A little over a year ago my friend Blair called and asked me how I felt about Tanzania. "I don't know. It sounds like a great place to visit". After a month here, I couldn't agree more. I'm coming to the end of my stay and I feel regret about having to leave after "only a month". (This regret may have proceeded frantic efforts to change my plane ticket that were met time and again with resistance. There is a time and a season for everything and I suppose it is my time to go back to the United States.)

Last week was the culmination of a lot of my projects at Haydom. I finished my short chart audit of tracking malaria diagnosis and treatment and presented them to the appropriate people. I met a gentleman at the hospital who is working on a US-funded project in another town to develop a malaria vaccine. He invited me to visit the project (again, bummer that I'm leaving). We discussed the diagnosis of malaria at Haydom and possibility of many febrile illnesses being misdiagnosed as malaria and he said that this is a widespread problem in Tanzania. I won't bore you with any more of the details but there are fascinating things happening here.

The changes for reception were presented by the nursing officers to the nursing staff and they started working on implementation. I helped to find some additional supplies for ICU and reception from one of the storage containers (here is my plug: if you want to give donations to missions organizations/hospitals, give money. It is much easier for them to buy their own supplies than sort through donations). I also worked with Elin Mari and a local nurse Beatrice to develop curriculum and a plan for training the staff on recognizing and treating the deteriorating patient. The training starts today; I can't wait to hear how it goes.

I thought I eluded sickness while I was here until Tuesday. There is a virus making its way through the Norwegian volunteers. As Dr. Erik said, I joined their "club." I literally laid on the concrete floor and didn't move for a long time. I had to miss a day and a half of work but all is well now. I am so thankful for Elin Mari and Nina who took care of me when Mom was a continent away.

I spent my last day at Haydom biking through the country with Andrea and Elin Mari. Andrea is the nurse manager of ICU, surgical ward, reception, AND theater. He was kind enough to take us by his farm and introduce us to his family who was harvesting beans. When I returned to Haydom I said goodbye to the little one in CCU who has just stolen my heart. After dinner many of the volunteers gathered in the gazebo for goodbyes to Lillian and me. It was such a sweet time. There are so many amazing people that I met while at Haydom.

I'm in Arusha with some of the other volunteers and visitors that are heading home. Our flights leave tonight and, if all goes as planned, I will be in Seattle Tuesday afternoon.

"From the time we arrive on the planet
And, blinking, step into the sun
There's more to be seen than can ever be seen
More to do than can ever be done
There's far too much to take in here
More to find than can ever be found"
-The Lion King

Have I mentioned that Tanzania is absolutely breath-taking? Just riding in the car is an adventure. This weekend I travelled to Ngorogoro Crater. You may guess that I was with Norwegians but this weekend everyone was German; there is a German pediatrician volunteering here for the next 2 years (admirable, to be sure). She has several friends visiting and they, along with a German medical student, made up the group.

To get to Ngorogoro from Haydom you travel about4 hours in the Land Cruiser. We spent Saturday night in a town named Katesh and started the day early on Sunday. I was unprepared for the grandeur of the crater. You enter through the Ngorogoro Conservation gate where you are immediately greeted by baboons. Watch out! They like to help themselves to food in your car, per the guide. You travel through the conservation area for a while and pass through beautiful vegetation. Here we encountered our first elephants munching by the side if the road. We also saw some traditional, inhabited dwellings of the Masai tribe. The Masai have been granted permission to live within the conservation area. After driving for a little while you start your descent into the crater. It is incredible. I saw so many animals. Perhaps I'll let the pictures speak for themselves? Enjoy!

I think rainy season is upon Tanzania. Perhaps not officially but I don't know if there is a defined start date. Each afternoon it rains so hard that it is inevitable to get soaked if you are outside. From the entrance to the hospital (where reception is) I watch as Tanzanians run from all directions towards town, trying to make it home as quickly as possible. I brought laughter and smiles to some of the people as I sported my rain coat today. I don't know if they have ever seen a rain coat before... Umbrellas are nowhere to be seen.

This week is a little different because of the tropical medicine course taking place at Haydom. I am as likely to hear Norwegian as Swahili. In fact, I think I've learned more Norwegian than Swahili. I'm also pretty sure that I may return speaking as though English is my second language. The course is great- I'm getting to participate in lectures led by the Tanzanian and Norwegian physicians. The lectures include topics such as malaria, TB, HIV/AIDS, and other febrile illnesses.

I continue to work on the rapid malaria project. Today was a good day- 100% compliance of ordering rapid malaria tests in reception on all patients admitted with malaria yesterday. Elin and I have also finalized the goals for reception, list of equipment that should be in reception at all times, and triage classification. We've met with several of the Tanzanian nurses that asked us to work on this project and they seem to be excited about what we've developed. Next week we meet again to introduce and discuss with the staff nurses. I've been pretty emphatic about not presenting the changes but having the nurse officers bring it to the nurses so it doesn't seem like mizungos are coming in and telling the Tanzanians how to run the show. It's still their hospital and I am well aware of that fact.

I spent a lot of yesterday going through the supply room in ICU and equipment hunting. It is really frustrating; there is a lot of great equipment that was donated but is missing key components. For example, IV pumps were sent without the accompanying tubing. I found 5 different pulse oximeters but no probes.

I've spent more time in the child care unit this week. I'm happy to report that one of the babies went home with a family member yesterday. There are 2 new babies, though. I am learning about some of the Tanzanian traditions and superstitions. As it has been explained to me, if a mother dies in childbirth the child is blamed and considered unclean for 9 months. That is why the child care unit exists. After the 9 month period the child is accepted into the family. It's hard to imagine a world where those sweet faces are considered unclean but such a great thing that Haydom is meeting that need here.

*I should have mentioned previously that the physicians in Tanzania ended the strike pending negotiations shortly after the interns at Haydom joined.

Add to my repertoire of things I never thought that I would spend my afternoon doing: sewing up holes in my mosquito net. A group of Norwegian physicians arrived this weekend for a tropical medicine conference. Some of the volunteers are traveling for the week. I am staying with Phil and Iren who have graciously taken me in. Thus, I have a new room with a new bed and new mosquito netting which needed a little help to be effective.

This weekend I climbed Mount Harang with Phi, Iren, Erik, Asta, and Eli. Mount Harang is the fourth highest mountain in Tanzania. It is 3,420 meters (10,260 feet for the Americans who think in feet). We traveled approximately 2 hours from Haydom to Katesh where we spent the night at Summit Lodge. The hike took about 12 hours traveling at a leisurely pace. It was amazingly beautiful. There were parts of the hike that were quite steep and we did a bit of scrambling. I loved it. We climbed to 2 peaks with incredible views of the Great Rift Valley.

I'm an infectious disease dork at heart. My new project with measurable outcomes is related to malaria. There are a large number of patients that are admitted with the diagnosis of malaria. However, this seems to be a catch-all for every patient with a fever. The physicians are concerned that a large number of patients are given this diagnosis without any diagnostics. Translation: people are told they have malaria based on symptoms and no lab work. I'm told that the Ministry of Health provides rapid malaria tests for free so there is absolutely no reason that patients suspected to have malaria are not being tested. The infectious disease physician was informed that this test is being done on every patient admitted for malaria from reception (the emergency room). I've been there for 4 days now and can't even find the tests.

Solution: the physician and I are working with the medical director, chief nursing officer, nurse manager of reception, clinical officers, and nurses to ensure that patients are being tested. Today I developed teaching instructions and taught how to perform the test. I'm excited about the project and hope to see it work out well and improve patient care. There are some photos of the teaching I did today.

Things otherwise are going well. I'm building relationships with the nursing staff. It continues to be frustrating at times. I have gone in later the past 2 days so I could work with am and pm shifts. This also allowed me to go play with the babies yesterday. I've included a couple of those pictures. The weather is beautiful and there are always people around to enjoy the leisure time with me. Several of the Norwegians are leaving today and tomorrow so we had a small going-away party last night.

The last pictures that I've included for your information and visualization of where I am are of the reception area (emergency room). The purple stuff in the bottle is the mystery solution they use for sanitizing everything- your hands, the table, before starting an IV...I have no idea what it actually is.