Weekend #2: homework and hashing.

So last weekend was super fun. Friday night, Helen and I had a quiet night in, working on homework and other projects. Saturday we woke up and walked into town and that was an adventure. There are a few roundabouts, and we had never walked in from our house before, only taken a taxi (it’s only about 3 miles away) and we got a little turned around trying to find where we were going. But it was a beautiful morning for a walk and we finally made it to where we wanted to be and popped into a curio shop to look around. We were meeting two girls for brunch and had some time to kill. I don’t know why but I love the curio shops. They’re filled with “African” things, but no Tanzanians actually shop there, they’re just filled with touristy things. But I love them anyway, they are very fun. Although I hate bargaining, and most of the shops don’t have prices on things so you have to bargain unless you want to get gouged.

But anyway, we went to the curio shop and then we met the girls for brunch; there’s a nurse from Canada who’s here volunteering at one of the clinics, and a girl from the UK who’s volunteering in one of the schools, teaching art classes and English. They’re both in their 20’s and are a crack up. They live near each other in a little village outside of Moshitown. So we ate and then went to a fabric and dress shop and looked around. Then Helen and I went back to the restaurant because our neighbors had invited us to come scout a trail for a hash on Sunday.

Hash, as in hash house harriers, as in the group for “drinkers with a running problem.” It was super fun actually. Wikipedia it, but essentially the run is supposed to go for several miles and the trail is marked with flour, with false trails and forks in the trail so that the runners ahead are finding the trail, which gives the slower ones a chance to catch up, so everyone finishes more or less together, and there is booze along the way and at the end. In theory. Our actual hash trail this time was pretty straightforward and only a few miles, but it was more hike in the mountains than run. The scenery was beautiful though; there was a little spring about halfway, and just after that a lookout where you could see Moshi and Kilimanjaro. The couple who was “haring” this hash has lived in Moshi for 10 years, he’s a physician and works with the Duke-KCMC collaboration. It was really nice of them to invite Helen and I along, we had so much fun hiking and scouting the trail on Saturday.

by the little spring.

Jess, Candy, and me at the top of the mountain.

The next morning I worked on my lesson for this week for about 6 hours and only got about 1 hour of material prepared. Yeah. I’m going to need to get faster at this. But at 1:30 I walked over to my neighbors’ house and caught a ride up the mountain to actually set the trail for the hash (Helen had a conference call, so she couldn’t come). So the hash started at this guesthouse way up in the mountain, up really rough dirt roads/paths, and we busted something on a tire when we were almost there. I am not a car person, I have no idea what broke, but luckily we made it and had a fundi come and fix it while we did the hash. So the hash started at this guest house, which is owned by some Germans who have a Tanzanian family living there as caretakers, so the Tanzanian husband took us on the trail on Saturday and Sunday to show us where to go. So the four of us set out to set the trail, got back and set up the food and drinks, and waited for people to show up. The Canadian and Brit came and convinced me to hike it again with everyone else, which ended up being really fun, but my calves are killing me today. Those girls are super hilarious, and I’m going on safari with them this weekend.

That was pretty much the weekend. 

just call me "U.S."

Today was my third day of class, and I have not seen the same professor twice, so it has been interesting to observe different teaching styles. The professors all follow the same basic formula of standing in front of the class and lecturing for two hours, but today one of the professors gave the students a five minute break after about an hour, so that was kind of refreshing! Normally they just power through and talk for the whole two hours. The most memorable professor today either couldn't pronounce or couldn't remember my name and so he referred to me as "U.S." Also today, two of the professors went around the room and had the students say their names, where they were from, and whether they were "fresh from school" or "in service," meaning they were previously working as nurses before going back to school. The program I am observing in is the bachelor's program, but it is only open to students who already have their diplomas in nursing. So it is a three year continuation program. For the first year though, the nursing students and the physiotherapy students take the same classes. So those who were "fresh from school" tended to be the physiotherapy students. The nursing students however, all have to have at least 3 years of experience as nurses before they can be accepted into the BScN program.

So anyway, everyone is going around the room saying their names, and since I'm sitting amongst the students, when it gets to be my turn I said "my name is Jael, I'm a Duke student from the US, and I am both in service and fresh from school." For some reason the students thought that was funny and I got a laugh, so I tried to clarify that I am working as a nurse and studying nursing education, but I don't know if that got through. Our accents are very different and we often need to ask the other to repeat what was just said. Unless I am talking to someone one on one, it is very difficult to understand names in particular due to the different accent.

I think that I confuse the teachers though. None of them show up for class until 10 minutes after class is supposed to have started, so I don't have a chance to introduce myself and tell them what I am doing ahead of time. And like I said, there has been a new teacher for every class. So I try to talk to them after class to let them know what I am doing, but a couple times the teacher has just ran out of the room right after class. The dean of the nursing school is also gone right now, she is actually at Duke, so it apparently wasn't communicated to the faculty what I would be doing, or even that I would be here. Which is fine, it just makes for some interesting moments when the teacher is obviously confused by my presence and I try to explain myself.

I have met a couple of the students now though, and they have been very nice. One of the girls yesterday walked me to class in a different building so I would know where to go, and we had a great conversation about nursing in Tanzania. One of the things I learned from her was that the scope of practice is the same whether she has a diploma or a bachelor's, the difference is in salary, at least in Tanzania. This is similar to the US though, where an ADN RN has the same job as a BSN RN, although usually there isn't a salary difference, just in the type of job you would be qualified for with a BSN as opposed to an ADN.

There is also a dress code that I was reading today. Trousers are on the "indecent" list for women, at least in the nursing school. Female students have to wear dresses and they have to be at least to the knee. I had been planning on rotating my pants into my weekday wardrobe, but it looks like I might need to go dress shopping instead!

Kili was looking beautiful this day.

first day of school.

Healthcare in Tanzania is crazy. I went on a tour of Kilimanjaro Christian Medical Center yesterday and was shocked by the wards I saw. What would be considered a med-surg floor had hallways lined with cots filled with patients, and 10 beds per room. Peeling plaster, bare concrete floors, overcrowding; forget about things like IV pumps, one of the ob-gyn residents told me they had to cancel all surgeries the other day because there was no blood in the blood bank. I might go donate, since nobody in the US will want my blood when I get back. But this is one of the largest, best, and well-funded hospitals in Tanzania. A resident said they don’t have access to imaging studies like CT scans or MRIs, so surgery is often performed without a firm diagnosis, based on physical assessment information. So like, “we think you might have a brain hemorrhage so we’re going to do a craniotomy and see if that’s therapeutic.”

Another crazy thing that same ob-gyn resident was saying was that the labor and delivery culture here is so different. Like women labor in silence. Silence. If she makes any sounds during labor, even if it’s just a little whimpering, she will get slapped and told to be quiet, or a member of the healthcare team might say she is being “uncooperative.” When she is getting close to deliver she’ll start rocking and then whoosh! Out comes a baby! I told the resident if anyone slapped me and told me to be quiet while I was laboring I would slap them right back; cultural differences, eh.

Another rumor I’ve heard is the lack of bedside manner among doctors and nurses. I haven’t seen this myself as I haven’t spent enough time on the floor yet, but therapeutic communication is apparently not a thing here. Patients aren’t kept informed about their care, patients don’t make any decisions, it’s apparently pretty rough. I am curious to spend some time on a unit and observe how things run and what the nurses are like.

I spent my first day at the school today, and that was interesting. The teachers all lectured for two hours straight. No break, very little student interaction, just the teacher talking for two hours; one teacher asked the students if there were any questions one time, at the very end of his lecture. It was kind of mind numbing. I am also now even more nervous to be the one to teach. I will definitely NOT be standing up there and talking for two hours, but if this is what students are used to, how will they react when I ask them to participate? Will they even do it? What kind of activities can I use to engage them and make class more relevant and interesting?

So today I just sat in on the classes. The first teacher gave half his lecture in Swahili, even though English is technically the language of education in Tanzania. During the second class, a student asked the teacher a question in Swahili and the teacher said “the language is English” and made him repeat it in English. I guess it just depends on the teacher. I am a little worried that the students will be able to understand me when I teach. Our accents are so different, I often find myself trying to politely ask people to repeat themselves, and they sometimes ask me to as well. But anyway, this week is likely going to be observation only, and next week I am going to the hospital with some of the nursing students. I talked to the pharmacology teacher after class today and she said I can teach for her within the next couple weeks, she will give me a topic on Friday. So that is exciting/nervous. One day down! 

My office!

in which we go to town.

Because "going to town" is a thing. I did not take any pictures today, mostly because Helen warned me that if you flashed your iphone in public somebody might try to take it off your hands. So there you go.

Yesterday Helen and I went into Moshi to get some groceries, an internet stick, and look for some seeds for Helen for the garden she wants to plant. The doctor’s compound we are staying at is maybe 5 km from Moshi proper, which is a 5000 T shilling cab ride, or about $3. We went to the Zantel store in town and I bought a usb internet stick with 6GB of data for Tzsh 50,000 and promptly used nearly 1GB of it on a video call with Paul as soon as we got back. Ha.

Anyway, we then walked around town for a good 45 minutes trying to find the outdoor market so Helen could buy seeds, and while we saw a good bit of Moshi, we never found the market and eventually gave up and went to Nakumatt, a grocery store in town to buy food for a few days. I bought peanut butter, raspberry jelly, and some bread, so no mom, I will not starve. I also got some fruit juice, toilet paper, and bug spray; just the essentials. Quirk about the store that reminded me of Sam’s or Costco: when you are walking out the door there is a guy checking the receipt, but instead of just marking it with a pen he has an official stamp he uses. We called Belda our cab driver and while we were waiting I went into a little curio shop next door. Belda picked us up and then he drove us to where the market is, and we are going to try to go back next week, now that we know where it is. The market looked crazy, I am curious to go next week.

Walking in Moshi is interesting because there aren’t sidewalks or anything, and there don’t seem to be any real traffic laws either, and pedestrians most definitely do not have the right of way. Even the shoulders of the road are rocky and uneven and pitted and difficult to walk on if you are looking up, which I don’t think helped when we were trying to find the market.

We came home and ate PBJ sandwiches together at our little dining table. Later that afternoon we went for a walk to a little grocery store 15 minutes’ walk down the road just to see what is there. There is a whole line of products from a brand called American Garden that for some reason was cracking us up. Like the label will say things like “US Mayonnaise” or “US style *whatever*.” Although then we realized that it’s like in the States with bottled curry sauce or something, when it says “Thai style curry.” On the way back we stopped and got some fruit from a fruit stand on the side of the road. Bananas were 1000 Tzsh for 6, oranges were 4/1000 Tzsh. Breakfast for the next couple days.

That night Helen invited me to dinner with her mentor and some of his colleagues. He was apparently the first person here for the Duke-KCMC collaboration, and lived here for 10 years. He’s here for a week this time, as he still does research in the area and is here on and off throughout the year. His colleagues, two British women, are involved with the same research project and split their time between Glasgow and Moshi. Very interesting people to talk to, and dinner was lovely too. I could probably take notes on entertaining from them: we chatted on the back porch for about an hour while dinner finished cooking, and they had nuts and banana chips in bowls to snack on; then we came in and ate, then there was dessert, then we moved to the living room and had tea to finish it off; the whole affair was about three hours. It sounds simple, but we never do that! Maybe we’ve been students too long, or our house is too small, or it’s just not common with our friends, but we don’t eat at home or in a friend’s home often at all. This article made me want to change that, though. But anyway, it was great, and the two women had apparently just purchased an oven for the house since they are there so often, and they roasted a chicken for us, which was delicious. Helen told me most of her cooking experiences at home have been mostly miss so far; she eats lunch at the school on weekdays for about 2600 Tzsh, has fruit for breakfast, and tries to cook or goes out at night for dinner. So eating in someone’s home and meeting some new people was fantastic. Overall, a very good first day. 

Just chillin in our front yard.

My bed.

I've got jeg jet lag brain. But I made it.

Wow. Okay so I'm here.

I went to bed at 1900 last night, woke up at 0030, fell back asleep an hour later and woke up at 0611, and it is now 0656 and I feel like going back to sleep. But I am going to try to not nap today.

More than anything right now I am thirsty. I am used to drinking 3 liters of water a day, and have only had two cups since yesterday. For some reason in Ethiopia I had to go through airport security again after arriving and getting on my connecting flight, so I drank the water I had brought and then there was nowhere to get more once going through security. My housemate here, Helen, had part of a bottle but I don’t want to drink all her water, and the power has been out since I arrived so we can’t even boil more. Ah well. We are going to the market this morning and I plan on stocking up.

So I arrived yesterday afternoon and have been getting settled in. I flew from Arkansas to Chicago to London to Addis Ababa to Kilimanjaro. Whew. I had a 9.5 hour layover in London and went into the city in order to stay awake. When going through customs the gentleman there asked why I was in the UK and I told him I would be only for a few hours and he was talking to me about that and I told him I was a student and he asked what I was going to do with my few hours in London and I said, “oh you know, get some fish and chips, walk around.” And he laughed and his buddy said, “she’s doin’ it proper, en’t she?” and then my guy told me to have a pint of beer as well. I said I would and then he let me go on my merry way. I love British people.

I also love London. I’ve been a couple times and done most of the “big” things so I took the Piccadilly line all the way into Russell Square and got off and walked to a fish and chips shop, got it takeaway and walked around til I found some steps to sit and eat on. I forgot to grab one of the little wooden forks so I ate it with my fingers. So good.

YES

Then I literally got lost for an hour. Ah well, there are worse places to get lost. I just walked around and ended up by Hyde park. I went to a Marks and Spencer and got some candy as gifts for the faculty at the nursing school and a croissant (I’m obsessed with their croissants) for myself and then bought myself a pen at a Cath Kidston store, because for some reason I only brought one pen. By then I decided to head back, so I trained back to Heathrow, collected my bag, logged on for my 45 minutes of free internet, and called my husband. We chatted for a while, I bought a yogurt, and headed to my next flight. The plane to Ethiopia actually had power, so I was able to charge my electronics, and slept fitfully for the 8 hour flight.

Addis Ababa airport

When we got to Addis Ababa I power napped for 20 minutes in a chair then realized I had to go through security again. I should have taken a picture of the line. There was a group of women in front of me who were all wearing white or off-white dresses and head coverings, with embroidering and applique decorations. One of the women had a head covering which was elaborately embroidered with gold accents saying “facebook” and the letter “f” like the facebook f. That was it. It was just sheer white fabric with rhinestone accents and embroidery saying “facebook.” I wanted to take a picture so bad.

Also, the ebola precautions being taken at the airports in Africa were interesting. It was just a temperature check. When we arrived in Ethiopia there was one man in a lab coat, gloves, and a mask who scanned everyone’s temporal temperature before letting them through. When we arrived in Kilimanjaro, we had to walk a couple hundred yards through the heat and sun and then before we could go inside you had to walk through and they did an infrared body scan thing. Yeah. So if you failed that you just waited in the shade for a bit and tried again. I had to try like 7 times before I passed. And when we arrived in Kilimanjaro we had to fill out a health survey asking about the countries we had been in over the last three weeks and if we were having any symptoms such as fever or vomiting.

ebola checkpoint??

Anyway. I got my visa and collected my bag and was met by the driver from Duke, who drove me the 45 minutes to Moshi. He stopped on the way and got me these little fried dough things, one was spicy and filled with meat and onions, the other was just a fried ball of dough and vaguely sweet. He dropped me off at the house and gave me three skeleton keys on a leather keychain in the shape of Africa. I unpacked, showered, and crashed for 30 minutes until my roommate got home. She is a med student at Duke, tiny, nice, and brilliant, apparently. She’s been here a week and we plan on going to market today. She will be living here for 8 months.

Duke van!

That’s all my brain can handle at this point. I already need a nap. I’m so glad I arrived on a weekend and don’t have to go to school straight away. I have pictures but don’t know that I’ll be able to upload them, might have to wait til I get home. 

Pre-trip.

My flight out of Arkansas leaves in less than 4 hours. I am sitting on my bed in my underwear, waiting for my hair to dry after taking a nice hot shower. My travel outfit is laid out on the kitchen table, my bags are packed on the bed next to me, my tablet is loaded with books and movies for the 36 hour journey to Moshi, Tanzania. Paul and I just had our "last supper" at Red Robin, where I downed a bacon cheeseburger and three root beer floats. Plane food makes me gag, so my next meal will hopefully be fish and chips in London, where I have almost a 10-hour layover.
I feel like I've been planning for this trip for so long, it's crazy that I actually leave today. I'm nervous and excited and want to take a nap. I have never been to Africa before and am not really sure what to expect. I talked to a lady who went in May and she said to "think of it like camping," and suggested that I bring duct tape and lots of breakfast bars, so half my bag is snacks. She also said the faculty were very welcoming and the students seemed to like her, so I'm hoping it goes well. I'm kind of more nervous about actually being at the front of a classroom than I am to go to a new continent without knowing anyone.
But doing things that both terrify and excite you is good, right? I think I need to get out of my comfort zone more often. I'm also interested in global health and nursing as a global profession and am excited to learn more about nursing and health outside of the States. The next month will definitely be a unique learning experience!