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.