running in circles, chasing our tails

huge apologies to those of you wondering where I’ve dropped off the face of the earth to, it has been so long since I’ve written an update.

to be honest, it’s because I haven’t had lots to write home about. I mean, I could’ve easily written about the severe diarrhoea I’ve had off an on for the past couple of weeks and the very intimate relationship I’ve had with the toilets in my house (sorry, oversharing is caring), but I’m pretty sure that’s not what you want to read about. bit just a little on that topic, this is now my sixth month in africa, and seventh month away from home, I can’t believe I’m still dealing with such a temperamental stomach. someone please remind me to enquire about an entire gastrointestinal transplant when I get home. one of my friends I made volunteering in kenya, richard (who’s a fellow aussie), uploaded an instagram picture and used the quote “used my butt as a trumpet filled with soup” when he and a mate were sick. it couldn’t be more true.

okay sorry, enough ‘toilet talk’. but being sick and confined to either my bed or a toilet has made time absolutely fly – I’ve already been in tanzania for a month now.

for a couple of my weekends here, I’ve spent my saturdays helping a really lovely girl alice, from england, help build a new house for a mama she met here in arusha when first volunteering in 2010. I got in contact with her through the tanzania volunteer group on a facebook when I was still in kenya as she was asking if anyone wanted to help out on their spare weekends. figuring I’d have not much else to do when I’m not at work, I let her know I’d be keen. long story short, I’ve been for two of the saturdays that I’ve been in tanzania helping with whatever needs help with at the house. god it is strenuous work, I don’t know how alice has been doing it at least six days a week for the last five or so weeks. incredible.
things we’ve helped to do include excavating existing dirt and clay that was piled up after digging the 12m hole for the squat toilet, hacking away at the existing clay retaining wall behind the new house, scrape off concrete from the newly installed doors and window frames, sanding down said doors and window frames with a piece of sandpaper and a machete and a steel wire brush, painting the doors and window frames… it has been amazing to be a small part of such a huge project. click here to check out alice’s website for a much more detailed re-cap of all she’s achieved.

work at my clinic has still been quite interesting, including a day of working solely with a midwife doing fundal height measurements and listening for a heartbeat with an archaic tool that looks like a funnel, as well as spending time doing ‘growth and monitoring’ on bubs, which occurs every month until about the age of 4 years. it’s a bloody great system – they have a scale suspended from the ceiling (like you see in the fruit and veggie shop) and all the mothers hand make these little jumpsuit things that has a loop that hooks onto the scale, so their bub is suspended (which most of the kids hate) but it’s fast, efficient and easy. I’d then record their weight on a brochure like piece of paper and any serious abnormalities compared to the last time they were weighed, I had to report to the midwife. luckily there were no bubs on this day who were malnourished or weighed significantly less than they did a month prior. africa might be behind in a lot of things, but this is advanced to the max.
also gave polio, tetanus, and rotavirus meds/injections to newborns and as much as it was awful making them cry, at least these kids are getting vaccinated like we all were.

I really love living at the volunteer house now, obviously I didn’t when I first got here, but it’s buckets of fun and the bunch of people living here now are a great group and we all get along really well. just took a bit of getting used to living with 20+ other people. it’s so nice coming home to friends asking how your day was, as well as asking how everyone else’s days were. we all have such different experiences at our respective workplaces. I would love to visit a couple of orphanages while I’m here, apparently they’re really well orchestrated here in arusha – including a baby orphanage that I’m really looking forward to hopefully visiting.
also couldn’t be happier that I decided to buy a ukulele when I was in germany, it’s getting a good workout here in tanzania – sitting around the outside fire pit of an evening with a few beers having a singalong is probably my idea of heaven… glad there’s a scottish bloke called iain who is more than happy to join in so I’m not singing all alone. we’ve treated everyone to a rendition of “the four chord song” by axis of awesome (you should youtube it) and added extra songs in as well. but it’s making me really miss my guitar.

okay i guess now that I’ve written all that, I did have stuff to write home about. apologies for being slack.

it’s hard to believe I’m on the home stretch now, about 5 weeks until I’m back on australian soil. christmas looks like it will be loads of fun here, about 10 or so other volunteers spending the holiday in arusha – see what happens when it arrives! can’t believe I got to africa on the 30th of june and now it’s december. if anyone needs a reminder of how fast time goes, do volunteer work… it flies.

people like us, we don’t need that much

my first week in tanzania was really interesting. obviously, you all read about my severe “homesickness” from kenya, which I should let you know I am almost over. I still miss the kids at little ray of hope like crazy, and I really miss my host sisters, but I don’t feel as upset about it as I was 11 days ago. but I am going back to nairobi for a weekend visit in my couple of weeks… I just spoke to anna and vicky and makena, and I miss them all so much, I will happily spend money on buying another visa to re-enter kenya, and then to re-enter tanzania. I might be crazy, in fact I know I am, but it’s only 250km away.

anyway, tanzania. I have been placed in a clinic called kijenge RC dispensary, RC stands for roman catholic. so there’s usually a few church songs playing in the background during the working hours, which definitely make me feel like I’m in a gospel choir or something (that’s my ultimate dream, to be a gospel singer. I’m just not a good singer nor am I black enough… one day). there’s two huge (and I don’t mean tall) nuns who run the show who I’m waiting for them to start singing “oh happy day”. the clinic is quite nice, they don’t need for much. I’ve had a look in their pharmacy and it’s stocked to the brim – they obviously have great sponsorship.
my first couple of days there were relatively observational, which I expected, and to be honest, it’s really captivating as people just don’t go to the doctor in australia for these sort of things. I sit in with the doctor (who is also my supervisor) as he does consults , and some really interesting cases have come through over the past week. the doctor is awesome, he includes me in the consults and asks my opinion, as well as translating to me what the patients say and what he thinks they have and what he will prescribe, and asks if patients in australia would receive the same treatment. I’m not completely up to date with what diagnoses require what medication, but a few things I recognised and could say yes or no. obviously we don’t have malaria cases back home.

the doctors office; the wall I sit and look at while he chats to the patients

things that came through the clinic last week include (but certainly not limited to):
– 3yo girl with malaria
– 25yo female with hypertension (220/150 on both arms)
– 6yo boy with mumps
– HIV positive woman for medication to prevent spread of disease to kid (niverapine)
– 25yo guy with cut finger
– 6yo boy with UTI
– 30yo female for stitches removal post caesarean
– 8 month old baby boy with otitis media
– 18yo girl with malaria
– 14yo girl with mumps
– baby with facial skin rash whose mother is HIV +
– 8yo boy and his 30yo dad with amoebiasis (a type of gastro) – treated with flagyl (metronidazole)
– 18 month old girl with bronchitis
– 5yo boy with productive chesty cough
– 3yo boy with malaria
– 5yo boy with huge abscess behind right ear (lidocaine before lancing, hardly done at all kid screamed the whole time, lots of shit (obviously not a medical term) came out)

hand washing facilities in the treatment room… yep, gross.

I spent one day working alongside a midwife doing antenatal checkups; learnt how to measure fundal height (basically measuring how big a women’s pregnant stomach is… that’s a very lay person description) and how to listen for a heartbeat with an archaic tool that looks like a weird mini-trumpet but not before harassing the baby through mum’s tum to figure out where the head is, therefore where the chest/heart might be (I’m still practising this new and difficult skill).

some of the things in the treatment room, apparently anything inside the silver tins is sterile. yet to see a steriliser though

some awesome things I learned this week:
– all malaria tests and treatment are free; children just don’t die of malaria here anymore as treatment is free (provided they can make it to a clinic)
– all tuberculosis tests are free
– all HIV testing and treatment are free

I still can’t wrap my head around the fact that we had three mumps cases in the clinic. for those of you who don’t know, mumps is one of the things that we’re all vaccinated against in the big MMR injection (measles, mumps and rubella) at 12 months of age and (I think) the booster is at 2 years. mumps is a viral infection that usually causes painful swelling of the salivary glands, but can cause other serious problems including encephalitis (swelling of the brain), which can lead to permanent brain damage and/or deafness.

I was dumbfounded. like measles, isn’t mumps ‘extinct’? I mean obviously nothing is ever completely extinct – except dinosaurs- as these patients had it. even things like the bubonic plague (the black plague) have surfaced in madagascar and the middle east in the past few months. crazy stuff. I guess because I’ve not seen it in australia, and I know I certainly don’t have an extensive work history due to only just finishing uni, but I’ve never heard or seen anyone being diagnosed with mumps, at least not my age or younger. even though vaccines are pretty much readily available here in east africa (as far as I’ve seen), there are many factors that prevent kids being vaccinated against things that we’ve all been vaccinated against – unless you’re one of those crazy people who believes there’s a correlation between receiving certain vaccines and developing autism. don’t even get me started on that, that’s a topic for another day and a lot of wine… moving on… one website writes about the challenges of getting kids vaccinated here; i) lack of medical personnel to administer the vaccines, ii) lack of vaccines, iii) inability to store refrigerated vaccines in rural areas, iv) inability to transport refrigerated vaccines and v) poor record-keeping (reference: east africa partnership). I’ve seen all of these things, even to the point of only being able to have certain vaccines at the medical camps I worked at in kenya.

beautiful baby girl with the awful skin rash on her face, likely correlated to being HIV+

the baby girl who had the facial skin rash was such a beautiful little kid, I managed to take a picture (obviously after checking it was okay with her mum and the doctor). she wasn’t the patient, but the doctor and I obviously noticed something was wrong. her mum was coming in for more HIV anti-retrovirals (ARV’s) and the doctor mentioned that the baby’s skin rash is almost 100% indicative that she is also HIV+. I’ve done a lot of google-ing about rashes that relate to HIV and haven’t seen many that correlate to the same rash as the baby, but her mum didn’t consent to having her daughter tested on the day. the frustrating part of our job; you can’t force anybody, even when it’s in their or their child’s best interest.

it’s been really eye opening. and I’ve learnt a lot. not in terms of clinical skills, and by no means are they improving, but I’m learning a lot about patient care and how important it is for patients to feel like they’re being listened to. picking up on small cues about how certain medical professionals look at and/or speak to (or don’t) their patients; I know how much they drummed it into us at uni that you need to give patients eye contact so they aren’t feeling ignored. I thought it might have been a culture thing, but now I don’t, because patients are constantly looking at the doctor or midwife, hoping for some sort of interaction, yet they rarely receive it.

on a side note: I’m totally and utterly exhausted. I had no idea how tiring this volunteering thing would be, and I think I’ve been chronically tired since mid-september. dragging myself out of bed some days has been really difficult, I’m really sick of not showering (when the power goes off here in tanzania, so does the power, so you have to get water out of the well in our front yard to bathe with), I’m so so sick of eating carbs and carbs and more carbs (dinner the other night was spaghetti and mashed potato), I’m so tired of having irregular bowel movements and getting ‘travellers diarrhoea’ on a regular basis (yes that’s an overshare but I don’t give a shit) and spending every fortnight sick like I am now.
but it’s made worth it by a lot of little things – including an elderly gentleman who paid for my bus ride home from town yesterday to thank me for what I’m doing for his community. this guy was so unbelievably old (I always say that africans always look young, until they hit a certain age, then they look 150 years old), and had hardly any teeth left, and spoke terrible english, but I felt so humbled by how generous his gesture was. or by the kids and how they have to run their hands over your skin to admire how different the colours are… or pull your arm hairs out.

I’d be lying if I said I wasn’t counting down until my holiday in zanzibar, only 27 days until I’m lying on a beautiful, idyllic, crystal clear beach and actually relaxing. bring it on, baby. I’ll be so ready for a break by then!

if there’s one thing you can’t lose, it’s that feel

after figuring out my last placement wasn’t really what I hoped to do, I changed to a different clinic in nairobi, called dagoretti community health centre, after a great referral from a fellow volunteer at outreach. but to go here, I had to change from the straight medical program that I was doing into the HIV program. so while its not as holistic as medical, HIV is still a medical problem so I’m still medically working (most of the time). I’m not necessarily working on my clinical skills just yet, but I’m sure that will happen in the coming months. it’s all a matter of helping where its needed most. the clinic is fantastic but that said, I’m hardly in the clinic as I’m usually out in the surrounding slums doing HIV testing in the field or at a school for kids who are from the streets or slums and might be HIV positive. but the school will get its own post in the next few days.

since arriving in kenya, there have been so many occasions where I’ve wished I didn’t ‘feel’ so much. probably more times than I can count on both hands and feet. wish I was one of those real tough bitches who had an exterior of concrete and was super unaffected by things I’ve seen. but I’m not, and I have been affected, already. but I’m kinda hoping that at least by my third month, I’ll be less shocked by things I see.

vincent & jemima; both are community health workers in the clinic I’m at, thought it was pretty cool that they get to wear white coats anyway. this was the area where we did testing one day, the slums right in nairobi.

my first day testing was eye opening, to say the least. I really need a new phrase other than eye opening… overwhelming. it was seriously overwhelming. I’ll try and explain as best I can, it’s probably going to be really wordy. before you test people, there’s a few questions to ask: age, sex, if they’ve been tested before and how long ago, if they are at risk or not, if they are being tested as an individual or as a couple. then comes the question about the marital status. I didn’t know, in kenya, that men often have more than one wife. I was shocked. so when we ask about their marital status, a lot (and I mean a lot) say they are married polygamy (MP for short). otherwise they’d be MS (married single), or just plain S (single). crazy. another instance of reminding myself that dis is africa.

HIV testing is very similar to testing a blood glucose. we have a “finger pricker”, which while its not the same as our BGL ones, it still does the job (except when you rip off the top plastic bit, a needle that looks just like a thumb tack is just sitting there – it doesn’t retract) but you have to be super careful because you literally shove it into someone’s finger (after wiping with a bit of cotton soaked in what I think is some sort of alcohol solution) and most people jump… my mantra when testing has become don’t get a needle stick injury. it’s a matter of being quick and confident, no second guessing yourself. like sticking a cannula in.. which I’ve found I’m decently good at, you just have to do it.

this is probably the “gold standard” of field HIV tests. similar to a pregnancy test, two lines = positive result; one line = negative result.

this is the test we use when we’ve run out of the first one (which is often as it is more expensive), but it isn’t as accurate. however, sometimes this one is used first, but if a positive result is achieved, the patient has to do repeat the test with the gold standard test, or come into the clinic if we’ve run out

so after a “little prick” (still gets my rocks off when I say that, even though kenyans don’t understand the hilarity of it), you wipe away the first bit of blood, then use this clear little tube thing that seems to osmotically draw the blood from the finger – with a lot of manual squeezing of the hand, kenyans bleed really slowly. it’s kind of a ‘squeeze, squeeze, draw blood’ routine. and repeat, at least 5-6 times. I wonder if they all have problems with poor circulation.

then you put the blood onto the test, and then put a drop of some sort of liquid on top of the blood (like real csi-style) then wait 5 minutes. in the grand scheme of things, 5 minutes is a seriously short wait, but when your standing there with someone who is visibly nervous and worried, it’s the longest 5 minutes ever.

the hardest part about testing is seeing people react when a result is positive, particularly as we’re testing in a pretty public arena (in the slums) and anyone can be watching to see your reaction – and some people’s reactions are pretty obvious. one guy couldn’t stop shaking when he was shown his result, he just wasn’t really listening to us anymore, his hands shaking more than what my pa used to with parkinson’s disease. I couldn’t help but feel for him. another guy just walked off when told of his positive result, not wanting to hear anymore about it. one guy laughed and shrugged it off, and went straight back to work.

for me, testing is overwhelming because of the vast reactions you get from people, because of the areas you’re testing in, because of how little or how much being diagnosed HIV+ means to people, and because of the uncomfortable feeling of not knowing what to say to people like the guy who couldn’t stop shaking. obviously I’m not trained in the counselling, obviously I can’t speak swahili. so my role – at times – feels very cut off. however I’ve been assured by my incredible mentor, vincent, that me being there is a huge help because people in the slums see me, a mzungu, as someone bringing extensive knowledge from another country and are encouraging them to get tested and know their status, as it is their right. that’s part of the huge campaign kenya is running, that its your right to know your status – which is why testing is free.

it’s hard work, being out in the blistering heat for hours testing people. I couldn’t tip my hat off to people more than vincent and jemima – they are so caring and thoughtful when testing others, encouraging of those who aren’t sure if they should be tested and extremely protective when I get proposed to by drunk kenyan men or hassled for money by kids sniffing glue. so it’s no wonder we all come back to the clinic, after a good day of walking all around nairobi, take tea and collapse into a 15minute power nap.

and so it is just like you said it would be

so I’ve already mentioned, I was first placed at the family planning clinic in thika – a town about 45 mins north of nairobi. I had actually organised to be in maasai land for my first 2 months but obviously that wasn’t communicated from the organisation I booked with (IVHQ) to the organisation I now work for (NVS)… but hey, I’m a volunteer so I’ll go where I’m needed most.

so steve, vince, ashley, chelsea and I were supposed to be picked up from nairobi at 11am but in true african time, that didn’t happen until almost 2pm. classic kenyans. arriving in thika, we met josephine (our host mum) and her two year old son prince. we weren’t actually staying at their house, it was an apartment that NVS was obviously renting for when volunteers came out that way. it only had 2 couches, a coffee table and mattresses in it when we got there; bunk beds were supposed to arrive that night (but you probably don’t need me to tell you that that didn’t happen… I’m slowly learning to not expect anything to actually happen when people say it will)

the view from our apartment

josephine walked us around the town, which was just another big city really – felt similar to nairobi, with the horrible exhaust fumes and dust and smog… I swear if I don’t come back from kenya with only half a functioning lung, it will be an absolute miracle.

the streets, mainly dirt roads

the city centre; so unbelievably busy, pretty sure I got a headache just from walking through it

my first day at the clinic was, how should I put it… uninspiring. I don’t want to write too negatively about it because I’m sure some students would be fine there, but I’ve done my fair share of sitting around and being treating like an incapable first year who can’t take a BP, or even a resp rate. I definitely didn’t come to kenya for that. long story short, it felt as though the clinic either didn’t know what to do with me, didn’t really want me there or had never had a volunteer before. there are a lot of reasons why I think that, and I don’t think it’s necessary to write them all down, but I did change my placement. after showing up on monday morning to a very surprised lot of staff who sent us home, I called NVS to change places and they obliged. thank the good lord, because I definitely couldn’t go another day in a place where you don’t feel welcomed or wanted.

the clinic itself was pretty shocking and eye opening. a family planning clinic, as the name suggests, has a whole lot to do with contraception options as well as some maternal/child health stuff and a small theatre. initially it sounded promising, but on my first day, I realised how ‘backwards’ the clinic was. I totally get that each culture has their own beliefs about contraception, but I was totally shocked to see that the “withdrawal method” was in the book of accepted safe sex practises released by the health service within the kenyan government. um, pretty sure the last time I checked, that method does not stop you from becoming pregnant, it does not stop you from getting STI’s and it most certainly doesn’t prevent the spread of HIV. the lactation method also got a mention (where for 6 months after child birth, if you breast feed, it stimulates certain hormones to prevent you releasing eggs thus preventing you from getting pregnant… I think that’s how it works anyway). but even that isn’t completely safe. I wish I could ask the men of kenya what the problem is with using condoms. I even got to watch a demonstration of how to use a female condom… didn’t even think those bad boys were still in circulation/they should be in a museum of “how people used to prevent getting pregnant, back in the day” alongside diaphragms.

another example of me still having to remind myself where I am.

another unbelievable thing was seeing the posters on the walls. one in particular was about aseptic technique when in theatre (ie. how not to give your patients infections when you’re operating on them) and it was dated 1992. I was speechless. coming from a country where a new journal article is considered old if it was published over 3 years ago, I couldn’t believe they were still relying on research done over 20 years ago.
dis is africa.

what the clinic looked like inside one of the consult rooms. note: the pink bucket is where they put used equipment like speculums and forceps, it had some solution in it that sterilises them

trying to make it look like I had a productive day… didn’t even use my stethoscope! totes just for looks.

so for a number of reasons, not just the clinic, I was glad to get out of thika. we all were. we never really felt comfortable, useful or helpful. but hey, you have to have the bad days to appreciate the good ones, right?

happy days.