Bridge2aid

Tanzania - February 2013

 

 
   

Monday 4 February 2013

 

I delivered Liz and her nurse, Tracey, to Terminal 5 at Heathrow where they met with the rest of the team. This time there will be 14 dentists and 7 nurses, split, as always, into two separate teams (of which more later).

Also flying out with them today was one of the Bridge2Aid UK-based staff, who is primarily involved in fund-raising around the country. It is important to remember that, whilst the volunteers who go out on the training programmes, in which Liz participates, largely pay for themsleves, there is a lot of other work that the charity carries out, including giving a full set of dental instruments to the clinical officers whom they train. As the girl put it, it is difficult to sell a product if you have never seen it and so she was going out to see the work of the Hope Dental Clinic (the permanent clinic run by the charity) and to meet some of the clinical officers and the UK teams who will train them.

The volunteers (left) have made about 30 visits to Tanzania in aggregate. Most of the others arrived after I had left, including one nurse who had very little time between an arriving flight from Leeds and their flight to Da-es- Salaam. As always they had to travel light as some of their baggage allocation was taken up by a number of packages of dental equipment (gloves, instruments, etc.) which arrived whilst I was there.

Liz phoned me from the plane to say that it was not full but, unfortunately, she didn't think they were going to be able to lay out to go to sleep.

Their flight - BA 047 -  which was due to leave at 18.45, pushed back at 18.53 and was airborne at 19.07 and is due to land in Tanzania at 07.24 (local time).

Temperature in London: 30C      Temperature in Dar: 300C     Enough said !

 

Tuesday 5 February 2013

 

Good to see (from feedback received) that the blog is already being read in some far-flung locations. After sending out the email last night, I received emails from Los Angeles (our nephew) and from a friend who is spending a few nights in a very cold and windy Glencoe, in Western Scotland. I have also heard from two friends from church who recently 'emigrated' to Lanzarote. When I speak with Liz, I will pass on best wishes from everyone.

When she arrived at Dar (early at 07.12), she texted me to say that she had, after all, managed to find a row of 3 seats to go to sleep. They were waiting in an enormous queue to get their visas. A couple of years ago Tanzania changed its system; instead of going to the High Commission in London to get your visa in advance, you have to buy the visa (ca 100) at the airport. As with many countries, you have to make sure that you have a full empty page in your passport for the official to stick the visa into. The charity have been trying to persuade the government that they really should not require visas to work but, so far, to no effect.

Apparently Liz managed to watch the first episode of the new series of CSI on the flight so I must watch out for that,

Unfortunately a later text advised me that the flight to Mwanza with Precision (?) Air had been cancelled and that they were catching a later flight at 15.00 (local time). The website of Precision Air says:

WE'RE GOING PLACES

Unfortunately, that did not include Mwanza this morning ! For the first-timers the humidity and lack of organisation must be quite a rude awakening. They were going off to a shopping mall, just to get into some air conditioning and to have brunch. It will be late by the time they get to Mwanza as I cannot see that there is a direct flight in the afternoon.

I have been asked whether Welwyn Garden City counts as 'far-flung'; I am afraid that, remote as parts of WGC may seem, they do not compare with our son, who emailed us from Phuket in Thailand. I also had an email from a friend I used to work with who said that she had read today's blog whilst on Langkawi in Malaysia, where she is on holiday.

   

If you have read the blog in previous years you may know that they normally stay at the Vizano Hotel, which leaves a lot to be desired. This time they are staying at the hotel where they usually have the welcome dinner - the Ismailo Lodge which is shown on the right.

I phoned Liz when she had arrived at the Lodge and she had just met with the whole team and they were going to eat at the hotel. She said that Dar had been unbelievably humid and that, bizarrely, a man in the shopping mall had tried to sell them a laminated 'map' of the human body, which, together with a laminated map of Africa, seemed to be his sole wares. One cannot help but conclude that, somewhere, a classroom wall is missing two posters !

The flight up to Mwanza was not full and they inferred that the previous flight was cancelled due to lack of passengers. Dar is rapidly diminishing in importance as a hub and BA are ceasing flights there soon.

 

Wednesday 6 February 2013

 

What I have not mentioned so far is that, as last year, Liz and Tracey, her nurse, are being split between the two teams. This is because the charity needs to ensure that each team has experienced staff, who have been out before. Liz will be with Judy, who has been out about ten times. They will be based in Musoma (see map below) which means that, en route, they will pass the Stopover Lodge where Liz was based on her first trip back in 2008. Musoma was the birth-place of the founding father of Tanzania, Julius Nyerere. As you can see, the town is on an inlet of Lake Victoria, near the border with Kenya. By contrast, Tracey will be flying up to Bukoba, diametrically opposite Musoma, near the border with Uganda and not that far from the border (to the West) with Rwanda. To give you some idea of the size of Lake Victoria it is about 140 miles from Bukoba to Musoma as the crow (probably the local pied variety) flies.

 

 

I received a very long and detailed text from Liz which she had sent whilst being driven along a very bumpy road, driving past fields of rice with cattle egrets in the fields and kingfishers on the telegraph wires (for the non bird-watchers, despite the name, not all kingfishers live or operate near water). They had just crossed a river, prior to which the sign read 'Narrow and damaged bridge'.

The view from Ismailo Lodge over Lake Victoria was wonderful and this morning they had the orientation session. One of her team has been working out at the Hope Dental Centre for 6 months and lives in St Albans.

Facts from the orientation session are as follows:

  • More work-days are lost in Tanzania because of toothache than because of malaria and hepatitis combined

  • The ratio of dentists to people in Tanzania is now 100,000:1 and in Musoma (where they will be) the ratio is 400,000:1 (about 5 times the population of Stevenage for each dentist)

  • The B2A Dental Volunteer Programmes have trained 212 Clinical Officers since 2006 and have treated approx 25,000 patients (but, of course, the main purpose is training)

  • Aim is train 86 COs in 2013

  • There is now a B2A office in Dodoma (the new capital)

  • A pilot in Rwanda will take place in June and B2A hopes to expand into another East African country next year (I am currently writing a risk assessment for them)

  • HIV rate is now at about 10-15%

  • Urban population (where the dentists are) = 800,000 whilst rural population = 45 million.

 

Whilst in Musoma, Liz and the team will be based in the Afrilux Hotel (shown oin the left). As you can imagine, Liz has confirmed that the emphasis is more on the 'Afri' part of the name than on the 'lux'.

I spoke to her when they had just arrived at the hotel. On the way to Musoma they passed the entrance to the Serengeti National Park and were able to see zebras and wildebeest - just like rural Hertfordshire, really !

They are all looking forward to their first day out at the clinic; Liz is paired with Chris, a first-timer from Scotland.

 

Thursday 7 February 2013

 

They had a rude awakening this morning as the call to prayer at the nearby mosque started up at 04.30 and immediately woke up all of the dogs in the neighbourhood. Apparently it is live and not recorded and so Liz is praying for laryngitis to strike the muezzin. They drove out to the village of Murangi, which is about 1 hours along a narrow single track dirt road. It is on the shores of Lake Victoria, south of Musoma. Liz is going to try and send me a photo of the clinic but, for now, I have found a photo of the road to Murangi that was posted on the internet by someone who had been driving around that area.

They first went to the offices of the District Medical Officer, who welcomed them with a prepared speech In English. There they met the District Dental Officer (Dr Joseph) and the 6 clinical officers (5 men and 1 woman). Liz has been training Mzalengo, whose English is not that good. He seemed a bit put out, at first, that he was going to be trained by a woman but became more impressed the more he watched Liz treating patients. With them also is Stella, a permanent employee of B2A in Tanzania, who has been interviewing patients as part of a Monitoring and Evaluation exercise ('feedback' to those of us who hate jargon).

The clinic is a new building with holes ready for switches and wiring and air-conditioning. Note the word 'ready', though, because this is all set to be completed by June (year not specified) and today they were sweltering under the corrugated iron roof and made regular use of the bottled water that they always have available. Liz says that these are the hottest conditions she has ever done dentistry in. Sufficient to say, also, that any plumbing that may be planned has not yet been completed and that the lavatory arrangements are very 'African'.

 

Friday 8 February 2013

 

When they arrived at the clinic this morning they found that there were bat droppings on the tables as bats have nested in the roof of the, as yet, unfinished building. Luckily they had covered all of the equipment. They saw 107 patients and Liz trained a clinical officer called Bonny (male!), who was excellent. The clinical oficer who is based at Murangi was trained by B2A about 8 months ago and he will be there tomorrow for a follow-up assessment. A friend of B2A has been with them taking photos as well as two representatives from Barrick Gold, the mining company that sponsors B2A as one of their community projects. If you have read this blog in previous years you will remember that they were billeted at gold mines before.

2 patients fainted in the heat today but that was probably brought about by the fact that they had been up for a long time; one woman, who had a very swollen face, had walked for 5 hours to get to the clinic. I let Liz know that the forecast here is for snow over the next few days !

Liz's prayers must have been answered because the loudspeaker system in the nearby mosque had broken today and, whilst they could still hear the muezzin, it was just his unamplified voice.

Unfortunately the water in the Afrilux appears to be unreliable. Liz got a shower (no hot water at all) at 06.00 but by 06.30 there was no supply to the floor above hers, where some of the others have their rooms.

When she phoned they had just been playing Jenga, highly appropriate as it derives its name from the Kiswahili for 'to construct'.

Liz had tried to send me a photo but without success. The kingfisher on the left (a woodland kingfisher) is the type that you see on the telegraph wires

 

 Saturday 9 February 2013

 

Today was not a rest day for the team. I got a text from Liz at 18.05 (her time) to let me know tha they were still at the clinic, waiting until Dr Joseph (the District Dental Officer) had finished treating the last patient. Just as well they are not about 1 hours from Musoma with a drive back along a dirt road in the pitch dark !

I sent a text to Tracey today, asking for a brief update on the other team; it will be interesting to see how they are getting on.

I spoke to Liz when they got back. Interesting to hear that they have been accessing this blog themsleves on an iPad, using a WIFI connection to avoid the data roaming costs. Dentists who have been out with them before have also been reading it and I have duly passed on greetings from whovever has contacted me.

Today Liz has been training a lady with the imposing name of Theotister, who only qualified as a doctor a clinical officer a year ago and is very good. The last patient today fainted, which was why they were late back. Together they treated 119 patients today. It rained heavily at lunch-time, which eased the humidity but, as always in the tropics, the ground soon dried out, although the road on the way back was even bumpier than normal! The fields mostly contain cotton (now about 1 foot high) and maize, although they have also seen a lot of cassava (right) being sold, this being a shrub with a tuberous root, from which we get tapioca. According to Wikipedia it provides a basic diet for about 500 million people in the topics.

They all sent some clothes off to the laundry yesterday and were surprised to get anything back washed, given the absence of water yesterday. Liz's clothes came back minus one T-shirt; good job she saves all her old clothes for the B2A trips. Tomorrow is a rest day and they hope to go to a hotel near the beach on the shores of Lake Victoria - I will try and find a good photo of a Nile crocodile for tomorrow's entry !

 

 Sunday 10 February 2013

 

During a hymn at church this morning, I got a text from Tracey. As you will recall, she is with the other team in Bukoba, in the far North West of Tanzania, also on the shores of the lake. They have two women and four male clinical officers to train, each of whom is learning quickly. Their first clinic was in Kishogo, which seems to be a fair distance from Bukoba, near to Lake Ikimba. Apparently the weather is much cooler and they had thunderstorms on the first two days. The area is different from anywhere they have been before, with the main crops being bananas. There are also pine tree plantations for timber. Today it was also their rest day and so they went off to visit a waterfall and also a bat cave, which was amazing. Next week they are at Kishanje, which is further North towards Uganda.

Today Liz and her team went down to Tembo Beach in Musoma, after first visiting the local market, where Liz bought yet more brightly-patterned material (we already have one bedroom full of batik artwork on the walls!).  Amazingly, I discovered that you can buy a poster of the beach on Amazon (see left) although I have, howvere, also managed to find a photo that someone has posted, looking along the beach, which is presents a less idyllic image (see right). When I spoke to Liz she said that they had already been onto the blog themselves and had been amazed that I had found photo of the beach.

They went and sat at the restaurant and, as always, had to wait ages for their food. They watched the pied kingfishers hovering, the egrets and herons on the shore and four fish eagles working the shoreline. When their food arrived, all of a sudden a black kite swooped down and took the chicken off one of their plates. Later the same happened with some fish.

Important news - Liz got to have a hot shower today ! She also got some laundry back, only to find that a pair of her socks were missing and had, mysteriously, been replaced by a pair of No.6 football socks. The lady was distraught because she had made a hole in Liz's socks whilst ironing them. At last they seem to have found a way to get photos through to me; one of the team, Elaine, emailed to me the photos shown below. Just click on any one photo to enlarge it. Thanks, Elaine.

It's also interesting to see the cycle of fund-raising and the delivery of the training in Tanzania. I had an email today from someone who regularly fields a team for the annual Quiz Challenge that we run, saying that they were enjoying reading the blog and asking when the next quiz will be. The answer is Saturday 28 September.

As in previous years, I passed on a message about MANU's latest exploits, only to be told that they knew, because they were watching the game !

Laundry

Forever blowing ...

... bubbles

Spice Market

Tembo Beach

'Waiting Room'

 

 

Monday 11 February 2013

 

The most important task for me yesterday evening was to ensure that nothing went wrong with the recordings of Call the Midwife and Mr Selridge, or my life would not be worth living when Liz gets back. During the evening I got a nice email from Edie Allan, whose husband, Chris, is on the Musoma team with Liz. She wanted to know if Tealing in Angus counted as 'far-flung'. Given the snow that was falling at the time (there and here), it probably felt pretty remote !

Today the team went to a different clinic, this time in Kiagata. I have marked the location of the two clinics on the map below, together with Musoma, where they are based. As you can see, getting to Kiagata involves crossing the main road to Kenya and the heading off into the bush towards the wildlide reserves.

 

 
More photos made their way through today...
 

 

 

       

 

The Kiagata clinic is about 45 km away, half of which is along an unmetalled road. It took them 1 hours to get there. Bonny is the resident clinical officer at this clinic and has 5,000 patients. The clinic is larger and has great potential: showers, flush toilets and large sinks ..... just no water or electricity ! The main room was larger but, as it had the same bat problem, they set up in smaller back rooms. The place should be finished 'later this year' but one has to wonder about how quickly it will all deteriorate if water and electricity do not arrive. They saw only 46 patients today, one of whom was a 24-year old man who had a large tumour on his face (ameloblastoma for the medically-minded amongst you) which is non-malignant and slow-growing (he had had it for two years). He will have to go to a town to have it operated on. Liz had been training Zacharia today and tomorrow will be training Paul, who was trained by B2A four years ago but failed then, although Liz said he is excellent now.

Their driver is also a safari driver and advised them that the punishment now for killing a rhino or elephant is 30 years. This had echoes of the final episode of Attenborough's Africa series, which Liz has yet to see.

Today's technological development is that they have sent through a small video clip of the team in action. Click on the icon below to see the video; it may take some time to open but gives you an idea of the set-up.

 

 Tuesday 12 February 2013

 

They arrived today to find that there were only 4 patients waiting but things picked up later and they saw a total of 55 patients, including one patient who had a large swelling on his face called a pleomorphic adenoma of the parotid gland, which he had had for four years. As with the medical complaints yesterday, Liz had never seen this type of condition before.

She treated a 20-year old today, whose teeth were fine apart from the fact that one of his incisors was missing. The reason, which Liz had never encountered in Knebworth, was that the tooth had been kicked out by his cow !

Whilst they were having lunch a man came up to them and tried to give them a bag. They thought, at first, that he was trying to sell them something and almost felt like shooing him away before they realised that it was someone they had treated before who was giving them a bag of corn-on-the-cob as a Thank You present. Needless to say they felt awful and have now asked the chef at the hotel to cook them for their dinner

They saw 4 green vervet monkeys on the side of the road and, as I spoke to Liz, there were upwards of 200 black kites circling overhead. Even as we spoke the pictures below popped up in my InBox from Elaine.

              

 

They blew up a pair of gloves and gave it to the little boy as a football for him to play with, whilst he was waiting. Ian, one of the dentists, is showing the trainees a walk-through on YouTube of the difference between baby teeth and adult teeth and things to watch out for. There may not be any electricity or water at the clinic (yet?) but this does not mean that they cannot use technology to great effect.

 

 Wednesday 13 February 2013

 

Today was their last day at Kiagata and, indeed, their last day with the trainees. In the morning they continued the training and saw about 47 patients. The trainees then sat a 1 hour written exam. Each of them is given a certificate by the charity in a little ceremony (left). They then had a cake and some soda and Dr Joseph made a short speech, thanking them coming over from the UK and for the training.

As the team clear up each day they give their water bottles to anyone who happens to be around. The lady pictured here was SO happy to be given some simple empty bottles.

What happened next reduced a number of them to tears and Liz was tearful as she told me about it. She had been wearing an old pair of trainers that, back in the UK, she uses for gardening. I am not sure of the circumstances but she gave the shoes to the girl seen holding them, who had been around for the last couple of days, watching them work. This now means that the little girl can go to school as she needs shoes to attend the school. Cue lump in throat !

At the end of the day they said farewell to the trainee clinical officers and drove back to Musoma. Tomorrow they will set off for Mwanza at 08.00 and have the formal de-brief with the B2A staff there.

 
 

        

 

Thursday 14 February 2013

 
St Valentine's Day
 

I awoke this morning to find a text from Liz who was obviously in the jeep on the way back to Mwanza. It had rained heavily last night and there had been a power cut with the result that, mercifully, the PA system in the nearby minaret was broken ! They stopped off at Stopover Lodge for a break; this was where she had been based on her first trip 5 years ago. They saw lots of people working in the fields, including a group of prisoners in bright orange uniforms. There is a lot of sisal being grown, which is used, amongst other things, for hedging. Ever the birdwatcher, Liz saw two hammerkops on the road (right). This is an odd, squat bird which is actually a member of the heron family - easy to see why it has a name that means 'hammerhead'.

They took 5 hours to get back and were stopped en route by a police patrol and the vehicle license papers were found to be slightly incorrect. As Liz said, she did not see any money change hands but has her suspicions.

The Bukoba team had already made it back to Mwanza on the morning flight. Liz then phoned me when she got back to the Ismailo Lodge and had met up with Tracey who seemed to have had a good time. Tracey had had a similar experience, at the end the clinic, in giving away some shoes to a child.

Liz had decided not to go off to the local market and was working her way through the trip evaluation form. They were then all going off to Tunza Lodge on the lake for a Thank You meal.

 

  Friday 15 February 2013

 

Today they all went their separate ways:

-  Some of them (including Tracey) flew back to the UK and arrive tomorrow morning

-  Some went on a safari to the Serengeti, which B2A arrange as an optional bolt-on (at own expense)

Liz, Judy and Brian have done the Serengeti trip before and so they have arranged (at own expense) to go to Tarangire National Park, near to Lake Manyara. They fly from Mwanza to Kilimanjaro Airport and, because the park gates shut at a specific time, they are spending tonight at the Osupoko Lodge and will then enter the park early tomorrow for their safari. This will give them almost two days of watching wildlife. With this in mind, Liz has taken our 39x spotting telescope and tripod with her, as well as her binoculars. Whilst in the park, they will be staying at the Tarangire Safari Lodge. Personally, I can't say I envy them; I would much prefer to spend the weekend in Knebworth, washing the car ! The only downside is that Knebworth doesn't have many of our favourite bird, the lilac-breasted roller (left), which looks as if someone went berserk with a paint-pot and has to be one of the prettiest birds in the world. The three of them (dentists, not birds) will fly to Nairobi and catch an overnight flight back on Sunday, arriving at 05.20 the next day.

No, the surgery is not open on Monday !

Before she set off Liz was keen that I stop the blog at this point as she is now on a private holiday. Many thanks for reading the blog; I hope that it has given you an idea of the work of Bridge2Aid and of life in rural Tanzania. If you live in or near Knebworth then we hope to see you at the fund-raising quiz on 28 September.

Colin