Monday 28 November 2011

On surely teenagers and English weather during an African HASH..AHT


I have been allowed to contribute to the Blog…Yipee. But, as Zanner’s posts have been really good I feel under pressure to write something interesting (stop reading now so as not to be disappointed!).
 As Zan has said I am doing voluntary work at the International School, which is quite an experience. To-date I have been concentrating on delivering presentation skills, although it doesn’t form part of the International Baccalaureate some of the graded learning outcomes are delivered via presentation. So in effect a poor presentation can have a huge impact upon their overall grade. The students by and by are much like any other around the world I have met. They feign an outwardly surly attitude underlined by a distinct air of not needing to be told anything as they know everything. However, deep down they are going through a really difficult period and I believe it is our responsibility to help as much as possible guide them through the tick boxes necessary to get though this stage to the next in an interesting and invigorating way.

The school have asked if I can help with their UN Resolution Debating team who are to present their own resolutions at the UN Congress in Nairobi 2012. It is really exciting to see such a small school preparing to take on the kind of debate usually reserved for university teams. We are also hoping to create a mediation programme to introduce the students to ADR.

So the HASH, I’m told there is a similar thing in the UK but have to admit to never hearing of it before! It is rather like fox and hounds, two people (foxes) leave 30mins ahead of the bunch (hounds) and drop markers (flour) along a route. The markers are sometimes dropped at 15mtr intervals until you come across an X which means the next marker has to be found somewhere around 50mtrs of the X but, this can be anywhere in any direction. The fox does a circuitous route back to the cars covering around 10km.

This HASH was run by one of the longest running HASH organisers who is an amazing guy called Greg who owns a coffee plantation and farm here in Tanzania; he originates from one of oldest Mazungu (White) families in Tanzania.

We started at altitude (3400mtr) in the Kilimanjaro National Park, following a 3hr journey in 4x4s. The air was extremely thin but what was shocking to me was the cold and completely English looking environment surrounding us.  The foxes set off as we readied ourselves, with the runners to the front and the pack to the back; There were around 45 people making the trip. After the allotted time we were off, my enthusiasm sending me to the front as I bounded off down the trail, Nordic sticks helping me jump over rocks and mud pools at a surprising rate. Around the 2km mark I felt like someone had placed a plastic bag over my head forgetting to put holes in, (I apologise in advance to those members of the RM’s who had this experience on some of the RTI course run throughout the 1990’s).

Suffice to say the dull thud in my head and restricted oxygen intake was something to do with now being at 3650mtrs. We were now completely shrouded in mist with visibility reduced to such an extent that even on the flats I couldn’t see the following pack. At around 5.5km (3800mtrs) I was caught by a French chap and his compardre, they ran in a pair to aid the finding of the false trails that are planted around the X’s (doh!). My inexperience had cost me dear as I was now struggling to find a comfortable pace. I clung to these two and together we soon picked up the trails and headed for home. A wiry 65 year old ex pat caught us on the homeward track as he proved the tortoise rule!  The race in from there was less up and down but the rain had started on vertical trajectory just to add to English feel of the event. The final Km was achieved at the standard IronMan shuffle speed due to having to take three breaths to gain the equivalent oxygen normally achieved with one.

First finishers! L-R... French Guy , African Guy, Wiry
American Guy, Short English Guy, French Guy 2,
Guy the Guy!
By the time we reached the cars (1hr 22mins) for 10km we were wet, cold but in good spirits. This was made all the more so by a large trekking group who had turned up looking ready to ascend Everest who looked at us in our shorts as though we were aliens…LOL. Unfortunately they had the last laugh as nobody had any car keys as they were with the main group over an hour behind us; cold suddenly took over from joy as I lost feeling in my fingers.

Suffice to say I'm typing this with feeling and function restored. Having gathered the rest of the group and defrosted in the cars, we headed down to an altitude the sun was happier to come out and play in.The whole event was a great experience and I met some more amazing people with great stories to tell. Oh yes and the Wiry American? He had lived here for quite sometime having being a bit of a track and field guy in the states he now organises Hash's, runs the Kili Marathon and was a sub three hour GUY in his time...a tortoise with redbull wings!


Sunday 27 November 2011

On being an intrepid bug catcher and drawer by Zac Husdon-Tyreman aged 7


I do like Africa because you can see lots of interesting bugs and animals.  This week I have seen lots of lizards but the ones with the orange heads are very poisonous.  Today I caught a green grasshopper and a stick bug and a red, orange, blue and black butterfly.  They have funny types of money with elephants and different types of animals on the notes which I steal out of Daddy and Mummy’s wallet so I can buy stuff.
The Coca Cola is very famous all over Tanzania – Daddy says it is because they have the cartel but I don’t really understand what that means.  My school is very nice and it has a lot of coloured uniforms and a gigantic swimming pool.  Yesterday we went to this very nice artists’ place that had wooden lions and wooden necklaces and beautiful paintings of Africa and lots of wooden elephants.  Don’t worry Lennon I will get you one. 
I miss you all very much and that’s all…..

On why giraffes have very long necks by Josh Hudson-Tyreman aged 6


When the first meteors hit the earth that’s when all the dinosaurs became extinct and giraffes used to have very short necks and trees were very short then.  When the meteor hit the earth the giraffes stretched their necks so their necks wouldn’t catch on fire. 
At first I was very shy but then I made some friends.  Before play time one of my friends asked me if I wanted to try a new game with him called Love Love.  In this game first someone is it then they chase other people and try to it them and you climb onto the climbing frame. (I have just established that it is Lava Lava as you can’t touch the ground as it is hot this is Mummy speaking).  But now it is called Love Love…… as you can have a girl and boy cos they both love each other.
I like swimming in the swimming pool and eating dinner in the dining room.
My Mummy bought me an elephant called Mooks he is yellow, blue and orange and sometimes at night Gorillian (the gorilla) plays with him by throwing him up in the air.  He is a flying elephant
And that’s all really….

On African dermatology, student prayers and why Josh wants a fever


(written on 26 november but no internet available)

Zac woke us up with a high fever on Thursday night and spent the night as a kicking hot water bottle in our bed.  Don’t worry it is too early for malaria and I understand there is a viral infection going around –just like in the UK only Tanzanian flu is more exotic than boring UK flu.
Therefore, Zac was allowed to stay at home on Friday, as a swimming gala in the rain didn’t seem the best idea with a temperature.  Josh then turned into a cross between a tantruming 2 year old and a grunting Neanderthal teenager as he didn’t want to go to school either and told us the swimming teacher was an ogre and made them swim a whole length before they could get out (all said of course in a very whiney voice).   Zac’s answer to that happening to him the previous day was to ask to go to the toilet and then he got changed and went to a different club!  Josh’s constant refrain was “I wish I could have Zac’s fever – Mummy take my temperature as I have a poorly tummy”.  He went off to school in a huge huff and they were caught in a tropical downpour on the way.  Luckily for Josh it rained all morning so the gala was postponed but, he was very grumpy to discover that Zac’s class ate all the popcorn Daddy had made for the planned picnic.
I was very glad of the umbrella that Jane kindly brought out for me for my 15 min walk to work.  You can see from the photo that the landscape is somewhat different and my walk takes me past goats, termite mounds and through lots of mud when it is wet. 
I have now had a full week at work and am reflecting on the experience.  The Regional Dermatology Training Centre is unique in being the only Dermatology training available outside South Africa.  The RDTC was established I think by Barbara Leppard and Professor Grossman with its remit to train Dermatologists and non-medical officers in Dermatology.  In Africa there is huge burden of skin disease as surprisingly many patients suffer from all the common conditions of atopic dermatitis, psoriasis and acne.  These conditions are then seen to extreme in the high number of HIV positive patients who also present with skin diseases of the immunosuppressed such as Kaposis sarcoma, lymphoma and extensive viral warts.  Anti-retroviral are free in Tanzania and in the Kilimanjaro Medical Centre people are started on treatment in both the Infectious Diseases unit and within Dermatology.  The RDTC has fantastic facilities and was built only 15 years ago.  You walk into an airy atrium complete with “water feature” where patients arrive and sit on long wooden benches.  Clinics are run on a Monday, Wednesday and Friday and patients arrive at around 8am.  They then sit and sit without complaining and after our 8am morning meeting we take tea (very British) as it seems to take 2 hours for the nurses to bring the files over so we rarely begin before 10am.  I have tried to establish why it takes 2 hours but apparently it just does and no-one seems the least bit perturbed by this delay.  Sebastian – a German volunteer counsels me in patience over tea and gives me the low-down on the political situation at the centre.
There are 10 clinic rooms off the corridor, 2 theatres, a pharmacy and an HIV test counselling room.  One half of the corridor benefits from enough light to see the patients’ skin but on the opposite side due to the frequent power cuts and the trees outside the window we resort to looking at skin with the light from mobile phones and the torch I have now learnt to bring in.  I haven’t really understood yet who goes in which room.  We teach 4th year medical students, the Diploma students and the Dermatology Residents (the doctors in training).  Some rooms have five people in them taking a history and examining the patients and some only have one.  It seems that the larger the number of students in a room the lower the interest level of that group in learning.  Mondays are smaller general clinics and follow-up patients and Fridays is the Paediatric clinic leaving Wednesday as a massive general adult clinic.  On Wednesday we worked from 10am – 3pm without a break or lunch so imagine how grumpy I was at the end!  As the morning merged into the afternoon the rooms became emptier and emptier as first the medical students disappeared and then many of the Diploma and Dermatology Residents until at the end it was just the foreign volunteers seeing the patients! 
Yesterday a lovely nurse came and found me at 4 pm in the library, as I was the only doctor to be found.  That’s the problem with having a shared list…  However, earlier on in the clinic everyone is very keen to learn and I have re-discovered my love of teaching.  Getting an accurate dermatology history is challenging as the patient often changes their story and is very taciturn.  As the dermatology residents and diploma students come from all over Africa there is often a hilarious 3-way conversation going with the few Swahili speakers in the room.  It is heart-breaking to see how late so many people with obvious HIV present.  Commonly people have CD4 counts of 14 and after 5 days I am frequently diagnosing Kaposi’s sarcoma and other HIV related skin disease.  It is excellent that patients can be immediately counselled and have an HIV result within an hour and then start on anti-retrovirals, I only wish they had come earlier.  Wednesday was a fascinating day as in one clinic I diagnosed two rare genodermatoses (that’s genetic skin disease to you)– Tuberous sclerosis and Neurofibromatosis and will give a lecture on these on Tuesday morning to all. 
Last night the second year Diploma students held their annual party to welcome the first year Diploma students to the course.  All the doctors were invited to the Aventure outdoor restaurant for the formal occasion, which was opened with solemn prayers thanking God, Professor Masenga (our Principal) and the King of the RDTC hostel.  Professor Masenga gave a speech memorable in it’s brevity and content stating that he had been in a very boring meeting all day and had another one tomorrow so regrettably he had to go home and could not stay for the party.  It was therefore left to Dr Nabrato to open the proceedings by dancing with Prosperina.  We had a great evening and as the Serengeti and Kilimanjaro beer flowed the dancing became more energetic until at 10pm Michael (a lovely retired Dutch consultant) sensibly rounded us up to go home as they were setting off at 6am for the Kilimanjaro Hash.  I will leave Aaron to tell this tale as I, after another broken nights sleep with Zac, spent the day with the boys in town.
Now as the electricity has been off for 2 hours, which means I will have to bake my bread in the morning, I will take my torch and go to bed………



Wednesday 23 November 2011

On Josh's idea of a date night



First I need to keep my promise by explaining how Josh fell in a drain.  We have discovered the Impala Hotel, a 15 minute walk from the compound,  which has a great swimming pool so the boys love going there.  We went there on our first weekend and on the way home on Sunday Josh decided to walk along reading his Star Wars colouring book.  By the side of the Lima road are storm drains and I kept asking him to be careful and not to walk too close but Josh being Josh thinks he knows best so one minute we were all walking along and the  next there was a big Josh howl but when we turned round there was no Josh!  We rushed back and there he was in the drain luckily absolutely fine and so was the colouring book which was Zac’s first concern!  On the same trip he managed to drop the beautiful black and white butterfly wing that he found into the drain on the other side of the road.  Again he whined and wailed and cried so much that a lovely black Mama jumped into the drain and retrieved the wing as his cruel mazungu parents refused to do this for him!

The boys have now been at school for 3 days and have settled in very well.  Apart from Josh clinging to me on day 1 in assembly they have been delighted to go and have been making lots of friends.  Zac made a card for his “beast friend” so I am hoping that his spelling will improve – they certainly have more homework.

Life is settling into a routine – we have to get up at 6 30am which is a shock to the system as the boys start school at 7.30am.  Mind you we have generally been awake for hours listening to the very loud and annoying cockrel strutting his stuff and crowing at top volume from about 4am!  My work starts at 8am and as it’s Africa all the patients arrive from 8am or earlier and sit patiently on benches until their files arrive generally around 10am when we can start clinic.  Today we worked solidly in clinic seeing patients from 10am -3pm without a break and with no lunch I was finding it difficult to concentrate at the end.  It would be much more sensible to start at 8 and finish at 1pm but I know better than to try to work out why it takes 2 hours to get the files.  I am teaching 4th year medical students, Diploma students who are Medical Officers but not doctors and Interns who are doctors on the 4 year dermatology intern project.  There are about 4-5 per room and not all speak Swahili as different governments sponser the Diploma students to come to the RDTC to learn Dermatology so they can set up clinics back in their country.  Sometimes it is hard to work out who is who and it seems the Interns teach the Diploma students and the medical students but it is the foreign volunteers who teach the interns.  Many of the doctors, medical students and diploma students seemed to disappear mid morning leaving us to finish clinic.  Today there were some amazing cases and I saw things I normally see in text books.  People seem very long suffering here and often wait far too long before seeking help and we see huge numbers of HIV related skin conditions.  I was very worried that I would not know enough dermatology but my HIV treatment knowledge has rapidly expanded and it is the basic general dermatology that needs to be taught and also how to take a proper history, find the physical signs and make a management plan.  I was back home today at 4.30am and am thinking about my lectures for next week.

We went to the school for dinner for the second time this week.  On Monday we had beef pasta, chocolate milkshake and banana fritters and chocolate sauce and on the way home Josh said “ tonight was like a date night – you know when you love each other and you  go out and eat fancy food at a fancy restaurant”.   Bless him…I feel sorry for his future girlfriends!

Aaron has been doing some volunteer teaching at the school teaching presentation skills to surly teenagers and getting on with his PhD.  He has also been going into town with Rebecca to buy a mop and bucket and source coffee and fruit and vegetables.  Rebecca made us mango and avacado smoothies (not mixed together) which are delicious.

It has been restful to have no TV and instead we play old fashioned games after dinner – happy families, snap and Zac has been teaching me chess although he was very stroppy when he didn’t win last night..
Our main problem is lack of transport as the dermatology car is now under contract for sole use to the Spanish pharmacist and it seems to have broken down as well.  We take taxis everywhere at present but it would be great to have some transport to get out and about at the weekends.  It is impossible to hire cars here so not sure yet what we will do .

I can’t believe we will have been here a week tomorrow – it seems much longer than that already….We are thinking of you in cold England whilst we bask in the heat and scratch our bites.

Sunday 20 November 2011

How Josh fell in a drain whilst reading a Star Wars colouring book

We had a good flight over, once the boys had got over the disappointment of not having working TV consoles - which was a bit of a bummer considering we had sold the 8 hour flight to them on this basis.  Luckily we found 2 that did work which happened to be situated next to a poor unsuspecting lovely Dutch nurse on her way out to work in Momabasa who surprisingly moved within an hour and a half of fairly constant zac and josh questions!  Somehow she managed to convince a lovely bloke to swap with her, obviously not mentioning the children, who was highly good natured and explained X-men 4 and then put up with Josh kicking him a lot overnight!  In the morning or rather after about 2 hrs sleep we got chatting and it turned out he is a rally driver and driving one of the support vehicles for the mad classic car race round Kenya and Tanzania.  We are hoping to bump into them again round Kilimanjaro..

Moshi is leafy and feels very safe and we were picked up late from the airport by Dr Andrew in his 4WD straight from the Regional Dermatology Training Centre.  We persuaded him to take us shopping in Moshi as arriving with 2 hungry boys to an empty house was not my idea of fun.  So we went haggling in the market and bought bags of papaya, mangoes, pineapple, cucumber, peppers, mountains of tomatoes and garlic and all fresh and local and not flown across the world in a Tesco plane!  Aaron was in 7th heaven once we found him the Union Coffee shop which serves amazing coffee as Tanzania is a world renown coffee plantation.

Our house B22 has seen better days but is fine once we put a red plastic bucket under the leaking sink u bend.  It has loads of space and a fabulous garden with papaya and banana trees.  There was minimal kitchen utensils as i had been led to believe - 4 plates, 4 glasses, 4 cups, 2 pans and some cutlery and that was it!  Nothing for the boys to eat cereal from so Aaron went on a market trip with Rebecca who lives next door and who arrived immediately to tell us she was our house mama and would look after us (after negotiating a fee of course).  She is lovely and we have been communicating of a fashion via the Lonely Planet Swahili phrasebook and made her laugh by saying the mosquito net was takataka (rubbish) as we tried to pin it up with string and nails.

The boys school is across the road and we took them there on Friday.  It is great - leafy and open with cool vernadas and bright fun classrooms.  There is a fabulous outdoor pool and a coffee shop for Aaron - oh dear there goes our safari money!  They start school tomorrow at 7.30am which will be a shock to the system but as it gets dark at 6.30pm we will all be going to bed a bit earlier.  I start work at 8am and went into the Regional Dermatology Training Centre on Friday morning to get my bearings and to do a clinic.  The building is magnificent -built only 15 years ago and very well equipt with numerous outpatient rooms and 2 excellent theatres.  There is a pharmacy and all the ointments are prepared in a buliding in the garden.  The patients are seen by 4th year medical students and then the Dermatology residents with the volunteer Dermatology doctors going inbetween rooms doing the teaching.  I am discovering there is a certain way of doing things and need more time to work out how I will best fit in and hopefully make a difference.   I was worried that I would find the Dermatology difficult as my Tropical dermatology and HIV knowledge is neglible but i was pleased to find that as Claire and Richard said most is general dermatology often in extreme due to the very high prevalence of HIV infection.  Fortunately anti-retrovirals are free but patients often present very late with low CD4 counts and hence have awful disease which is impossible to adequately treat until the HIV is better controlled.

and on that happy note and so to bed as a busy day for all tomorrow.  I will try and post some pictures soon so you can see where we are living.

Love to all

Wednesday 16 November 2011

The night before the day we go!

It's 1.15am and we fly to Tanzania tomorrow and yes you've guessed it I haven't finished packing yet!  However I have managed to start this blog.  And so to bed......