Thursday 23 February 2012

On challenging patients and weekend exploits


As we enter our 4th month in Tanzania I seem to be becoming busier and busier.  So I think I am going to go for the little and often approach as otherwise these blogs are going to become few and far between.
These blogs will be less about my medical experiences as I am now writing a blog for the BMJ and the first one can be found at http://blogs.bmj.com/bmj/2012/02/21/susannah-baron-will-there-be-lego-in-africa/

ITU in the corridor whilst cleaning went on

Since the strike and Kelvin taking over the ward we have had a huge number of challenging adult and paediatric patients.  We had a man admitted with toxic epidermal necrolysis, which is when all your skin peels off due to a drug reaction, and this is a dermatological emergency (yes we do have emergencies in dermatology!)  We do not have up to date treatments here so treated him with IV hydrocortisone and he was nursed on ITU.  Fortunately the inflammatory process switched off and he has made a good recovery as mortality is usually up to 50%.  We have had up to 18 inpatients and many of these have had other difficult blistering conditions and I think Kelvin, the ward resident is jinxed as the ward is the busiest it has ever been!  The ADDV students are in the midst of exams so Kelvin and the medical students have been very active.  I was in charge of the ward whilst other senior consultant staff were at an albino outreach clinic in Tanga.  Surprisingly I actually really enjoyed the diagnostic and clinical challenges of managing all these complex, sick patients.  We forget how fortunate we are in the west where investigations such as biopsies and blood tests are available and are free as many patients cannot afford the limited investigations and medication available here in Tanzania.  You can read more about the ward on my next BMJ blog.



So what have we been up to?  We spent a fantastic weekend back at Marungu Hotel camping with a group of friends.  Sadly it was Sebastian and Julianne’s last weekend and also joining us was Tobias, a Danish physio and his 2 children Alex and Edvin and Camilla and Jeremy, both homeopaths, and their children Ike, Amy and Noga.  The weather was glorious and we splashed about in the hotel pool on the Saturday and then did the beautiful waterfall walk on the Sunday.  




Nguduru falls at Marangu


This time however the sun was shining and the Ndura falls were spectacular and we all dived in and swam (well not Aaron as he is such a wuss in cold water!) and Zac and I swam right under the waterfall.

Amy and Noga wrapping up at dinner whilst camping
Juliane and Sebastian


The boys have started a weekly horse-riding lesson which they love and on Friday they will start tennis lessons as last week it was rained off.  Yes we are getting some rain now, which is a blessed relief as it has been SO hot.


 


Last weekend we drove out to the hot springs which are literally an oasis in the middle of nowhere reminding me of passages from the bible!  You drive and drive and turn off the road and down dusty, forking tracks which wind through villages where we had to keep stopping to ask directions.  Eventually a 4WD truck beeped us and we followed him in a cloud of dust until we arrived at a tree fringed beautiful pool full of green, glassy water. 
where are we going????

Vicky Yates, my work colleague and Aaron getting his feet nibbled!
going, going...
gone....


In the water are tiny fish that nibble the hard skin off your feet, a sensation the boys and Aaron loved but I hated!  There was a rope swing which we swung on to jump into the water and I managed to stop the boys from climbing an enormous tree to jump in even higher!
We returned dirty, tired and happy and slept very well.  



On Sunday was the hash and this time it was held in the hilly region of Machame.  The walk was stunning and we tramped up and down into gorges and over rivers and through banana and avocado fields.  I think we are all getting fitter and the boys seem to be used to 2-3 hour walks now.  I hope this will continue when we get back home!


This weekend we are off to Arusha national park on Saturday and Sunday is the Kilimanjaro marathon.  Aaron is running the half-marathon due to his knee and the boys and I will be running, or more likely walking, the 5km fun run along with the whole of Moshi I think!
Simon Matui the current record holder for running up and down Kilimanjaro unassisted in 8 hours!!!! 

making chocolate brownies for Friday night dinner!

And now some other animals that i couldn't upload to the last blog.  And yes I do like elephants!







 


Friday 17 February 2012

On safaris, amazing animals and lego in Africa



We have exciting news we now have lego in Africa! The boys were sent lego star wars storm troopers and rebel men in star ships by their grandmother Chris, much to their delight!  They say a big thank you for this fantastic present.





Fantatstic: the Star Fleet made it to Tanzania!
So very much after the event the boys want to tell you about their amazing safari adventure on 4-7 January 2011




Zac
On the safari we saw amazing animals.  On the first day we went to Tarangire national park and we saw hundreds and hundreds of BIG BIG elephants.  



Tarangire national park

They were grey with very thick skin and their tails were like the end of broomsticks.  We also saw tiny, very cute baby elephants, which were bigger than a man.  



Natural sunscreen - grass


The exciting thing was when we were right in front of an elephant he began to flap his ears and paw his foot.  Our guide Tuma told us that it meant that the elephant was very cross and about to charge and so we were scared and drove off.


do you fancy a dust bath?
The next day we went to Serengeti and saw spotted leopards in a big, tall baobab tree.  Very early the next morning we saw two amazing yellow and spotted brown cheetahs stalking out an imapala. 



cheetah

After that we saw some gigantic snoring lions who was sleeping in a trench underneath the car.
The next day we went to Ngorogoro crater and we drove down very early in the morning.  However it was worth it as we saw a gigantic black rhino, more lions and thousands and thousands of wildebeest.
My favourite part of the safari trip was seeing the enormous lioness sitting on top of the rock in the Serengeti.


Zac's lioness looking out for breakfast..






Our trusty safari jeep

Adventure on safari by Josh HT
On the way to Ngorogoro crater we saw baboons.  When we were having lunch we saw lots of monkeys who tried to steal our food. 
Josh loved these monkeys

In Nogorogoro crater we saw all the BIG 5.  The Big 5 are cheetahs, leopards, lions, rhino, elephants and buffalos.  At the lake we saw hippos and an ostrich. On the path there was a baby giraffe running after his Mummy.  The wildebeest and the zebras grazed together so that the zebras could look out for any predators that might eat them.  The wildebeest showed the zebras where the food was.  Mummy says that this is a symbiotic relationship but I don’t really understand what that means!



We had a very good time camping and in the car on the way back the chef fell asleep and he was dreaming about making food with our guide Tuma.  I liked camping and sleeping in the tent with Mummy and Daddy.  On the way back I got a necklace that was an elephant’s head and Zac got a necklace that looked like a tooth.



Popping out the pop up roof





It's all too much this early in the morning!


Zanz
We were picked up at 5.30am on the Wednesday morning so you can imagine how difficult it was to get Josh out of bed!  He immediately assumed his back seat sleeping position which he perfected over the next few days.  We had a fabulous guide called Tuma and he had a great black book which had information and pictures of all the animals and birds in Africa.  Zac loved spotting and looking up all the animals that we saw and then telling us about them.

Leaving Moshi at sunrise.  I was the only one awake in the jeep!
A poor monitor lizard run over by a bus thundering by



Safari was exhausting but great fun – we spent hours bumping over the dusty dirt tracks in an ancient landrover with over 300,000km on the clock and this was just the number that the speedometer stopped at!  We kept passing pristine, gleaming landcruisers that had broken down by the side of the road, whilst our trusty ancient beast kept on going.

My favourite park was Tarangire.   I am not sure if this is because it was the first park we visited or because I so loved being extremely close to elephants, such prehistoric creatures.  They are amazing animals with thick, lined hides, tiny eyes and that dexterous, sensitive trunk.  The first night we spent in a lodge with a swimming pool, which the boys loved, and then we drove through the Nngorogoro conservation area where we saw the incredible migration.  As far as the eye could see were thousands and thousands of wildebeest, rhino and antelopes grazing quietly in the lush grass.

bachelor impala


It was such a difference entering the Serengeti where the land went on and on and on and when you reached the horizon it went further and further and further.  

a huge baobab tree with a hole rubbed by the elephants as they chew the bark


No wonder as the Serengeti covers an area 15000km2 – the name is derived from the Masaii word serengit meaning “endless plain”.  The Masaii migrated into the area in the 17th century but now it is a national park they live in Masaii villages outside.
 The Serengeti was green and had quite high grass due to the recent rain which made animal spotting quite hard.  We camped that night and unfortunately the campsite was packed and a far cry from my last safari 20 odd years ago with Lizzy and Jo when we camped out in the middle of parks on our own with no-one else to be found for miles!  How times have changed…  Still social Zac made friends with a large group who were sitting around a big campfire.  In true Zac fashion he sat down, made himself at home and then started questioning 2 girls who had just climbed Mount Kili. 

I was so impressed by the 3 course meals that our amazing cook produced every night.  He didn’t seem to understand that the kids ate approx half an adult portion and was constantly making mountains of food.  The next morning we set out on a game drive at 6am and yes Josh went straight to sleep on the back seat waking up periodically to munch biscuits.  It was amazing seeing the sunrise over the Serengeti and we and one other truck traveled together on our own leaving the masses behind.  The early start was so worth it as the safari driver in front spotted a cheetah in the grass.  We were so close to him and then as we were watching another head popped up a few metres away.  They are such stunningly beautiful creatures and as Tuma our guide says they walk like models on the catwalk swinging their hips elegantly.  I had never noticed before how giraffes walk – they are very unusual as they move the 2 legs on the left together and then the 2 on the right when they walk which is very unusual in an animal.  When you look closer you can see that they have to walk like this due to their necks and how their front half is much higher than their bottoms.






















Masaii warrior


On the way to Simba campsite we visited a Masaii village which was fascinating. 


playing ring a ring a roses..
 The Masaii children spend their days walking long distances with their flocks of goats and cattle.  They live in round huts enclosed with walls but have no electricity and no running water but wash in nearby lakes and rivers.  They are a nomadic people and often walk miles with all their animals to another grazing land.  
I am a Masai warrior too



Their diet is based on the cow and they drink milk, eat meat and drink the cows' blood but eat little else.  I think they also eat roots as otherwise they would have little vitamins and minerals in their diet.  The Masaii use the money they obtain from visits to their village to improve facilities and they have built a kindergarden where we saw all the children which was fantastic. 





 Our visit ended with a huge football match outside which was hilarious.



who's going to get that ball?
Camping on the rim of the Nngorogoro crater was amazing and waking up to see sunrise over the crater was incredible.  Another early start and we were one of the first vehicles into the crater which was brilliant as by late morning it was packed! The crater is the worlds largest intact volcanic caldera – the floor of the crater is 260km2  and the floor is 600m below the rim.  The crater supports a huge concentration of animals in it’s lush enviromens.  We were very lucky to watch a cheetah stalking an impala and it was fascinating watching how patiently he waited and watched.  Unfortunately he wasn't hungry enough to go for the chase and so went back to sleep much to our disappointment.  We saw all the animals in the crater - black rhino, wildebeest, buffalo, beautiful zebra, flamingos along the lake and lots and lots more lions.




very early at the Nogorogoro crater


Back to a hot lunch at the campsite and then off on the long drive back home via the Arusha National Heritage centre where Zac was very happy to show us all his favourite exhibits.  This is a very strange place which seems to be a glorified shop pretending to be a museum.  There is even a handy DHL centre in the grounds where you can arrange to ship all your large objects home!


By the time we got home we were filthy and very, very tired but very happy as we had had the most wonderful safari.  We have stayed in touch with Tuma our brilliant guide and met up for lunch with him and his 6 year old daughter Grace a few weekends ago.  The boys, especially Zac had a wonderful time and they both drew fantastic pictures in their diary books of all the animals they had seen.  Zac actually tried to draw the animals as we were driving and became very cross if we drove off in the middle of his picture!


And for the old folks here are some east african birds:



Red billed horn bill

superb starling



crown crested crane - Ugandas national bird


And more exciting animals.....
blue balled monkey!





mud too makes an excellent sunscreen