped the nurse place an IV line and Foley catheter (a great time to brush up on my old nursing assistant skills!). Afterwards a few of us went to the operating theater to watch a c-section — everything went smoothly!

We meandered back up to the house where we met up with a visiting group from Augustana Lutheran Church.  At first it seemed there wouldn’t be enough space on their bus for a few of us to join the visitors on an excursion to a nearby village, Image, but luck was on our side and Meghan, Michael, and myself were able to swipe the three available seats!

On the way to the village, we made a brief stop at a dispensary where the people from Augustana asked questions and took a look around while we dropped off a box of medicines.  We then continued our bumpy journey along the worn dirt road to Image.  After passing many fields and a few donkeys, we turned down a quite avenue towards a school.  As we passed through the gate, our bus was greeted by the whole student assembly who were in song and dance.  It was a warm and beautiful introduction of the school to the visitors!  The students then departed for lunch while we followed the headmaster on a tour and information meeting about the school.

Quick caveat: I’ve been living in Italy for the past 3-ish years for medical school so I’m a bit out of touch with the Minnesota culture.  It was a full-on teimmersion experience for me, ripe with idioms and colloquialisms that I haven’t heard in ages!!  Offda now don-cha know how delightful that sure was!!

Our return trip was somehow more rocky than the trip there but the panoramas of this area of the world are incredible.  The children of the area were also on their way home from school so there was lots of waving a hollering, exchanging greetings in Swahili and English.

We topped off the evening with a movie night with the nursing school students.  We brought them popcorn & a recently acquired bag of dum-dum lollipops. Due to technical difficulties we started the movie late and didn’t even make it through the whole film before calling it a night.

As we moseyed our way home, hopefully many took the opportunity to check out the clear and brilliant starry night sky!!

Baadae!
Kelsey

A day like any other (January 24th 2019)

This day started like any other day....woke up to the sound of clanging symbol
and like any other day...I rolled over and wondered how anyone could possibly wake up to ring bells. But this is a tradition like many things in Tanzania, and reverence to its complete adherence is key.

Like any other day, we lingered in our suite while morning church commenced... we are not apathetic to this event. We just like to enjoy our coffee and appreciate the splendorous Tanzanian hills and valleys. The air is crisp, while there is an overlay of mist as an afterthought of the past rain. It clothes us with a message of renewed hope. I too this morning feel renewed hope, as yesterday was a day that I felt stifled. As a self-diagnosed introverted extrovert, I am afflicted with an incurable need for solitude when faced with too much togetherness. I finally realized today that it important to take time to self reflect and each day I need to make it a top priority.

I was once again in the maternity ward. Three laboring patients today, one of whom had newly diagnosed HIV. I realized that unlike the US, there is no base viral load that this required for treatment. Breastfeeding is encouraged to women even if they are HIV positive. This practice strategy is unlike the US system. In the setting of low economic resources, unfiltered tap water, and severe malnutrition, it is likely that a child will die of diarrhea rather than any HIV complication. This sad reality is one that is faced by many of this disenfranchised and destitute nation. It saddens me to realize that many women have to choose between the lesser of two evils.

We completed our afternoon with a talk on anemia. While listening to this lecture, I looked over and saw a gentelman lowering the national flag. No one was watching him (well except me), but he took this job very seriously. He sounded his whistle and lowered the flag, folded the flag neatly and marched away like any ordinary sargeant in well formed army. Again, tradition to be respected.

Still, I am grateful to be here. I get to learn from my colleagues, get to find myself in an unfamiliar environment and get to enjoy the great splendor that is Tanzania.

Asante Sana!!

Gina

January 23, 2019

Jambo! It’s incredible to think that our group has been in Ilula for an entire week now! We have observed many interesting clinical cases, learned alongside our Tanzanian colleagues, and logged several kilometers on morning runs/evening walks.

Today, some of our group members had the opportunity to participate in palliative care rounds in the community where they visited patients’ homes with Dr. Nixon and Pastor Phillip. These home visits allowed the group to assess how the patients were doing, address medication needs, and provide spiritual support and prayer.

Before dinner, we were able to experience downtown Ilula with a cold beverage, an exciting hunt for popcorn and pineapple, and a round of pool with some locals. Whenever we are walking around town, it almost feels like we are celebrities when all the kids run up to the sides of the roads yelling “Mzungu!” (white person) and the vendors all welcome us to come back everyday.

We ended today’s festivities with a rousing game of Fishbowl (kind of like a combination of Catch Phrase and Charades). It’s great to see everyone’s creativity come alive during these games and have a little competitive fun. However, I think the group is starting to realize that Sarah and I should not be on the same team because we think a little too much alike.😜

Usiku mwema (good night),

-Deann

Jan 22

**I apologize for the formatting, our internet is spotty so I couldn’t quite get the pictures in the right order**

Hey Everyone, 

It’s Michaela & it’s my turn to blog! Today was a busy day... lots going on!

Today’s big news this morning was that the showers are working again! We’ve gone 3-4 days now without running water in the showers but we’re all feeling refreshed now! 

A few Tanzania’s were complaining how cold it was here in the morning and were shocked to hear how much colder it is in Minnesota. The weather is perfect here! 70’s during the day and 60’s at night, couldn’t be any better! 

During our morning huddle, Kikoti, the hospital administrator, called me to the front and said something in Swahili. Everyone clapped at the end and I had no idea what they were saying about me. We joked that they had hired me as the new permanent ultrasound tech without my knowledge. So we’re still unsure... maybe I got a promotion! 

(They really just said I’m here to do ultrasounds if anyone needs one since Dr. Sovelo is gone) 

Today was the first day that ultrasound wasn’t crazy busy so I actually got to eat lunch with everyone and have a lunch break! 

A group of 4, Kaylin, Deann, Gena, And Kelsey went on the outreach program today. They went out to a village where they provided family planning counseling, infant immunizations, and prenatal care. 

We got a tour of the lab in the evening and were able to learn more about what tests they have available here and what some of their struggles are. 

Megan lead a talk on antibiotics which I heard went well! 

We were invited to a small gathering in the church with the nursing students. Every night at 7:30pm they gather in the chapel, sing, and worship god. They have invited us to join them anytime and we enjoyed it very much! 

And then we ended the night with a lovely game of Headst up! 

“I bless the rains down in Africa”

I can’t recall exactly who it was, but it must have been either one of our three female pharmacy students (Deann, Sarah or Kaylin) or perhaps Michela (“the one who works with ultrasound”) since they seem to be the most musical in our group.  Anyway, one of them played a cover of the 1982 Toto song, “Africa” (remember, part of the chorus goes, “…I bless the rains down in Africa….”) while we were sitting around at Wista’s in Dar Es Salaam last week waiting for others to return with lost luggage.  The song now seems somehow prophet since it has been raining on and off every day since we arrived at Ilula.  Sometimes the rain is torrential resulting in small rivers coursing thru the drainage trenches around the hospital. Sometimes it is gentle and almost mist-like.  It can challenge the morning walkers/runners in our group, the afternoon strollers and anyone trying to hang laundry out to dry.

Monday 21Jan2019 was another good day at Ilula: we met two Swedish nurses/missionaries, Nora and Steena, at morning report. They are stationed long term in Iringa, working with the Iringa Diocese and come to Ilula twice per week to volunteer.  I, Dr. Seli and Kaylin spent some time in OPD assisting the clinical officer seeing patients. They have a new electronic medical record that seems relatively useful however the clinical officers are more than happy to have our students function as scribes since they are not familiar with using keyboards or typing. We saw a bunch of patients including a kid with amoebic dysentery, another with atopic dermatitis, a 15 yr old who had a recent miscarriage and a pregnant woman with two weeks of high fever.  It is inspiring to see how we all contribute ideas to evaluating these patients.

We have had some arrivals and departures as well as a small celebration: Dr. John Kvasnicka arrived Monday and will spend this week on the wards prior to next week’s medical conference. Dr. Yvonne Datta departs Tuesday for Arusha where she will be visiting the cancer center project there (www.tanzaniacancercare.org).  And…it was Katherine Zerbeic’s birthday today: she celebrated by making some water color paintings of the vista from the guest house; we serenaded her with a happy birthday song.  Kelsey arranged for a cake, complete with candles (the roman-candle kind!)

It is raining here in Africa, but everything is green! 

…and,…I think it is we who have been blessed.

Randy

Hi guys this is Deepthi, my turn to blog.
Like every day, our day started with morning bells at 5 30 AM ( bells to wake up the village). Every body had their usual morning work outs in the morniing after which it was time for breakfast  and thee usual morning banter. As our day progressed, we were serenaded with songs from the local church. It was refreshing, of course I did not understand a word of it, but able to enjoy the music though !!

Later we went to chruch, prayer begun with songs and traditional dance where most of the Villagers participated. We were then asked us to introduced our selves. All of us tried our best to introduce ourselves in Swahili and sang in swahili as well, which was really great. Church servicce was a little bit prolonged (total of 3 hours) today.

In the afternoon we went through the village market on our way to the orphanage . It was an interesting scene watching villagers sell and buy wares- groceries, clothes, shoes, bags etc.,with others congregating for the camaraderie.It was great to watch. I was reminded of my childhood in India.

The llula orphanage program(IOP) was our next stop. The weather was awesome as was the story about the IOP and how it was started. It started with song of welcoming and dancing, which later involved us as well. They pride themselves in educating and improving the lives of the kids who they serve with majority of their children in the 1st quartile of their national exams. Of note, these kids share the same story with the children we have come in contact with through the week; with majority of the kids dealing with or orphaned by HIVéAIDS . The IOP operates on the largesse of its partners whose donations have now made them a smooth self sustaining operation (with numerous vegetable gardens, poultry, goat, cow and diary farms around town), with the kids trained in farming, stitching, art making etc to be self sustaining when they graduate at age 18. Young single mothers are also included in the outreach of the IOP.  It is wonderful to see what the organization is doing and achieving in the community. Additionally, most of the people who are working there were once orphans who trained from the institution. Living up to the mantra of the organization - creating a standard for better living and taking with one hand and giving back with the other.

Another beautiful day in ilula, happy and blessed to be here.

IOP has website: www.IOPtanzania.org

- Deepthi

Iringa and the Massai Market

My day started like every other day since we have been here in Ilula. We however did not have to make it to morning report so the day was more laid back than our usual day. Breakfast and tea ensued with the typical morning banter.

We then gathered at the "Library"( kudos to Bob for this moniker of our hangout spot, I will let Bob explain this himself), did some studying and then decided on a walk. It was nice exploring downtown Ilula in the sun. Walking through the village I was reminded of the similarities of this place with some villages I had visited and seen in my home country Nigeria. Definitely nostalgic for me.
Children screaming Mzungu (white person) at my colleagues, running up for hand shakes and gifts( Deann gave them some pens), wanting pictures etc.

We also walked by vendors with wares of interesting colors and types ; mostly legumes and hibiscus leaves. It was definitely interesting seeing the the variances in living conditions as you walked down a stretch.
Our walk gave us an opportunity for interesting conversations and exposure to the things around us. We bought a tub of mangoes, they looked too good to pass up so 10000 TZS( later we are walking home with 3 bags of mangoes. The group thought it was cool. We felt good about our decision and action.
I personally got to talk to family today. This made me truly happy. Spotty phone service and poor internet service has made it difficult speaking with family  a shift from speaking with them multiple times a day. I was therefore stoked about my success.

Our trip for Iringa put a break in my communication today. I napped on our way there, but the tour around the industrial parts of the city as we sought for wares that would remind us of our time here was splendid. People sourced for Kangas , ketenge, massai beads, baskets, carvings etc. In the end everyone was satisfied with their buys and the cost of acquisition of each ware.

We then met up for drinks a local pub while we spoke with a USAID representative of her experiences working in TZ and other African nations she has had the honor of working in both as a peace corp member, an employee of Johns Hopkins and many other organizations she worked/ consulted for. The drinks were cold and refreshing, they also played Afrobeats reminding me strongly of home.

Our drive back was eventful as we trudged into a busy supermarket trying to replenish our snack boxes. Of note we also invested in libations from wines to whiskey, ciders, gin etc. We definitely are looking forward to weeks of bonding and relaxation post the hard work we do during the day.

In general, today was great. It was reflective of, and showcased the beauty that resides in rural life and living. As a group we continue to strive for balance and we seem to be doing a great job giving of ourselves, fulfilling destiny and dreams while also restoring our physical and mental bodies.