A Quiet Day at Ilula

It is Sunday. It has been a quiet day at Ilula.  The conference is finished, a great success, Randy H. and Anne J. boarded the plane at Nduli, Iringa’s Airport and the big group is off to Ruaha. Here at Ilula, it is myself, Michael R. and Mwamoody. We just finished another delicious balanced meal with soup, sphaghetti, mushrooms in a sauce, terrific sambusas, a few chapati, diced plum and mango.  Breakfast was veggie omelets, a kind of square donuts, coffee. Lunch was chicken, rice, and pineapple. Anna is a good cook!

The mosquitos are buzzing around tonight. Tomorrow we will spray and close up the house. One of our long fluorescents is out, so that will be replaced tomorrow. Dr. Saga came over for a beverage – he chose magi ma dogo, but we only have magi ma kubwa, so we poured it in a mug and sent the bottle home with him. We chatted about a number of things.

There is a move here to move from our certificate (2-year) nursing school to a diploma (3-year) school.  The nurses get quite a bit of didactic training, but I think they get much more clinical rotations in the third year. Gary and I will ask Mr. Chiteji that tomorrow. I know the big criticism of the two-year school is that it does not prepare the nurses well enough and there is a national movement to the three-year diploma. I believe I heard that some of the rotations would be off campus, e.g. the Regional Hospital has a good Ob unit. Ours is very active, but we see mostly low risk and should be sending some higher risk women there from Ilula.

I had a real pleasure meeting up with one of our first graduates.  His name is Yonah Kikoti. He told me that he got 4.8 on his certificate test. That is 4.8 out of 5.0!  Well done Yonah! He hopes to go on to get the third year, then would like to get a teaching certificate and return to Ilula to teach!  His younger brother Isaac is an instructor here already.  They are the sons of a pastor in a congregation near Kilolo.  I hope to interview Yona, so perhaps you will hear more.

Tomorrow I will go to the Devotions and then to the Morning Report before rounds on the patients. 

My hope is to do a new video recording to put on YouTube. David Marts and I took a lot of video last year, so between the two there should be plenty of material. 

For a while now, Ilula has wanted a new Ob/Postpartum ward. There are routinely two women per bed and with the newborns that is four humans per bed!  Certainly more, uh, romantic than raising money for a mortuary, which has been “on the list” since the first time I was visiting here in 2006.  They do need to do a formal “needs assessment” study to understand if the sketch they have is the right size. It might not be big enough!

Monday evening: I arrived back in Ilula yesterday.  It was great to see old friends and places. Church service clocked in at just over 3 hours! Our evening was a special dinner hosted at their home by Dr Saga and Anita.  We had a wonderful spread of Tanzanian food. Then we were entertained by stories from Dr Saga about his years growing up and his career.  When he was a boy he would hunt impala with a homemade bow and arrow near his home. Then during his career he and one other doctor covered all Ilula hospital for 15 years. They used to see 250 patients per day!

January 13th

Happy Zanzibar Day!!

Today’s was a national holiday, which gave us a light work load today. I hung out in the CTC, which is where patients are given their HIV/AIDs medications. The medications came from USAID, which we visited the first day, so it was nice to see the full circle. The pharmacist gave out the medications to each of the patients according to their card and the medications were kept track on a computer system. 

In the afternoon, we went to an orphanage down the road and heard all about the sponsors that make the orphanage possible. It was heartwarming hearing the stories about people across the world sponsoring these children. We heard a story about an 11 year old in the United States sponsoring an 11 year old in Tanzania. They came to visit their sponsee when they were 16. The girls in the orphanage sang for us at the end of our tour and surprised Mary with Happy Birthday. It was so special. We then played a couple games with the children and it was fun to see camp games are the same in different countries. 

Wednesday January 10th

The days begin early as usual with church bell clangs and roosters’ relentless calls.  Who needs an alarm??  Today after a quick cup of Africafe, sitting outside the guest house overlooking the valley I headed out for a brisk walk down the now familiar dirt road, through the hospital’s white iron  gates, past the man sitting outside his shop waving , red brick houses, past the primary school and the many children in blue and white uniforms wearing  their cranberry colored sweaters calling after me “Good morning” , and on into the farm fields of corn, beans, tomatoes and squash reaching far to the foot of the rocky hills surrounding the valley around  Ilula.  A walk most of us take at some point of the day early at sunrise or later in the afternoon when the sun is setting.  The smell of freshly plowed earth and rain from the night before is extra peaceful. 

After breakfast, we met with staff of Ilula Hospital every morning to lift up a prayer with those that wish to and to receive a report update on important events and statistics over the last 24 hours. Today Dr Sovelo, Doctor in charge, asked the staff to share their ideas about a certain interesting case that had been presented.  Maybe it is the teacher in me, but I really appreciate the opportunity it offers staff to express their thoughts, ask questions, and offer alternative solutions.  After the meeting which takes about 45 minutes, staff all retreat to their work areas and get started with their day.  Today, I joined one of the nurses in the general ward, one I had met and rounded with on Monday, on our first day.   She was happy to work with me this morning…and so we began!  We worked side by side…for hours, me mostly trying to figure out the flow of the morning, her role in relation to the other 2 nurses, processes of med admin, such as how physician orders were written, interpreted and carried out, their role in patient care, family involvement, and how to best work within such a different and resource poor setting. As Dr Randy stated on our bus ride here, most medical people experience medical culture shock and I certainly am one of those.  He said that people who travel usually embrace the change, enjoy the differences and experiences of different cultures but when it comes to medical care, medical people want things to be the same as they are used to.  I came away today swallowing a big gulp of that feeling.  I look forward to more working together in the spirit of collaboration, learning from each other, and lots of reflection

After lunch we all too a delightful bus trip to Iringa, where we were introduced to the open market, Neema Craft, Masai market and the Lutheran Center.  I was very impressed by the volume and variety of fruits and vegetables, and the piles of dried fish in the market and the incredible mission and success of Neema Craft center.  What an amazing opportunity offered to disabled individuals to learn handicraft skills and to perhaps someday even start their own businesses.  The handicrafts include weaving  textiles on looms, sewing, beading, jewelry making, wood carving to name only a few.  The work is beautiful.

One of several days so far…

with gratitude,

Mary Renquist

January 11th

Unfortunately today I was stuck in bed most of the day due to a stomach bug that is going around our group. Therefore, most of my post will be about things we did yesterday.

Yesterday, we went into Iringa to look around and do a little shopping. We stopped at this store called Neema's crafts and they did not have the typical touristy things such as magnets or carved elephants. The things they did have were incredibly beautiful and well made. We were able to tour the workshop and learn about their story. Neema's provides training and job opportunities to people in Tanzania with disabilities. Typically, disabled people in Tanzania have a stigma attached to them and either have to beg on the streets for money or are hidden away in their homes. Neema's trains and employs disabled individuals. They train their employees to make items for the gift shop starting from scratch. They use very old style machines. They also have a guest house, cafe, and conference center that is run by it's employees. After learning all of this it was easy to purchase an item from their store because you know that it is going to directly support their cause.

Another thing I have found entertaining on this trip is learning things from Evan, an agnsty 14 year old.

Things I have learned from Evan/Evan quotes:

Watermelon is a very inconsistent tasting fruit. However, cantelope is very consistent and underrated.

Evan's basic needs:
1. Food
2. ‎Water
3. ‎Shelter
4. ‎Gelato

"Snapchat is stupid. Country music is stupid. Everything is stupid."

"Hi. I'm Bri and I'm a pharmacy student."
"Hi. I'm Evan and I'm a child."

"BUT WHY????"

Mobile Clinic

1/9/18
Habari, jina languni Abby (Hello, my name is Abby)

I'm a second year family medicine resident through the U of M and I'm excited and grateful to be a part of this amazing experience in Tanzania. We have had so many wonderful opportunities already!

Today we got to experience a new aspect of medicine in Ilula. A group of us traveled with the mobile clinic to the village of Kipaduka. The purpose of the mobile clinic is to provide care for patients who may otherwise have a difficult time traveling to the clinics in Ilula. We accompanied Eliah, Imelda and Asifiwe, nurses from the hospital, who travel with the mobile clinic every Tuesday. When we arrived, we were greeted by a multitude of smiling faces - lots of babies and pregnant women ready for check ups. In Tanzania, children are brought in for a weight check monthly until age 5. At these visits, they also receive their required vaccinations. Our main job was helping to weigh the babies and make record of their weights in their clinic charts. Additionally, we helped the nurses in administering vaccines and performing prenatal visits. Another great component of this mobile clinic is reproductive counseling and contraceptive administration. It was amazing to see this group in action! We weighed in 201 children while also giving vaccines and providing education! Overall, a very successful and educational day!

In the Land Rover, on the way to Kipaduka

Example of a Tanzanian child's growth chart

January 7th - Evan's Perspective

Today was a day of exploration, and learning as we traveled across Ilula exploring the hospital and the town surrounding it. In the morning, we went to the church service and were able to participate in music and religious activities, learning how the Tanzanians practice religion. Later in the day, some members of the group walked through the nearby countryside and were able to learn about the country life surrounding Ilula and experience the amazing views it presented. We finished off the day by heading down to the local bar, where we were able to walk through the town and see the “city” life.