Amani Clinic

cow and manAt the clinic, Dr. Ben told us, many people keep their cows/animals under their same roof to avoid them from getting stolen.  Therefore, there is often cross contamination and infection.  Most common we saw hookworms, stomach infections, fungal infections, and UTI’s.

Cows are a sign of wealth and a dowry could be 12-16 cows.  A single cow could cost $2,000 USD.  People live on less than $1 a day.  People die over cows and the area of Ntagcha was filled with cattle wars before COH.  Many of the children are orphans because of cattle wars.  Now with the presence of COH, cattle wars are not present in the area and the local villages are at peace.

At our first day at the clinic, I helped sweep the dirt floors.  It was humbling and made me think of the skilled workers that seek refuge in the US and are unable to work in their trade.  They take up housekeeping and service jobs when they are more skilled.  Every person at the clinic helps out with sweeping and mopping every morning.

There is a strong community here in the City of Hope.  Everyone is welcoming and generous.  Each child I saw arrive at the clinic, walks with a friend.  Every child that came to the guest house for care, arrived with a friend.  Each child helps and leans on one another.

At the clinic, they use differential diagnosis to help each patient.  There are only basic tools and you must use your knowledge to find the cause of their pain and treat it.  I helped with a malaria test, which is very similar to a glucose test.  This test and a stool sample were the tests used most often with patients.  Medicine is a few cents to a few dollars and many people cannot pay the amount.  They are given a sliding scale and usually the loan comes from the community.  I was told my 1 person Duke education = 9 college student educations in Tanzania.

I observed them use every available resource.  For example, we would cut cardboard from packaging to give to patients to use as paper.  The pill bottles we use in the States, made their way to this clinic and are used to give to patients.

At the clinic, there is no running water.  There are solar panels but they do not work and there is not money to fix them.  They were installed a few years ago by a grant from the US embassy.  When we were there, they ran out of alcohol prep pads.

I watched Dr. Adam speak to the entire family about a diagnosis and prevention.  He didn’t just focus on the patient.  I watched also how they give IV injections straight into the wrist.  They do the IV injection with such precision, getting it right, finding the vein the first time. This is not a practice we do in the US, because we hang out IV medications.  In the US, inserting into the vein directly is only for emergencies.

During our time at the clinic and COH, we provided: health history and assessments of the children, wound care prevention, we taught on types of wounds and how to care for them, hand hygiene, UTI, menstruation/fertility cycle – reusable pads, and nutrition to community – mothers and babies.  I would add we were asked to speak on these topics to the children and community.  We did not come up with these topics ourselves.

teamwork city of hope

Dr. John Chacha and Regina Chacha met and married in the US/Canada and lived primarily in VA.  They have a few children.  Dr. John Chacha’s sister died in childbirth in Ntagcha, Tanzania and they adopted her children.  After her death, he went back to Ntagcha, and asked the elders of the village for land to start a clinic to reduce child and maternal mortality.

The elders gave him land, and in ten years, a vision from a pile of dirt to a growing village, became ranked as the #22 school in the country, top 3% in the country.  The school is a Christian private school, modeled after the UK school system.  First came the Amani clinic to reduce child/maternal mortality.  Then, Destiny primary school (400+ students), and (after Dr. Chacha’s death), the Dr. John Chacha secondary school (100 students).  Last year, Regina’s daughter, Tenzi started a sewing school for local village women.  Her work was featured in Glamour magazine last year.  She hopes to start an Etsy page and expand her goods to global markets.  COH next project might be to expand to a masonry and trade school.

Before they opened the secondary school, children would graduate from the primary school and walk 1.5 hours to the local secondary school, where sometimes teachers would not show up for class.  Some 23 secondary students were sent by scholarship to Mountain Mission School in VA.  The next year 10 more students were sent, totaling 33 students to finish their education in VA.  These students are also guaranteed a US college education.  These children, many of them took Regina’s surname on their passports.

Dr. John Chacha Secondary School has a chemistry lab, biology lab, computer lab, that is the same quality as our US schools.  The marching band has uniforms donated from the school Tenzi and Immani (Regina’s children) went to in the US.  When the band was upgrading their uniforms, they gave the retired ones to COH.  Each child has a uniform – red for primary, green and purple for secondary.  Girls wear skirts and boys wear shorts.

Devotion service begins at 5:30 am. There is prayer before meals.  Devotion in the evening.  Breakfast of porridge, lunch beans or sukuma (a version of collared greens), ugali (sticky cornmeal), and dinner, something similar.  They have a strict school schedule, going all the way into the evening with prep (study hall).  Each child is also assigned rotating chores.

The compound/campus has many construction projects, building a new dorm for the boys and girls of the secondary school.  Local women are hired from nearby villages to work at the construction projects.  They carry heavy cement blocks on their heads, carrying the same load as the men.

It takes $35 a month to sponsor a child, and each child has two sponsors to meet all their needs.  There are 3 groups of children at City of Hope – boarders (which are like boarding school children), paying their own expenses, living at COH and returning home for the holidays.  There are the residents (which are the orphans) and then there are the day scholars, who do not live at COH and walk from the nearby villages to school.  The orphans come from all over Tanzania, usually brought by word of mouth or a pastor.  If one or two of their parents have died, they are considered an orphan.  These children are all Regina’s legal children.  She is their guardian and many of them have taken her surname Chacha. COH is not an orphanage but a children’s home.

The guest house we stayed at has running water collected from the cistern (rain water).  They have electricity this year and our drinking water is filtered from a well.  The children use outdoor latrines and use water from the cistern.  They take bucket showers collected by themselves.

They each are assigned a bunk bed in the appropriate dorms and have an adult living in the dorm as well.  I don’t know if they sleep under mosquito bed nets, but we slept with them in our bunk bed rooms.

“Ka-ree-bu” Welcome.

4/21/18: Saturday, we arrived at the airport at 3 pm to check our 20+ bags of luggage.  Each one of us (10 students and 1 clinical instructor) were allocated two checked bags to bring on our medical mission to Tanzania.  Most of our bags were filled with donated medical supplies from Duke and donated hand sewn re-usable menstruation pads from another organization.  We carried with us syringes, gauze, gloves, hand sanitizer, pregnancy birthing kits, and much more.

From Raleigh, we flew to London, arriving in the AM on Sunday.  In London, Heathrow, every café/restaurant had on their menu – smashed avocado with a poached egg on sourdough toast.  Obviously, my breakfast of choice.

4/22/18: From London, we flew to Kenya, arriving in Nairobi, nearing midnight.

4/23/18: Monday, we drove to Wilson airport (WIL) to fly to the border of Migori, Kenya (MIGO).  The airline was Mission Aviation Fellowship (MAF).  Mission Aviation Fellowship is a Christian organization that flies to isolated areas bringing hope and sharing the Gospel.

At WIL, we boarded a puddle hopper (15 seat passenger plane).  We weighed ourselves with our backpacks, and then all the luggage was weighed.  We were able to take the majority of our luggage with us, and the remaining would be picked up by City of Hope by bus.

Landing in Migori, we were received by Hudson (Executive Director of Teamwork City of Hope) and 2 cars.  They drove us to the border of Kenya where we walked through customs, then to the adjacent Tanzania border, crossing customs.  They picked us up on the other side and we drove another hour to Ntagcha, Tanzania.

Arriving at City of Hope, we were greeted at the gates by the school marching band and lead in by a procession.  When we hopped out of the cars, all the children (500+) met us with songs and dancing.  It was an incredibly warm welcome to their community.

Karibu – in Swahili translates to welcome.


One of my pediatric patients had said to me after witnessing another family, “when is my mom going to pick me up?”  I could not answer her question, instead I witnessed a nurse provide this patient with the upmost love and support in hugs and kisses, as if this nurse was their caregiver.  The nurse gave the patient unconditional support to feel safe and nurtured while no one else was with them.  I do not have the emotional bandwidth for this type of nursing.  I cannot go to work every day and feel sad because a child looks to not be loved, or maybe they are loved, but I can’t see it.

Pediatrics was a difficult clinical rotation, more challenging than all the other rotations to date.  I did not enjoy working on the floor due to the psycho-social component of care.  I could not understand the circumstances that would leave a child to be alone in a hospital without family support or to have family support but to not have it be great.

Tomorrow, we go to UK-Kenya-Tanzania, where I will giving health assessments to 100-200 orphans, all should be mostly healthy.

Malaria and mosquito nets

Many years ago, I read an article in the New York Times about organizations doing good work – places to donate to during the holidays.  I remember reading, it takes less than $5 to buy a mosquito net to prevent malaria in Africa.  I remember telling, myself, that’s amazing, only $5 to help save someone’s life.  I’ll donate to this cause and tell everyone about it.

Some time in the recent past, in class, we watched a TED talk about malaria.  The talk equated malaria in Africa to how we, in North America deal with the flu during flu season.  It’s just something you might get, and need to get over.  The speaker said, in Africa, malaria is thought of in the same way to the local people, it’s something you might get, and have to deal with.  Local people don’t consider it a big deal, in the same way, many of us might think of colds or the flu.

Imagine, you get the flu, and someone says to you, to fight the flu, you should put a heavy bed net over your bed that does not allow for any cool air to circulate while you sleep.  You accept the net, but decide it might serve a better purpose by using it to fish in the lake to make money at the market.  But, the net is covered in a toxic bug repellent and makes all the fish die.  Instead of helping these people, with your great ideas of how they should improve their lives, you instead have created an environmental problem.

I am guilt of this thinking – and years ago, I donated money to this idea of buying mosquito nets for people in Africa.  I failed to realize the idea of malaria had to be resolved by their own people in a way they think is effective.  They need the motivation themselves.  Just like, I cannot convince anyone to go to the gym if they don’t want to go.

I leave for Africa in 11 days and will remember, my purpose is not to bring interventions to a community but instead help serve in ways that support their independence.

Pakistan, my refugee family

My refugee family is from Pakistan.  When I think about it, I’m not sure if I’ve ever met anyone from Pakistan.  Pakistan is bordered by Afghanistan (west), India (east), Iran (southwest) and China (far northeast).  The official language is Urdu and English, but many people speak Arabic, Punjabi, Hindi and other languages.  In 1947, Pakistan became an independent country for Indian Muslims.  (FYI: Islam refers to the religion or faith, and Muslim is someone who follows or practices Islam.)  In 1956, Pakistan became an Islamic republic, with many cultural identities adopted from the British.  The school system is modeled after the one in the UK and Pakistan students must pass A-levels to enter university.  At my refugee families home, the mom served us British tea and cake.

An ethnic civil war in 1971 resulted with East Pakistan, seceding to a new country Bangladesh.  This is all I know of Pakistan – and I vaguely remember reading a book about Benzair Bhutto a long time ago, the former Prime Minister who championed women’s rights.  This is a sad state of my knowledge gap when all I know about another country is a paragraph.

I don’t know about the political instability that led my family to leave their country but I would guess that it might have been related to Taliban rule, as was the case of Malala (the young girl who won the Nobel Peace Prize for championing girls education).  Malala is now 20 years old and recently made the news for returning for a visit to Pakistan this week for the first time since she fled.  My family, like many refugees relocated to other countries, before arriving in the US and also has been unable to return, leaving behind family members.

The plan for me and my team is to work with this family every week – on whatever needs they have relating to becoming U.S. citizens and assimilating to the U.S.  I think of how challenging it must be to find a new community and flee under such difficult circumstances as to leave your family behind.  Our immediate goals are to work with the mom on passing her driver’s learning permit exam and then finding resources for her to learn to drive.  For the children it is to work with finding them resources such as a playground, after school activities and getting a library card.

I continue to be surprised as to what it means to be a nurse.  Working with this family, brings me an unexpected education.

prepared, back to the gym

I often use the word, overwhelmed to describe how I feel.  The opposite of overwhelmed, might be prepared.

I went through this exercise where the facilitator said to think of a time when you feel overwhelmed.  Think about your emotions, your breath, every cell in your body – how does that feel, describe it, remember it.

Now, think about a time or a memory when you felt prepared, how did you feel?  What were your emotions?  How did your body feel?  What was different?  Remember this image and remember this moment.

He said when you feel overwhelmed, to think back to the moment when you felt prepared, conjure up that image and feel those thoughts, feel those emotions and think about how your body felt, down to each individual cell.

This imagery will help you overcome your feelings of overwhelmed.

When I thought about my moments of how and when I felt prepared – it was actually very physical. I felt physically strong when climbing Mt. Whitney.  Below is a photo after the second time I biked across the US when I felt capable.  The correlation might be that to feel prepared, I might need to be strong.

And so, I’ve joined a gym to get back into a routine of being strong.  I can’t get to the gym on my own free will, so I’m joined an expensive gym.  The workouts are different every day and you’ll never do the same workout twice.  I don’t have to come up with a play list, a workout routine, and someone is pushing me harder than I might be willingly to go myself.  Someone is holding me accountable for showing up.

I sign up for a class ahead of time and someone tells me what to do for 50 minutes or so.  They use heart rate monitors and even if I can’t quite see the details of the screen, I can see the colors.  They tell me I should always be in the red or orange colors.  Green or grey means I am not working hard enough.

If I cancel a class, I need to do it 8 hours in advance, otherwise, I am charged $12.  I wonder who thought of this pain point.  I’m ok with $5, maybe on a bad day $10, but $12 is past my limit of an acceptable waste of money.

When I signed my membership, the coach made sure to sign me up for 4 more classes this week.  Going from zero fitness to 4 – might be a little aggressive, but I need all the help I can get since I can’t motivate myself in this area of my life right now.

If I could have a personal coach for every area of my life, I would, but for now, here’s to losing the nursing freshman 15, and getting back to routine – of being strong and prepared.