Last Thoughts

It is Saturday late afternoon and the team is packing in preparation for our departure tomorrow morning for Dar es Salaam.

Friday afternoon we wrapped up our last bit of work—Doug and Chris and Ashley and Zach had three minor procedures that kept them busy while the rest of the team inventoried and packed supplies being left for the hospital and those being given to a remote dispensary, Mkulazi. 

Medical team with (L to R) Epsilon, Kishumu, Eliah and Christine (Nurse anesthetist)

And Will and Lance were tapped for a final repair on the cautery machine. As evening fell, we said our farewells to the Mazimbu staff and to the Tanzanian part of our team, Kishumu, Eliah and Epsilon. Goodbyes are tough but, God willing, we will see each other again next year.

Kristen and Tisho and their baby Ethan dropped by Friday evening to visit. Kristen and Tisho are missionaries who have worked with the team in the past and now live full time in the Morogoro region. They are preparing a move to an area a bit far out from the town because Tisho has accepted a position as director of an orphanage. He is also working with an organization called GO (from go and make disciples) to bring a school to his home village of Melele. It was so good to catch up with them!

This morning we became tourists, getting up before dawn to drive to Mikumi National Park, about an hour and a half away. A little more than a year ago Tanzania elected a new president who won election based on his promise of sweeping change and stopping corruption. This means that there are many changes happening in the government. We were told earlier that one of those changes requires that the entrance fee to national parks be paid before going by loading the amount on a pre-paid debit card designed just for that use. The parks no longer take cash for the entrance fees. That little errand took Cindy and Kilatu 3 hours at the bank yesterday to arrange, but we arrived with debit card in hand. What we were NOT prepared for was a new rule that will not allow vehicles into the park unless they have a permit and have already paid the taxes for the fees. This cannot be done at the entrance to the park. That meant that our comfy mini-bus would have to be left in the parking lot and we would have to use the vehicles and drivers provided by the park. These only seat a maximum of 9 so our party of 12 required 2 vehicles. It was an additional expense that was not budgeted but we found that we really enjoyed driving around in the open-air vehicles. One of them was an old Toyota 4Runner that had had the top cut off (Will says this is a no-no since it is a uni-body frame but that won’t ever stop a Tanzanian who wants to solve a problem) and 3 tiered rows of seats installed so that each row could see above the heads of the row in front of them. The second vehicle was on old mini-truck that had a similar modification of tiered seats added to the bed of the truck.

Click the link below to enjoy a few of the pics taken of these wonderful animals!

Mikumi National Park slideshow

Our driver is picking us up in a few minutes for dinner at the diocese with Bishop Mameo. We have not seen the Bishop yet as he has been in the US studying for his PHD. He has just arrived back in Tanzania so this evening will be our only time to pay our respects.

As we wrap up this year, we want to thank all of you—our friends, family, church families and other supporters—for your prayers and encouragement. We are so far away here from all that we call dear, but the people of this beautiful land have become a part of our hearts. Your support allows us to go and, most importantly, to return to your warm and loving welcome.

Slide show of team with our patients

Slide show of team with our patients

Slide show of scenes of Tanzania

Slideshow with scenes of Tanzania

Final days at Mazimbu

Our surgeries over the past few days have gone smoothly. Chris and Ashley, our surgical technologists, have enjoyed working with their Tanzanian counterparts. For all of our non-medical folks back home, a surgical technician is responsible for ensuring all necessary supplies—sutures, instruments, medications, etc—are ready for each procedure. A surgical technician also scrubs for the case so that they are sterile and can assist the surgeon. That can include clamping blood vessels, suction, cutting suture, retracting tissue and passing instruments. Peter and Faudha are the technicians at Mazimbu and, as they have worked with Chris and Ashley over the past week, their set up has begun to mirror our surgical setup.

Ashley with our anesthesiologist, Christine

Faidha and Peter

Chris with Faidha

This streamlining of prep seems to have resulted in a faster turn time in the theatre. It is Thursday, just before noon, and we have just begun our third case of the day. In past years it was not uncommon that the SECOND case of the day did not begin until afternoon.

Cindy and Pati were approached yesterday by a Maasai mother, Lukia, seeking help for her oldest son, Papaa, a 17-year-old-boy. Because our schedule has been full since last week, the initial reaction was one of sorrowful regret that we cannot help. But Lukia was persistent. As we talked with her, we learned that she is raising her six children alone since the death of her husband and that she came from a very far distance to see the team. Papaa has been suffering with an abdominal distension for six months and has been to hospitals and to doctors and none have found the cause. When we examined the records, we saw that Papaa has an enlarged spleen and liver. Lukia has sold cows to pay for this medical treatment over the past six months and has none left to sell.

From L to R, Cindy, Papaa, Lukia, Goa and Pati

In the evening, before dinner, we were able to relax at Rosemary’s duka again so the problem was brought before the team. It is a difficult problem because the next step is to go to Dar es Salaam, where there is advanced medical treatment available, but there is no way to know in advance the cost of those tests and treatment. After discussion, we decided to give Lukia the bus fare to Dar, money for meals and lodging for a few days, and enough additional to cover consultation with a specialist and for at least some more testing. Our hope is that they will receive a diagnoses and that Papaa’s condition will be treatable with medication.

However, we encountered another problem today when we met again with Lucia and Papaa. She has never been to Dar in her life and does not think she would be able to navigate the challenges of this city of 4 ½ million people. Eliah, who helped with translation, said it would be like “leading her to the lion and leaving her”.  This is when God stepped in again, in the form of Goa, a man who was treated by Doug four years ago. Goa had heard about the team and brought one of his family here this year, who had surgery a few days ago. Goa is evidently a distant relative of Lukia’s. It is not clear if he even knew her but just realized from her description of her village that he was related. But Goa stepped forward and offered to take her and Papaa to Dar. They have Kishumu’s phone number and will let him know the results, and Kishumu will then communicate with the team. We will be praying that the money is enough and that God will send him to a doctor that is able to treat his condition.

On another note, Cindy had a bit of a mishap while flossing one evening and lost a crown. She caught it in the sink and brought it with her to Mazimbu today. The dentist, Dr. Patric, had everything he needed to pop that crown right back in and Cindy reports that it is even better now than before!

Cindy with Dr. Patric

Replacing a crown

Our fundis have continued to be tapped on the shoulder for one repair after another. Today they were troubleshooting (successfully) computers that were not functioning. Thanks to Will and Lance!

Tomorrow will be our last day and it is a short one. Doug will only do outpatient surgeries because we will not be here for him to follow up on any inpatient surgeries. So we have set aside the morning for six of the team—Doug, Nancy, Will, Chris, Ashley and Zach—to climb Mt. Uluguru with Kishumu, Epsilon and Eliah. The rest of the team will sleep in and then enjoy a bit of shopping in Morogoro before meeting the climbers for lunch. After lunch, we will be packing up our supplies to donate to the hospital or to another dispensary, and then saying our farewells.

Pre-packing supplies

Kishumu has a few inches on Pati, despite the puffy hair!

Video of Cows at Rosemary's Duka

Faudhia Goes Home

Faudhia before discharge

Great news when we arrived this morning to begin our second week at Mazimbu! Fuadhia has shown marked improvement every day since her surgery and was well enough this morning to be discharged!

And then Doug began the big surgery for the colostomy reversal. We thank you for your prayers because all in all, it went as well as could be expected—it did not take longer than Doug had anticipated and he did not encounter any complications during the surgery. So now our prayer is that Salumu's pain will be manageable and that he will recover without suffering infection.

Our translators are invaluable to our mission and we could not do our work without their help. But as our work has shifted from the front desk and triage over the the surgery part of our work, we do not have as many patients that need the help of a translator to talk with us. So today we had to say goodbye to three of our translators, Juliana, Sarah and Magreth. All three have worked with us in past years and we look forward to seeing them again in future years.

From left to right, Sarah, Eileen, Juliana, Glennis and Magreth

From left to right, Sarah, Magreth, Cindy and Juliana

Will doing another emergency repair on the Bovie, with Cindy and Glennis looking on

Soldering the Bovie

We were able to leave the hospital at 5:30, which meant we arrived back at LJS at 6 pm. Although dinner is served at 6, several of the team enjoy walking the short distance off campus to a local duka where we can enjoy a beer. This is a small, local storefront owned by Rosemary, who lives in back with her family. When we arrive, we walk behind the duka and shout “Habari” until the family waves to let us know they will be right there to help us. Chairs are brought out for our comfort and we can watch the local life around us. It is very relaxing.

Beers after work

Rosemary's duka

Tomorrow will be a long day for us again—the team will be assisting Dr. Swai, who is doing a gynecological surgery on two of our patients. And we have three more procedures in addition to those two. Since it will be a late night, we are planning dinner at one of our favorite restaurants, the Oasis. Which means we will not be posting to the blog tomorrow night. But we will catch up with you on Wednesday.

Benedictor, our first patient tomorrow morning

Worship at Sokloine

As in many past years, we were again welcomed to worship in Sokoine parish with our brothers and sisters in Christ. Hospitality among the Maasai is of the utmost importance. When our daladala pulled up into the churchyard, there were chairs arranged under the trees waiting for us. We were invited to sit and one of the village elders brought water to pour over our hands before eating, holding a basin below to catch the overflow. 

Georgia riding under the seat in the daladala

Our daladala

Boiled sweet potato and Maasai chai were offered to all of us. The sweet potato here is not a yam, but a white sweet potato. And the Maasai make wonderful tea by boiling the tea in milk, not water. While we were being fortified before service, many of the men and women of Sokoine came over and shook our hands, one after the other, welcoming each and every one of us.

Tea before worship

Maasai do not adhere to a strict time schedule but, instead, move on to the next activity once the preceding one is done, like moving the cows or preparing our lunch. So the 10 am service actually began at 11:30 and lasted 2 hours.

Worship included performances by three different choirs. We may not understand the Swahili, but the joy of praise needs no translator.

Sokoine altar

Georgia was given to the pastor as the offering from the team. She was very well received by the congregation and, when the pastor was thanking us, he assured us the nanny goat would bear twins! He added that next year, when we visit again, one of her offspring would be in our dinner pot. We are opting for beans and rice that day.

Cindy presenting the nanny goat Georgia to the pastor

Chairs were assembled in the church after service and we were ushered in and offered the luncheon meal—rice, meat in a flavorful broth, beans, a squash similar to spaghetti squash, and stewed beef. We all enjoyed it and were bid farewell by our friends until we see them next year.

The team with Sokoine friends

Maasai Cattle Market Slideshow

Maasai Cattle Market

End of our First week and Maasai Cattle Market

Our work week ended at 7 pm Friday, after another long day of surgery. During that day we filled our surgery schedule for the rest of our time here. So the front desk will not be checking in any new patients next week. This is the fastest we have ever filled all available slots on the schedule. Dr. Kivuma and Dr. Swai will continue to work with the remaining patients who have been registered but not yet been seen by a doctor and it will take several days for all of their test results to be received and reviewed by the doctors. That means the team will still be busy facilitating that part of our mission, but the focus has certainly shifted over to the surgical side of our trip.

We invite your prayers, not just for the rest of the trip, but for a specific surgery Monday morning. A young 20-year-old man, Salumu, suffered a sudden, severe volvulus last year requiring an emergency colostomy. He was told to return to Dar es Salaam in December to have it reversed, but when he arrived and was told the price was 1,000,000 shillings, that was so far beyond his means as to make the repair impossible. We met with him on Friday, and this is a surgery that Doug can do, so other patients were moved to later days to allow Salumu’s procedure to be done on Monday morning. It is a long procedure with a higher risk of infection, as it deals with the bowel and large intestine.

Dinner Friday night was a celebration of the end of our first week’s work with pizza at a local favorite, Dragonaires. It was a great start to our weekend!

And our weekend continued with a trip to the Maasai cattle market, accompanied by Kishumu, Eliah and Epsilon. Eliah gave us a bit of history, which helped with our understanding of some of the Maasai traditions. We were warmly welcomed and greeted by the Maasai and strolled among the milling cattle as buyers and sellers discussed prices. Eliah ordered a portion of fresh roasted goat and beef for our lunch. This is sliced into strips with a machete and then bite-sized pieces of meat are sliced off of each strip and passed around. We added several portions of chips mayai which are French fries fried with scrambled eggs, seasoned with salt and hot sauce and eaten with a toothpick.

The highlight of our day was witnessing about a dozen Maasai warriers, including Eliah, singing and dancing. They stand in a circle and sing/chant rhythmically, following the cues of a leader. Some songs feature jumping where they will take turns, singly or in pairs (or even threes!) coming into the center and jumping as high as they can in time with the chanting. American Basketball coaches must not have seen how high these warriors can jump or our NBA teams would be full of Maasai!

Just before leaving, Eliah happened to talk to a man and discovered he was suffering severe after-effects from a spider bite. Eliah asked Doug to look at the injury and when the man, who we learned was called Edwin, rolled up his pant leg, his lower leg was overwhelmed by an area of dead skin about 6” X 8” and the leg is still, 6 weeks after the fact, swollen to more than double the normal size. In addition, there was a marked swelling and bulging of a vein that snaked up the inside of the leg and past the knee. We learned that he had consulted a doctor and surgery was recommended, but that the price was 350,000 shillings (about $150). He was trying to raise the money and had collected 130,000 shillings so far. Could we help? The team withdrew to discuss privately and we all felt like this man needed our help. So each of us chipped in personally and the money was raised to make his surgery possible. His gratitude was obvious to all of us and he welcomed our prayers. We all joined hands to pray with him for his recovery.

Before we left to head back to LJS, the team bought a nanny goat to bring to worship tomorrow as our offering. Lance has named her Georgia.

A Few Pictures to Share

Slideshow with scenes around Mazimbu

Here is a slide show with pictures from us with our translators at work at Mazimbu.

Faudhia

It seems as if every year God clearly shows us the reason why we are here. That happened yesterday. It was our first day of surgery and we had a full schedule-5 cases in the major theater and 1 in the minor theater-so there is no way we could take any additional surgeries for that day. On top of that, surgeries keep the docs in the OR so we cannot see many new patients to evaluate for surgery. 

But yesterday, despite all of that, Doug was consulted by a family with a 12-year-old girl that, according to an ultra sound, had an abdominal cystic mass. This is normally benign and asymptomatic, except for causing some abdominal distention. When he examined Faudhia, her pulse was 148 and her respirations were 36. These are seriously bad numbers. One of our team happened to walk in to Doug's exam room when he was making notes on her chart and he remarked that he was really worried. The young girl had extreme pain, both on depressing and releasing pressure, which would indicate a problem far more serious than a cystic mass. Doug was very worried and wanted to do surgery asap, which he knew meant the following day IF we could get lab results in time. In past years, we had been able to get lab results in about an hour. However, Mazimbu’s machine is broken this year and they have been sending the blood samples to the main hospital campus, Sua, just a few miles away.

So, if Sua has the same machine, why the longer wait for results? It seemed a consultation with the head of the lab, David Mwanuka, was the logical next step. Well, it turns out the delay in results is due to a transportation issue. The hospital only has one transport--the single ambulance--and it goes to Sua once a day, at middday, delivering new samples and picking up results from the previous delivery. We asked if WE could send a driver over to Sua with the sample and wait for the results. Sure, no problem. So that is what we did. We had results back by 4 pm and started her surgery at 5 pm. And it is a very good thing we did. Faudhia had a ruptured appendix, which, by the timing of the onset of pain and swelling, we think ruptured 4 days ago. Her abdomen was completely full of pus—2 liters--and other nasty stuff. Had we not been able to do surgery until the following day, Doug thinks she may not have survived overnight. And this morning when we arrived for work and checked on her, she was awake and alert and smiling in bed. Praise God!

After our long day on Wednesday, we enjoyed dinner out under the stars at one of our favorite restaurants, The Arc Hotel.

Moving to today, the line of patients waiting on our arrival was substantially longer that the previous two days. And, again, Doug was booked in the OR with four procedures so his time in clinic would be minimal. It became clear very quickly that the patients waiting would be all that could be seen today—we could not take any additional that may come for services. That is always very hard for us, as Americans, to turn away people that are seeking help. And of the thirty-one patients that we registered, most had to wait five or six hours to see the doctor—some even longer. Our last patient was seen at 6:45 pm. But Tanzanians are willing to wait patiently for as long as it takes. Something we, as Americans, would never accept.

First Day at Mazimbu

When our daladala pulled in to Mazimbu yesterday afternoon, our patient bench was empty, so our visit was only to accomplish our formal first meeting to greet our co-workers at Mazimbu and to unpack our medical supplies. But this morning, our first official day, began with patients awaiting our arrival, sitting patiently on our benches.

Much planning and discussion went in to our game plan before today.

But first, let us give you an outline of what our work at Mazimbu looks like—we work concurrently with the Mazimbu staff. The hospital is shaped like an inverted U, with the Mazimbu reception area on one side of the U and our reception on the opposite side of the U. Once our patients have been registered, they enter the U and meet with our nurses, who gather their history for the doctor. After they have met with the doctor, labs or pharmacy may be ordered. Mazimbu lab techs will pull the blood and run the tests. The meds may be filled by our pharmacy or, if it is not a med we brought, by the Mazimbu pharmacy. If an EKG or an Xray or an ultrasound is needed, it is performed by Mazimbu staff.

This year two of the Mazimbu doctors are working with Doug as team doctors because they each can help in different ways—

                Mazimbu’s Dr. Swai is a gynecologist so his focus with the team is women who need a surgical solution but cannot afford the cost.

                Doug’s focus is people who need a surgical solution, other than those who are within Dr. Swai’s scope.

    Mazimbu's Dr. Kivuma is a general practitioner who can help those who are not surgical candidates.

Ok, back to our game plan. Lines are a way of life here so Tanzanians are content to queue up and wait in line, all day if necessary, for their turn. The tricky part is taking a well ordered single queue and separating it into three queues—one for each of our three doctors. In this culture, this just cannot be done. Our translators are invaluable and without them we could not carry out our mission. But God has blessed us with three amazing men who are so much more than translators. Kishumu and Eliah are young Maasai men who are relatives of our very close friend, Tisho, and Epsilon is a brother to Gamma, who has also worked with us over the years and is now married to one of our two-time former team members. These men have helped us in the same manner that Tisho and Gamma have in past years—not just translating, but advising on ways we can say or do things better in this culture. With their help we were able to quietly and diplomatically triage the line in the order needed to allow the doctors to help all of our patients.

Renewing Relationships

Sunday Afternoon and Evening

The graceful grounds of Lutheran Junior Seminary (LJS) will be our home for the next two weeks. This campus began as a seminary but over the years has changed to a boarding school for middle and high school age children with a Swahili language school that serves students from around the world. Although the focus of the school has changed, the name remains the same.

Arriving yesterday shortly before the family-style dinner was served, we scrambled to unload our mountain of bags so our bus driver could leave and we quickly dropped everything, untouched, in our rooms. Dinner was a selection of rice, boiled potatoes, baked beans, beef and carrot stew and fresh cucumbers and tomatoes.

Although the long trip and lack of sleep was apparent on the face of every team member, directly after dinner we met in the common room for our first team meeting where we discussed some of the cultural differences that are important for us to know and observe. A brief plan for the next day was outlined, but Cindy warned to consider all plans drawn in very light pencil!

Meeting concluded, the team turned to unpacking and settling in to our basic but clean rooms. All are furnished with a foam mattress on a frame, a cabinet for clothing, a mat on the floor and a trash can. And a self-contained bathroom!. The bachelor boys (Chris—because his wife is not on this trip, Will and Zach) have individual rooms near each other in the B wing. Both married couples are in the H wing and have rooms with a large bed and the 4 solo women are paired up in the F wing with Cindy and Pati right next door to Ashley and Nancy.

Monday Morning

We are not yet on Doug’s early morning rounds time table, so we took our time with breakfast (yogurt, granola, the local porridge called uji, and toast.) Our attire is our Sunday-go-to-meeting best since our first stop is the diocese office at the parish in Morogoro of Mjimpyia. Bishop Mameo, the bishop of the Morogoro diocese of the church, is currently in the US for a few weeks so his assistant, George Pendua, formally greeted the team. We were warmly welcomed and treated to a tour of the multi-story church that, year by year, is ever nearer completion.

Communication woes were solved this morning when our friend, Kishumu, and his cousin, Eliah, helped us get set up with a wireless modem and activation of the team phones. This means that we will all have access to good, fast, internet every evening in the common room. We are all pretty stoked about this!

Lunchtime found us at a local restaurant, the Hilux, where we enjoyed typical Tanzanian food. Our day will finish at Mazimbu, the small government hospital where we will be working. We will be greeting everyone at Mazimbu and showing the new team members the layout. Once the formalities are concluded, we will unpack our medical supplies and medicines and set up our work spaces, including our locking pharmacy. We do not know what we will find when we arrive but are prepared to begin our work if hopeful patients have already begun to arrive.

Safely Arrived in Dar es Salaam

Just a quick introduction to your team this year--

      Doug Treptow is our surgeon and is joined by his wife, Glennis, who works as our pharmacy tech. The Treptows live in Rogers, AR and this will be their 6th trip to Tanzania.

      Lance and Eileen Miller are retired and live in Hot Springs Village, AR. Lance is an engineer and a car enthusiast and works as a "fundi" or fixer. Eileen is the church organist and directs the choir and will be helping Glennis in our pharmacy

      Cindy Pennie is our team leader and is a retired RN from Stillwater, OK. Cindy has led the team each of our 10 years and, before that, was a member of a different medical team twice. 

      Pati Murdock handles team logistics. She manages a law firm in Rogers, AR so those skills carry over to our work here. This is Pati's 10th year to serve.

     Will Murdock is Pati's oldest son and she is so happy to share her love of Tanzania with Will, who is a Junior at Metropolitan State University in Denver, studying Industrial Design. This qualifies him to be our 2nd "fundi" so he and Lance will be putting their tools and mechanical knowledge to the test.

     Nancy Bean is a retired veterinarian from Texas, who has served on the team three times before this year. She will be working with our patients and doing initial interviews and triage.

     Chris Buzzelli and Ashley Jones are surgical techs who work with Doug in Rogers, AR. This is their first trip and they are looking forward to working with their Tanzanian counterparts as they scrub in and work with Doug in the surgical theater.

     Zach Lewis is a sophomore at OSU studying management information systems. Zach will be assisting the team wherever help is needed.

36 hours of travel

Our travels yesterday took much longer than we originally planned. Team members left from Dallas, Houston and Oklahoma City and met in Washington DC for the 2 international flights--DC to Zurich and then Zurich to Dar. The rest of the team left from (XNA) Chicago to Newark for the flight to Zurich, which is where the team met all together for the first time. 

Connections were very tight for the Arkansas group. We landed in Chicago with just enough time to make it to the plane. Newark was a different story. We arrived much later than planned so we had to make a run for it! As we arrived at the gate--4 of the 5 of us--they were ready to close the doors. They told us we could not wait for Glennis (who had made a pit stop) so we boarded the plane. Our lagger panted up to the gate moments later and they did let her board--thank you United Airlines!

We enjoyed visiting in Zurich during the short 1 hour wait to board for Dar es Salaam. Once boarded and settled in for the long (11 hour) flight, the plane taxied to the runway...and stopped...and stopped...and stopped. After half an hour the intercom crackled and there was a long speech in Swiss-German. Followed by the English version that told us mechanical problems would require a repair, we would be asked to deplane, it should only be 3-4 hours, and please accept Swiss Air's gift of CHF 20 for food and beverage, and please stay in the terminal (with the other 280 passengers) and you can use your choice of 2 restaurants or Starbucks.

Four hours later than planned, we were wheels up and finally landed in Dar es Salaam at 1 am. Quick--we arrived on the 23rd instead of the 22nd--change the date on all our entry forms! All 21 of our check bags arrived safely, with some minor scuffs or rips and tears.

We found our beds at 4 am and are now writing this blog from the Southern Sun, after enjoying a sumptuous brunch. It will take us most of the day to get to Morogoro and get unpacked. Monday will begin our first day where we renew our acquaintances with our friends and coworkers in Tanzania. We cannot wait to begin!

Countdown--Just 2 Days Until We Leave

The team for this year is in our final stages of packing and last minute arrangements.

We leave the US on Friday from different airports and come together for the first time in Zurich. From there we fly to Dar es Salaam and arrive late Saturday evening. Our first night will be spent in Dar and we will travel on to our final destination, Morogoro, Sunday morning.

We will post to this blog as often as possible. That seems to be usually about every other day. Remember, we love comments! The team usually spends the evening together after dinner each night, reviewing the day and discussing the blog and we love to share your comments with the team.

Please keep us in your prayers for safe travel and for us to do the work Christ has waiting for us.