Kindra Hook, BSN, is doing a 5-week internship at Gonja Hospital in Bombo, Tanzania. She approached ETI last spring as she was finishing her undergrad in nursing, wanting an opportunity to get some Global Health experience before beginning her master’s program in January of 2013. I’ll admit, she was a college friend of my youngest son, Alex, and since all of his friends are pretty amazing, I knew I’d like her and want to work with her before I even sat down to discuss her role as a volunteer nurse. Even so, she has exceeded all my expectations!
Enjoy getting to know “Friend of ETI” Kindra Hook!
(intro written by Sheri Krumm, Development Coordinator)
(taken from her blog)
August 13th- 15th
Well, my adventure has certainly started out on an interesting foot. First, I flew to Minneapolis on Monday morning. Second flight to Amsterdam went well and I sat next to an Ethiopian immigrant who was traveling back home to visit his family. He was a very lively man who instantly made me feel like I had known him for 30 years. It’s just that good old African sense of unity…it’s beautiful. The flight to Kilimanjaro was unremarkable, as I slept through the majority of it…it was 2 am back home and I was exhausted! When our plane landed in Kilimanjaro, we walked off stairways into the 80 degree Tuesday Tanzanian night. I have seen small planes let passengers off this way, but never a large international jet! Quite a sight to see the plane just sitting in the middle of a concrete path with no terminal attached. Well, then again, the airport itself was like 300 square feet. Welcome to Kilimajaro . It was here that I met a man named Ben as we were busy trying to figure out what forms we needed to fill out to receive our visas (quite the mess, let me tell you). We exchanged plans for travel and decided to try and meet later in the month to possibly go to Zanzibar together. Instant friend. I love that. I love his openess.
After finding my 3 bags containing about 2,000,000 lbs full of donated medical supplies for the hospital, I rushed outside to encounter 30 or so locals holding signs with people’s names on them, and sly others attempting to get the new tourists to get into their taxis or dalla dalla (bike transport). Within about 3 minutes, I was in a van with a man I had never met, driving down a road late at night through the equivalent of the African countryside. Sounds safe, right? Oy. We passed some obscene amount of people who, despite it being pitch black outside, were carrying babies, bananas, and buckets of water on their heads while walking barefoot on the side of the road. And I’m pretty sure we almost hit an armadillo. Yep.
About two hours later I was reasonably convinced that this man was in fact taking me to a guest house for the night and had no plans to, oh, kill me and make a shrunken head from me. Ok, I wasn’t that worried. But I was glad we made it there to Same. It was a motel of sorts, cement floor in my room with a simple bed, a mosquito net, and two buckets- one filled with water for bathing, and an empty one to use as a toilet. Welcome to Africa. Actually, I slept rather well and was awakened to the sound of chickens and of motorbikes around 6 am. After a bit of tea (breakfast), I paid the owner 14,000 shillings- or about $12, and departed for another 2 hour drive from same up into the mountains where Gonja Hospital is set. The trip was breathtaking. It was like every depiction of Africa that I had seen in the movies, with rocky red dirt roads, people in ordinate dress carrying water on their heads, children running around in tattered clothes kicking balls that are long past their prime. But they were so happy it was incredible. And the scenery, oooooh, the scenery! Twisted trees and long grass, mountains that ascended through white, fluffy clouds with a scent of sand and humidity. Beautiful. The dirt and rock roads, however, were so bumpy I almost flew out of my seat on a regular basis. Martin, my driver, must’ve noticed me clutching onto the seat for dear life because he grinned and said “sorry, African roads!” and with a belly laugh, stepped on the gas peddle, sending us flying over another huge rock in the road. Boy, was I in for it.
Finally, we arrived at Gonja. I set my stuff down in my duplex (ok, it’s a concrete floor living room with a single old couch and with two simple bed rooms attached (I have two house mates- the hospital accountants), and a bathroom that includes on old sink that sometimes works, a toilet that leaks, and a shower curtain attached to a rope that you can use to shield yourself with as you ‘shower’- in other words as you pour buckets of spring water over your head.). Hey, I didn’t expect much. At least I have a toilet. Since I live a whopping 50 feet from the hospital, my journey there every day will not take as long as some of the other employees. Sister Dora was the first woman I met. She is a plump but very friendly nurse who is the equivalent of the nurse manager of the hospital. She took my hand (very much the custom around here), and took me on a tour of the hospital. Explaining the structure and inner workings of the hospital is going to be a large undertaking, so I will save that for another time.
Next, I was lead off to a small hut where a tribal lady was preparing me a meal over a fire. Rice, beans, and bananas. Delicious. However, I did not realize this will be the gist of what I eat for the next month. JOY. At this point, Dr. Amani (one of the three doctors of the hospital) sat down and sipped tea while I ate, and we talked about the differences between the US health system and the Tanzanian system for over an hour. It was the beginning of many questions that would slip into my mind about care in the United States versus here, which I will talk about later. He then lead me by the hand to the market to show me around. In a small hut made of the familiar red dirt bricks, I bought my first kanga- a colorful fabric . The women will twist and turn and sew them all sorts of ways. My beautiful kanga is a dark blue with tiny white polka dots and white lilies. I am just in love with it’s beauty. When we returned to the village, Dr. Amani’s wife and daughter giggled as they tried to show me ways to tie the kanga. I apparently was not learning very fast. Finally, I decided a style I liked and mastered how to tie it, and his wife exclaimed “You look like real Tanzanian woman now!” I twirled in front of the mirror a few times and grew so in love with the gorgeous fabric. Not quite a Tanzanian woman. But it’s a start.
The morning of the 16th, I was to start seeing patients at the hospital for the first time. After a delicious breakfast of chapati (a flatbread) and tiny bananas, I entered the lower end of the hospital (where the patients will come and sit in endless rows on wooden benches to wait to see the doctor) and joined Sister Dora and the rest of the staff for the day in an opening prayer & hymn singing. Even though I could not understand the Swahili language, the hymns were so melodic and beautiful that I didn’t much care. These people spend much of their lives singing, and it shows. It nearly took my breath away. Next, I began rounds with the doctor, with orders to instruct him and the nurses on how we ‘do things in America’. The wards of the hospital are often crowded, with about 12 beds shoved like sardines in two rows up against opposite walls. Take into account that most of the patients have family members and their children that will sit at bedside day and night, and you realize these rooms are packed to the brim. It made me shudder to think of the illnesses that were likely being passed from patient to patient around the rooms, but what choice did they have? To get to the hospital for most of them is likely at least a day’s walk, if not more. So clearly if they were willing to walk that far, they really needed medical care.
Despite the fact that I had no idea what kind of training it took to be a doctor here in Tanzania, doctors at the hospital seemed to be well-educated and knowledgeable. The problem is, they just don’t have the resources to be able to properly diagnose and treat patients. While they do have necessary equipment such as x-ray and dopplers (ultrasound), they rarely get used, I’m assuming due to cost of operation. Anyone who comes in with chest pain, a fast pulse, and difficulty breathing is labeled as having pneumonia (which may be true, but there are also a number of other things that can be going on). I saw a man the other day with severe jaundice, who was clearly in need of urgent medical attention if not a liver transplant, and he was labeled simply as having ‘liver disease’. And I thought- but from what? Is he a drinker? Doesn’t matter, there are no counselors here anyway. Is an infection causing liver failure? Maybe, but I doubt we have the ability to determine the causative agent, much less to actually treat the infection. Does he have a blocked duct somewhere? Even if he did, anything over a simple operation here would be next to impossible to perform. So they do the best they can, give him Diclofenac (which isn’t really used in the US, but I gather it’s something close to Tylonel), and send him on his way. What other choice do they have?
One of the female doctors and I were trying without much luck to insert a peripheral IV into the arm of a very frail man one afternoon (rarely do they start IVs here unless absolutely necessary, as they don’t really have the supplies to get it to stay in place or keep it from getting infected). After realizing this was not going to be an easy insertion, my first instinct was to call the Flight team (who insert difficult IVs at many US hospitals because they are used to having to insert them during helicopter transports for unstable patients, so they are very good at it). And then I had to laugh to myself….there are no flight teams in Tanzania. Good call, Kindra. Problem was, this man was so incredibly dehydrated that his veins had contracted to the width of dental floss, and we poked him 4 times before we got any blood return on the IV. I was thinking I had FINALLY gotten this line in…and then the site begins to swell. Well, glorious. The doctor said she didn’t know why it was swelling, and I explained to her that I had likely punctured through both sides of the vein and that the needle was no longer where it needed to be. This poor man. I had to remove the line and try yet again. Finally, I found a vein that seemed thick enough to be able to get a line in without rupturing through it completely. This one was a success. Dear lord, I’m going to be really, really good at IV’s by the time I get home.
Seeing as everywhere in this hospital can need help and I am free to move around as lulls and peaks in traffic arise, I spent time in several places within the hospital. One morning after rounds, I joined the lady (I can’t remember her name) in the pill dispensing room. Patients who were not admitted to the hospital were often given medications to take home with them, and they would stand, some twenty at a time, in front of the window waving their prescription orders. We would take the hand-written scripts, try to decipher what was written, and fill the order from stock bottles of medication. However, because we had nothing to put the pills in, we would stand at a tiny counter and wrap the pills in half sheets of computer paper. You can imagine what a disaster this was. It was hard enough for me to wrap these things in a way that they would stay inside the paper, and I wondered how many patients would lose pills while carrying them home. In addition, telling a patient to take a pill “three times a day” isn’t too clear. I also noted the need to mention taking pills for the entire time they were prescribed. Many times even in the US, patients will take pills just until they feel better, and then discard the rest, which in time has caused a host of drug-resistant organisms that we have had to find new ways to kill. We need to make sure this never happens here, as getting access to new, more expensive drugs could be quite problematic.
That night, after noticing the layer of grease in my hair as it had been 4 days since I had showered, I finally gave in to the inevitable. I…took my first Tanzanian ‘shower’. Let me tell you, this was quite the experience. It amounted to something like me standing over a small drain in nothing but flip flops clumsily trying to pour water that I had heated myself over my body. Pour a little, scrub a little. My long hair…which is now well past my shoulders…was quite the disaster. I’ve now resorted to tying it in a bun and covering it with a scarf most days. While all of this was going on, my host brothers were sitting in the living room laughing hysterically as they hear me slip and struggle to figure out how this whole thing works. It must be hilarious to watch Westerners come to Tanzania!
Perhaps my favorite experiences thus far have been meeting people. Not everyone speaks English, but some do speak enough, and the doctors and accountants are fluent. I have enjoyed many wonderful conversations with my host brothers, who are the accountants for the hospital, about life in America vs. life in Tanzania. Yesterday afternoon, I was welcomed into the house of one of the young nurses. About 20 years old, she lives alone near the hospital and is the sweetest little thing you ever did meet. She graciously prepared for me chai tea and a delicious egg and potato dish, which we shared in her tiny entryway as we watched Tanzanian Christian music videos her portable DVD player from America (a prized possession which she has to charge at others’ houses because she has no electricity). While we are eating, there are wild dogs, cats, and chickens literally walking in and making noise, hoping for a bite. There are few doors on any house up here (also, there are none on the entrance to the hospital), and the animals and children run around as they please). Comical.
By the morning of the 19th, I was significantly exhausted. Minus rising for breakfast, I slept til past noon, rising to the beautiful sound of music, shouts of joy, and dancing. While only about 40-50 percent of Tanzanians are Lutheran, the area I am in is rather Christian. And let me tell you, their Sunday Church services go all out. The singing and dancing echoes through the mountains, there is literally leaping for joy, and the smiles on faces are incredible. If it was easy to send pictures over our internet connection, I would attach one, but you all will have to wait until I get home. Despite the hardships these people face, their joy is absolutely unbeatable. Their connection to each other is so amazing. Rather than being afraid to hold on to each other like we see in America, they are afraid to let go of each other. It’s amazing. I love America, but nothing beats this. You do not see this kind of joy and gratefulness in America, and that is the honest truth. We can learn so much from them. That afternoon, after being confined inside because of the rain for several hours, I ventured down to the market with the doctor’s young son to put more minutes on my Tanzanian phone and to purchase more kangas. God bless him, he is so helpful. And Oh, how beautiful the kangas are. Again, pictures you all will see another time. But I can’t wait to wear them!
Love to you all. Kindra