On happiness, harmony and holidays

On the boat trip by Josh HT

At Fish Eagle Point we went out on a boat trip with our friends Luke and Josh. The boat was big and made of wood and had a big white sail but also a motor. The men on the boat helped us fish and showed us around the good snorkeling points. At a sand bank where we caught lots of fish and we used a hand-line and we put bits of squid onto the hooks and they called it calamari. We caught a parrot fish and a orange fish that had a very spikey fin and I was the first one to catch it. My Dad caught a very long grey and blue fish (Daddy says it is called a trumpet fish). We put the fish into a bucket but we threw the parrot fish back into the water because it was a mummy parrot fish. The mummy parrot fish would have died very quickly and it needs to protect its babies. We caught a yellow fat fish with blue stripes on it. We should have thrown all the fish back but the naughty men on the boat didn’t because they wanted to eat the fish. Then the owner of Fish Eagle Point called Steve told them off. One had his head down whilst Steve was talking to the other so the other one poked his head up and he was going to run away. Then Steve caught him and told him off again!
There is a swimming pool and it has lots of chlorine in it so you can stay in it for a short time or your eyes will be stingy.
For breakfast there was yoghurt and I ate 5 pots of yoghurt and then I threw up in the toilets and then I played in the pool with my friends called Josh and Luke.
On the beach there were big red army crabs and they had ginormous claws and they had orange big round eyes on big fat stalks. We picked up hermit crabs that were very small and they hide in shells so we had to scare them so they went in their shells and then we could pick them up and put them in our t-shirts and scare Mummy with them coming out showing Mummy their claws. Then Mummy screamed!!

On Stranger Tides by Zac HT

When we got to Fish Eagle Point we were very tired and then after lunch we went for a walk around the rock pools. It was very beautiful and we played on the house built at the end of the jetty. When we were walking along the beach we saw gigantic red fiery crabs scuttling along the sand. A few days later we went out snorkeling and I saw the biggest fish which was called a lion fish. It had long sticky out white and black fins that looked like they had been burnt in a fire and it looked like a big zebra fish but with seaweed fins.
Then I went out kayaking with my daddy and my daddy tipped over the boat so I fell out. Luckily I had my goggles on and then he made an anchor attaching the kiyak to a rope attached to the bottom of the sea. Then I went swimming under the water and saw a lot of colourful fish and another trumpet fish who was swimming on top of a big rock. My favourite fish that I saw was the lion fish and I saw 2 whilst I was swimming.

Another cappacino please.....

Have you seen my eggs?

The fisherman at Pangani

After 5 nights at Fish Eagle Point we drove to another beach called Pangani where we had to take a ferry across the river to get to Beach Crab Hotel. At Beach Crab we found a pirate look out point where Josh and I played in and used the alcoholic bottle lids as treasure. Our favourite was the elephant tusker tops. My Mummy went riding along the beach with a Spanish man called Carlos. He was very funny and we went riding in the sea with the horses called Swallow and Mephisto. The sea came up to the horses tummies and then I jumped off without my goggles on so I got some water in my eyes. I really enjoyed it because now I know how to ride a horse in the sea and the horses really enjoyed it too.

On the stretching and contracting of time

I remember arriving in Tanzania in November and that smell of Africa assaulting my nostrils and seeping through my being.  It had been so long since I had last been to this continent, 1995 I think but it didn’t seem that long ago.  The first 6 weeks we were here went so very slowly and they were hard.  It is always difficult adjusting to a new place but our house was decrepit and depressing and I found it hard to find my place at work due to the African communication, or lack of it.  We had no transport and it seemed no way out of our contracted world of the hospital compound, the RDTC and ISM – all within walking distance with brief forays out to town for shopping at the market and the occasional decent coffee at the Union Coffee shop.

I just have to take a break in this dialogue to tell you that Josh has somehow managed to fall fully clothed in trousers and freshly laundered T-shirt into the foot bath leading into the swimming pool.  To make matters worse he came back whinging that he had also wet himself and I just don’t understand how a clean and tidy Josh turned into a soaking wet and smelly Josh in the space of less than 5 minutes in a footbath less than 0.5m squared!  He is now wandering around naked partly clothed in a towel and hitting me in a very grumpy fashion.  This is because I keep commenting on his nakedness and I have managed to take a photo of him in his towel on the bridge back to our gorgeous cottage at Fish Eagle Point.  I am feeling slightly guilty as my child knows me so well and told me in no uncertain terms that he didn’t want a photo as he didn’t want me to put it on the blog.  He was trying to extract a pinky promise from me (I am not entirely sure what this means but it is something to do with your little finger) but I managed to distract him as he thought I had lost his toy car over the bridge so forgot about his promise so I am hopeful about posting said non-compromising picture on the blog!

So where was I?  I think I was telling you how slowly and somewhat painfully the first couple of months here in Tanzania went.  Painfully as it had been my dream and my rose tinted future for over a year so to admit to myself that I wasn’t really enjoying myself was an impossibility!  But as with anything new it does take 3 months to settle in and find your feet no matter how you don’t believe it when you hear people say these words.  After 3 months we had moved into the dermatology houses in the Doctors’ compound as our toilet in B22 decided to seep sewage and KCMC in their usual efficient manner didn’t fix anything.  This and the fact that 2 out of 3 of the Dermatology houses were empty meant that Professor Grossman relented and allowed us to move in with strict instructions not to let the children dig up the garden!  It is amazing how different I felt in a more aesthetic living space.  The Dermatology houses are only 15 years old and are beautifully maintained and whilst smaller than our old house are worlds apart.  We have breakfast and dinner on our gorgeous veranda and from the garden is the most magnificent view of Kilimanjaro.  Such that communing with the mountain is a breakfast ritual with me now, and the kids look back to check the weather on the mountain on their way to school each day….

So what I am trying to say in my long winded fashion is that after the initial  months dragging by in a slow and painful fashion now they are flying by and I am terrified of the thought of returning to the UK in 6 weeks.  Six weeks!!!  Where has the time gone????  How am I going to manage without this full and active community of people and this amazing social life.  Mondays is horse-riding/ jumping lesson, Tues morning is netball at 7.30am and I have discovered a demon talent for goal shooting and obviously missed my vocation in life,  Tuesday evening is Flamenco class with Mafalda who last taught Flamenco when she was living and working in Iceland, Wednesday is full body workout at the Moshi gym complete with water bottles filled with sand instead of weights – an amazing workout in an old squash court with a mirror, where the sweat actually drips into your eyes, Wednesday evening is film club, like a book club but better as you watch a film and eat lots of chocolate chip cookies, Thursday morning is netball again and often riding again and Friday is tennis lesson, Saturday is swimming and Sunday Pilates… I will need to go home for a rest as everyday I cycle to and from work and the ISM school. 

We have met an amazingly interesting and kind close-knit community of people since being in Tanzania and everyone does far more activities together.  I was thinking about this and not only is it that the Mazungus stick together and arrange things together but also how no-one spends their free time in Tanzania on house improvements!  In the UK the weekend is often taken up with boring jobs such as gardening, clearing the gutters, going to Homebase or worse still Ikea, clearing out the loft, painting things not to mention washing, ironing, sorting, boring paperwork, stuff on the computer…..

 Josh has just reminded me how much he liked pulling up weeds in the garden at home but only when we played the Viking weed game.  For those of you who are not familiar with this method of getting your children to weed Josh will tell you the basics:

“We find their home and destroy it so they will all leave forever”

I don’t think this violent wanton destruction will work for those of you with lovely colouring in girls…….

Anyway where was I this time?  Oh yes marvelling at how much we have done in our 5 months in Tanzania partly as we spend little time at home, I have only been shopping once at the Memorial second hand market which was fantastic actually.  It was Martina’s birthday so us girls got a free pass to spend all morning there while Tobias and Aaron looked after the boys.  You did have to rummage a lot but hey I have been starved of shopping and I came up with some amazing finds although one of my lovely green flowery tops turned out to be a dress for a girl aged 8!  I can never find trousers to fit me in England but here at the market I pulled on trousers to try under my summer dress and Martina was my very effective mirror telling me whether my bum looked big!  I came back with 4 gorgeous dresses, 4 pairs of trousers which actually fit me which is an impossibility in England and 1 of these was my demon find a pair of Seven jeans which is apparently a very expensive posh make in which my bum apparently looks very svelte!  

On economics and education

I think we are all feeling the need for a break and I am glad to say that tomorrow we are driving to the coast to Fish Eagle Point, which I hope is a beautiful beach lodge, for Aaron's birthday and some much needed R&R!

We have been ill again with weird Tanzanian bugs and i had horrible pus on my tonsils so am on antibiotics.  I am also feeling a bit jaded at work so am including my latest BMJ posting for you to read.

I promise I will post some cheerier fare whilst we are away...

  

On education and economics

There are many differences between health care and medical education in Tanzania and in the UK, but the concept I find hardest to understand is “attendance or sitting allowance”.  This allowance is paid to all staff that attends courses for their health care education and it seems that staff will not attend educational events unless they are paid their attendance allowance.   The allowance can be a significant sum and the educational facility providing the training event is expected to cover the cost.

Apparently this practice originated many years ago when the WHO began running educational events and courses about HIV/AIDS and now seems to be ingrained.   I am used to a society where we seek and pay for medical education and now with the reduction of study budgets it is common practice to self-fund attendance at courses and meetings.

Now I understand that western salaries are much greater than salaries paid in Tanzania but mixing economics with education seems to be detrimental to the will to learn.  Perhaps a different form of attendance bonus allowance based on an 80% attendance in the workplace per year would be more successful, although I am not sure how it would be policed or funded.

The Tanzanian government is struggling to meet the doctors and nurses strike agreed 100% pay increases and this is due in part to the fact that within a population of 45 million there are only an estimated 800,000 tax payers.  There was another mini-strike of 2 days recently and we are awaiting a re-shuffling of the cabinet.  I don’t think there will be many willing volunteers stepping forward for the job of Health Minister!

Currently we have 4 Spanish surgeons who come each year to the RDTC, at their expense, for a 10 day period, to operate on our patients and train the dermatology residents in surgery and dermatopathology.  Last Monday was amazing as there were over 100 Albino and Xeroderma Pigmentosa patients in the department being screened for surgery.  All the patient expenses are paid for by a Spanish organization, as well as attendance allowance for the local staff, and some patients had traveled for 2 days across Tanzania thinking they had skin cancer to be told they had tinea capitis (a fungal infection of the scalp)! 

Xeroderma pigmentosa is a dreadful autosomal recessive disease where there is a defect in the gene responsible for repairing DNA following photodamage. Photo-damage begins in early childhood and is characterised by cutaneous and ocular changes such as freckles, photophobia, corneal keratitis and ulceration.  In Africa if strict photo-protection is not adhered to then malignant tumours such as squamous cell carcinomas, basal cell carcinomas, keratoacanthomas and malignant melanomas develop in children as young as 3 and 4; death from metastatic disease occurs from the teenage years.  

Peter and Mafalda trying to sort out paying out the expenses to the patients

queing up for the expenses with Peter trying to keep order!

It is very difficult to arrange for children to be operated on under general anaesthetic due to no dedicated paediatric theatre space.  It is the first place I have worked where adults are prioritized over children but perhaps this is due to economics as well.  As in many places there seems to be a two tiered system with those who can pay being fast-tracked to theatre and those who can’t waiting weeks and sometimes months.  We have watched a 4 year old girl’s scalp tumours multiply five fold whilst she has been an inpatient for 6 weeks.  I have found this the hardest part of my job watching but not being able to get her to theatre as inevitably there is an adult emergency and she is bumped off the list.  This week however she has been operated on thank goodness.  Dermatology are currently building their own wards and theatres so if dedicated anaesthetic time can be arranged, and this is a big if, we will be at last be able to operate on our patients.

On the facts of life and running the Kilimanjaro Marathon (25-26 Feb 2012)

Tobias not gloating at all as he beats Aaron across the finishing line!!!!

It has been another action packed weekend - at this rate we will all need to go home for a rest!  However saying that it is great to have the time to do so much outdoor activites and to feel properly fit again.  Well I do but unfortunately Aaron has come down with man flu - or a viral infection he picked up by hugging Martina (and yes she is blonde and attractive even with flu!) who was poorly when she flew back from Sweden.

So Thursday saw me get back into tennis as I haven't played since before my knee operation.  I played against Terri Emmanuel (who runs the stables at the ISM school where we ride) as she was playing in a tennis tournament that weekend.  I was very rusty but had a tennis lesson booked for Friday afternoon after the boys had a lesson with Ron who is an ex-professional coach from the USA.  In the morning I went out for a wonderful ride with Terri across the coffee fields and on the tracks behind the school and it was brilliant to be cantering along the tracks in the sunshine.  I was in clinic by 10.45 am and am pleased to report that the intensive 2 week period of exams for our ADDV students is finally over.  There does seem to be a huge emphasis on exams in Tanzania and it has a huge impact on clinic time.  I do think that there should be more emphasis on teaching and learning and less on exams.  After the exam meeting reading the complicated computer analysis of the grades I was glad to get onto the tennis court.  Ron is a superb teacher and a few pointers on hand position and wrist flick have made a huge difference to my ability to hit the ball hard and in the right direction!  The boys enjoyed it too although Josh kept wanting to show Ron his "best throw" - wrong game Josh!

Another fabulous Friday night dinner but i had to leave Aaron languishing in bed feeling poorly and then I had to get 2 grumpy boys up early as I was off to Arusha National Park with Vicky and Catherine a Duke (medical school in the USA) research student working on projects in Tanzania.  We took a packed lunch and left at 8am and did not get home until 6pm. I have to say that much as I love my children it was exhausting, not due to the driving or the heat or the bumpy roads but because I had 10 hours of relentless questions from both Zac and Josh!

The road between Moshi and Arusha is pretty hairy due to the fact that buses/ dala dalas (mini buses extremely overcrowded), cars etc... tend to overtake at moments where visibility is nil usually up a hill or round a bend causing much knuckle biting. You can imagine that Zac and Josh fighting in the back of the landrover, sometimes with sticks was not conducive to concentrating on the road!

Arusha national park is a small but very pretty park about 90 minutes from Moshi.  The park was very very dry and dusty but the views were beautiful, particularly from the top of the caldura (volcanic crater) and over the string of alkaline lakes.  

Me and the Biblical Boys, Catherine and Vicky

We saw giraffes and zebras and warthogs and lots and lots of baboons and monkeys much to Zac and Josh's delight.  The forest in the park is well known for its colobus monkeys which are furry black and white ones with bushy tails and mime artist faces.  I wandered into the forest watching them hurl themselves elegantly, almost flying with arms outstretched high up in the canopy of trees.  









Meanwhile Zac and Josh went into the little museum filled with very old stuffed birds.  Zac came out and loudly asked me "why does that man have one blue eye and one brown eye?" and then Josh went into full whine mode saying "can we buy a stuffed bird?" and when I said no he said " but we only need a small one"...  In true Josh fashion he went on and on and on and on and on and didn't seem to think that my not wanting to cart a dead bird around Africa and then back to England was reasonable.  I tried to distract him by getting him to look at the flying colobus monkeys but as only Josh could he told me he wouldn't because I wouldn't buy him a dead bird! Clearly I am a most unreasonable and unkind mother!!!

Ooh there is a yummy louse..

We saw amazing icing sugar pink flamingos who all had their heads buried in the water until Zac and Josh came charging along shouting.  They then kindly popped their heads up to see what the racket was much to the pleasure of a photographer with an enormous zoom lens.  The boys then proceeded to get their croc shoes covered in a mixture of mud and flamingo poo which they delighted in sinking into on the lake shore.  

What was that terrible noise ? say the flamingoes

I asked them to wipe their shoes off on the grass but no Josh knew better so went down to the lake shore to rinse off his shoes.   So Zac followed and let go of one shoe which began to float off.  I then shouted "NO - Zac get your shoe" bringing the flamingo heads up to rapid attention - and fortunately for him he managed to lean out and hook his shoe with a stick!!  Never a dull moment with my boys...  

Just before Zac let go of his shoe!

I am sure there is a lion out there somewhere......

Luckily they fell asleep for a while which gave us all a respite and then Zac woke up to do great game spotting.  We saw a big bird which i think was an eagle, a dik-dick (antelope with very short legs) and more baboons.  Vicky had been to the park a couple of times before and was an excellent driver and guide.  She has 3 grown-up boys herself so is used to noisy boys but I think Zac and Josh have worked their natural contraception magic on Catherine.  So you are probably wondering about the facts of life conversation...

Catherine and I by the water.  Where are the children? Catherine is thinking "thank goodness the children are not right here!"

On the way out of the park we went to a deserted looking safari lodge for a drink.  We are not sure how they survive as there seemed many staff, no guests and only 2 drinks on offer: the ubiquitous coca cola or Safari beer.  We were so dusty and dirty that it was great to have a wash and a cold drink.  I think I was telling Vicky and Catherine how we came to be in Tanzania; the choice I gave Aaron of either having another baby or coming to Africa when Josh suddenly said "How do you get pregnant?" None of us could cope with that particular conversation so somehow I deflected it and then Zac said "You don't want to know it's disgusting"!!

Back to the ISM school for a quick pre-marathon pasta meal by the swimming pool where there was an outdoor showing of Chariots of Fire.  Aaron rose from his sick bed to eat large volumes of pasta and then the boys had another melt down as they were supposed to be showing a childrens’ flim: Puss in Boots but it wasn’t happening and by 8pm we thought the boys should be in bed as there was an early start planned for the morning.  Aaron had decided to run the half not full Kilimanjaro marathon due to his damaged knee and flu and the boys and I were to run the 5km fun run around Moshi. 

The full marathon was due to start at 6am, the half at 6.30am and the fun run at 7.15am so we all got up very early at 5.30am!  Actually we had to practically drag the boys out of bed as after 2 late nights they were pretty tired.  To add to the mix there had been torrential rain in the night and it was still raining in the morning so Aaron took the car to the school to catch the ISM bus to the start point.  We were going to go in the car with Mafalda but she decided she wanted to stay in bed at the last minute but luckily drove us there in her pyjamas.  So there we were all in the muddy stadium by 6.15am but this is Africa so first the inflatable start line fell down and then lord knows what happened but everything started very late.  Aaron set off about 7am and then we had to walk 1km to our start line and set off at 8am – so we were glad we got up so early!!!

Before the start and we are all very muddy already!

The fun run was great though and Zac and Josh even ran quite a bit with Noga and Amy until Zac ran along a kerb by the roundabout and fell over and hit his knee…  There was an incredible atmosphere as it was the 10th Kilimanjaro marathon and everywhere you looked there was a sea of orange T-shirts worn by the ISM brigade.   The Kenyans sprinted through Moshi like gazelles, lapping the half marathon participants!  I don’t know how they keep the speed up.  The weather cleared up and it was a blessing that it was overcast and cool.  Aaron came in at 2 hours 7 minutes I think and was just beaten by Tobias who has been gloating a lot….

At the end with lollipops and coca cola

Aaron and Mebrato at the finishing line.  Mebs ran in 1hr 45mins and Aaron in 2 hrs 7 mins but he was ill and had a dodgy knee...

Team ISM - can't lose this lot in all this bright orange!

Taking off over the bumps in true para olympic style

A very pleased Tobias !

We then had a great brunch at Camilla and Jeremy’s house followed by tea and swimming at Katie Burton’s house before collapsing into bed after another quiet weekend!