My birthday post

Today is my birthday and I keep forgetting as it seems so out of place in this context without all the usual cues and prompts. Birthdates are clearly not as important here and are often unknown. As I write referral letters for patients in Teule to send them to Dar for cancer treatment at the Ocean Road Cancer Institute, there are no birthdates to confirm the identity of someone, only names and approximate ages.

We have been here almost a month and the passage of time feels simultaneously both disturbingly fast and amazingly slow. Fast as day after day passes in the work context with little outward evidence of us doing anything, while a cacophony of discussions and ponderings go on inside my head and out with Ambrose and others as we try to make sense of the medical scene. And painfully slow as we focus on the computer screen waiting for an individual email to be successfully sent (or not) or a webpage to pull up (or not) in the brief hours when we can access a computer and the power is on.

Gratefully, a big theme of our existence here is the bicycle. We have purchased 3 and daily rides have become a wonderful part of our routine. I had worried that we would have no bike fitness leading into the cycle trip, but I think that will not be such an issue! The boys’ school is about half an hour away over some seriously hilly but beautiful and un-trafficked terrain (except for pedestrians and other cyclists). We are a curiosity here for sure, as wazunga’s (white people) don’t usually ride bikes but rather are driven around in big white land rovers. Some folks are getting used to us, and simply greet us as regulars, but usually the ride stimulates some comments and shrieks (usually amused and encouraging) from onlookers. We have been strongly advised that the boys should be accompanied out of concern that they could be stopped and have their bikes stolen. Property security seems to be a very big issue here (you should see all the locks on our doors) but gratefully not personal safety.

Mostly I am riding the boys up in the morning, leaving home around 7:30 and at that time the air is still tolerable. I am back by 8:30 and a quick shower is in order before the work day can possibly begin. The ride home (3 pm pick-up) is more of an epic daily dehydration fest, truly feels like you are exercising in an oven, sweat pouring down all surfaces. We carry loads of water with but never can we seem to be able to drink enough. The bikes are made in China, single-gear clunkers that take me back to my blue CCM bike of childhood, although these are noisy (cheap), heavy (cheap) and feel like driving a shopping cart. We are regularly at the bike fundi (repair person) as bits and pieces rattle loose and drop off and inner-tube valves crumble with attempts at pumping up tires. Repairs always cost 500 Tsh (about 50 cents), so that’s tolerable. However, the initial flurry of problems and repairs seems to have leveled off (now that we have prophylactically removed baskets (cheap) and lights (cheap cheap) and we have had a good week of rides without a peddle falling off.

The boys are having a hoot with the bikes. Simon’s is a blue very comfortable slightly better quality with a cushy back seat for doubling someone. Sometimes a friend (Kevie) rides Griff’s bike home and Griffin and Simon double over the bumpy muddy terrain laughing their heads off (until Sy falls off and the heat catches up). The birds and insects usually show us some new species every day and Simon loves to see all the new creatures and try to identify them. It is a curiosity of timing that Sy was just launched into a serious love of mountain biking and dirt-bike jumping just before we left home. His friends have been sending emails detailing their adventures and new jumps they have built and it is just about killing him to hear of their exploits without him !! Hard to reassure a 10 year old that it will all still be there when he gets back…His bike here and our rides over the deep red earth (and mud post torrential but brief bursts of rain) of Muheza district, are a metaphor for how profoundly different everything is here for him. He is coping (in fact thriving) remarkably well. He said to me yesterday.. “can you believe that a month has already gone by ? Don’t you think its going very fast !! “

Griffin has had to face a few more challenges on the other hand. Chiefly he has had a terrible time the last couple of weeks with mefloquin side-effects, the anti-malarial he was on. What began as nocturnal nausea and vomiting (preceeded by non-specific anxiety and claustrophobia characterized by an intolerance of mosquito nets!) eventually (after a normal week without any problems) lead to full on decompensation complete with hallucinations (crawling ants and monkeys) and a couple of completely sleepless nights fraught with intense anxiety and mental restlessness. Poor kid. He has been a trooper through it all as we discussed the symptoms with others and helplessly watched the thing unfold. (We got out the ativan and curtailed the 3rd night) Sadly, Mefloquin is a long lived medication given weekly, so the final effects are still lingering I would say even though it has been 11 days since his last dose. (Some say it can take weeks to completely wash out !!) We look forward so much to seeing him back to his normal self, as he was the first couple of weeks, venturing to the market, playing soccer with the local kids, and reflecting so competently on his experiences in his writing and blogs. ( I will have a thing or two to say to the travel doc we saw in Canada who confidently told me children never get the neuro-psychiatric side-effects of mefloquin!!)

Otherwise, tummys have been reasonable ok and we are enjoying local market shopping and cooking mostly adapted Canadian meals. Sally and Rose have arrived and it is wonderful to see them. The first few days we kept shaking our heads at the sight of them here with us, but now we are settling into a new expanded family and configuration of routines. Rose has already been up to the school and today she met with Sister Gwynneth (the Welsh nun who runs has built and run the school over the last 6 years) and is preparing to teach the newly developed Tanzanian IT curriculum for forms 3, 4, 5 and 6 (todays late-breaking news!!). Sally has a few tasks dropped in her lap researching the ordering or meds for the hospital, and reproducing charts detailing the patient flow systems for the Diana Centre. I will introduce her to the orphan program folks there this aft and see where that leads her. (see their blog for further details of their safari adventures before they joined us).

We went away last weekend with Sally and Rose (as well as Sally and Ben and kids and Alex and Emily) to Peponi a low end rustic beach resort on the Indian ocean and had a wonderful (except for poor Griffin’s bad night) time swimming in the sea and visiting the sand island (white seashelled beach exposed only during low tide) and snorkeling along the coral reef that runs along much of the local coast. It was fantastic snorkeling with colourful coral, fishies, urchins, starfish and tubular mushy things. It was lovely to get away although the contrast of life in Muheza and the resort was a bit jarring, and perhaps a bit early in our time here. That being said I am sure we will re-visit the coast and enjoy those spectacular beaches many times.

Graham arrives in a couple of days and there is great family excitement anticipating his arrival. He has managed to take a couple of weeks out of life at university and fed ex and we hope this is not too detrimental to his studies. It feels right that he come now and share in the early weeks and be able to picture our adventures better from Ottawa. This will be his first real foray into a ‘resource poor setting’ and I’m sure will feel truly surreal in the middle of his school term.

Work continues to be an unfolding adventure of revelations, ponderings, discussions and tiny planning steps forward. We are learning tons about HIV, TB and malaria. We certainly are helping with consults and direct patient care (endless and could consume all time if we chose to), but understanding the big picture of the troubled forces and resources that fuel patient care and palliative care here is much more complex. Sadly, in Muheza what was a relatively thriving palliative care infrastructure since 2003 ish has largely fallen apart over the last two years due to a complex web of problems. What is worse is that there is bad blood in its dissolution and the hospital is not a wholly receptive environment to palliative care and is strained by extreme human and material resource shortages. Perhaps we are fresh faces who can try to redevelop the palliative care foundation in Teule hospital in a sustainable way, but perhaps the division between Muheza Hospice Care and the hospital is also too deep and complex for our timeframe here. We are more hopeful that we can be of benefit down the road in Tanga where the history is different and the interest to learn about palliative care and pain relief appears keen. Every effort to build even the smallest of capacity here and in Tanga that will persist after our departure, remains our goal. So while Muheza has been absolutely ideal from a family adventure perspective, there are unfortunate extra layers of challenge that encumber the work.

Internet access continues very difficult, often extremely slow, characterized by crashes and power outages. It looks hopeful that we will get our own hook up at the Diana centre, but the schedule for this seems definitely on an African timeframe. This would really help and then we could access more reliably as long as there were power. In the meantime blogs and emails will appear in bits and pieces and we thank you for your patience.
Our snail mail address is

C/o Dr.Leah Norgrove
Hospitali Teule
Private Bag
Muheza, Tanga District
Tanzania