Saturday Morning Farewell

Mikumi National Park is about 1 ½ hours from Morogoro and we spent our day there on safari yesterday. Beautiful weather, amazing animals, good fellowship.

Arriving back at 2:30, we went straight to Mazimbu so Doug could perform his final two procedures—both out patient—as the rest of the team wrapped up and said our farewells. We all look forward next year to working with the amazing staff at Mazimbu.

Our bus arrives at 8:30 this morning and we hope to be in Dar es Salaam around 1. We will be able to play tourist today until catching our plane at 10:30 tonight.

In about 60 hours we will be seeing all of our families again. Our time here has been a blessing for all of us. We love you and thank you for your prayers.

Our Shipment Arrives!

One benefit of being without electricity is the stunning beauty of the night sky. The generator supplied steady power all day so our work was uninterrupted. And once evening fell and we were away from generated light, last night’s sickle moon blazed among a blanket of diamonds in the sky.

Our day Tuesday was full with surgery and follow-up with our many patients. Dinner was at a lovely restaurant near Mt. Uluguru called Nashera, after which we all headed to bed, tired from the long day.

Wednesday brought a change of pace for most of the team. Doug and Cindy arrived early at Mazimbu for our scheduled surgeries. But our schedule is now full and, as Doug will be in the OR for the rest of our time, we are not able to accept any new patients. So the rest of the team enjoyed a leisurely morning at LJS until our dala dala driver returned at 9:15 for the 5 remaining team members and our translator, Juliana. Shopping was on the agenda for Nancy, Glennis, Eileen and Pati and Lance was graciously allowed to join the group. Our first stop was our favorite market, Pira’s, where we found coffee, soap, wine and snacks. Juliana then led us on a hunt for the local “hot pots” which are used for keeping food hot or cold. She disappeared through a narrow doorway overhung with assorted buckets, brooms and shoes, with her little troop trailing behind. Inside we met Mohammed, the shop owner, who rummaged behind a counter piled precariously with all kinds of goods before producing a very dusty box tied together with twine. We had found our hot pots! Some friendly haggling followed and Nancy, Glennis and Mohammed were all pleased with the outcome.

After dropping the hot pots in the dala dala, we headed for the open air market where people gather to sell all manner of fresh fruits and vegetables, rices and grains. The vendors go to great care to arrange their goods in an attractive manner, and wherever your eye falls you find a riot of vibrant colors. Bananas, mangos, avocados and pili pili peppers found their way into our bags.

When the shoppers arrived back at Mazimbu, news had spread that our package from Oklahoma was waiting at the post office. Picking it up was not as simple as we thought—Cindy had to show her ID and then make several trips from the post office to the government office for the right papers, going across the street and up and then down three flights of stairs each time.

Doug wants Ben to begin sitting in a wheel chair and getting outside his room for a short while each day. The arrival of the mattress triggered his first time to leave his bed in two months. Nancy wheeled him outside while Cindy and the aides prepared his new bed. Once he returned to it, Ben agreed it was much more comfortable. Our main goal, though, is to relieve the stress on his body so his wounds can heal.

Our day ended with dinner at Bishop Mameo’s home with his family—Rose, his wife; Evelyn, his 11 year old daughter; and Edwardi, his 1 year old son. We were honored to end our day with friends, laughing over Mameo’s stories about his adventures from his first several visits to the US.

Shopping and pics of Bens delivery

Short video of a choir at Mjimpya

http://vid515.photobucket.com/albums/t360/patiannem/2015%20Tanzania/Tanazania%20Church%202015.mp4

Sunday pictures

Worship at Mjimpya/Raina

We have watched the progress over the past several years of the construction of the church next to the diocese office. The main part of Mjimpya is now 90% complete and boasts seating for about 400-500 on the lower level and a balcony for additional seating for about 200. The tower that will ultimately hold the bell is still under construction and will have two levels for rental to generate income and a level for use as a conference room. (Pictures of the church were posted in our first set of photos on this blog.) Mjimpya is the home church for our Tanzanian liason, Tabitha Kilatu, who invited us to join her for worship on Sunday.

We arrived just in time for the start of the 7 am service and were ushered up to the front row. Bishop Mameo was also visiting and was dressed in his formal Bishop robes and mitre and carrying his staff. He made an impressive sight!

Three different choirs contributed to the worship and their choreography, blended with their syncopated African melody, had us swaying and tapping time with our toes. One of the highlights for the team was when the strains of “How Great Thou Art” began swelling over the Swahili and we were able to sing the beloved words with our Tanzanian brothers and sisters.

Bishop Mameo preached on the passage from Matthew 7:15-20 about knowing the tree by its fruit. Kilatu and two of our other translators were sitting among the team and whispered the translation of the sermon to us so we were able to follow the message.

After the two and a half hour service we were treated to tea in the pastor’s office which included chai, coffee, bread, hard boiled eggs and braised liver. Little did we know how important this morning snack would be to us.

It was about 11 am when we headed to Mazimbu to do rounds and check on Ben. Doug was finishing up and making notes in his charts when he became curious about an 11 month old baby on the desk getting a blood transfusion through a scalp IV. Doug, Cindy and Nancy reviewed the baby Raina’s chart and were worried when they saw the hemoglobin was 1.8, barely sustainable for life. Normal is 10-12. Notes in the chart stated the baby fell a week ago and had been bleeding out of the mouth. As they were reviewing the chart, the IV blew out and the transfusion was not able to continue. The staff asked Cindy and Doug for help starting another IV. As the hours wore on, the team was praying while Cindy, Doug and Nancy struggled to get an IV started that would hold. Because the baby was so little and was dehydrated, her blood volume was so low that even the tiniest needle could not enter the vein without piercing through the back wall. At the second hour, the power went out and Doug continued work with a head lamp. At about 2 and a half hours, Dr. Swai arrived to do rounds and joined the team to assist. At about 3 and a half hours Doug asked who was in charge of praying because either they got the IV in place or the baby would die. Nancy replied that we were all praying. Numerous small incisions were made to identify a vein into which we could insert a stable IV. At about the fourth hour, Doug decided to retry one of the previous sites, the left groin. As he shifted to this area, Doug stated “I ellt good about this” and got a successful IV right away. Prayers were answered! To ensure it would stay, he sutured it in and fluids were immediately started. The baby revived within a few minutes and began looking for her mother to nurse. Shortly after that, a bag of blood was transfused. The team offered up prayers of thanks for this gracious gift of life.

So the afternoon waned and the team was able to leave the hospital at 5:30. We headed to the Morogoro Hotel for dinner. As we were sitting around our table, enjoying conversation about the day, we were greeted by one of the managers, Robert, who saw us that morning at Mjimpyia. We shared greetings and stories and well wishes.

As we have finished our first week, we are humbled and moved to see God at work in our mission every day. From the smallest things like meeting Robert at dinner after being in the same worship to the big things like being at Mazimbu at the right moment for Ben and for Raina.

Pictures from Friday night and Saturday

Tikwa Moreto and the Maasai Cattle Market

Although today was our first free day, we woke early to meet up with Kishumu, our Maasai translator, for a trip to the Maasai cattle market. Tanzania has a large Maasai population and every Saturday they gather to sell their cows, sheep and goats. The men will drive to market the animals they want to sell, some coming from as far as 20 kilometers away. There are stalls for vendors of various goods and many twig shelters where one can sit in shade and visit with friends over a soda or a meal. This is a day of much community and fellowship for Maasai.

Our white faces made us stand out today and, thanks to Kishumu’s translation, we were able to chat and make friends with many young Maasai men. We all asked questions of each other and our answers were met with much laughter by our Maasai friends. One group in particular became very interested in Doug, especially when he produced his IPhone. One handsome young man, Elia, quickly took possession of the phone and was taking pictures of himself and his friends. When we reversed the camera to forward facing and then showed him how to zoom, he was tickled and immediately began testing all of the new functions. He asked Doug for a price for the IPhone and when we said “2 cows!” he laughed but then countered with “1 cow!” That is about $400-$500, not a bad price for an old phone.

Meanwhile, we were surrounded by small groups of Brahman cattle being herded with encouragement from the long slender sticks wielded by the Maasai. Occasionally a cow or bull would break free and several agile young men would chase him down and bring it back under control. A bit of excitement, for sure!

Bishop Mameo, who is also Maasai, met us at the cattle market and welcomed us into one of the twig shelters. He then introduced us to his uncle, an elderly man in tribal robes named Tikwa Moreto, and explained that Moreto is the chief of all Maasai in Tanzania. As we were sitting with the Chief and the Bishop, learning about Maasai leadership, one Maasai man after another strolled through our circle to greet the Chief and the Bishop, then after “salama” and shaking hands with us all, proceeded on their way without another word.

Maasai highly prize roasted meat and Bishop arranged for a haunch of freshly roasted beef to be brought to our small group, which by now included half a dozen Maasai men. The newly butchered animal is cut into manageable parts and stretched open with horizontal wooden sticks. A vertical stick is then threaded through the meat and it is roasted over a hot charcoal fire. This whole skewer was brought to us and laid on top of a bed of freshly cut leaves. One of the Maasai men used his 18” razor sharp machete to easily slice bite sized chunks off and we passed them from hand to hand, popping the fragrant meat into our mouths.

After our meal, we browsed through the vendors and Kishumu helped us get good prices for our purchases. Everywhere we went we were welcomed, greeted and made to feel at home.

It was mid-afternoon before we began the hour ride back to the hospital, where we stopped for Doug to make rounds. Our surgery patients from yesterday are doing well and Ben is resting comfortably.

Answered Prayers/Friday at Mazimbu

For all of you who prayed for power today, prayers were answered. Although fuel for the generator had not yet been purchased, the electricity worked uninterrupted. Please continue to pray for consistent, dependable power for us for the rest of our trip.

Doug did one surgery alone today and worked with Dr. Swai on two more. The power outage yesterday delayed our start because they were unable to sterilize the instruments until this morning. So we got started later than intended. That caused us to reschedule the fourth surgery to Monday. As we always find in Tanzania when we have to change a schedule, our patient was understanding and did not complain. She accepted the news and wished us a good weekend.

Due to the late start to the day, it was almost 7 pm before we left Mazimbu. To celebrate the end of our first week, we enjoyed pizza at a local haunt, Dragonaire. It is almost 10 pm now and we are just finishing up our meal, sitting at an open air table under the stars.

Update on Ben—He was blessed by a visit from his aunts and uncles and cousins, who travelled from Dar es Salaam to see him. The mattress was successfully purchased in Oklahoma and, thanks to the USPS, is en route to Tanzania and is expected late next week. He is no longer troubled by nausea and is enjoying food again, along with protein supplements. Our hope is that he will start to regain some of the weight he has lost and that he will be able to begin to rebuild muscle.

Pics after starting work at Mazimbu

Electrical Challenges

Tanzania is in the midst of presidential elections. The majority party has chosen their candidate and the incumbent president was eliminated for consideration. The minority party will soon choose their candidate and the general election in several months will decide the leader of the country for the next five years.

Because the sitting president is now a lame duck, some government services are not at the normal level. It has been explained to us that no one is responsible, no one is taking charge, no one is accountable.

In Tanzania, the power company is government owned and operated.

Therefore, we are experiencing blackouts every day. Some are short lived. Some are hours long. Mazimbu does have a generator. The day we arrived the hospital was dark and we asked why the generator was not providing power. Because it had not been used in some time, the batteries needed to be charged. That was accomplished overnight and today at about 10 am, when the next power outage occurred, the generator kicked right in. And powered the hospital until 1:00 pm when it ran out of fuel. Discussions between the hospital and the general secretary, who controls the funds, continued throughout the afternoon. We are hoping that the fuel will be on hand by the time we arrive tomorrow morning.

Our day was full with new patients and with our first two surgeries. The second surgery, a minor procedure, was done without power with the aid of headlamps.

Doug was called in to assist Dr. Swai when a hysterectomy also developed into an appendectomy. The two doctors have been enjoying a rewarding exchange of knowledge and ideas thus far.

Tomorrow we have a full day scheduled—4 major surgeries. Dr. Swai will be working with Doug on several of them. The uncertainty of the power may affect our ability to work as planned. If the generator is fueled, and if running out of fuel has not damaged the generator, we will be able to continue even if power is lost. We are asking for prayers for electricity throughout the rest of our time here.

Update on Ben—an egg-crate mattress is crucial to his healing and to his future health because it disburses the pressure away from his pressure ulcers. All attempts to buy one locally or to order from Amazon have been unsuccessful. But we have worked out a solution—Cindy’s husband Dana will go in to a hospital supply store and buy one and ship it through UPS. We are told it will arrive Thursday! God is good! Tomorrow our plan is to begin physical therapy to gain upper body strength with the intent that he will be able to reposition himself without relying on anyone’s help.

Wednesday and our work begins

Our transportation this year is a dala dala, which is a van similar to a VW bus that seats 18 passengers in 4 and a half rows. Our driver, John, has driven for us for the past two years and we made arrangements months ago that he and his excellent skills will be with us again this year. John picked us up at 8 and took us straight to Airtel. Thirty minutes later, with only half of our tech issues solved, we arrived at Mazimbu.

Word has not yet spread about our visit so there were only about fifteen patients waiting to be seen. Because Doug is our only doctor this year, we will be focusing on surgical patients. However, Mazimbu has a resident gynecologist, Dr. Swai, who will be consulting with the team on any gynecological problems.

Over the past several days we have been recording any items that are needed either at LJS or at the hospital. These are usually something that we Americans might assume are readily available, but Tanzanians may view them differently. For example, for some reason, the LJS has been putting only one salt shaker out for more than three separate dining tables and we wanted our own salt shaker. In addition, yesterday the team identified many simple changes that could be made to improve Ben's comfort--protein bars and Ensure, an egg shell mattress, foam heel protectors, four inch surgical tape and pillows. This led to an unusual shopping list.  So Lance and Eileen, together with one of our translators, made the trek into town to begin their hunt.

One of the hardest items on the list was salt! In Morogoro, every shop is specialized and you must know exactly where to go for every item you are looking to purchase. This means that a list with 10 items on it can very easily mean at least six different shops. And this is if the shop keepers help out by pointing the way to a competing shop instead of just saying "no, pole sana" when asked for an item.

Pati began working in the reception area, registering potential new patients. Cindy then interviewed the patients to get their medical history and vital signs. Nancy worked with Doug as he examined and diagnosed our patients, while Glennis was prepared to fill the pharmacy orders written by Doug.

Three patients have been scheduled for surgery tomorrow, including a beautiful, shy 5 year old girl who will have a hernia repair. Dr. Swai has also been referred several patients and ordered further testing to help him in his diagnosis, but it looks like most of them will be helped with surgery.

Our day ended with dinner under the stars at one of our favorite restaurants, The Oasis. As we enjoyed the chance to relax, the conversation flowed easily from one topic to another. It will be an early night to bed as we look forward to tomorrow, our first day of surgery.

Pictures from second day

Photos from Dar es Salaam

Prayers for Ben

Technical difficulties have plagued us for the past two days. We have had some success—we now have working cell phones. The internet modem we purchased has not yet been successfully activated, after many hours with tech support, but one of our friends working at LJS that we see every year has loaned us his personal modem. This so typifies the amazing hospitality we see every year in Tanzania!

Our day began today with a visit to the KKKT diocese office to pay our respects. Lance and Eileen presented Bishop Mameo with three stoles as a gift from their retired pastor, Ross Worch. Discussions of our schedule led around to our tech concerns and Bishop Mameo brought our visit to a close to accompany the team to the local Airtel. Several hours were spent trying to reactivate the phones and the modem we purchased last year. Phones were successful but Airtel said they still needed to work on the modem and it would be several hours.

Lunch was at a local café and we lingered over great local food and conversations. Unfortunately, Airtel was not ready for us as promised, so we continued on to Mazimbu hospital.

Our arrival at the hospital was met with heartfelt welcomes from all of the staff. Matron Seguru, who has worked with us each of our years at Mazimbu, was ready for our arrival and had a room prepped and ready for our dedicated space. The team set to unpacking our supplies and drugs and organizing for tomorrow, our first day with patients.

Dr. Omar Kasuwi, the cardiologist that is the head of Mazimbu, was particularly warm in his welcome of the team. After our initial greetings, he told us about a particular patient that he wants Doug’s help in consulting and advising. Ben is a 27 year old father that was gravely injured many months ago in a motor vehicle accident and was left paralyzed below the waist. His treatment for his injuries has been thorough, including orthopedic surgeries and travel to India for neurological treatment. He is now suffering from pressure ulcers on both hips and both heels. He was admitted to Mazimbu more than two months ago and has been slowly failing. Dr. Kasuwi told us he began praying for Ben when Cindy’s last email, 3 weeks prior, told him our General Surgeon would be part of the team.

The day before we left the US, Doug was doing his last minute preparations. He has received donated meds in the past and stockpiled them in his office. On this last day, he decided to review the donated meds. Most of it was a med that was unlikely to be used. Included in this group was a 9 day supply of a strong IV antibiotic which are frequently used on serious infections. Doug has had access to this med in the past but has not brought it as it is heavy and a space-hog because it includes the fluid necessary to administer.

As we were preparing to pack up and call it a day, Doug decided to look in on this patient Dr. Kasuwi had mentioned. Ben is fluent in English so was able to help Doug in his examination. Ben’s pressure ulcers had advanced to the point that they were close to life threatening. In addition, the open
wound caused by the ulcers led to an infection. Ben described a sensation of burning down his leg. Doug suspected osteomyelitis, an infection of the bone.

Treatment of osteomyelitis requires strong IV antibiotics, which are not normally available in Tanzania. Which happened to have been packed at the last minute by Doug.

How can we express our feeling when this mission, which we have worked to make happen for so long, is so clearly touched by God’s will directing all of our actions? All we can do is give thanks and pray for His guidance throughout the rest of our time.

Karibuni Tanzania

Note--This blog was written Sunday afternoon but we have not had internet access until now, Tuesday evening. We will post this blog and one more (which is not written yet) and then come back in and add photos. So check back often!

Our typical first 52 hours:

4 am Saturday, leave for the airport

6:20 am, plane departs for Houston. First leg.

9:10 am, plane departs Houston for Newark. Second leg.

5:30 pm, plane departs Newark for Zurich. Third leg.

2:30 am Sunday (9:30 am in Zurich), plane departs Zurich for Dar es Salaam. Fourth Leg.

1 pm Sunday (9 pm in Dar), arrive in Dar.

3 pm Sunday (11 pm in Dar), Visas in hand, luggage collected, customs cleared.

4 pm Sunday (midnight in Dar), arrive at guesthouse for the night.

12:30 am Monday (8:30 am in Dar), Load up, stop for brunch, begin drive to Morogoro, Fifth Leg.

8 am Monday (4 pm in Morogoro) arrive at our home for the next two weeks in Morogoro, LJS

As we switch over to Tanzania time we are 8 hours ahead of our families back home. We will have some limited access to internet, but it is not dependable. Please remember to send your comments to us on this blog. We read it together as a team every evening and it is so rewarding to hear from our friends and family back home!

This is the first year all of the team members have been on the trip in prior years. Our leader, Cindy Pennie, is an RN from Stillwater, Ok and has led this team for the past 8 years. She also served with another group in 2 prior years, so 2015 marks her 10 year in Tanzania. Pati Murdock, team manager, is from Rogers, AR and has helped the surgical team with the onsite logistics each of the 8 years. Doug Treptow, general surgeon, and his wife Glennis, are also from Rogers, AR and are making their 5^th trip to Tanzania. And, finally, Nancy Bean, Weatherford, Tx and Lance and Eileen Miller, from Hot Springs, AR, were with the team last year and have returned again this year to renew their friendships with our Tanzanian sisters and brothers. Nancy is a retired veterinarian; Lance is retired R&D from Nissan and Eileen is a retired musical educator. God brings together the right team members each year. Glennis’s experience on multiple mission trips with Doug has focused on managing an ad hoc pharmacy. Nancy’s skills carry over into clinical screening. Lance has technical skills and is a whiz at fixing almost anything. And Eileen’s affinity for music and rhythm fit right in with Tanzanian culture. The final member of our team is Tabita Kilatu. Kilatu works for the Evangelical Lutheran Church in Tanzania (KKKT) and is our liason each year.

The familiar sights and sounds and smells of Africa washed over us and softly whispered karibuni as we had our first sight of Tanzania in the July sun. The busy traffic-clogged streets of Dar es Salaam were alive with the buzz of men and women off to their morning jobs. Bicycles and motorcycles, often laden with cargo or passengers, wove among the many pedestrians. Dense groupings of tiny wood and tin framed shops nestle in the shadow of tall modern office buildings. As the city gives way and becomes more rural, narrow footpaths wind between the hills to clusters of small family homes. Families often build their homes within walking distance of each other so the people in a small village may have 8-10 houses, all of whom are related.

The two lane highway to Morogoro runs East to West and is called the TanZam highway. There is only one other major highway in Tanzania, which is a North South route. Our 3 hours on the TanZam highway are the most dangerous part of our trip. Traffic is very heavy and the more aggressive bus drivers pass the slower moving tractor-trailers, often forcing oncoming traffic to slow or swerve before they are back into the traffic flow. It is always a relief to finally arrive on the peaceful grounds of Lutheran Junior Seminary and get settled into our rooms before the final meal of the day.