Letter One from Tanzania, 2015

Hamjambo from Tanzania!

Sorry for the long e-mail. I haven’t had time to write until now.

I’m back in Africa, although it feels strange to say ‘back’ in Africa. From the moment I arrived, it felt in my heart like I’d never left. It’s amazing how quickly I can re-adapt to the smell of campfires, the background noise of African drums and children singing, and the many layers of dust on my feet. Applying bug repellent is as automatic as brushing my teeth. (Of course, that may be because I grew up in Minnesota, rather than an African habit.) And the traffic, which used to seem chaotic and haphazard, now looks almost orchestrated – like they’re all moving to the same song. So the trippy mix of safari vehicles, enormous trucks, super-tall busses, motorcycles, bicycles and men hand pushing hand-made wheelbarrows share the road in different tempos and somehow avoid hitting each other.

I landed with a near full moon over Kilimanjaro, and was greeted by my friends – our global health team here. Julius, Sky, Eliphas, and John (who is the younger brother of George who traveled with us two years ago) all picked me up from the airport. No, I didn’t have massive amounts of luggage that required four Tanzanian men to carry it. They all think of me as family and they wanted to meet me there. And I think of them as family too. Julius has traveled with me for eight years now. I’ve known Sky and Eliphas for more than four years. It’s fun to work with these guys because we know each other so well. I can open my mouth to request something and it’s done before I finish the sentence. In addition, they love NUNM students. They tell me all the time how our students are the most kind and compassionate people who do safaris with them. We treat them like friends, not servants as many other people treat them. And, usually, we aren’t the loud Americans who embarrass them.

Our lodge is called Backpacker’s Paradise. It’s owned by the local Moshi Rastafarian, and run by an Indian/Tanzanian/Londoner. It’s conveniently located in the center of Moshi, a city of about 30,000 people. Unfortunately, the convenient location means it’s also a bit noisy. I confess that I only lasted one night at the lodge before I moved to a quieter location one block away, the Zebra Hotel. The students seem to sleep through anything – even motorcycles and trucks rumbling by in the middle of the night. And the lodge is great. It has a rooftop garden that serves as a perfect place to view Mount Kilimanjaro. An open common area beneath that serves as a wonderful place to hold class.

We had our first TIA (this is Africa) moment with the student’s arrival. The students had informed us that that would arrive at 3:00 p.m. Julius, Sky, and I drove to the airport, about an hour away from Moshi, to pick up 10 of the 13 students. Kilimanjaro airport has no signs outside the airport telling people when different flights have arrived, and no one is allowed into the airport without a ticket. Essentially, it forces you to just wait and be present in the moment. So, we waited as plane after plane landed. No students. We waited a little longer and two more planes landed. Chinese people to climb Kili, a Qatar flight… No students. Finally, we found an office outside the airport that could check each of our student’s itineraries. It turned out that they landed in Dar Es Salaam at 3 p.m., but didn’t get to Kilimanjaro until 9 p.m. Somehow that didn’t get communicated to us.

What do you do when you have five hours to kill in Tanzania? Well, go on safari of course! TIA. Arusha National Park was only 45 minutes from the airport. So Julius, Sky, and I set off for the park. Zebras, dik dik, waterbuck, baboons, and giraffe were eating their evening meal. Giraffe are my favorite safari animal… Must be that long neck that I wish I had… And on my first day in Tanzania, I got to see 5 adults and one baby giraffe! What could be better? Africa!!!!

The students did arrive, and we collected them all and hustled them back to the lodge. After one day of orientation and jet-lag recovery, we took the students to Mowo, the village that we work with in the foothills of Kilimanjaro. Mowo is about 15 miles out of Moshi, but it might as well be 100 miles. Mowo is remote. With no cars, and public transportation that consists of a mini-bus (dala dala) that comes through town one time per day, it’s rare for the villagers to make it to Moshi. The average tourist would never encounter Mowo. We discovered Mowo through our friend Eliphas who grew up there. Eliphas brought Maria to Mowo to be the town physician many years ago. The relationship has sustained even though Maria has long since returned to NUNM to be faculty. Every year we go to Mowo, we learn more.

This year, the students went to the newly finished Mowo clinic. Yes, it’s done. You may remember that the clinic had barely been started when I was first in Mowo four years ago. Last year, I found it comical that they had put in light fixtures even though there was no electricity. This year, they’ve put light bulbs in those fixtures… still no electricity. Wishful thinking – and good preparation? But the building is done! More importantly, the clinic has a ‘clinical officer’ now. Scholastica is the town doctor – with about 2 years of medical training under her belt. As you can imagine, her knowledge is pretty limited. Two years of medical school only gets you so far. But then, the medicine is also limited. In fact, the only medication that Scholastica has in her pharmacy is birth control injections and erythromycin. There are only about 10 bottles of pills in the brand new 8 room clinic.

Some of the students shadowed Scholastica as she saw patients on Friday. They reported that every patient had upper-respiratory symptoms and pneumonia according to Scholastica. She gave them all erythromycin. In the US, we wouldn’t give erythromycin for pneumonia. While erythromycin may be effective for pneumonia, it’s only effective at high doses and those doses cause nausea and vomiting. So a low dose of erythromycin does pretty much nothing. One fear is that it might breed an antibiotic resistant strain. Hard to say whether there’s even enough antibiotic to do that. However, when you don’t have access to amoxicillin, what else is there to do?

Of course, there’s lots of medicine in the village in other forms – specifically plant medicine. Eliphas has an uncle who is an herbalist. His uncle spent all day on Saturday, walking the students up and down trails and pointing out different plants and what they do. It was amazing how many of the plants were specific to GI symptoms. We questioned whether more plants are specific for GI symptoms in this area, or if because the villagers tend to get parasites and worms, they are just more aware of the GI plants. Interestingly, not many of the plants were upper-respiratory focused. We wondered whether this was because the respiratory disease is relatively new the village. Mamas in the village are now cooking over a fire in a closed room, inhaling all of the smoke. Previously, they would have cooked outside. It’s hard to say why so much pneumonia – or whether it was even an accurate diagnosis. On the plant walk, the students touched, smelled, and chomped on leaves from dozens of plants. I decided that we were either going to have very healthy or very sick students today.

And the students didn’t get sick. They headed to the hot springs, as today is their day off. And they need to experience African hot springs. The springs are out in the plains – an oasis in the desert – and they have a fantastic view of Kili.

Badaaye! (Later!)