Happy New Year

Happy New Year

Weather: Sweltering

Swahili Word of the Week: “Upo? Nipe!” My favorite greeting in Tanzania. Literally translates to, “Are you there? Yes, I am here! “

Special Shout Outs: To the lovers of mail, its been a great week at PO Box 80297! Chloe- Loved the package, thank you!; Picky- Great Christmas Card, and GREAT house, hope there is room for auntie alice; Kate, Rupert, Amy and Lila- Your Christmas card made me smile and the glitter remnants are scattered throughout my office; Ronnie- Love the Christmas card.

I am sorry for the long gap and lack of communication from me and my side of the world. I wish I had some glamorous excuses (well I have a few) but more than that is has been hectic with a capital H out here lately. This note will hardly suffice but here goes anyway…

I have been busy with work with a variety of projects. The most labor intensive is working with representatives from all 67 of the nursing schools to develop, design and format standardized nursing lesson plans for 3 years of nursing curriculum. The lack of books and access to up to date teaching materials plus the huge shortage of nurse tutors created a need for standardized lesson plans that all nurse tutors could use as templates to teach the nursing students. Work is well underway and I will be traveling around all of Tanzania in February to check on progress. The libraries and skills labs are in progress. Mum’s charity kindly donated stacks of new nursing textbooks to our libraries as there is such a need. We had a party to inaugurate them where over 40 people came. It was like little kids and candy, we could not keep the nurses away from them, they are so excited to have access to up to date information (many books here are from the 1960-80’s). I spend every Friday volunteering at the local ICU which is always fascinating and gut wrenching at the same time. But I love the patients, nurses and docs too and it’s a nice combination of learning and teaching…

Dar has become very hot again, to add to this we seemed to have missed the short rains completely. Everyone is distressed not only for the maize and kasava planting but also because the government has not properly rationed the water for hydroelectric power so now we have daily power outages ranging for 4 – 12 hours and no water at all Saturdays and Sundays. Hmmmmm On a lighter note Mangoes and plums are now in season so Hip, hip hooray.

Mum and I have been busy traveling, Zanzibar for her birthday which was heavenly. Pemba island for snorkeling and relaxing for Christmas. This included Christmas dinner of a clove infused turkey (Pemba is the island of cloves, clove turkey sounds weird but it was delicious!) and then we went up to a river camp in the Southern Highlands for horse riding, hiking bird watching and swimming. Not that I’m bragging BUT we saw a 6-foot python swimming in the river right next to our path AND an endemic Loveridge Sunbird in the Udzungwa Mountains. No big deal!!!

Mum has been visiting for the past two months and has extended her stay to take care of me (and avoid the frightening UK weather). She has been a star taking care of house stuff and garden stuff and of course the chickens. We have had some chicken excitement in that they contracted either mites or lice. So new years day was spent sprinkling them with insecticide powder and rubbing their combs, legs and beaks with Vaseline jelly to suffocate the bugs. Happy 2011! We did end up having a lovely evening sailing on a dhow and watching fireworks from 4 different spots. Lovely.

No real updates on 2011 but will keep you posted. I am heading to Bangkok for 10 days in January as we have been shortlisted for an award and then I plan to be in the US in May for the birth of my Niece/Nephew (whoop, whoop).

Much love and Happy 2011,

Alice

Planned Planning

Weather: Has been glorious, last week stepped out of my office and whoosh, HOT and humid, just like that. There goes winter.

Swahili Word of the Week: Mukutano- Meeting

Special Shout Out: Vive La France, Enjoy the French Party. Wish I was there with you. I hope no one ends up with cheese in their underwear!
Rita, loved the card and photos, I have them pasted around my house, Thank You!

Planned Planning

When I was about 18 and Heather was 16 we watched a show that stated that a common similarity between successful people is they have a life goals list. It may be in a book, scrap of paper on simply in their head but as they go through life they are moving towards solid and set goals. We proceeded to write our own goals list, and we still check in once in awhile to see how we are doing. A nice ritual I enjoy and it does help define my somewhat nebulous life.

Life goals are one thing, but what about country goals, continent goals and world goals? It is easy to set a goal to climb a mountain, it is something else to say you are going to lower child mortality rate by a certain percent in a certain time frame. Millennium Development Goals have been set and 2015 is quickly approaching. Unfortunately I think will not all be met. There are many theories on why aid and Africa has not worked for the last 30 years. I do not even begin to believe I would know the answer to this burning question, but I do see on small scales projects that are successful and many that are not and like the life goals of successful people, the similarity that I commonly see is planning.

I have been working in the hospital on Fridays. It’s a highlight to my week and makes my office work seem more worthwhile because it reminds me why I am doing this. Right now I am simply orienting in the hospital, in anticipation of students arriving in November, when I will become their clinical instructor. Orienting to the hospital is the BEST. You have no true responsibilities so if I am in the ED and I see a woman come in with her bowels hanging out I follow her into the trauma room, or I can simply sit with a patient and hold his hand. You get to nurse because your job isn’t doing the 50 other things that nurses do, its simply nursing the patient. But back to planning! The ED is a swanky new one, sponsored by a US company. The contractor who put it together, I am sure, thought he was doing a good job. The problem was planning. The IV tubing does not fit the peripheral IV’s so both are useless. Batteries in the machines are not rechargeable so most sit without being used because they are all dead. Staff (especially nurses) weren’t trained to use the new equipment so much of it sits unused. Sustainability is the big buzz word in aid right now, but as cliché as it is. It is essential to plan well so that the time and effort and resources are utilized well not just now but for years to come. Yet sometimes the best laid plans don’t work as well. Plans need to change to the environment, culture, and setting. A plan built in a vacuum that is unchanging I believe is worse than no planning at all.

The lack of planning does not just come with aid agencies, the Tanzanian government is just as much to blame. No infrastructure planning, no city planning, buildings are going up all over the place. Still worse IS the plan to build a gigantic highway through the Serengeti; environmentalists are saying the migration will never be the same. Not planning for the future.

It probably has not made international news here but we are all gearing up for the election on October 31st. As most African Countries can attest to, we know our winners already. CCM is the leading party. I was surprised at their lack of confidence of a win (contrary to what everyone tells me on the street), there lack of confidence has shown itself by the party pasting green and yellow EVERYWHERE. Every billboard, sign, poster is CCM. Not only that, though this is good planning, CCM somehow made it legal to tack on a 10% fee to every, I mean every, phone call or text message. Profits go directly to the CCM party. You have to subscribe out of it. I cried that’s illegal to my work colleague Stella, she laughed and said who do you think made it legal?

It is not all gloom and doom here though. Some of us are planning well! After planning to get chickens for months (on the life goals list, tick), and having an empty coop for months, they have finally arrived. Moja, Mbile, Tatu and Nne (1, 2, 3, 4 in Kiswahili). I am off to do nursing school site visits crossing almost ½ of TZ by road this upcoming week to make it back in time for Halloween party in Dar. Mum is arriving in November with lots of exciting activities planned, and finally Heather making it out in January. Hip, Hip Hooray.

Skills labs are getting placed in nursing schools in January, Mum and Mediae Trust have donated masses of textbooks to 3 nursing schools which they are in dire need of. And an Image of Nursing Media Workgroup in November and our curricula developments are well under way. Its all go, go, go!

Connections and Communication

Swahili Word of the Week: Kwanza Kalima- Farmers Fest, Nane Nane- literal translation 8 8, or Aug 8, date for Kwanza Kalima.

Weather In Dodoma; Arid, Dusty and Biridi Sana at night.

Special Shout Out: Happy Birthday Little Viv!

Connections and Communication

This past weekend our team traveled up to Dodoma to celebrate national farmers day. It was a huge event covering 400 acres. It was seriously quite a spectacle, similar to a county fair but African Style (lions on display, roasted goat meat on a stick etc.). We went because we were supporting the Tanzania National Nurse Association who set up a booth to check random blood sugars. The Tanzanian Ministry of Health set up a “city” of health in the middle of nowhere complete with blood donation, dentistry, ophthalmology, pediatrics, cervical cancer screening, sugar checks, mobile lab, HIV screening. It was very impressive, so much so, that they won the overall Prize when competing with all the other Ministry’s (including the Ministry of beekeeping, YES beekeeping). When traveling up there it went through my head, “what was the point of many, many top level officials taking the entire week off”, not to mention the prep time to travel to the middle of the country to stand in a field under a tent to talk about their work. I have learned living here though that often my perspective, judgment and preconceived notions are wrong, and yup I was wrong again…

Communication here is different. There is the obvious; that a greeting will often go on for 3-5 minutes. Hello, Whats the News? News is good. How is your Home? My home is fine. How is your work? My work is fine. Is business good? Yes, business is good. Are you here? Yes I am here. (this is my favorite, though it is better in Swahili- Upo- Are you there? Nipo- I’m here!). This is done with almost everyone you meet. It is considered rude to pass someone and not at least ask how the news is.

Then there is the subtle communications that I blatantly butcher and am just forgiven because I am a visitor. When someone comes to your house you say Karibu-Welcome. And then you go and get them juice. Instead I would welcome them and ask if they wanted chai, water, juice, soda etc. In Tanzania this is considered rude as I am showing off with all that I have to offer. I learned this the hard way.

Communication is also key with work and getting tasks accomplished. Email is very rarely an effective way of communication. I send them and they go into a black hole with about 10% getting a response. Internet and electricity are luxuries that are often not consistent enough to rely on. Cell phones are everywhere and most Tanzanians carry at least 3 if not 4. Why? Because the networks are much cheaper to call from the same network. If someone is on Zain, I will call them using my Zain phone. Makes life very complicated.

Face to face time is the best and accomplishes the most. After working the developed world there is something endearing about doing business face to face. You don’t misinterpret what someone says (like in an email), you can cover a lot in one meeting and finally you really form a relationship with someone. In Tanzania relationships are key, if you have a relationship with someone the job gets done, if you don’t, it doesn’t. This brings me back to Kulima Kwanza. The amount of networking, sharing of information and meeting of the minds at this festival was evident and more got accomplished then I could have imagined.

Our Nurses collected 300 pints of blood, checked 810 blood sugars (with 20% being referred to treatment!). I also was lucky enough to meet the president and discuss nursing in Tanzania! Unfortunately, as you will witness in the photo, I was wearing quite the outfit to try and avoid the sun, wind, dust storms but oh well so was he; a plaid jacket, neon green polo and white hat. Please don’t report either of us to the fashion police.

Miss you all.

Signing Out from Dar…

Patience and Patients

Swahili Word of the Week: Haraka Haraka Haina Baraka- Hurry, Hurry has no blessings

Weather: Mild, Breezy with the occasional shower.

Special Shout Out: Danny and Lynn- I am so excited!

Patience and Patients

As you grow older you begin to realize your traits and how hard they are to change. My thirties have been a time where I have learned to love myself for all my faults, pet peeves and idiosyncrasies. That being said, I know I am not a patient person. I turn into the evil lady who hates children when they kick my seat on the airplane. I will become mkali (fiery) at the taxi driver that does not take the jam free way home and don’t get me started in waiting in non-moving queues.

It is amazing that I have chosen to spend the following year in a country where every phrase seems to relate to the fact that going slowly or taking time is rewarded where haste and speed is considered reckless. I am looking at it as life test, at times it pushes me to the edge of sanity as I try to use logic to resolve issues. There is a different type of logic here but in its own way, it’s a beautiful and endearing quality of tanzanians. Their patience appears to be endless. I try and focus on this rather than the annoyed and impatient voice in my head that starts an inner dialogue on how this could be run so much more efficiently. Tanzanians appear not to get angry or frustrated. I have not seen road rage, middle fingers or swear words even though the traffic is some of the worst I have experienced (though they do like their horns). They wait in hot, disorganized lines without complaining and will chat away as my frustration builds and builds. I obviously have much to still learn.

This weekend I was lucky enough to get to ZIFF- Zanzibar International Film Festival. There were some great films, lots of live music and a great atmosphere. On Saturday afternoon I headed north to Kendwa in search of white sand and turquoise waters; I was not disappointed. We took up a Chai Maharage (translates literally to “tea and beans” because you sit on benches in the back of a pickup truck facing each other, similar to when you sit across from the ladies who sell you tea and beans for breakfast!) which when I asked the conductor how long it would take, was nicely surprised when he answered 50 minutes- 1 hour tops. Two hours later I kicked myself for believing him, when I asked my friend why the man had said an hour was told “it was to keep you warm” ie he gave me an answer I wanted to hear. The journey was only about 50km on a relatively good road. “Why?” you ask, did it take so long to go that far. Well quite simply in the fact that the driver stopped about every 100ft to pick up or drop off a passenger. This was infuriating to me. We would pick up a passenger and then get going only to stop within easy walking distance to drop off someone else (and of course each person getting on/off would have bananas, children, sewing machine, spare tire etc.). Meanwhile there were nicely placed blue signs in appropriate areas of the road saying “Bus Stop”; No one stood at those. After about 20km of stops and starts I had started to lose my cool and asked why people didn’t gather at the bus stops or at least in a couple central locations in each village. The reply I got was “This is Zanzibar”, I guess that is an answer I can’t really argue with.

After a fabulous weekend away, I returned to my new house newly furnished. On average my furniture arrived about 2 weeks late per piece. I would call everyday to see progress after the deadline for completion had passed. Each day I was told “Kesho Dada”- Tomorrow Sister, again it was so I stayed “warm”.

I am happy to say after a good 6 months I am now officially a TZ nurse and will be volunteering at the national hospital. I have missed my clinical practice and am so looking forward to working with patients, especially here. Patients here have a completely different outlook on medical care. It is a privilege, one that they will wait for hours and days to experience. The national hospital here has patients on the ground, outside on gurneys for hours and dead bodies often in the halls for hours til they are finally transported to the morgue by overworked and understaffed employees. When going in to get my ID card, I passed through a medical ward. I stepped over a patient who was breathing about 32 times a minute. For the non nurses out there, respiration rates are generally between 14-14 times a minutes. In the US this person would be sitting up, oxygen applied and most likely having breathing treatments. This lovely girl was instead of the floor, flat on her back looking very uncomfortable, but not complaining and waiting patiently until the nurse could attend to her. The nurse was frantically looking after another patient that was worse off than this one.

Work has been amazingly hectic, but with that it means we are moving forward nicely. How exciting! My place has spare room so if anyone needs a vacation, Karibu.

Are you happy to be back?

Swahili Word of the Week: Nitarudi- I have returned

Weather: Glorious, light breeze, sunshine, low humidity and a cool 28 C. Perfect Beach weather, definitely where I am headed this weekend.

Special Shout Out: Oh so many this week…
Ellen- you are a legend in packing, how I couldn’t have done without you.
Dad- Flying up to SF meant so much and who would have thought we would get our mountain of a to do list done and still get to Swans!
Heather- Thanks for flying all the way from NY to see me, loved our Epic Trip and yes there will always be the Tiburon
Kate- Hostess with the mostest
Nons and Si- Awesome dinner party
Mum-Love the London Time, Oliver!, camera and the skirt!
Chloe- my birthday card from you is officially the best I have ever gotten, thanks for the laughs
And everyone else was amazing too, thanks for making home such a great place to come home too.



Are you happy to be back?

I have to say it was with some trepidation that I returned back to SF to finalize the move to Dar. Moving out of Hoffman seemed like cutting the last tie and I was worried upon return, that I would realize I had made a decision that was not right for me. Although it was great to see everyone and everything, the trip home confirmed that at least for the next year, the decision to stay here is a good one.

I was able to visit both my old hospital floors in SF, and although I miss bedside nursing tremendously and miss my patient interactions, I came to realize that it will always be there. I have a chance to affect change on a large scale here in Tanzania and I am going to remain focused and motivated on that thought.

Making it back to SF, SB and London was such a treat. If you ever need an ego boost moving out of the country is a good way to get one. I got a lot of ‘is it good to be back?’, ‘are you having culture shock?’ etc. And yes it was good to be back and no I didn’t really have culture shock. I have had it before; going into Whole Foods on the first day I got back probably wasn’t the wisest choice but it wasn’t as bad as I have had it in the past. Maybe because I am getting used to the to and fro or maybe I have become jaded (hopefully not). Similarly, when I got back to Dar I was greeted with a Hero’s welcome. Not just because I was bearing gifts, but a true welcome ‘home’.

Many of the nurses were happy to have me back and gave me a little pump up for the slog ahead. I wanted to share the following email, not because he sings my praises, but because I really believe people here are doing such great work with limited resources. We need to remember that sometimes recognition can be reward enough.



Hi Alice!

I am very happy that you are now back to Tanzania.
I thank God that your trip was wonderfully and you traveled all the
way safely.
Thank you very much for appreciating what we are doing here at Kiomboi,
you have impressed my heart,for me is enough just knowing that there is somebody somewhere
who real recognize our work.For sure i tell you Alice,we do a lot of important things
here but few people do recognize.
I have got an information also that you have brought some books,thank you so much.
This library is real helping us and our students too, although Hospital staff members are not
yet motivated to use our library but I believe one day it will be of great important to them too.
Thanks also for the fund and every thing.
Your welcome once again here at Kiomboi and see the progress.

With Humbleness


I am not normally a promotor, but I discovered a great organization for those that want to support African and Global Nurses http://www.grettafoundation.org/

Asante Sana

Uuguzi huleta afya...Nurses bring health!

Swahili Word of the Week: Uuguzi huleta afya...Nurses bring health!

Weather: It is perfect. Blue skies, Upepo season has arrived and it is lovely. Breezes, sun and clear air. I love it!

Special Shout Out: Thank for all the birthday wishes and cards. Made my birthday season!

Nurses in Tanzania

So as I prepare for my trip home (YIPPEEE) I contemplate my time here so far. Last week was a very nice summation of what amazing experiences I have had so far. I had a superb birthday and then traveled upcountry to do site visits on our libraries that we have place in VERY rural areas. This gave me an opportunity to see some of the work that we are accomplishing.

A wise woman once told me (thank you kate campell) about the lollypop theory. Bedside nursing, although very hard work ,generally gives you a little lollypop at the end of each shift. When you walk out of an exhausting 12 hour shift, there is generally at least one thing that you did well and had a positive affect on a patient. The work I do now does not have this immediate gratification, but hopefully in time there will be a huge lollypop that will make up for all the little lollypops I am missing being away from bedside nursing.

Last week I got to have a quick lick of this larger lollypop. After traveling for 2 full days up to Singida I arrived at a nursing school in very remote Tanzania. Although, very minimalist compared to developed nation standards, they are churning out good nurses. What was amazing was the dedication of these nursing students. There were 265 enrolled nursing students, most of them were 18 years old. Very shy, polite and dressed in pink pinafores. The school had a total of 4 nurse tutors for all 265 students. No skills lab and a very, very outdated library. The capacity of the school was 120 students. This meant that all students shared a twin bed. Dorms were set up with two bunk beds so in a 12 x 8 room there were 8 nursing students. Yet when I arrived, they greeted me with shy smile and told me how much they enjoyed and appreciated their new Mobile Library; As did their exhausted and overworked tutors.

We continued on through to 4 more nursing schools and met an amazing third generation Norwegian MD TZ resident whose grandfather was a Dr in TZ in the 1950’s, as was his father and now he is the medical director. They were running an amazing hospital in the middle of nowhere. People travelled from miles around. The tribes around the area are very primitive, I saw my first tribe members with facial scarring. Beautiful. The nursing students here were also amazing. I met with the 3rd year leadership students. As part of leadership they are assigned different school tasks. Some were assigned to the kitchen and as part of the leadership class had just slaughtered a cow (only in Africa moment). These nursing students are entering jobs where they generally have 30 patients, they are underpaid, not respected and very overworked. They share beds, books and uniforms in order to get through nursing school. It makes me proud to be a nurse because nurses are a dedicated and amazing breed.

The trip was grueling on awful roads. I was physically sore from being jostled around for 8 hours a day in the back of the car. My life flashed before my eyes at least three times. Once when a daladala stopped short in the middle of the road. The driver had me in stitches when he stated that “DalaDala drivers are all born from the same father.” This is so true. Every country you go to DalaDala drivers all drive too fast, play their music too loud, stop in inconvenient places and have no regard to anyone else on the road. My second life flash moment happened as we were traveling down from Arusha. We came upon a quite spectacular crash where 4 Lorries had collided. Two being petrol tankers. One exploded, the other lay on its side with about 200 people crowded around it with Jerry cans. I asked the driver why and he said the driver of the Lorry would charge the people to fill up the Jerry can to empty the truck. I guess the nearest petrol station was a few 100 km away so it was door to door service for most of these people. It does make you wonder if the money ever makes it back to the petrol company though, and the safety of emptying fuel in the bush out of a crashed tanker with an exploded tanker a few hundred meters away, hmmmmmm.

Food for thought
Tanzanian nurses comprise over 60% of thehealthcare workforce
By 2020 they will only have 50% of the nurses they need (at the rate their producing nurses)
The average age of a nurse tutor in TZ is 55.

the affair

Weather- The rain is here, seriously. It has not stopped in three days, there are floods everywhere and the city is a sodden mess.

Swahili Word of the Week: Nakupenda- I love you

Special Shout Out: Happy Birthday DAD! You are hands down the best dad in the world and I love you so…

The Affair

No, for all you expecting juicy details about a lover, alas the affair is with TZ not with a man.

I was lucky enough to be invited to a lovely birthday party last week where we chartered a 120 foot, 100 year old schooner. She was a true beauty, many G & T’s at sunset, delicious dinner and then dancing under the star all in the Indian Ocean. LOVELY. While on the boat I met a lovely soul, she and I philosophized about life in TZ. She had read a book called the four stages of culture shock. She thought moving to a foreign country (especially a developing one) was like a relationship. The first three months were the honeymoon period, everything is exotic, new and exciting. The second three months you are settling in, you become comfortable and enjoy it. The third stage you hate everything. The traffic, the noise, the fumes, how slow everything moves and that takes you to the fourth stage. This is where you are truly comfortable. You see the good, bad and the ugly but you take it all in and live your life happily. For those of you that don’t know I have decided to stay for a year. It seems only fair that I make it to stage 4 so I am going to give it a try, though seriously, the project I am working on needs a person on the ground, I am learning a lot and I am liking this shake up of my life a bit. I am so far following the plan and have moved nicely into stage 2, not looking forward to stage three.

I have become to analyze Tanzania in this affair I am having with her. The rain has come this week and it seems to have washed away all the masks and bandages Tanzania wears; she is now showing herself with all her wounds and vulnerabilities. The rain has been incessant and with it has come chaos. Tanzania is stuck between desperately trying to become a modern nation while having little of the infrastructure, governmental support and planning to get it there. I will use traffic as an example because it rules your life here. Tanzania (at least Dar) has a middle class that can afford to buy cars. The roads were built when Dar was a city of 1-2 million, we are now close to 6 million. Roads have not been improved, the public transportation is not really public, it is uncomfortable and not consistent. Finally the ministers don’t have to deal with the traffic. You see them block huge amounts of roads so that they can drive their black Mercedes through the traffic while the rest of us pay dearly for the roads being cleared. Traffic is AWFUL but the rain has taken it to a whole new level. Dar roads functions barely in the sun, with the rain and the floods it stops, literally. Yesterday it took me 3 hours to go 25km. Huge surges of people marched along the roads with water up to their knees, there is no drainage, the dirt roads now have 3-5 foot puddles, taxi’s, dala dalas and pedestrians try desperately to get around. The lack of traffic laws that are always in place (quote from my taxi driver “I don’t worry about traffic lights, no one is going to stop me anyway) seem to become anarchy in the rain. Gridlocks like I have never seen were in every junction. I have to say that I was a little smug when I biked to my local Indian store, talked on the phone for an hour, shopped, ate some dhal and then returned and the same cars were in the intersection. Go Bikes. But it is sad that Tanzania is stuck and I hate to say it but I do not see a solution happening anytime soon. It has made me appreciate urban planning. That being said, they say true love is loving something for its faults, wounds and vulnerabilities. Even after my long traffic days, a quick bike around my neighborhood let me witness my community building stepping stones through newly formed lakes. My local chip seller took my hand so I could balance on them as I marched across. This made me smile and fall in love all over again.

Job is going very well. Started on some new activities, working with many nurse leaders on curriculum development, working on a national standardized HIV course for all tutors and looking into placing skills labs in the nursing schools (right now nurse students practice their first skills on their patients, YOUCH!)