"Quit fooling around
Give love to the ones who can't love at all
Give hope to the ones who have no hope at all
Stand up for the ones who can't stand at all"
- Jon Foreman, "Instead of a Show"

My first week of work is complete; time goes quickly. I've learned and been challenged. There is so much sickness and death. The frequency appears to make the local healthcare providers not address emergencies; it is as though they are defeated already. I've not seen a local nurse or doctor seem concerned about any deteriorating patients (again, I've only been here a week) while the American and Norwegian providers rush to the bedside. I'm talking about sick patients here; I've assisted with CPR on the same infant twice while moments later a 14 year old died. I would like to light a fire under their butts.

On a positive note, there have been wonderful opportunities for teaching. Some of the nurses and nursing students are excited to learn and show signs of putting the pieces together. We talked a lot about preventing complications today and I watched as the nurse put those ideas into practice- yay!

I toured "casualty" today. Casualty is basically the receiving area of the hospital. To call it an emergency room is really giving it too much credit so I refuse. There is no triage system so patients are seen in the order in which they arrive, somewhat regardless of acuity. The chief nurse of Haydom requested my help in establishing a triage system and making sure the right equipment is available. I spent the afternoon researching and found that the lack of emergency care is a big problem in developing countries. One study found that people in Nepal are far more likely to present to primary care centers for emergency care and that this is a big obstacle in promoting good outcomes. Interesting contrast since many Americans use the emergency department for primary care. I found some really good resources and will work with the Tanzanian nurses to help implement some changes that hopefully are sustainable. If you are thinking that I'm under-qualified, you are correct. Thankfully this week Karen has been here with me and she is a wonderful resource.

Yesterday we visited the primary school and took some supplies. Children love to touch the "mizungos." They are fascinated by our white skin. The children are so joyful and trusting. Karen and I took a walk around Haydom Mountain yesterday and I had 2 small girls grab my hands and just walk with us for a while. After our walk we had dinner at a local cafe. It is a dish called "chips miyaya"- french fries cooked into egg. Weird concept but delicious. You may be wondering what exotic cuisine I have been eating here inTanzania. They serve a lot of potatoes, rice, and bread. I miss fresh fruits and veggies! We do eat mangoes and oranges- delicious. The locals eat a lot of beans and ugali (some type of dish made with corn) but they do not make those dishes for us.

Top 10 diseases treated at Haydom:
Malaria
Pneumonia/stroke
Amebiasis
Gastroenteritis
HIV/AIDS
CHF
Typhoid
Cirrhosis
Psychosis
Peptic ulcer disease