On cooking a dinner party for 10 with no electricity

I have forgotten to tell you about our first dinner party here in Tanzania.  It was lovely to be invited to Mafalda’s house on our second weekend where we feasted on delicious home made bread baked by Julianne, Sebastian’s girlfriend who is teaching physiotherapy here at KCMC.  I can honestly say it was the best bread that I had eaten since being in Tanzania (not difficult) and apparently the secret ingredient is mashed potato!  We had several more courses and it was a great evening in the dermatology doctors compound where the houses have sinks that don’t leak and proper cooking utensils!

Now we're cookin' on gas! Not an AGA

So we decided to reciprocate and invited our new friends over to dinner on Saturday night.  Now those of you who know Aaron know that he takes his dinner parties very seriously and likes to impress!  Maflada had given Aaron a packet of Arborio rice and Aaron planned to cook a mushroom risotto.  Then on Friday Josh, Aaron and Rebecca went in search of a chicken to slaughter in Shanty Town (yes it really is called this and is where all the Mazungus live).  Luckily they didn’t find one and instead Aaron bought two frozen rangy birds from Woodland supermarket which we roasted on Friday night much to Zac and Josh’s disgust as they had gone to bed and missed the roast chicken dinner! So the plan was to cook a chicken and mushroom risotto and chicken stock was duly made that night.  We had Maya a vegetarian coming so Aaron was cooking a mushroom risotto with vegetable stock for her and for dessert a banana cake and I was doing the starters of guacamole and fried aubergine and greens and garlic. For the 3 children (Zac, Josh and Edward who is Maya’s son) we were making a tuna pasta bake.  All quite ambitious with 2 pots but do-able. Aaron was also baking fresh bread a la Juliannes recipe…

So far so good – all was prepared and so on Saturday afternoon we took the children swimming whilst Aaron’s first loaf of bread was in the oven.  He then went back to take it out and continue with his military precision cooking timings.  I came back about 40 minutes later to discover that the electricity had gone off – a common occurance but usually it comes back on.  So we waited and waited and waited and Aaron became more and more and more grumpy.  Finally we gave up - luckily we had cooked the kids pasta dish but it wasn’t going to be a pasta bake any more.  We hung up a paraffin lamp from the ceiling and Maya brought a spare gas stove and Aaron made 2 risottos simultaneously in the kitchen sink!

It was a great evening once we had had few Kilimanjaro and Serengeti beers and even the dodgy red Tanzanian wine tasted good.  Aaron did sulk a bit as his food was not up to his usual standard and the banana cake was a bit dry but who needs all those pots and pans and an oven when you can manage with 2 pots, a camping gas cooker and a paraffin light?  All our guests had to bring a plate, cutlery, a glass and a chair which made the clearing up much quicker!

Just to whet your appetite here is a photo of beautiful Lake Chala:   I will update you on this trip tomorrow.

Look Ma no crocodiles!

Now a short competition - we encountered this beasty whilst walking down to the lake on Saturday.  There will be an African prize for the first to correctly identify it by posting a comment........

Ahhhh what a pretty puppy :)

On the Albino outreach clinic and why you should lock your door whilst sleeping

I had no idea that there was such a large albino population in Tanzania nor that this group of people is both ostracised and sought after.  However they are sought after in a frightening fashion as traditional healers believe that albino body parts have mystical healing powers.  Membratu, an Ethiopian dermatology consultant working at the RDTC told me a terrifying story of an albino man waking up to find someone trying to chop off his hand!  This practice is still ongoing and will probably continue whilst such a large proportion of the population believe in the power of traditional medicine.  I was reminded of this yesterday on our ward round when we were seeing a very sick HIV positive young man who had been admitted with anaemia and widespread Kaposi sarcoma.  The medical student told us that he had stopped taking his anti-retroviral (ARVs) drugs last year and when I asked why I was told a long and involved story about a supposed priest/ healer who last year was selling a drink of holy water for 500 Tanzanian shillings (about 25p) which he claimed was a cure for everything from HIV to cancer to Diabetes and heart disease.  Apparently there were massive queues and people visiting to take the waters included government ministers as well as hopefuls from all over the country.  It seemed there was a savvy business mind behind this project as although the “healing water” was cheap as chips the refreshments were not and food cost up to £4, which is a fortune for many Tanzanians!  So half the country stopped taking their ARVs and insulin and beta blockers etc with fairly dire consequences.

The albino population is increasing mainly due to the fact that these people continue to be ostracised so tend to marry amongst themselves.  The RDTC runs a fantastic outreach programme to support the albino population.  Outreach clinics are run usually once a week and we drive to different areas in one of the two large RDTC landrovers.  For those non-medics amongst you albino patients do not have pigment in their skin, so in Africa they are at great risk of skin cancer.  It is therefore imperative that sun protective measures are begun right from birth.  Most albinos have poor eyesight and many are blind due to the lack of pigment in their eyes so the outreach programme provides sun protective clothing, wide brimmed hats and sunglasses as well as sun block for free. 

Ready for work but where are the patients?

Last Wednesday we drove to the slopes of Kilimanjaro and it was truly wonderful to be out of the KCMC compound, as without a car I had begun to go stir crazy!  The drive was beautiful through rolling hills where the land became greener and greener after the recent rains.  We stopped at a dusty clinic and all  8 of us piled out of the landrover – our driver, 2 doctors, 3 diploma students, 1 nurse and Peter who is albino and runs the excellent education campaign.  Then we sat down in true African style and waited and waited and watched the other comings and goings at the clinic and waited some more.  After about 20 minutes walking through a cloud of dust came a solitary albino man.  It seems that after the short rains is a fertile time to be working in the fields.  As albinos continue to be discriminated against many farm as their livelihood so it seems that coming to an outreach clinic is not a priority.  This single patient therefore received a full MOT and we examined him from top to toe and found several skin cancers, treated large areas of sun damage with liquid nitrogen and tried to advise him further regarding sun protection as he had obviously been wearing short sleeves, an inadequate hat and had lost his sunglasses. 

up a bit, left a bit.....

We drove to 3 other sights and I am sad to report only saw only one other patient, a little girl of 5 who seemed terrified of all the attention and whose non-albino brother had appropriated her hat and sunglasses.  Good to see that brothers are the same the world over!  I was pleased to hear that most of the outreach clinics are much busier and hopefully the patients that missed their appointments will come to the RDTC for screening if they are worried.  Sadly people often present far too late and only last week we saw a young man with a huge basal cell carcinoma above his eye and extending into his eye.  We offered him surgery and although it would have been curative he would have lost his eye.  He declined not because of this but because of his belief that the tumour would spread all over his body if it was operated on.  Sebastian, a fantastic final year dermato-surgical Registrar from Germany, has been doing great work operating and doing flap and graft repairs on many of the albino patients.  Unfortunately for reasons unknown albino patients have a very high incidence of post-surgical cutaneous infection and if any of you know why I would be grateful if you could send me a comment.

Working presently at the RDTC is a brilliant, warm and funny Spanish  pharmacist called Mafalda who reminds me of a cross between Amy Winehouse (who she dressed up as at a Halloween party and Penelope Cruz in Vicky Cristina Barcelona).  She has a masters in Tropical Medicine and was working with albinos in Malawi before coming to Tanzania.  She is employed by a Spanish NGO on an excellent project and is raising money for a small building in the RDTC grounds where suncream can be manufactured by local people using local ingredients.  Last week there were queues of albino patients at the RDTC who had been given 3 different suncreams to try for 24 hours and then they came back to fill in a questionnaire about their preferences.  Interestingly the patients’ preference was the least expected one as it caused the most whitening of the skin.  It is always fascinating how ones preconceived ideas are

 often wrong!

how much for all the tomatoes?

I took advantage of the long hours in the bus to take Swahili lessons from Alice a Resident from Rwanda.  I have promised to teach her paediatric dermatology in return.  I had a chance to practice my new skills when we stopped at a great fruit and vegetable market on the way home.  I was very proud when I could ask the price of cucumbers “Ni bei gani tango?” but unfortunately couldn’t understand the answer!  I can also say “that’s too expensive, reduce the price as I work here” although the dramatic effect is lessened by reading it off a scrappy piece of paper!  It was interesting to see that you pay about half the price of a pineapple if you are shopping with a local….

Rebecca helping to carry the shopping home!

On Schools Day's and whats missing in our life!

Mummy said we needed to think about our school here and whats different. The first thing thats different is that it doesn't rain a lot! We are not that happy about the fact that school starts at 7:15am which means having to get up at 6am to get ready. Daddy said we always woke up a 6am at home anyway just to be annoying, but it is still a lot rubbish. 

School T's are different

We have to walk to school and mummy says it only takes two minuets, but as you can see in this blog two minuets is never two minuets in Africa. We walk along a dusty and very bumpy track through the compound but the school is then only over the road.  

We don't play outside in the playground in the morning, but have to go straight into class. In our classrooms we have children from all over the world, such as Holland, Germany, America, Japan, China, Sweden, and some from the Middle East. 

We do key Swahili lessons, we are not sure when we will use this back in the UK, but if there are any African children at Wickhambreaux when we get back we will be able to speak to them a little. Although we have all decided that learning Swahili is a bit TAKA TAKA (rubbish).

There is a really big swimming pool here and we have lots of swimming lessons. None of us really like the swimming teacher as he is a bit cruel and expects everyone to be able to do lots of lengths even though the pool is at least a mile long!

How Josh gets to School

Although School starts early it finishes at 1pm which is cool. There are lots of after school clubs including swimming, football, pottery, cooking and arts & crafts. 

We have lots of homework, in fact we have way too much homework which gets in the way of playtime. Mummy and Daddy think homework is a good thing but they don't have to do any even though they say they have stuff to do on the computer. I think mummy just spends lots of time writing emails to her friends now daddy says she can't buy lots of stuff on-line! 

The other lessons we have are a lot like in England but without our best friends around. We have made lots of friends but they are not the same as our best friends in England. We have both agreed we miss our school and especially our friends but this is quite a good adventure to be having. 

We are enjoying our adventure and will be going on a safari soon which we will write about afterwards.

Bye for now 

Zach & Josh

On why Triathlon is not a Tanzanian Sport and Witch Doctors

The girls I left behind.

Breaking news!!! By this I mean nearly breaking news as I have now had my first cycling accident since childhood, but without actually breaking anything other than a possible rib or two. I have come off numerous motorcycles in my time racing the odd track and once when seeing earth sky earth sky having borrowed a Suzuki GSXR 750 for a trip up north which ended up in A&E. 

My new Aero Machine......NOT

So I thought out here I would be safe on two wheels using pedal power forgetting all I had seen when running. The rule of the road here is simple, have car am tank...lesser mortals on foot or bike don't exist. I have traded my beloved bikes in the UK for a new (17 years old) Chinese.....Jalopy. I wouldn't say that the list of faults can't be sorted with a 26oz lump hammer but had I had one on me when I came round I think I would have given it a good go. 

Handlebar and brake impact

I have to blame my Physio for my injuries, not because he was  driving the car that pushed me into the drainage ditch, but because he said to lay off running and try cycling a lot more whilst out here. In fairness he said I'm too old for any of this stuff and I should know better but as long as I keep breaking bits of me he has promised to keep bending them back into some kind of ergonomic shape. So Andy to my back and knee I can now add ribs.

Left knee gravel rash.

Other than taking the full force of the handlebars into my chest and stomach I have added a rather distinctive deep gravel scrape to my left knee. I am hoping this might actually now help with the inner knee pain I'm getting whilst running.

After the light concussion caused by an inability to breathe I managed with the help of a passing runner to pull myself out of the ditch and make the 1/2km home. I debated getting back on the bike but by this time I wasn't sure if my head was spinning because of the impact of the ditch or the complete lack of oxygen I was able to take on due to my constricted airway.

Zanner came home from the hospital and quickly arranged a trip into town to visit the X-ray and Ultra Sound guy. What a nutter!!! First he wanted to give Zanner an ankle X-ray but then got stroppy about us not putting on some rubber croc type shoes that had definitely seen better days. After I showed him my chest he changed the film and pushed me against a badly painted film holder. The X-ray would have been great if it hadn't had a huge exposure line down it that made it look like I had been impaled on a lamp post. The second attempt was little better but between the two we had a decent left right picture. Nothing serious but with Zanner and a paediatric colleague in tow they demanded an ultra-sound. Which was a little like some medieval torture as he pressed the probe onto the rather sore part of my chest as he gabbled away to Zanner out this organ and that organ not being punctured. 

Eventually he decided to squeeze my ribs firstly from the front; followed by much remonstrating by the two female doctors. I was then given light relief by his squeezing me from the side which seemed to allow me to breathe a little more easily. 

So any of you training back in the UK thinking it's a bit cold, a little wet or generally not very nice remember out here the cars really do see you as a target, the weather is too hot for anything other than training for the Marathon Des Sables and the bikes would qualify for the London to Brighton Veteran rally. 

On why 2 minutes is never 2 minutes in Africa and why you must always travel with ear plugs, string and a universal plug

1st catch of the day.

You will be pleased to hear that Zac is much better; but he did have a nasty chest infection.  I started him on Azithromycin after 4 days of high fever and, bad mother that I am, I finally listened to his chest on day 7 of him being ill.  Imagine my surprise to hear that he had right basal crepitations – that’s crackly cornflake crunchy noises to you non-medics – signifying infection in his right lower lung.  Fortunately, the antibiotics worked quickly and after another few sleepless nights for us with Zac elbowing us in our bed and coughing all night he is now right as rain. I then had an odd fluey bug with headache, 

achiness and extreme tiredness on Thursday and Friday but am also much better now.  Our other night time companions are bush babies cough howling, wild dogs making such a child like crying noise that last night I pulled out my Muffles ear plugs and ran into the boys room wondering who had had a bad dream to find them both fast asleep.  Then from 1.30am onwards the cockerel struts his stuff cock a doodle doing at top decibels – I thought this only happened at dawn but clearly not.Anyhow, I was going to tell you about when Zac, Josh, myself, Julia – a German medical student and Maria a Finnish physio student, went to town for breakfast the day Aaron was running the Hash.  

Eat it or let it go? Never too sure where his next meal is
coming from, Zac faces another African quandary!

We had a lovely breakfast at the top Mazungu (foreigner) frequented coffee shop where the boys had Nutella crepés and ran round terrorising everyone. Later we trailed round town in the mid-day heat collecting Julia’s clothes from the tailor and buying new mosquito nets for the boys.  This was followed by a long walk in the heat to the craft village where Julia was picking up the bookends she had had made for her Mother.  Julia reminds me of me 20 years ago collecting all sorts of heavy ethnic objects (tat..aht) from every country I visited.  Like Proust’s madeline cake, the wood-carvings prompted the memory of George my huge wooden giraffe which I carefully carried around South Africa.   I can still remember the silence that fell over the occupants of the airport departure lounge restaurant as everyone watched George topple very slowly and then the collective ‘Aaaaaaahhhhhhhh’ as everyone watched as his neck cracked and head fell off!  I found some sellotape for cursory first aid but he was never quite the same.  I am not sure what happened to George – I suspect during a move he was a casualty of Aaron’s ethnic ‘tat clearout.

The boys had a great time running round the craft village choosing paintings they wanted for Chanukah and multi-coloured soapstone hippos and wooden animals.  We then had to wait and wait in the sun as first the wood craftsman was not there and when he did appear with the bookends they hadn’t been stained.  One of his colleagues told us not to worry and that he would get some stain and be back in 2 minutes.  The 2 minutes stretched to 20 minutes and the boys got hotter and hotter and more and more grouchy.  I said to them “not to worry that in Africa 2 minutes was never 2 minutes” and all the craftsmen thought this was hilarious.

We are still struggling with leaky u bends on all our sinks and have to rush round with our one mop bucket.  We have reported this and are waiting for the engineer to come “ maybe Monday”, “ maybe Friday”… It is amazing how much you take for granted in England.  Everything here is washed by hand in a leaky sink and then hung out to dry outside in the sun.  I wish I had brought the universal plug I used to carry everywhere in my backpacker days!  Unlike in England, everything here has to be ironed due to mango fly.  This delightful creature is the maggot of the exotically named ‘cordylobia antropophaga’ fly. This fly likes to lay its eggs in wet warm clothes and these then hatch into larvae that can burrow into your skin leaving a lovely boil…which is nice!

On surely teenagers and English weather during an African HASH..AHT

I have been allowed to contribute to the Blog…Yipee. But, as Zanner’s posts have been really good I feel under pressure to write something interesting (stop reading now so as not to be disappointed!).

 As Zan has said I am doing voluntary work at the International School, which is quite an experience. To-date I have been concentrating on delivering presentation skills, although it doesn’t form part of the International Baccalaureate some of the graded learning outcomes are delivered via presentation. So in effect a poor presentation can have a huge impact upon their overall grade. The students by and by are much like any other around the world I have met. They feign an outwardly surly attitude underlined by a distinct air of not needing to be told anything as they know everything. However, deep down they are going through a really difficult period and I believe it is our responsibility to help as much as possible guide them through the tick boxes necessary to get though this stage to the next in an interesting and invigorating way.

The school have asked if I can help with their UN Resolution Debating team who are to present their own resolutions at the UN Congress in Nairobi 2012. It is really exciting to see such a small school preparing to take on the kind of debate usually reserved for university teams. We are also hoping to create a mediation programme to introduce the students to ADR.

So the HASH, I’m told there is a similar thing in the UK but have to admit to never hearing of it before! It is rather like fox and hounds, two people (foxes) leave 30mins ahead of the bunch (hounds) and drop markers (flour) along a route. The markers are sometimes dropped at 15mtr intervals until you come across an X which means the next marker has to be found somewhere around 50mtrs of the X but, this can be anywhere in any direction. The fox does a circuitous route back to the cars covering around 10km.

This HASH was run by one of the longest running HASH organisers who is an amazing guy called Greg who owns a coffee plantation and farm here in Tanzania; he originates from one of oldest Mazungu (White) families in Tanzania.

We started at altitude (3400mtr) in the Kilimanjaro National Park, following a 3hr journey in 4x4s. The air was extremely thin but what was shocking to me was the cold and completely English looking environment surrounding us.  The foxes set off as we readied ourselves, with the runners to the front and the pack to the back; There were around 45 people making the trip. After the allotted time we were off, my enthusiasm sending me to the front as I bounded off down the trail, Nordic sticks helping me jump over rocks and mud pools at a surprising rate. Around the 2km mark I felt like someone had placed a plastic bag over my head forgetting to put holes in, (I apologise in advance to those members of the RM’s who had this experience on some of the RTI course run throughout the 1990’s).

Suffice to say the dull thud in my head and restricted oxygen intake was something to do with now being at 3650mtrs. We were now completely shrouded in mist with visibility reduced to such an extent that even on the flats I couldn’t see the following pack. At around 5.5km (3800mtrs) I was caught by a French chap and his compardre, they ran in a pair to aid the finding of the false trails that are planted around the X’s (doh!). My inexperience had cost me dear as I was now struggling to find a comfortable pace. I clung to these two and together we soon picked up the trails and headed for home. A wiry 65 year old ex pat caught us on the homeward track as he proved the tortoise rule!  The race in from there was less up and down but the rain had started on vertical trajectory just to add to English feel of the event. The final Km was achieved at the standard IronMan shuffle speed due to having to take three breaths to gain the equivalent oxygen normally achieved with one.

First finishers! L-R... French Guy , African Guy, Wiry
American Guy, Short English Guy, French Guy 2,
Guy the Guy!

By the time we reached the cars (1hr 22mins) for 10km we were wet, cold but in good spirits. This was made all the more so by a large trekking group who had turned up looking ready to ascend Everest who looked at us in our shorts as though we were aliens…LOL. Unfortunately they had the last laugh as nobody had any car keys as they were with the main group over an hour behind us; cold suddenly took over from joy as I lost feeling in my fingers.

Suffice to say I'm typing this with feeling and function restored. Having gathered the rest of the group and defrosted in the cars, we headed down to an altitude the sun was happier to come out and play in.The whole event was a great experience and I met some more amazing people with great stories to tell. Oh yes and the Wiry American? He had lived here for quite sometime having being a bit of a track and field guy in the states he now organises Hash's, runs the Kili Marathon and was a sub three hour GUY in his time...a tortoise with redbull wings!

On being an intrepid bug catcher and drawer by Zac Husdon-Tyreman aged 7

I do like Africa because you can see lots of interesting bugs and animals.  This week I have seen lots of lizards but the ones with the orange heads are very poisonous.  Today I caught a green grasshopper and a stick bug and a red, orange, blue and black butterfly.  They have funny types of money with elephants and different types of animals on the notes which I steal out of Daddy and Mummy’s wallet so I can buy stuff.

The Coca Cola is very famous all over Tanzania – Daddy says it is because they have the cartel but I don’t really understand what that means.  My school is very nice and it has a lot of coloured uniforms and a gigantic swimming pool.  Yesterday we went to this very nice artists’ place that had wooden lions and wooden necklaces and beautiful paintings of Africa and lots of wooden elephants.  Don’t worry Lennon I will get you one. 

I miss you all very much and that’s all…..

On why giraffes have very long necks by Josh Hudson-Tyreman aged 6

When the first meteors hit the earth that’s when all the dinosaurs became extinct and giraffes used to have very short necks and trees were very short then.  When the meteor hit the earth the giraffes stretched their necks so their necks wouldn’t catch on fire. 

At first I was very shy but then I made some friends.  Before play time one of my friends asked me if I wanted to try a new game with him called Love Love.  In this game first someone is it then they chase other people and try to it them and you climb onto the climbing frame. (I have just established that it is Lava Lava as you can’t touch the ground as it is hot this is Mummy speaking).  But now it is called Love Love…… as you can have a girl and boy cos they both love each other.

I like swimming in the swimming pool and eating dinner in the dining room.

My Mummy bought me an elephant called Mooks he is yellow, blue and orange and sometimes at night Gorillian (the gorilla) plays with him by throwing him up in the air.  He is a flying elephant

And that’s all really….

On African dermatology, student prayers and why Josh wants a fever

(written on 26 november but no internet available)

Zac woke us up with a high fever on Thursday night and spent the night as a kicking hot water bottle in our bed.  Don’t worry it is too early for malaria and I understand there is a viral infection going around –just like in the UK only Tanzanian flu is more exotic than boring UK flu.

Therefore, Zac was allowed to stay at home on Friday, as a swimming gala in the rain didn’t seem the best idea with a temperature.  Josh then turned into a cross between a tantruming 2 year old and a grunting Neanderthal teenager as he didn’t want to go to school either and told us the swimming teacher was an ogre and made them swim a whole length before they could get out (all said of course in a very whiney voice).   Zac’s answer to that happening to him the previous day was to ask to go to the toilet and then he got changed and went to a different club!  Josh’s constant refrain was “I wish I could have Zac’s fever – Mummy take my temperature as I have a poorly tummy”.  He went off to school in a huge huff and they were caught in a tropical downpour on the way.  Luckily for Josh it rained all morning so the gala was postponed but, he was very grumpy to discover that Zac’s class ate all the popcorn Daddy had made for the planned picnic.

I was very glad of the umbrella that Jane kindly brought out for me for my 15 min walk to work.  You can see from the photo that the landscape is somewhat different and my walk takes me past goats, termite mounds and through lots of mud when it is wet. 

I have now had a full week at work and am reflecting on the experience.  The Regional Dermatology Training Centre is unique in being the only Dermatology training available outside South Africa.  The RDTC was established I think by Barbara Leppard and Professor Grossman with its remit to train Dermatologists and non-medical officers in Dermatology.  In Africa there is huge burden of skin disease as surprisingly many patients suffer from all the common conditions of atopic dermatitis, psoriasis and acne.  These conditions are then seen to extreme in the high number of HIV positive patients who also present with skin diseases of the immunosuppressed such as Kaposis sarcoma, lymphoma and extensive viral warts.  Anti-retroviral are free in Tanzania and in the Kilimanjaro Medical Centre people are started on treatment in both the Infectious Diseases unit and within Dermatology.  The RDTC has fantastic facilities and was built only 15 years ago.  You walk into an airy atrium complete with “water feature” where patients arrive and sit on long wooden benches.  Clinics are run on a Monday, Wednesday and Friday and patients arrive at around 8am.  They then sit and sit without complaining and after our 8am morning meeting we take tea (very British) as it seems to take 2 hours for the nurses to bring the files over so we rarely begin before 10am.  I have tried to establish why it takes 2 hours but apparently it just does and no-one seems the least bit perturbed by this delay.  Sebastian – a German volunteer counsels me in patience over tea and gives me the low-down on the political situation at the centre.

There are 10 clinic rooms off the corridor, 2 theatres, a pharmacy and an HIV test counselling room.  One half of the corridor benefits from enough light to see the patients’ skin but on the opposite side due to the frequent power cuts and the trees outside the window we resort to looking at skin with the light from mobile phones and the torch I have now learnt to bring in.  I haven’t really understood yet who goes in which room.  We teach 4^th year medical students, the Diploma students and the Dermatology Residents (the doctors in training).  Some rooms have five people in them taking a history and examining the patients and some only have one.  It seems that the larger the number of students in a room the lower the interest level of that group in learning.  Mondays are smaller general clinics and follow-up patients and Fridays is the Paediatric clinic leaving Wednesday as a massive general adult clinic.  On Wednesday we worked from 10am – 3pm without a break or lunch so imagine how grumpy I was at the end!  As the morning merged into the afternoon the rooms became emptier and emptier as first the medical students disappeared and then many of the Diploma and Dermatology Residents until at the end it was just the foreign volunteers seeing the patients! 

Yesterday a lovely nurse came and found me at 4 pm in the library, as I was the only doctor to be found.  That’s the problem with having a shared list…  However, earlier on in the clinic everyone is very keen to learn and I have re-discovered my love of teaching.  Getting an accurate dermatology history is challenging as the patient often changes their story and is very taciturn.  As the dermatology residents and diploma students come from all over Africa there is often a hilarious 3-way conversation going with the few Swahili speakers in the room.  It is heart-breaking to see how late so many people with obvious HIV present.  Commonly people have CD4 counts of 14 and after 5 days I am frequently diagnosing Kaposi’s sarcoma and other HIV related skin disease.  It is excellent that patients can be immediately counselled and have an HIV result within an hour and then start on anti-retrovirals, I only wish they had come earlier.  Wednesday was a fascinating day as in one clinic I diagnosed two rare genodermatoses (that’s genetic skin disease to you)– Tuberous sclerosis and Neurofibromatosis and will give a lecture on these on Tuesday morning to all. 

Last night the second year Diploma students held their annual party to welcome the first year Diploma students to the course.  All the doctors were invited to the Aventure outdoor restaurant for the formal occasion, which was opened with solemn prayers thanking God, Professor Masenga (our Principal) and the King of the RDTC hostel.  Professor Masenga gave a speech memorable in it’s brevity and content stating that he had been in a very boring meeting all day and had another one tomorrow so regrettably he had to go home and could not stay for the party.  It was therefore left to Dr Nabrato to open the proceedings by dancing with Prosperina.  We had a great evening and as the Serengeti and Kilimanjaro beer flowed the dancing became more energetic until at 10pm Michael (a lovely retired Dutch consultant) sensibly rounded us up to go home as they were setting off at 6am for the Kilimanjaro Hash.  I will leave Aaron to tell this tale as I, after another broken nights sleep with Zac, spent the day with the boys in town.

Now as the electricity has been off for 2 hours, which means I will have to bake my bread in the morning, I will take my torch and go to bed………

On Josh's idea of a date night

First I need to keep my promise by explaining how Josh fell in a drain.  We have discovered the Impala Hotel, a 15 minute walk from the compound,  which has a great swimming pool so the boys love going there.  We went there on our first weekend and on the way home on Sunday Josh decided to walk along reading his Star Wars colouring book.  By the side of the Lima road are storm drains and I kept asking him to be careful and not to walk too close but Josh being Josh thinks he knows best so one minute we were all walking along and the  next there was a big Josh howl but when we turned round there was no Josh!  We rushed back and there he was in the drain luckily absolutely fine and so was the colouring book which was Zac’s first concern!  On the same trip he managed to drop the beautiful black and white butterfly wing that he found into the drain on the other side of the road.  Again he whined and wailed and cried so much that a lovely black Mama jumped into the drain and retrieved the wing as his cruel mazungu parents refused to do this for him!

The boys have now been at school for 3 days and have settled in very well.  Apart from Josh clinging to me on day 1 in assembly they have been delighted to go and have been making lots of friends.  Zac made a card for his “beast friend” so I am hoping that his spelling will improve – they certainly have more homework.

Life is settling into a routine – we have to get up at 6 30am which is a shock to the system as the boys start school at 7.30am.  Mind you we have generally been awake for hours listening to the very loud and annoying cockrel strutting his stuff and crowing at top volume from about 4am!  My work starts at 8am and as it’s Africa all the patients arrive from 8am or earlier and sit patiently on benches until their files arrive generally around 10am when we can start clinic.  Today we worked solidly in clinic seeing patients from 10am -3pm without a break and with no lunch I was finding it difficult to concentrate at the end.  It would be much more sensible to start at 8 and finish at 1pm but I know better than to try to work out why it takes 2 hours to get the files.  I am teaching 4^th year medical students, Diploma students who are Medical Officers but not doctors and Interns who are doctors on the 4 year dermatology intern project.  There are about 4-5 per room and not all speak Swahili as different governments sponser the Diploma students to come to the RDTC to learn Dermatology so they can set up clinics back in their country.  Sometimes it is hard to work out who is who and it seems the Interns teach the Diploma students and the medical students but it is the foreign volunteers who teach the interns.  Many of the doctors, medical students and diploma students seemed to disappear mid morning leaving us to finish clinic.  Today there were some amazing cases and I saw things I normally see in text books.  People seem very long suffering here and often wait far too long before seeking help and we see huge numbers of HIV related skin conditions.  I was very worried that I would not know enough dermatology but my HIV treatment knowledge has rapidly expanded and it is the basic general dermatology that needs to be taught and also how to take a proper history, find the physical signs and make a management plan.  I was back home today at 4.30am and am thinking about my lectures for next week.

We went to the school for dinner for the second time this week.  On Monday we had beef pasta, chocolate milkshake and banana fritters and chocolate sauce and on the way home Josh said “ tonight was like a date night – you know when you love each other and you  go out and eat fancy food at a fancy restaurant”.   Bless him…I feel sorry for his future girlfriends!

Aaron has been doing some volunteer teaching at the school teaching presentation skills to surly teenagers and getting on with his PhD.  He has also been going into town with Rebecca to buy a mop and bucket and source coffee and fruit and vegetables.  Rebecca made us mango and avacado smoothies (not mixed together) which are delicious.

It has been restful to have no TV and instead we play old fashioned games after dinner – happy families, snap and Zac has been teaching me chess although he was very stroppy when he didn’t win last night..

Our main problem is lack of transport as the dermatology car is now under contract for sole use to the Spanish pharmacist and it seems to have broken down as well.  We take taxis everywhere at present but it would be great to have some transport to get out and about at the weekends.  It is impossible to hire cars here so not sure yet what we will do .

I can’t believe we will have been here a week tomorrow – it seems much longer than that already….We are thinking of you in cold England whilst we bask in the heat and scratch our bites.

How Josh fell in a drain whilst reading a Star Wars colouring book

We had a good flight over, once the boys had got over the disappointment of not having working TV consoles - which was a bit of a bummer considering we had sold the 8 hour flight to them on this basis.  Luckily we found 2 that did work which happened to be situated next to a poor unsuspecting lovely Dutch nurse on her way out to work in Momabasa who surprisingly moved within an hour and a half of fairly constant zac and josh questions!  Somehow she managed to convince a lovely bloke to swap with her, obviously not mentioning the children, who was highly good natured and explained X-men 4 and then put up with Josh kicking him a lot overnight!  In the morning or rather after about 2 hrs sleep we got chatting and it turned out he is a rally driver and driving one of the support vehicles for the mad classic car race round Kenya and Tanzania.  We are hoping to bump into them again round Kilimanjaro..

Moshi is leafy and feels very safe and we were picked up late from the airport by Dr Andrew in his 4WD straight from the Regional Dermatology Training Centre.  We persuaded him to take us shopping in Moshi as arriving with 2 hungry boys to an empty house was not my idea of fun.  So we went haggling in the market and bought bags of papaya, mangoes, pineapple, cucumber, peppers, mountains of tomatoes and garlic and all fresh and local and not flown across the world in a Tesco plane!  Aaron was in 7th heaven once we found him the Union Coffee shop which serves amazing coffee as Tanzania is a world renown coffee plantation.

Our house B22 has seen better days but is fine once we put a red plastic bucket under the leaking sink u bend.  It has loads of space and a fabulous garden with papaya and banana trees.  There was minimal kitchen utensils as i had been led to believe - 4 plates, 4 glasses, 4 cups, 2 pans and some cutlery and that was it!  Nothing for the boys to eat cereal from so Aaron went on a market trip with Rebecca who lives next door and who arrived immediately to tell us she was our house mama and would look after us (after negotiating a fee of course).  She is lovely and we have been communicating of a fashion via the Lonely Planet Swahili phrasebook and made her laugh by saying the mosquito net was takataka (rubbish) as we tried to pin it up with string and nails.

The boys school is across the road and we took them there on Friday.  It is great - leafy and open with cool vernadas and bright fun classrooms.  There is a fabulous outdoor pool and a coffee shop for Aaron - oh dear there goes our safari money!  They start school tomorrow at 7.30am which will be a shock to the system but as it gets dark at 6.30pm we will all be going to bed a bit earlier.  I start work at 8am and went into the Regional Dermatology Training Centre on Friday morning to get my bearings and to do a clinic.  The building is magnificent -built only 15 years ago and very well equipt with numerous outpatient rooms and 2 excellent theatres.  There is a pharmacy and all the ointments are prepared in a buliding in the garden.  The patients are seen by 4th year medical students and then the Dermatology residents with the volunteer Dermatology doctors going inbetween rooms doing the teaching.  I am discovering there is a certain way of doing things and need more time to work out how I will best fit in and hopefully make a difference.   I was worried that I would find the Dermatology difficult as my Tropical dermatology and HIV knowledge is neglible but i was pleased to find that as Claire and Richard said most is general dermatology often in extreme due to the very high prevalence of HIV infection.  Fortunately anti-retrovirals are free but patients often present very late with low CD4 counts and hence have awful disease which is impossible to adequately treat until the HIV is better controlled.

and on that happy note and so to bed as a busy day for all tomorrow.  I will try and post some pictures soon so you can see where we are living.

Love to all

The night before the day we go!

It's 1.15am and we fly to Tanzania tomorrow and yes you've guessed it I haven't finished packing yet!  However I have managed to start this blog.  And so to bed......