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Thursday, August 5, 2010

Final words

We have been kept very busy the past several days and arrived an hour and a half late for our dinner at LJS on Wednesday. By noontime yesterday, it was clear the surgery schedule would again keep us late, so we called LJS to tell them not to make dinner for us, which allowed us to visit the Arc hotel for our meal. A table was quickly arranged for the 11 of us on the patio with a breathtaking view of Mount Uluguru looming over the valley. Different dishes were sampled by the team and we enjoyed a relaxing several hours under the African stars. Surprisingly, the temperature dropped to the low 60’s as the evening waned and we actually became chilled. Everyone welcomed the quilts on our beds last night!

The invitation from the Aga Khan has expanded into two evenings that will involve the whole team. Adam will be speaking tonight, Thursday, and the entire team will be attending, along with two of our interpreters, Nova and Godfrey. After the presentation tonight, there will be a question and answer session, followed by socialization with “bitings”, the local word for appetizers.

The following night, the President of the community is hosting us in his home for dinner. Barbara has warned us that there is a definite class in the Muslim community and that there will be a high table that will include her, Cindy, Adam and Doug. The rest of the team is of a lower rank, so will be seated separately.

When Barbara spoke with the President yesterday, he marveled that there will be a group of Christians joining his group, saying that has never happened in his lifetime. He went on to say “But this is so important in our world today, that we learn to understand each other.” We are going in the hope that we can build a relationship that will allow us to show Christ.

Tomorrow will be our last day at Mazimbu, but it will be a very busy one. We had to move one surgery from today to tomorrow because the patient’s blood pressure was too high. That gives us five operations for tomorrow, which will take all day. The following day we arise at 5 am and after a short journey, we will see the sun rise over Mikume National Park. During our safari we will see the animals of Africa in their natural setting. And the following day, Sunday, we will worship at Bishop Mameo’s church in Morogoro before our return home begins with the 3 hour trip to Dar es Salaam. If time allows, we will post pictures from Mikume, but this will probably be the last blog we will have time to share.

Thank you for your prayers and support of this vital mission. Until we see you again, kwa heri, farewell.

Tuesday, August 3, 2010

Peter, the Tanzania applause and Joyce

After a great Sunday, we were well rested and ready for the crowd that awaited us yesterday morning. In anticipation of greater numbers, we shifted the team slightly to have Elizabeth and Christopher both work in our screening/triage area so we could get patients to Adam faster.

We were again delayed in starting surgeries, but Doug used the extra time to consult with patients to be evaluated for operations. Once the OR staff was ready for the first patient, it was after 9:30 am. But once they have begun in the OR, they move very quickly. Doug remarked that the turnaround time between procedures was so fast, he did not have time to complete even one surgical consult. The up side to this, though, was that all three scheduled patients were out of surgery before noon, which allowed an opening for another patient after lunch. And at about 11:30 am, when Doug was finishing the last procedure, a patient checked into triage who 1) needed a hernia corrected, 2) had not eaten yet that day and 3) had recent lab test results with a CBC with him. Presto, he is added to the schedule, prepped for surgery and in the OR before 1:30 pm. Now that’s speed.

During the day, the offsite lab we were using for our CBC experienced a breakdown of the machine used for that test. Barbara had been transporting the samples to that lab and bringing the results back. Quick consultation by phone with the Mazimbu docs suggested she take the samples to the Aga Khan center, which is a private Muslim hospital second only to the regional hospital in size. In talking to the hospital administrator, Barbara mentioned the work the medical team was doing at Mazimbu. When asked about the type of doctors on the team and told that one of them was an endocrinologist, the hospital administrator got very enthusiastic. After some discussion, an invitation was extended to have Adam come and speak with their faith community and stay to have dinner with them. Adam has readily accepted and will be speaking with them Thursday evening. What an amazing opportunity God has given us for a Christian doctor to speak and eat within the Muslim community!

As an endocrinologist, one of Adam’s primary areas of expertise is in management of diabetes, which is prevalent in this society. During the day yesterday, our luncheon host from Sokoine came to see Adam. He had been diagnosed with type 2 diabetes five years previously and was managing it by omitting the sugar from his chai tea, while continuing to drink his soft drinks daily. When Adam checked his blood sugar, the number was dangerously high at over 500. Normal is around 100. Adam immediately injected him with insulin and prescribed 3 shots daily for treatment.

As we were leaving for the day, we saw an wondrous site: Peter was up and walking, although slowly. His brothers William and George were by his side and the team applauded his amazing progress Tanzanian style—rubbing our hands for a few seconds as if warming them, then three loud claps in unison. We continue to praise God for the healing He has wrought in Peter’s life.
The morning today again began for our docs with a joint morning report at Mazimbu, after which Adam gave an agreed-upon presentation to the staff about type 1 and type 2 diabetes and ideas about how he would manage inpatients and outpatients in Tanzania. The presentation was very well received and the Matron and several others reported that they were glad to have the information. The longer morning report meant that we started late again, but the team has gotten better every day and we were able to quickly get a patient for Adam, with many more in the wings.

Pati was greeted at her desk as soon as she sat down by a patient who was seen the previous day. Adelita had bagged tomatoes, carrots and a cucumber and taken the time to write a 2 page letter to Pati thanking her for her service and the care and concern shown to her. She also gifted Pati with a hand-made drum in appreciation and Pati responded by taking the nail cross from her neck and draping it around Adelita’s neck. It was so good to know that we are successful at building relationships in Tanzania.

Adam is getting a wide variance of patients, utilizing his skills learned in his internal medicine residency that preceded his endocrinology fellowship. We have seen a burn patient, a woman that has not developed physically beyond childhood and other patients suffering with problems such as rheumatoid arthritis, asthma, pelvic infections, a blocked kidney, prostate problems, rashes, and many with diabetes or with high blood pressure.

Our burn patient today suffered severe burns over 30% of his body a year ago and has wounds that have not yet healed. Christopher and Elizabeth worked together to clean and debride his wounds and he will continue to seek followup treatment at a local wound center.

Our last surgical patient today was Joyce, a tiny 52 year old woman who had an abdominal mass larger than the size of a full term pregnancy. Joyce had been to many doctors seeking help over the 6 years she has suffered with this problem and all had turned her away. We, too, initially turned her away, referring her to a gynecologist. After reflecting about the problem overnight, though, the team agreed that Joyce was unlikely to get help from another doctor and that we might be her best hope. We had gotten the number of a relative and called to ask them to send her back in the following day. After reviewing an ultrasound and determining there were no apparent negative indications, we scheduled her for exploratory surgery and the gynecologist, Dr. Lyamuya agreed to come today to assist. Once Doug was able to get a good look inside, he worked with Dr. Lyamuya to remove an ovarian cyst that was estimated at 25 pounds and nearly filled a 5 gallon bucket.

Matron told us that there is a saying in Tanzania—if you travel long enough, the path will lead to God. And she said it meaning that God was at work in bringing us together with Joyce.

Sunday, August 1, 2010

Our day began at 9:45 with the trip to Sokoine for worship. We were warned to eat a hearty breakfast because services could last well into mid-afternoon. As we turned onto the dusty road that led to the church, the Masai turned to look at the wazungu, white folks. Children ran up to us waving and smiling and many Masai interrupted their visiting to personally welcome us, making sure to shake the hand of every one of us.

We were told that there was to be a wedding at the church today, and we were all curious to see this ceremony from a Masai point of view. Barbara told us the bride might choose traditional clothing, which would see her covered in beads, or a western style long white gown.
Tanzanian time is in full force in the Masai villages. The worship scheduled for 10:30 actually began at 11:30, which left time for refreshments. Benches were brought into the shade of a nearby tree and we were proudly offered sodas. Shortly after that, the villagers began making excited noises and we heard the honking of car horns as two vehicles pulled in to the church yard. The wedding party had arrived—and we quickly discovered this was to be a double wedding! Both brides wore long white gowns with veils.

Once it was time to start, we were ushered in and given seats up front with a great view of the services. We all stood for the procession of the wedding parties, which was a very slow affair with much ceremony. Both parties consisted of a bride and groom, the best man and the maid of honor, a flower girl and ring bearer and one attendant.

In celebration of the festivities, there were six choirs to add to the worship today, including a youth choir and several children’s choirs. The music at a Masai service is beyond description and we hope you all will get a chance to hear the recordings that accompany some of the videos shot by the team.

Because both of the grooms are evangelists with the Lutheran church here, the Bishop was on hand to lead the service, along with 2 visiting pastors and the local pastor of the church. We were glad we were warned about breakfast, because the service lasted until 3 pm. On the closing song, everyone moved outside into the church yard and circled around one of the church leaders. Two lengths of fabric that were donated were auctioned off, with the proceeds benefitting the church, and Pati was determined to walk away the owner of one of them. After a little bidding, it looked as if she would be the high bidder at 15,000 shillings, which is almost double the value. But at the last minute, a tall Masai man moved to stand next to her and entered the race. There was rapid bidding back and forth, with Barbara translating for Pati, who finally prevailed for 42,000 shillings.

Afterwards, we were given lunch in the home of the village chairman. Before the meal was brought in, 3 Masai men brought a pitcher of water with a basin to help us wash our hands, and Barbara said it is a very rare honor to be served by men.

We left for home filled with the sights and sounds of a day in a Masai village playing back through our minds, an experience we will never forget.

Saturday, July 31, 2010

Patients or patience

Americans want productivity—give us numbers. Thursday was a slow day for the clinic, which gave the team more time to talk with the Tanzanian staff at the hospital. God may have been pushing us in the direction of solidifying our relationships, which is so crucial here. But when we pulled up at 8 yesterday morning, there were patients lined up waiting for us and they continued to arrive throughout the day. The team was kept very busy and enjoyed meeting and talking with so many seeking our help.

Doug had an audience during each of his procedures. Neil, who is a pre-med student at OSU, observed the first; Elizabeth, who is a third year nursing student at U of A, watched the second; and Shelby and Jordan were present during the third. Cindy, who circulated through the OR to be ready when Doug needed anything, instructed them in sterilization safety procedures and was able to narrate through each surgery so they would all know what they were looking at and what Doug was doing. The rest of the team will have an opportunity to observe in coming days.
Cindy’s face was alight with joy every time she left the OR. Her interaction with the Tanzanian nurses assisting in prep and care of the patients held a degree of give and take that is beyond anything we have experienced in the past. St. Mary’s is a small private hospital and is only manned by surgical staff when a surgery is scheduled—they will arrive and perform the procedure and then return to their jobs at other hospitals. When we have worked there the past two years, the OR was dedicated to our use, so there wasn’t any surgical staff with whom we could compare notes. Mazimbu has a full staff and they are very well trained. The exchange of knowledge is stimulating and exciting and is a benefit we did not anticipate.

Christopher’s skills in wound care were put to use yesterday when a patient arrived with a wound that required debriding and cleaning. And both he and Elizabeth have helped with injections, which leaves Cindy free to remain in surgery with Doug. God has brought together a team whose skills mesh and we are constantly reminded of the beauty of His plan.
Lingering long after dinner last night, the team discussed the day and solved the problems of the world. After a while, Jordan mentally tuned out of the discussion as she began making plans for the evening. After a quick check with Adam, a sleepover was arranged for Elizabeth and Shelby at Jordan’s room. The team is housed in 4 double rooms (Cindy and Elizabeth, Pati and Shelby, Doug and Glennis and Adam and Jordan) and 2 single rooms (Neil and Christopher). Adam and Jordan have the only double room that is actually a 2 bedroom and each of them have a full size bed. The girls enjoyed movie night on Adam’s laptop and then, because we must all sleep under mosquito netting and there is only one net per bed, all 3 girls slept together in Jordan’s bed. A good time was had by all.

The temperature this morning was the coolest we have seen, and the faint notes of a songbird singing a morning song followed us to breakfast. Being Saturday, we knew we would have a lighter day today. The hospital runs a much smaller crew on the weekend and we did not have any additional patients arrive after noon. That meant we stayed just long enough to miss lunch at LJS, so we got to experience a local restaurant, the Oasis, and a local favorite, chips mayai, which is close to a french fry omelette. Yumm!

Tomorrow we travel to a Masai village for worship. Christopher has made arrangements to attend mass at a local Catholic church at 8 and will be joining us for the trip to the village. We are all looking forward to the day and will have lots to share with our families.


The pain in Peter’s belly was just a gnawing ache when he finished his day as a tractor driver last Friday. He passed up the dinner his wife had prepared for him and their six children and lay down, hoping for relief. By Sunday, the worm of pain coiled around his midsection and into his back and his concerned family took him to the hospital in Turiani.

Peter’s eldest brother, George, got a phone call on Monday with the news of his brother’s condition. When he did not get good news by Wednesday, he made the hour and a half trip from his home in Morogoro to Turiani, only to find that Peter had been released that day because the hospital did not know what was wrong.

Arriving at Peter’s house, George found his brother wracked with agony and realized he had walked the two kilometers from the hospital to his home. He quickly gathered his cousin and other brother to help transport Peter to Morogoro, and they arrived at their father’s home on the outskirts of Morogoro in the middle of the night.

Thursday morning, during the last leg into Morogoro, George decided to change his route from the large Regional hospital to Mazimbu, a smaller hospital that does not normally treat critical cases. When questioned about that choice, George said that he knew how things worked at the Regional hospital: hurry up and wait. By the time they arrived at Mazimbu, Peter’s pain was beyond endurance and his belly was noticeably distended. George believed he was bringing his brother in to die.

At the entrance, the receptionist asked “Why did you bring him here?” and the doctor told him to take Peter to the Regional hospital, saying “Your brother needs an emergency surgery.” George pleaded, asking him to reconsider. Dr. Kizuma recognized the severity of the problem and pulled Doug for a consultation. Would he be willing to assist? Doug readily agreed and together they did a procedure to address Peter’s massive intestinal blockage. The next day, Peter was smiling and complaining about the tube down his nose. Doug was very happy to know that was his only complaint—the abdominal pain was gone!

George said that God led them to Mazimbu.

This team very nearly aborted the surgical mission trip this year because of lack of medical personnel. Within days of the cutoff beyond which we would not be able to purchase airfare, God brought Adam onto the team. The addition of a second doctor allowed the trip to continue, which meant that Doug was at Mazimbu when Peter arrived in an acute condition, and made possible the surgery that saved his life. It is humbling to think of the perfection of God’s plan and we praise Him for His divine intervention in Peter’s life.

Thursday, July 29, 2010

Thursday at the hospital

Surgery on Thursday

The day started early for Doug and Adam, who were invited to join the staff doctors and nurses for morning report and called a taxi for the ride to Mazimbu. Four patients are currently in the hospital and both medical teams conferred on the best treatment plans. All of the medical staff learned from each other. Adam had some suggestions that surprised the Tanzanian doctors, who then made some changes to their plan of care. Doug mentioned he has learned how to improvise and do without, how to make the best of the situation. It was a very open exchange of knowledge and ideas and the collegial atmosphere was a welcome side effect of the meeting. We are excited at the foundation that is forming between the surgical team and the hospital staff. Tanzanians value relationships above everything. Americans tend to value justice. If we can bridge the cultural gulf and build a relationship with the staff here, it will open the door to future teams and allow this vital mission to continue.

Mazimbu hospital has resources we have not had available to us in the past. The lab is able to do many tests, including a complete blood count as prep for surgery, and there is an Xray machine and a radiologist on site. The ultrasound machine is not currently working, though, but Barbara has helped solve that problem. Two men and one woman from yesterday needed an ultrasound before Doug and Adam could decide how we can best help them. They were waiting for us when we arrived this morning and switched places with us in Barbara’s car. The radiologist joined them and off they went to Sua, where there is a functional ultrasound machine. This is an interesting process—the radiologist goes with the patient to read the ultrasound on site and returns with the patients to the hospital.

Our turnout for medical, non-surgical patients was lower today than we hoped. Adam was kept busy through lunch, but the team spent the afternoon chatting, getting to know our translators better and comparing the differences between our two countries. And Shelby and Jordan spent the afternoon learning Swahili from Geofrey, the translator who worked with them, and teaching each other games from their countries. Geofrey, who has just graduated from University and plans to be a teacher, is now proficient at hangman and rock/paper/scissors.

Doug has been very busy today, though, and was pulled in for an emergency procedure. A patient presented today with a severe bowel obstruction requiring immediate surgery, and the Tanzanian doctor asked Doug to scrub in and assist. The patient was in obvious pain as he was wheeled into the “major theatre” and two hours later the doctors were relieved to know that the procedure, which likely saved his life, was successful.

One humorous incident happened—the emergency procedure bumped two scheduled patients who were already prepped for their surgery and were patiently waiting, draped in a bed sheet for modesty. Once we realized both of them would have to be rescheduled for another day, Cindy and Pati went to discuss timing with them. When they walked into the room, only one man was waiting. When they searched the hospital for Yohana, he was nowhere to be found. The Matron of the hospital and her staff were recruited for the search and, after some rapid Swahili, reported to us that he had escaped. Hopefully, we will recapture him tomorrow!

Wednesday, July 28, 2010

Work begins at Mazimbu hospital

We met the staff at Mazimbu yesterday and introductions went very well. This is a new hospital for us. The private hospital that hosted our team the past two years, St. Mary’s, experienced a change in administration last year, and the new management is focused in other directions. Bishop Mameo, who heads the Morogoro diocese of the Evangelical Lutheran Church in Tanzania, worked with Barbara to find an alternate location for the team. So we are working with the government hospital in Mazimbu, an outlying area of Morogoro. The facilities are wonderfully clean, airy and spacious and the staff has welcomed us with warm smiles and Tanzanian hospitality.

In preparation for today, the team met last night to brainstorm logistics, weighing our new knowledge of the facilities with past methods that had helped streamline the flow of patients. It was decided that Cindy and Elizabeth, who have the most medical training after our doctors, would be the initial point of contact. We have learned from past years that some initial screening is very important. We want to work with the Tanzanian medical system and offer our skills in areas that are not routine. We do not want to see patients that need treatment for malaria, parasites or other common ailments, giving the impression that the Tanzanian doctors are not competent. That is certainly not the case! Cindy and Elizabeth are able to ask enough questions that they can direct those types of patients to the hospital for help from the staff doctors.
Patients were then guided to our registration desk, where Pati entered their information into our computers and organized the minor paperwork we are using for records. Jordan and Shelby then worked together to record their vitals and lead them to the waiting area for the doctor they would see. Doug consulted with all of the surgical cases that were referred from the Asbury Methodist team, making the final determination of whether surgery was indicated. All other non-surgical cases were seen by Adam, who would diagnose their conditions and prescribe treatment, sometimes referring it to Doug for surgical consideration. Neil worked with Adam to record his case notes and be available for any other help that might be needed.
And after the doctors were done with their examination, medicine was usually prescribed, which took them to our pharmacy, manned by Glennis and Christopher.

This flow worked very well for us today, especially since we had four translators, in addition to Barbara. Although we will make minor adjustments each day as we fine tune our procedures, the team left the hospital today knowing that we had worked well together, with our patients and with the hospital staff.

Tomorrow will see our first surgical cases. We have four procedures scheduled, beginning at 7:30. We know that we must be flexible—in Tanzania a schedule is only a rough draft and the only time it is firm is at the end of the day, when it is complete!

Monday, July 26, 2010

We arrive in Tanzania

After 2 full days of travelling, we arrived in Dar es Salaam Sunday evening on the last flight of the day into Tanzania. As we waited patiently for our visa that would allow us to enter the country, our rumpled clothes and sagging shoulders told the story of our journey. We gave a prayer of thanks that we all arrived safely, along with our 18 bags of personal items and medical supplies. Barbara Robertson, a Washington state resident who works for the ELCA and has been in Tanzania for more than 7 years, spotted us as we talked with the customs agent to explain the contents of our bags. Once he understood the bags were filled with medicines and supplies that were to be a gift to the Tanzania people, he waved us through. We exchanged hugs, greetings and introductions with Barbara and piled our luggage into two Land Rovers for the short drive to the Catholic guest house, where we stayed last night.

After a quick breakfast, the team helped rearrange the bags in the two vehicles. The plan was for us to split up today: Barbara would take Doug, Adam, Cindy and Jordan to the ministry of health in Dar es Salaam to present medical credentials for the licensed team members and the rest of the team would go to Morogoro and get settled in to our rooms at the Lutheran Junior Seminary. We were prepared for the possibility that meeting with the Tanzania officials could take all day, but after just a few hours, the paperwork was completed, the fees were paid, and the other half of the team began their drive to Morogoro, where we would be reunited by dinner time.

Tomorrow morning we will move our medical supplies to the hospital, meet the staff and our interpreters, and learn how we can best serve and show the love of Christ. We have already talked with Robert Spitaleri, who worked with Asbury Methodist last month, so we know that patients have been told to come see us beginning Wednesday,

Tuesday, July 13, 2010

In preparation for the third surgical mission trip to Tanzania, the team met for the first time on Saturday, two weeks before departure. We learned a little bit about each other and what we can expect over our two week stay in Tanzania. We all have much to do over the next two weeks but are excited at this opportunity to serve Christ and get to know our brothers and sisters in Tanzania.

2010 Travel Itinerary Tanzania Medical/Surgical Team

July 24, Saturday
Leave Fayetteville @ 10:54 am / leave Tulsa @ 10:45 am
Arrive Detroit @ 2:14 pm (1:14 pm) / arrive Detroit @ 2:13 pm (1:13 pm)
Leave Detroit @ 5:40 pm (4:40 pm)
July 25, Sunday
Arrive Amsterdam @ 7:35 am (12:35 am)
Leave Amsterdam @ 11:00 am (4:00 am)
Arrive Dar es Salaam @ 10:25 pm (2:25 pm)

August 8, Sunday
Leave Dar es Salaam @ 11:35 pm (3:35 pm)
August 9, Monday
Arrive Amsterdam @ 7:40 am (12:40 am)
Lv Amsterdam @ 12:55 pm (5:55 am) / lv Amsterdam @ 2:40 pm (7:40am)
Arrive Detroit @ 3:35 pm (2:35 pm) / arrive Minneapolis @ 4:35 pm
Leave Detroit @ 7:35 pm (6:35 pm) / Leave Minneapolis @ 9:30 pm
Arrive Fayetteville @ 8:58 pm / arrive Tulsa @ 11:28 pm

Times are local for the city (Times in parentheses are home times)
Fayetteville flights / Tulsa flights