Postcards are all sent......lets hope they all arrive.

Public Holiday

So we have a public holiday here today in Tanzania. Sadly that seemed to mean that that Swahili church service did not take place this morning. Nevertheless we made the most of it and Enoch and I went up onto the roof of KCMC to get some great views of Kilimanjaro.

T.I.A

We have officially run out of water. Houses all across the doctors compound a gradually running out. We're uncertain as to whether we have been cut off or if the supply has dried up. To make matters slightly worse, our fridge is more like an oven. Fun times :-)

Lushoto and the Usambara Mountains part 2

We had an amazing lunch at Irente Farm. Homemade rye bread, cheese and jam. Irente Farm is a conservation area owned and run by a Swedish lady and her husband. They have been trying to reintroduce many of the indiginous trees back into the area. Much of the Usambara Mountains are populated by eucalyptus trees which were originally planted for their quality timber. After lunch, we then hiked on to the Irente viewpoint on the western edge of the Usambara Mountains. We were greeted by astonishing views out overlooking the Maasai plains. It was hazy (because of the heat) but nevertheless a beautiful sight. At an altitude of approximately 1500 metres, on a clear day, I am told that you can see Kilimanjaro from Irente - 130 miles away! Our second night in Lushoto was far less eventful than the first - no more exploding water pipes. We had managed to arranged a taxi to take us down into Mombo and then catch a fast bus back to Moshi. Our driver however had other ideas and decided to pick up two locals en-route which turned our journey into one more like that experienced in a dalla dalla. The bus journey to Moshi was infinitely more comfortable than our outbound trip even though the driver felt it necessary to absolutely floor it along the Dar-Moshi highway. All-in-all, an amazing weekend had by all with some of the most amazing scenery I think I have ever seen.

Lushoto and the Usambara Mountains

We left early on Friday morning to catch a bus to Lushoto - about 130 miles south-east of Moshi. About 5 hours into our journey we arrived at the town of Mombo at the foot of the Usambara Mountains. We then began our ascent into Lushoto along a single-track road with sharp hair-pin bends. This was slightly daunting - made worse by the fact that there were no barriers to stop you plummeting off what was essentially a cliff and that the driver felt the need to travel at 50 mph and not used his brakes nor slow down for traffic.

Lushoto was absolutely beautiful - lush, green, hilly countryside, unlike anywhere else I have been before. At an altitude of approx. 1400 metres it was cooler with a nice constant breeze which was refreshing. This also meant that sleeping was more comfortable and warranted the need for a warm blanket. All was well until 4am on Saturday when one of the water pipes in our bathroom decided to explode and send 'clean' water cascading everywhere. Unable to find the stopcock nor anyone who could be of assistance, I spent the next 2 hours making certain that the bathroom was not flooding. Thankfully, shortly after 6am there was a power cut and the water stopped flowing for the time being.

We then met up with a group from the hospital in Muheza (where I had previously applied to do my elective) and went hiking for the day. We were led by three fantastic guides from the Friends of the Usambara Mountains Cultural Tourism Centre. The morning consisted of hiking through villages and farmland then further on up into the rainforest. We then emerged from the forest and climbed to the top of Magamba Peak. 

Sadly, shortly after this, my camera battery died and I had left my charger back in Moshi. So for now, I'll be saying goodbye, but more to come when I can get the photo off my phone and write about our afternoon hike to Irente Farm and viewpoint as well as our trip home today.

From left to right: Lindel, myself, Laura, Jaye, Fiona, JR, Enoch, Turbo, Talia and Lucy.

Had an interesting couple of days with regard to medicine. Had some great teaching yesterday from one of the British doctors (Dr Howlett) who has been at KCMC intermittently since 1983. He spoke to us about the causes of paraplegia in East Africa. One of the major causes is konzo - a disease associated with high-dietary intake of cyanide, primarily from the cassava plant. Dr Howlett himself helped to describe this disease in the Lake Victoria region during several outbreaks throughout the 1980s. More stories to come, but for now, a few more pictures...

Ultimate frisbee

At the Marangu Gate

Dinner

Had a great day today. A group of 20 of us (mainly Aussies and a few Brits) headed out towards the Marangu gate entrance to Kilimanjaro National Park. Had a little walk around there then moved on towards a nearby waterfall and coffee plantation. The waterfall was spectacular as you can see. Very hot and humid but no swimming unfortunately because of the risk of schistosomiasis. Back into hospital tomorrow......

The first few days here have been very good. Spent Monday sorting out various admin things and paying KCMC for accommodation etc. Can only take cash out in shillings then exchange into dollars so ended up carrying around 700,000 shillings - too much to fit in my wallet. Moshi is a lovely place. A real eye-opener but has lots of character and great views as it is dwarfed by Kilimanjaro. Everything seems to slope upwards towards Kili.

Have met plenty of other elective students - a couple from Scotland, lots from Australia, a few Americans and some Germans. The accommodation is pretty basic but comfortable. Still far better than the conditions that the majority of the locals have to live in. The electricity has a habit of going out a lot - this is 'interesting' to say the least, especially when midway through cooking dinner.

Tuesday was the first proper day in the hospital. Hospital life starts with a 7:30 meeting followed by breakfast (pancakes and fruit) then onto the ward round. Tuesday was a real wake up call - 72 patients on our team's side of the ward. Many patients are dying from conditions that easily treated in the western world but there simply aren't the resources here. It has really made me realise how privileged we are at home. A few examples are that thyroid function tests are only available on Thursday; serum electrolytes cannot be done; chemotherapy is not available unless the patient has Kaposi's sarcoma; there are ten patients to each small bay (not to mention those on stretchers in the corridor). Patient confidentiality does not really come into play - not for want of trying, but in such conditions it is not physically possible.

The variety of presentations has been huge in just a few days. I saw more infectious and tropical diseases in a day than I have seen throughout the whole of medical school. HIV is a huge problem here and this just complicates many matters furthers.

I was rather surprised to learn that there are no "do not attempt resuscitation orders" here. At first I thought there might be a cultural reason for this but when I discussed the matter with one of the British doctors, he said that the staff are trained to preserve life and often don't consider whether an attempt at resus will be successful or futile.

Death is daily occurrence. It is not uncommon for 10 patients to die each day on the medical wards alone - that's about 10% of the hospitals medical capacity. This was brought home towards the end of the ward round on Tuesday when there were cries coming from the room next to us, followed by wailing, screaming and relatives coming out in floods of tears.

That's enough for now. I'm not sure what the plan of action is for today (Saturday) but tomorrow we are all going to Marangu waterfall which is further up Kilimanjaro.

Tanzania number

+255 712 266 992

Jambo

Jambo from Tanzania. Finally arrived after two plane journeys. All went smoothly and had some great views of sunrise over Ethiopia as we came into Addis Ababa. The second flight to Kilimanjaro was a slight disappointment as much of southern Kenya and Kilimanjaro itself were covered in cloud. Was met at the airport as previously arranged and had a good - and somewhat eventful car journey into Moshi. We were flagged down by a police officer who then proceeded to get into the car as he want a lift into town. Currently at a hotel near to the hospital before moving in to the doctors' accommodation tomorrow.

Ready to go