Photo Post From, Ontario!

Hello all,

Graham has finally received passwords and has found 15 mins (admittedly in the middle of class -discussing Western European "catch all parties" is not so riveting on a Monday evening) to post photos!

Hope everyone enjoys.

Another Post (one of very little)

It has been an incredible month of new discoveries, comings and goings of friends and family and visitors. A month of settling into the life here in Muheza. This past week we have hosted “the Anglicans” as they came to be known in our family (10 visitors from a church in Sunningdale, UK with a long history of significant donation to the workings of Hospitali Teule) who were here for less than a week and had a whirlwind exposure to Muheza, the hospital, the Diana Centre (Muheza Hospice Care and HIV Care) and even the boys’ school. It was strange to suddenly be the hosts and be the ones who “knew” and to be showing others about life in Muheza! In a curious way I think it helped us to realize we are settling in and becoming more confident and comfortable in life here and especially for the boys to receive such interest in their school and commending words of support for their adventures in Africa.

The boys are a joy to watch. Griff is back to his pre-mefloquin self and we are so grateful for that. Took about 2 -3 weeks for his confidence and poise to return, and now he is chief market bargainer and probably has the best Swahili of the family. He is super bored in school, but takes his home-schooling math book we brought with us and is working through his own math. During their Swahili, he works on “teach yourself Swahili”. He came forward with the scary experience of seeing his classmates hit (hard with a yardstick to the point of tears) and managed this with remarkable emotion and maturity. Fortunately, Sister Gwynneth has total intolerance of corporal punishment and for the moment the situation has been ’managed’. However, it will likely rear its ugly head again for him or for Simon as it is apparently the norm amongst Tanzanian teachers, despite there being a recent law forbidding corporal punishment in schools.

Simon has been a wonder, especially when I think of how far he has come from his initial huge fears of being the only white kid at school, and of missing out on everything at home. He is making friends, and making thoughtful comments about what he is seeing around him. For a couple of weeks it was really hard for him to go to school, but he seems over the hump of the early days of unbelievable adaptation to everything different. He is with kids a year or 2 older and the math work is actually about where he left off. My sense is that he is thriving with the family time and is pacing himself for the months and adventures ahead. No easy feat for a 10 year old. He has such a keen eye and appreciation for all the birds and insects and reptilious creatures here. We look forward to taking him on a nocturnal ‘camelion walk’ up at Amani Park on one of the upcoming weekends (and of course a safari at some point !)

They are both learning important life lessons such as how to navigate on a gearless bike at top speed the deep unpredictable ruts of the trails to school (especially after a rain when the slippery mud congeals between your tire and your fender), how to win at marbles on the playground (several different complex games) , how to take enough showers and drink enough water to stay alive in 35 degrees, how to sleep through the call to prayer at 4 am and the moaning cow across the road, how to avoid ugali and macheecha (Tanzanian staples) and squat toilets.

Graham ‘dropped’ in for a couple of weeks, in the middle of his university term. He got a good taste of life here although I am sure overwhelming for him and far too short. I am glad that he can now picture where we are and imagine the stories from afar. It was an epic journey for him to pull it off and we are grateful for the effort !

Our bodies feel in a state of suspended animation waiting for the damp cold and rain of a fall in Victoria to begin. Instead it gets hotter and hotter and hotter. Muggy days too with intense humidity that lifts only briefly after short unbelievable deluges of tropical rains. The other day I borrowed Rose’s little thermometer and attached it to the back of my bike as I rode up to the school for the afternoon pickup. We stopped on the way home at the hottest open patch and it read 40 degrees. Yikes! It is good that the kids are off school Dec and first half of January through the “hot season” !!!! It is all very survivable as long as the power is on, and the fans are working. Otherwise (recent outage for 3.5 days) the nights are long sweat-fests. We are all shedding pounds, just from the new rhythm of life, gratefully not from any serious illness.

Tonight we are entertaining Alex and Emily (2 young volunteering docs from UK) and the menu includes chicken on veggies, mashed potatoes, mango/avocado/tomato/red onion salad (your recipe Deb !) all well within the 100 mile diet. We are certainly eating well and enjoying fruit salads of mangoes and pineapple from our backyard, cooking with modified recipes from home.

One of my hopes for this trip was that time would slow down, and balance of life would improve and certainly I am loving the hours we have together, and all the reading aloud and games and discussions. The 6 of us (including Sally and Rose) are reading aloud “The story of the World: History for the Classical Child, Volume 4: the Modern Age”
(Thank you Eva for the suggestion) It is great to fill in our collective significant gaps in history especially around the colonial eras and how they have affected places like Africa.
The boys are becoming voracious readers and finding the joy in curling up with a good book.

On the work front it feels like we are making good progress. There was certainly a real low for a couple of weeks, where a feeling of futility and overwhelm would descend on a regular basis, but that seems to be getting better. We are engaged in a process now and feel significantly less ‘out of the loop’. We are doing consults on the wards pretty regularly and following a group of ever-changing patients, with cancers (always advanced and completely untreated) and HIV and end-stage this and that. We are building relationships with nurses and what are called AMOs and COs (assistant medical officers and clinical officers) and docs. Most of the time we are able to find someone who can translate for us so that we can have a decent exchange with patients and family, but not being able to speak Swahili remains a huge limiting force. The positive flip side of this is that translating for us actually places nurses and docs in the position of ‘role playing’ and practicing moments of information sharing, answering questions and ‘breaking bad news’ etc that are not typically part of care of the dying patient here (more often continued focus on inappropriate active care and/or general neglect of the patient). At the same we continue to be very aware of the different cultural context of illness and death and to tread very respectfully. My guide is the patient and family and try to let them show me what they need and want.

The politics of the ‘divide’ between the hospital and the Diana Centre are becoming clearer as we hear more and more snippets of the history of the last 8 years or so and the complex layers of government, NGOs, funders, egos and at times corruption that has shaped the delivery of first palliative care and then integrated active HIV care in Muheza. We are trying to keep neutral and focus on patients and certainly it is beyond us to maneuver. We have begun some formal teaching (with power point no less !) a series on palliative care that will provide a framework for what one can do in the face of incurable illness, and suffering. It feels like medicine at home, but 30 years ago. Ambrose recalls noticing on rounds as a medical student that the patients with incurable cancer were visited less often and for a shorter time, as death got closer. In fact, palliative care grew out of the gaps and lacking of acute care for these patients. Here palliative care is being born and growing up in response to a totally different context, the HIV epidemic. The definition of PC here is very broad, eg to “look after people with incurable illness, relieving their suffering and supporting them through difficult times”. So it is woven into active HIV care in a very different way than at home. We are learning, learning, learning.

Down the road in Tanga we are beginning the ‘roll-out’ of Palliative care and the use of morphine. We gave our first talk there last week at Bombo Hospital (big regional hospital) and took 20 handouts (based on the response in Muheza) and there was a HUGE audience of over 200 !! The questions were wonderful and the discussion after, more than we ever could have hoped for. They are keen, keen, keen and although the particulars of getting over the morphine access hurdles still need to be worked through, it feels very hopeful, and something we can really sink our teeth into. We will lecture, but more importantly attend ward rounds with the newly forming palliative care team, and teach at the bedside. We are feeling quite optimistic about this chapter….feels unencumbered by the unique history that burdens the development of palliative care in Muheza.

I am continually struck by how things here are both completely different and the same as at home. For example the politics of the hospital: the details are unique to Tanzania, but the heated human emotion feels very familiar. Also the patients: here they are in open wards, dressed differently, being cared for differently, different diseases and disease processes, but really in the end just the same. People are people it seems to me. Not to underestimate the huge importance of culture, language, history…but somehow a comfort to be finding common ground.

Religiosity: “at the same time both extremely important and not important at all” (Rose et al in conversation Oct 20, 2008). We are certainly the oddities here to be white and not Christian. But we are welcomed and not criticized it would appear. Perhaps it is because Christians and Muslims live side by side in complete harmony as do dozens of different tribal cultures. This is the legacy of Nyerere (the first post independence president) who set the tone of nationalism and one language of Swahili, insisting on peaceful co-existence that has been long-sustained.

That’s all for now. Thank to all for keeping in touch. Letters/snailmail very welcome !!
Love all around,
Leah

Contest Winners

The contest winners need to get announced

Our blog title was successfully translated by a number of you but there was definitely an order of receipt

GOLD MEDAL our friends in the highlands THE WENSTOBS/FLEMING

Not sure who of the 4 Kevin, Sarah, Erik or jack should get credit

SILVER MEDAL Bop and Charlene Leah’s dad and Charlene are very wired and resourceful I am sure this was a combined effort


BRONZE MEDAL back to the west coast The Svordal/Scarth family

With 4 very bright children I am not sure the parents should get much credit (except for creating them).


Congratulations to all

And a big congrats to Barack Obama

It is cool to be near his home country.

Finally a post

Rose and I just beat Simon and Graham 2 games straight at cribbage. Now it is time to reflect on our last few weeks.
You have heard from Leah lately and if you are reading the boys blogs you have even more idea of our tales

Got a speeding warning yesterday ( 85 in a 50) initially there was a suggestion of a 20,000 TZ.SH. fine but the more senior officer suggested a warning which garnered a hearty asante sana from me.

At a slower and hotter pace we still have a full life.It does end at 930ish at night although Leah and I watched our first movie ,since flying,the other night and stayed up to 11!
‘The Visitor’ highly recommended.

The ‘full life’ just has other less stressful and usually less time dependent issues. Going to the market to get today’s produce. A small fridge means daily market visits. Or roasting and grinding our own coffee beans. Using jay slater’s traveling coffee press technology we are hardly missing our Café Fantastico lattes (leah says’not’)

At present we are many .Graham is here which makes us whole at 5, Sally and Rose,plus we have daily visits from our new friends Alex and Emily , another couple who are docs here from England for 10 months.
They are staying with the nuns at the guest house at the school where the boys are attending and have lunch with us most days( Juliette’s soup is daily, different and delicious)
Ilse our last roommate( a dutch MD doing pediatric malaria research) has been here variably as her parents are visiting Tanzania for the first time from Holland and she is spending as much time with them as possible.

School for the boys is tolerated as they have other distractions ( Graham) and the courses work is a bit boring ad although lunch is provided.. beans rice and ugale (corn flour porridge) is not very appealing.They cycle with leah both ways every day ( unless a rain storm)This is strenuous and hot( afternoon rides can be up to 34 degrees C.) ,but they are getting fitter and fitter and the hills are flattening out. They started bringing a small lunch today and Leah meets them with a treat and water before their return sweat.

Rose has been teaching introductory IT up at the school to the 3rd through 6th formers with mutual enthusiasm.Sal is helping rose and dabbling in about 3 other projects . I think the boys like have them up at school( very familiar faces)

Much to our dear friend Paul Best’s chagrin we have started talking about Christmas and are making plans to go to Zanzibar.

I have been reading as much as I can both books ( slowly slogging through Paris 1919, embarrassed at my lack of knowledge of events that occurred before July 6 1954)newspapers, economists,walrures brought by Graham are being slowly devoured.

Not real happy about Canadian election results very sad for Brione Penn.
Highland political updates make me wish I was home to help during
the election.US election more promising. We get some info on line when power and internet connection and certain indeterminate stars line up appropriately. also I just found out that I can access CNN at the Diana center on some days

Can someone please lend me $$3.275 trillion or so?
those of you who know Dan Nevin( you should all know Dan.N.) should get a copy of an editorial he sent me ( and others I am sure) about the ‘Banksters”

Soccer a number of days a week is how I get a sweat up. Usually with a bunch of younger friends but once with men Graham’s age ( yes graham is a man) Griff stopped watching after awhile. It was not a pretty sight.After the game a fellow asked me if I would give him my soccer boots, I guess he felt I was wasting them or he realized there were many untapped goals still in them.

Silvia is in France for Paula’s 50th (I am not actually sure of the occasion but I am sure it is not her 60th) with Paula ( really) and joel.I found out our dear friends Suasan and Phillip ( who recently lost their wonderful son David)are meeting them and I seriously considered surprising them but just not enough notice to pull it off.

So for me this week was a perfect example of the wonders of this trip with all its ups and downs

Downs

-Graham left
-Sy not keen on school on Monday
-Long discussion with palliative care leadership( karilyn Collins the english MD who encouraged us to come and who developed much of the palliative care here during her 6 years here is visiting) executives of one of the Sainsbury trusts ( considering some funding). The challenges, the personalities, the politics felt quite overwhelming
-No power for over 50 hours( no fans!!,limited cooking- finally got kerosene cooker up and running for morning coffee)
-sally sick with GI complaints ( no further details necessary ) for 36 hours
-a poorly managed , poorly palliated pediatric death – very troubling and representative

Ups

-boys school routine better every day
-griff invited a new friend home for marbles and xactica( card game)
-10 visiting brits( Anglican donors-don’t usually hang with Anglican donors) brought along with their faith a grand enthusiasm- and another new card game Wizard.we assisted in hosting them even with a candlelight meal their first night here and other meals and times together. If you come and visit we found a great “bar/restaurant” the we call Frankie’s ( after the”Maitre D”). we had dinner there for graham’s last night and had 2 large wasungu dinners there over the last week.good food, cold beer, great conversations
-I finally won at Settlers of Catan.. a slightly hollow victory as simon made a late trade out of sympathy rather than strategy . but for now I will take it
-leah and my biggest highlight this week( after a few tough days in a row) occurred when we prepared ( adapted and improved) our local ( muheza) palliative care power point presentation( introduction to palliative care)it was met here with reasonable interest but low attendance, for presenting in the regional capital Tanga at their large hospital Bombo Regional hospital.We made 20 copies of the presentation , only to walk into a room of over 200 people.the presentation went very well, well received, and good discussion after. We will be following up with further didactic teaching and ward teaching over the next 4 months. It made us feel like we can do as we hoped and improve and help develop a sustainable palliative program in the 2-3 major hospitals in the region
next week is a 5 day workshop that had been previously planned to further develop a palliative care presence and we will be assisting in its presentation. It too is in tanga so there will be logistic issues both for our to and froms and the boys schooling. Fortunately sal and rose can help
-simon has restarted violin practice( with the encouragement of financial support for a dirt jumping bike when he returns…he has also developed quite a skill at playing hearts which was the second ”adult” card game I learned after crib
-and finally a wonderful card ..our first snail mail… sent by our dear friend deb lefrank with messages from a large number of friends congregated for a thanksgiving meal at debbie and dan’s place. Thank you so much deb


sadly this is sally and rose’s last week and we will all say goodbye with heavy hearts and leah and I will have to create a new chapter and routine

I heard this week that my dear friend nou’s father died suddenly( he had been in poor health but his death was unexpected)
It has been a peculiar year for life and death juxtaposition( sadly I believe this is the new stage many of us are in)I miss not being there to support him as has me for so many years.

This an adventure ……life is an adventure

Stay tuned don’t touch that dial……


Ps. Hopefully graham will soon download some pics from his visit onto the blog

PPS leah will soon add her thoughts to the blog.. as I said earlier it is a full life and electronic communication is only one of our
Priorities

a

winners

The contest winners need to get announced

Our blog title was successfully translated by a number of you but there was definitely an order of receipt

GOLD MEDAL our friends in the highlands THE WENSTOBS/FLEMING

Not sure who of the 4 Kevin, Sarah, Erik or jack should get credit

SILVER MEDAL Bop and Charlene Leah’s dad and Charlene are very wired and resourceful I am sure this was a combined effort


BRONZE MEDAL back to the west coast The Svordal/Scarth family

With 4 very bright children I am not sure the parents should get much credit (except for creating them).


Congratulations to all

Update

Rose and I just beat Simon and Graham 2 games straight at cribbage. Now it is time to reflect on our last few weeks.
You have heard from Leah lately and if you are reading the boys blogs you have even more idea of our tales

Got a speeding warning yesterday ( 85 in a 50) initially there was a suggestion of a 20,000 TZ.SH. fine but the more senior officer suggested a warning which garnered a hearty asante sana from me.

At a slower and hotter pace we still have a full life.It does end at 930ish at night although Leah and I watched our first movie ,since flying,the other night and stayed up to 11!
‘The Visitor’ highly recommended.

The ‘full life’ just has other less stressful and usually less time dependent issues. Going to the market to get today’s produce. A small fridge means daily market visits. Or roasting and grinding our own coffee beans. Using jay slater’s traveling coffee press technology we are hardly missing our Café Fantastico lattes (leah says’not’)

At present we are many .Graham is here which makes us whole at 5, Sally and Rose,plus we have daily visits from our new friends Alex and Emily , another couple who are docs here from England for 10 months.
They are staying with the nuns at the guest house at the school where the boys are attending and have lunch with us most days( Juliette’s soup is daily, different and delicious)
Ilse our last roommate( a dutch MD doing pediatric malaria research) has been here variably as her parents are visiting Tanzania for the first time from Holland and she is spending as much time with them as possible.

School for the boys is tolerated as they have other distractions ( Graham) and the courses work is a bit boring ad although lunch is provided.. beans rice and ugale (corn flour porridge) is not very appealing.They cycle with leah both ways every day ( unless a rain storm)This is strenuous and hot( afternoon rides can be up to 34 degrees C.) ,but they are getting fitter and fitter and the hills are flattening out. They started bringing a small lunch today and Leah meets them with a treat and water before their return sweat.

Rose has been teaching introductory IT up at the school to the 3rd through 6th formers with mutual enthusiasm.Sal is helping rose and dabbling in about 3 other projects . I think the boys like have them up at school( very familiar faces)

Much to our dear friend Paul Best’s chagrin we have started talking about Christmas and are making plans to go to Zanzibar.

I have been reading as much as I can both books ( slowly slogging through Paris 1919, embarrassed at my lack of knowledge of events that occurred before July 6 1954)newspapers, economists,walrures brought by Graham are being slowly devoured.

Not real happy about Canadian election results very sad for Brione Penn.
Highland political updates make me wish I was home to help during
the election.US election more promising. We get some info on line when power and internet connection and certain indeterminate stars line up appropriately. also I just found out that I can access CNN at the Diana center on some days

Can someone please lend me $$3.275 trillion or so?
those of you who know Dan Nevin( you should all know Dan.N.) should get a copy of an editorial he sent me ( and others I am sure) about the ‘Banksters”

Soccer a number of days a week is how I get a sweat up. Usually with a bunch of younger friends but once with men Graham’s age ( yes graham is a man) Griff stopped watching after awhile. It was not a pretty sight.After the game a fellow asked me if I would give him my soccer boots, I guess he felt I was wasting them or he realized there were many untapped goals still in them.

Silvia is in France for Paula’s 50th (I am not actually sure of the occasion but I am sure it is not her 60th) with Paula ( really) and joel.I found out our dear friends Suasan and Phillip ( who recently lost their wonderful son David)are meeting them and I seriously considered surprising them but just not enough notice to pull it off.

So for me this week was a perfect example of the wonders of this trip with all its ups and downs

Downs

-Graham left
-Sy not keen on school on Monday
-Long discussion with palliative care leadership( karilyn Collins the english MD who encouraged us to come and who developed much of the palliative care here during her 6 years here is visiting) executives of one of the Sainsbury trusts ( considering some funding). The challenges, the personalities, the politics felt quite overwhelming
-No power for over 50 hours( no fans!!,limited cooking- finally got kerosene cooker up and running for morning coffee)
-sally sick with GI complaints ( no further details necessary ) for 36 hours
-a poorly managed , poorly palliated pediatric death – very troubling and representative

Ups

-boys school routine better every day
-griff invited a new friend home for marbles and xactica( card game)
-10 visiting brits( Anglican donors-don’t usually hang with Anglican donors) brought along with their faith a grand enthusiasm- and another new card game Wizard.we assisted in hosting them even with a candlelight meal their first night here and other meals and times together. If you come and visit we found a great “bar/restaurant” the we call Frankie’s ( after the”Maitre D”). we had dinner there for graham’s last night and had 2 large wasungu dinners there over the last week.good food, cold beer, great conversations
-I finally won at Settlers of Catan.. a slightly hollow victory as simon made a late trade out of sympathy rather than strategy . but for now I will take it
-leah and my biggest highlight this week( after a few tough days in a row) occurred when we prepared ( adapted and improved) our local ( muheza) palliative care power point presentation( introduction to palliative care)it was met here with reasonable interest but low attendance, for presenting in the regional capital Tanga at their large hospital Bombo Regional hospital.We made 20 copies of the presentation , only to walk into a room of over 200 people.the presentation went very well, well received, and good discussion after. We will be following up with further didactic teaching and ward teaching over the next 4 months. It made us feel like we can do as we hoped and improve and help develop a sustainable palliative program in the 2-3 major hospitals in the region
next week is a 5 day workshop that had been previously planned to further develop a palliative care presence and we will be assisting in its presentation. It too is in tanga so there will be logistic issues both for our to and froms and the boys schooling. Fortunately sal and rose can help
-simon has restarted violin practice( with the encouragement of financial support for a dirt jumping bike when he returns…he has also developed quite a skill at playing hearts which was the second ”adult” card game I learned after crib
-and finally a wonderful card ..our first snail mail… sent by our dear friend deb lefrank with messages from a large number of friends congregated for a thanksgiving meal at debbie and dan’s place. Thank you so much deb


sadly this is sally and rose’s last week and we will all say goodbye with heavy hearts and leah and I will have to create a new chapter and routine

I heard this week that my dear friend nou’s father died suddenly( he had been in poor health but his death was unexpected)
It has been a peculiar year for life and death juxtaposition( sadly I believe this is the new stage many of us are in)I miss not being there to support him as has me for so many years.

This an adventure ……life is an adventure

Stay tuned don’t touch that dial……


Ps. Hopefully graham will soon download some pics from his visit onto the blog

PPS leah will soon add her thoughts to the blog.. as I said earlier it is a full life and electronic communication is only one of our
Priorities

a