Hamsaidiani?

I have had every possible experience that you can have on a bus here. I had a woman with two chickens sitting next to me, a Masai asking me to marry him (which i didn’t understand, so I just smiled and nodded politely. Until he alerted the whole bus to help him explain to me what he was saying. Once I grasped the meaning I said: Nooooooo no no no) and the most horrifying experience: I woke up and had a baby on my lap. I dimly remembered a woman with a child sitting next to me when I drifted of but now there was a middle aged man in her place. I asked him if it was his baby but he denied. My stomach sank and my mind went haywire. I could obviously not leave it there. I held it up in the bus like the monkey Rafiki held Simba up in ‘the lion king’ asking who’s baby it was. Fortunately the lady was sitting a few rows behind me and took her baby girl back. I was very relieved.

I had a flat tire in one small bus and even a crash where the bus hit a truck that did an emergency break on the highway (that’s why we use seatbelts people).

I arrived on Zanzibar yesterday. Turquoise water and white beaches. Everyone here either works in a hostel, is a kite surfing instructor, sells everything from bracelets over paintings and clothes for tourists or organizes trips to caves and snorkeling trips. It’s quite the opposite to the villages I stayed in before.

I think my favorite place was Iringa. The hostel I stayed in was incredibly beautiful and the owner Eric did a bonfire with us, took us to his friends farm for horse back riding, brought us to the great Ruaha river for swimming, took us to ‘Ismila’ a small canyon where traces of homo sapiens back from stone age had been found and hiked with me to the sunset on my last evening.

Arusha had a beautiful waterfall which we swam in (around 4 degrees water temperature) and in Moshi I went to the ‘hot springs’ – basically tropical island but naturally originated and in the middle of nowhere. The life guards there did an entire acrobatic show with the swing they had there and I was between wonder and anxiety for them to break their necks or the branch to break while little fish nawed on the dead skin of my feet.

Traveling alone is actually the exact opposite of being by myself. It feels like I am with everyone around me. I talk to everyone, i meet people on the bus, in the tuktuk, on my way hiking, in the hostels, on trips. Everyone is keen to help you here and when you ask for directions, they won’t just point out the direction but bring you up to the doorstep of your destination.

Mbeya – the green city

They call it ‘the green city’ though in a dry season like now it is rather dusty. That really didn’t matter though. The doctor from the endoscopy in Ndanda gave me the contact of a friend of his who was supposed to pick me up and help me. I arrived after almost 20 hours on the bus (it’s supposed to be 16 hours but I am simply lucky that way) at 1:30 am in the night. In the end it was actually his cousin who picked me up. He is actually the reason I will definitely remember this city.

Around here it is always a hustle and bustle. Getting on a bus is the first challenge since there are people everywhere trying to get you to enter the bus they work for. Then you have the people who sell snacks up to everything like watches, powerbanks etc. They open the windows and let their goods dangle in front of your face. I don’t think any of us are introverts or extroverts entirely but I once heard the description that introverts are the ones who charge up when they are alone while extroverts do that in a group. From that point of view I am definitely an introvert. An extroverted introvert though still an introvert. So travelling Tanzania by bus proves to be a challenge for me.

What makes it so worth it are the people you meet. Edo, the cousin, went with me for a day trip to lake ngozi, the second largest crater lake just outside of Mbeya. It was a real small adventure. We took a bus to the middle of nowhere – no one except us got of there – and found a decade old sign directing us to the crater. We met a motorcycle driver after a few kilomètres who took us to the brim of the mountain. The environment changed dramatically rain forest-like and we started to hike, passing giant wild banana plants. The path was tiny and I am so grateful for my hiking shoes. By the time we reached the brim of the crater we were sweated through. Edo had been the first on the path and he wasn’t slow. Turns out he used to play soccer for his university and had to run up several mountains when his coach hadn’t been satisfied with the team back in the day. I found myself very grateful for the time I spend in China. Not because I still had the condition from three years ago doing mountain runs every week but because of the mindset that had taken root in my mind back then: ‘If you are still standing, you are still able to continue’. Climbing down on the other side to reach the water felt straight out of an Indiana Jones movie. Edo had the mindset that is quite common around here: ‘We are almost there’. People here will even tell you that when they know you still have 10 kilomètres to go because they think if they’d tell you how far it really is your courage might leave you. Better you think your destination is behind the next corner. Or the next. I was laughing and told him we have another saying in Germany: ‘Don’t praise the day before the evening’. Since I was well aware that we had to climb back up the ‘path’ we were now tracking down I considered that more fitting. We held on to roots, branches and stones and climbed. The sun had already begun to set so we had to turn back before we reached the water completely. We should later learn that we had actually taken the route for rangers and not for visitors. The way we’d taken didn’t bear any footprints and had probably not been used in quite a while… It was amazing really. When we reached the foot of the crater again, we were full of earth, sand and sweat though laughing and congratulating each other. We had both underestimated the other one.

This is how friendship is formed. We talked and played cards into the night that evening after we showered. Incidentally yesterday, one day after the trip, turned out to be his birthday. I ended up being the first person congratulating him at midnight. It’s extraordinary how fast you can get to know someone and how overcoming challenges together builds trust. We celebrated his birthday during the day with his friends and neighbours.

Today I am on the road again. Next stop: Iringa.

Getting to know people deeply is what drives me, what gives me hope and confidence. I hope you have an amazing day!

Kwaheri hospitali

Let’s do a quick walk through the departments I interned in:

First Anaesthesia. The head of the department is an entire story itself. His name is Liundi and he is always joking around with everyone. He took us to his cashew farm the other day and accompanied us to a dancehall once in his ‘shamba car’. That car makes more sounds then any moving vehicle should ever produce. Any second you expect it to simply surrender to it’s many leaks. There are two football teams here from Tanzania whom are always competing and you are either a Younga (short for ‘Young Africans’) or a Simba (swahili for ‘lion’) fan. Liundi is taking his love for Younga to a different level. He is always wearing a scarf with their colours when he is not in scrubs. He works calm and efficient always quick with his tongue to make everyone chuckle in the theatre (OP in german). I’ve learned more about intubation and lumbal punction but I was a little shocked how random the dosages for the muscle relaxants, opiates and sleeping drugs are. Here the anaesthesists are not doctors as they are in Germany. The ones that work here did a two year training for it exept Liundi who studied longer in the capital city. In addition to that the machines for ventilation etc sometimes seize to work. I think it was one of the most interesting but also challenging parts I’ve seen here. Unfortunately I don’t yet have the expertise to help them really change routines, which sometimes proved to be a bit frustrating.

Surgery: They have two different surgical departments here: General and orthopedic. I was mostly in the orthopedic theatre because I came to highly respect the surgeon there very quickly. Erasto doesn’t talk much and is often mistaken for being shy. He is not yet a learned specialist but a ‘general practitioner’ as they call it here, which is why every two weeks a different orthopedic specialist comes from the big hospital Moi in Dar Es Salaam. I learned how exhausting surgery could be when we fixed a distal fractured fibula wearing an entire armor of lead underneath the operation overalls for two hours. I was soaked through aftwewards since they put the air-conditioning on 28 degrees in there. Erasto told me that he favored orthopedics because usually the people aren’t in acute danger and most of them will recover after surgery. When he had rotated through the gynaecology department he had to do many C-Sections and he said that he’d never want to become a Gynaecologist since if something goes wrong – and it’s more likely to since the women only come to the hospital the very first time when they are in labor if at all – you might have the woman and or the child dying under your hands. We don’t really have it in Germany either and I think it’s a very crucial thing that is missing: psychological after care for doctors. No one teaches us how to deal with death and we wonder why doctors tend to become numb. With the culture of endurance being expected here in Tanzania it makes the issue even more severe.

Gynaecology: The department is way to small for how desperately it’s needed. The ward is old and in comparison to the newer ones uncomfortable. I have beem lucky enough to see a few mothers giving birth and the doctor here Mbimbi is extremely good as I’ve mentioned in a previous blog post. There was a hospital architect here who is helping to build a new mother and child ward and give the topic a place congruent to it’s inportance.

Physiotherapy: I spend a day there to compare it to how it is practiced in Germany. From the physically hard farm work most people have problems with their lumbal spine and there were many cases of disc prolapses. The physiotherapist works on a clump foot camp together with german surgeons and has a really cute son who always greets me in the street since I’ve been at there home once and even comes to sit next to me in church.

Internal Medicine: That inculdes sonography and echo, endoscopy, the intensive care unit and the dialysis. The doctor from endoscopy loves what he calls ‘the german efficiency’. He told me us germans are great to have around in an emergency since we act fast. He is a memorable character with his enormous glasses and growing belly always making jokes. Every day I took a moment to visit the ICU because the nurses really grew on me. Dr. Saad who is in charge of the ICU impressed me as Ersato did in orthopedics with his quite confidence and accuracy. We had long talks about religion etc when we were done with work. It’s a very good organised department.

The time in the hospital and Ndanda itself with Chemchem, it’s people and the best food I’ve ever had the fortune of it being prepared for us was amazing. As you can see more then the departments and equipment I am describing the people. I have learned that they are what I value over everything else.

PS: we had a volleyball match the other day against a team from another hospital. I played too and we won all three rounds 🙂

Mwezi wa kwanza

Nimepanda mlima juu nyuma springi. Alafu nimeogelea kwa chemchem. Because I’d been missing the freedom of strolling around in the wild like I used to do in Kenya, I went hiking the other day. I had seen a mountain behind Chemchem and I decided to try and reach the top. On my way I found a house in the middle of nowhere. A man was just standing on the terrace jawning. I told him I wanted to hike the mountain in Swahili and he was laughing. He told me: “Basi” – Leave it. He wanted to invite me for lunch instead. After I passed his house the narrow trail I’d been following became less and less prominent. From my time in Kenya I am used to observing the ground closely. In the beginning there were only a few, but at some point there were more hyena trails then human footprints. That is how you know you are in their territory.

As I didn’t know the area well and I was on my own, I decided to not go too deep into it. I just wanted to climb a little higher. That’s when I found leopard trails. They usualy drag their prey up a tree after the kill so that they don’t have to fight with other animals such as hyenas over it.

That’s when I heard the hyenas calling each other. I know that sound. I fell asleep to it many times in my time in Mara. I took a different route down the mountain following the sound of the water so that I reached Chemchem in the end. It is incredible how much wildlife there is so close to a hospital with an X-Ray machine, CT-Scan, incubators for neonatal care and more. I would have never known if I didn’t decide to go last Sunday and see for myself. Normally the people from the village don’t go hiking. I am wondering: How much are we missing that is just beyond our normal routine? Just beyond the brim of our plate one could say. I am so fortunate to have spend a long time in Kenya learning to value the feeling ‘the wild’ can give you. I am seeking that feeling since then and I am very grateful for having experienced it again just a teenie tiny bit. The best way to protect nature and animals is to teach humans to respect, admire and love it. When one thinks it a personal matter, one will be more likely to act.

As well as that small adventure I am really grateful for people I have met here. The orthopedic surgeon here as well as the doctor in charge of the intensive care unit and one nurse from there have proven to me again that friendship blossoms just the same inspite of us living a different way. The administrator of the hospital even took the time to spend an evening with us discussing everything from our ideas for improvement concerning the hospital to german football players. Thank you very much to all the staff and their families who we’ve met over the time.

And just as important as it is to connect with the locals it’s important as well to notice the others who came here like me. I cherish the people very highly who I can be with and who give you the feeling you can just be yourself. I met another german intern here from Munich and we found us as partners in crime very fast. It’s shocking how fast we as humans adapt, so the two of us kept reminding us and reflecting on the feeling of numbness and detachment you can undergo working in a hospital here. Every day you need to reflect or you won’t notice the little subtleties that make all of us human. We went to the spring almost every day after work and sometimes just gave each other company. Not everyone you meet with ‘clicks’, but when someone does I count myself very lucky.

I am off to playing volleyball now, thank you for reading 🙂

Wiki ya tatu

Chemchem actually turns out to be the name of ‘spring’ or ‘origin’. In the previous blogpost I butchered the word but it’s still the same place we went swimming before. As time progresses and I get more used to the place I sometimes find myself wondering of alone as I usually do. As every person I change with the time. When I travel it underlines and brings out the traits in me that haven’t changed. I find myself exploring, swimming and splashing around like a little child in any place big enough, hiking and climbing up to the top of hills to look down from a mountain. I find myself mystified by sunrise and sunset, it’s colours and the gentle light. I find myself reading. I find myself talking to people trying to understand and to learn. Listening to their opinions and stories. For the three weeks he was with us: Dr. Markus, the gastroenterologist who went with Charlie, Marie and me to Mtwara amazed us all with his stories from all over the world. The ones I loved the most were the ones about how wild Tanzania used to be back than. How they roamed the bush with Range Rovers to reach even the most rural and excluded areas and how they improvised to help each and everyone to the best of their capabilities. He left to help establish a training center in a smaller hospital in the west of the country.

This is the third time now that I hiked up the mountain behind the Benedictin’s quaters and I am sitting here right now, the wind in my ears surrounded by an amazing view while I am writing this. Lately I have been talking more and more with the Tanzanian doctors and nurses that I have known for three weeks now. As I was lying here on my back gazing into the ever blue sky I am very grateful for being here and so very grateful for these conversations. Yesterday I had a conversation with the doctor and two nurses from the intensive care unit (ICU) about faith and tolerance, the ambivalent nature of what we decline as beauty, miracles and the different circumstances we were brought up in and the different ways we were taught. I was greatly reminded of ‘Nathan der Weise’ and the ‘Ringparabel’ since we all believed in something else but after talking for a few hours it became clear that we talked about the same things only with different words. That wasn’t the case for every regard but no one tried to tell the others they were wrong. We just listened and tried to understand.

I have by now seen another birth that luckily didn’t have any complications and the best part is always going to the postnatal ward the next day and finding them rested, happy and healthy. Sometimes I do wonder though. This girls had only been 18 years old. She had been very very brave especially when afterwards there were complications with suturing a ruptur she had endured in the process of giving birth. Impressive is also how Midwifes have a power of their own with their knowledge of different positions, tips for the patient and their experience.

The other side of trying to help people as doctors are the moments you can’t. There are amazing doctors here. Sometimes equipment will be missing, often the patients reach this hospital too late for all different kind of reasons and they have to go on afterwards. Wherever in the world you practice medicine, when something goes wrong we will ask ourselves if we made a mistake, if we could have done anything differently.

“Sometimes you do everything right and things still go wrong. The key is to never stop doing right.” (by Angie Thomas, author of ‘the hate U give)

Wiki ya pili

The first childbirth I ever witnessed was one with complications. The contractions were way to long giving the baby almost no time to breath in between. It was the third child and supposed to be quicker and easier but the umbilical cord had wrapped around the neck of the child so that it was hindered on it’s way out. The doctor joined us and immediately decided that a suction cup was the only way to go. Until that was ready it felt like it took an entire eternity. The worst part was that when we he finally managed to retrieve the baby it was completly blue. I have no exact time but I’d say they gave artificial respiration to it for at least 10 minutes and kept on pinching it to stimulate it. Meanwhile we got the placenta out to be able to stich the uturus. The baby is a boy, he is alive and breathing and currently on the neonatal care unit together with his mother for observation.

I was very impressed by the responsible doctor that day. Already in the morning he took the time to explain every single case on the ward to us using metaphors and even once miming an anatomical structur using one of the other intern doctors (equal to PJ’ler in german) to demonstrate how the urethras and arteries cross. When a cesarean section almost went wrong he ran into the theater (OP) without a surgical coat to protect the scrubs he was wearing from the blood, put on gloves and solved the problem, giving clear but not harsh instructions. The entire time he was strict but not mean, he didn’t shout, he didn’t hold anyone responsible, he just acted when necessary and once everything was back under control he was already joking again. Very impressive.

As for every culture I have had the luck to be able to experience there are a few things that are hard to understand for an outsider. In the hospital the most prominent for us are definitely the ‘pole pole’ – mindset which means ‘no hurry’. Somehow they manage with it in case of crisis. I have no idea how and sometimes they will forget something and when we ask them they will reply as chilled as ever that oh yes, that would be good at this time.

The second one is that they must have taken the saying ‘Nur die harten kommen in den Garten’ (only the strong ones get into the garden) directly to heart. The living conditions are rough and the people only come to the doctor when something is really really wrong after they have consulted with their family, their extended family, their neighbours, the village healer and searched for people who had the same symptoms before around them. After that they might consult a doctor. In the hospital they are expected to be strong. There is no other option. The staff and relatives simply don’t understand them otherwise and therefore the patient will soon feel very isolated. The children are to some extent excluded from that idea but the hand that treats them is from our eyes still a very rough one.

There is no judgment in my words. This is how it feels for the other german interns and me (there are five of us now) from the tiny insight we got. No culture can be declared better or worse in that sense. It is just important to reflect for each and everyone and not just follow what everyone around us does, what is declared ‘normal’. There are a million versions of ‘normal’ in the world that hugely contradict each other. Go see them, experience them and try to understand them even though it might not be what you believe in. As global as the community on this earth is by this day it is crucial that all of us try to understand each other. We don’t have to agree to tolerate and we don’t have to tolerate being treated a way we don’t agree to if we vocalize it with respect and the benefit of the doubt.

Thank you 🙂

First weeki – impressions

I spend exactly 24 hours at Dar Es Salaam, the capital of Tanzania: At 4:30 am I arrived at the guest house of the organisation that runs the hospital in the south and at 4:30 am I left to take the Matatu to Ndanda. The very brief impression I got from this guesthouse/monastery and it’s people was quite fascinating. It seems to be the base for all kind of people from around the world: doctors and volunteers mostly and in the end every occupation. When someone needs an electrician or an architect for example, the St Benedict-community can ask for them and they will come from abroad because they are happy to help. Their network reaches as far as Kuba or the Philippines.

The Matatu ride to Ndanda lasted almost 12 hours but the scenery involved all the nostalgia from my time in Kenya. Over the time there were two different ladys with their young baby girls on their lap sitting next to me and even though my Kiswahili is more than a little rusty they always bought snacks for me too, noticing that I was mal prepared for such a journey. It were always the ones owning so little that had shared with me within the blink of an eye.

There are already two other medical interns here, both girls from Germany and both here for at least a month: Marie and Charlotte. We stay at a Guesthouse run by the Benedictine Sisters which is painted in a happy orange colour and has a garden and a small church-hall. The most amazing thing is that you can actually drink the tab water. It comes from the Makondo Plateau – an accumulation of mountains that protrude over Ndanda – get’s filtered and checked and not only comes from the tap but is also filled in bottles and sold all over Tanzania under the title: ‘Abbey Water’.

Another truly genius construction is ‘Jem Jema’. It is a big pool of water in which we already went swimming once. It looks like a beautiful oasis between the trees and bushes climbing Makondo and is used to propel a turbin which ends up providing a big part of the hospitals electricity.

Jem Jema

The Ndanda hospital has grown rapidly over the last 30 years. The Benedictines founded it as well as a primary and later a high school. It has running water, a CT scanner and a few ultrasound devices as well as dialysis machines. The orthopedics theater which I have been helping and observing in has an X-Ray. Every morning we start with ward rounds, talking to every patient and discussing medication and further treatment. Where the doctors (who are btw all Tanzanians except the head of the hospital) don’t have the required instuments they improvise. As I have been in the surgical department I have seen many small children with fractured femurs mostly from falling from trees. A lack of the required cask which stretches the thigh so that the pieces can grow together again made them build a construction around their patients foot where they attach a weight hanging down from the bed.

The last weekend the two girls and I spent at Mtwara at the beach. We explored and collected shells. I swam every day until I didn’t think of anything else anymore and just existed. Even they jelly fish couldn’t keep me away. I was the only one who they seemed to always get. Every time it felt and looked as if I’d touched a nettle. And it was the most amazing weekend with card games into the night, an ocean so close the sound never left us and a good book. ‘Die Attentäterin’ isn’t exactly the light beach read you’d expect. In the center is the conflict Israel and Palestinians and even though it’s an older book it captures the ravine that streches into our present. I can highly recommend it, though it involves the real violence of the crisis.

With Marie, Charlotte and I travelled to Mtwara also a freshly retired gastroenterologist who had worked in Ndanda hospital over 30 years ago as a young doctor. We can listen to him for hours. He’s got more stories and adventures to tell than I could even imagine. He was here with his wife and kids for 3-4 years helping the hospital develop, training Tanzanian staff and providing ground care for villages so engulfed by the bush they had to travel for hours. He brought the first ultrasound device and trained them back then.

The four of us have had an amazing time this weekend together with another friend from Tanzania who I gave swimming lessons to every morning. He’ll be swimming in no time and maybe teach his friends, since a lot of people every year are still drowning.

Mtwara

Mangroves look like trees and survive on the coast in the saltwater. It’s roots look like stalagmites. I mention them here because they seemed to me a fitting metaphor for the people I’ve met here: Difficult circumstances but they manage graciously.

Mangroves during low tide

Détachement

Every time I am at an airport and have some time in transit between flights thats exactly how I feel: Detached.

I can explain it like this: I’ve once written a short story to capture the essence of wild things. In the story the main character comes upon a helpless bird on her way home in the pouring rain. If the bird is hurt or if it’s wings are simply to soaked to let it rise into the air again isn’t said. Either way she takes the bird home with her, carefully arranging a dry and warm nest for it. And from that evening on while the bird recovers she always leaves the window a crack open. Incidentally one morning the window is open and the bird is gone. Wild things stay wild. What I did not write was the pointe: Sooner or later the bird will come back. Even without her noticing, just checking in. Because if you give someone security and safety without taking away their freedom they will always, always come back.

So when I am sitting in one of these uncomfortable plastic rows obligatory in front of every nameless gate I feel like that: The window is open, the air outside smells fresh and moist: it’s time to spread my wings again.

Travelling for me is not only beautiful, it’s essential for me to be able to continue growing as it puts things into perspective like nothing else. I always encounter challenges that I would never stumble upon in the routine and well known life home.

So, let’s put things into perspective again, shall we?

Vivre – by Slimane (Remix)

Tu as laissé ton cœur mourir pour les autres mon frère 
Tu as nourri ton spleen ar fermé les vannes trop fier.
Tu as voulu porter les poids de mon monde sur tes épaules.

Mais sache que dans ma vie tu n'avais que le second rôle

-Il es temps de tourner la page et de fermer le livre, de sortir de ta cage pour essayer de vivre-
-Il est temps de tourner la page et fermer le livre, oiblier ta rage, essayer de vivre-

-Turner la page, essayer de vivre-

Spotify: https://open.spotify.com/track/7K1z3ex36HB9GkHcTU7QWu?si=DVN0kMfZTGG2_xEDPmFDGg&utm_source=copy-link

YouTube: https://youtu.be/LJGwxvRmJV0

The song is originally meant to tell a friend that one is the one responsible for one’s own fate and that the friend should stop blaming himself and start working on his very own path.

It says “tourner la page, essayer de vivre” (turn the page and try to live) which is important for every struggle we will face on our own paths. As the Buddhists core believe is that we are the forger of our lives luck the song as well doesn’t make that sound easy. It says ‘try’ every time.

So let us try

Revivre

Good morning

Get out of bed.
The day has been
asking about you.

It dragged the sun into
your room this morning,

pulled an entire disco of light
through your curtains,

hoping that all of this gleam
would be enough to get your attention.

This is how today says,
notice me.

by Rudy Francisco

I wanted to share this little poem with you. Every day is trying to be noticed by you for it’s very own. Have a great day!