John Bartlett

I don't often toot my husband's horn for him. But, I must say that he is constantly amazing to me. He has a way with words that make people stop and listen. He also has a way of listening that makes people believe that he has all the time in the world, just for them. His patients often comment on this, and his colleagues come to him for inspiration, advice, and sometimes just for the opportunity to vent to a person who will absolutely cherish their confidential problems and issues. When he watches others give speeches that he doesn't agree with, or pronouncements that are just plain wrong, he never confronts the person public because that would violate the rules of decorum that constitute the core of the way in which he was raised. There are exceptions to this, but only in the case of the Boston Red Sox have I actually heard them voiced out loud.

Indeed, rarely have I heard him talk about people behind their back, and since we are bedfellows, I would be the one to know. In stark contrast to me, the Irish hot-head, John is always willing to give the "other guy" the benefit of the doubt.

Well, John gave a marvelous presentation about the work in Tanzania on Tuesday for a new University Consortium in Global Health First Annual Meeting at the NIH campuses. It was an honor to begin with, and John as usual measured up to the task. What he managed to say in 10 minutes encompassed much of the work that he and his colleagues Nathan Thielman, John Crump and Professor Shao had dreamed about those many years ago. Here is the article.

http://sciencespeaks.wordpress.com/

And, the Red Sox did scrape another win out last night!

Last Days in Moshi Town

The trip to Moshi was much too short. We were both running all day and night. We didn't have enough time to get the work that we wanted to get done, and there were so many difficulties. As you go and come, it is easy to forget the electricity problems, the water problems, the food problems, the job problems. We certainly were faced with all of these problems (in spades) on this short trip. There had been neither short nor long rains this year and food prices had increased by at least 1/4. Jobs lost, Donor sources drying up.

We did have the time to bring our new med student and our between undergrad and grad school student to KIWAKKUKI. They will be doing some work there later in the year, and as you can see in the first picture, there was the usual joyous dancing and singing to welcome them. These singing folks always put on the best welcome belying the difficulties that they face immediately after morning meeting. At least 15 minutes of the day are easy! I think that as they toured the building and saw what each worker was doing, they were stunned with the amount of work, and the way that seemingly all of these departments overlap and come together, blending their speciality in with the specialities of the other departments.

I had the opportunity to visit quite a few students I knew and to meet others. The stories are just astounding. My favorite visit was to Jacinta's school in Kirua because she is such a success story right now Lubda (Hopefully).

Jacinta is standing just like a teenager. How cute. And she loved the fleece and the socks especially. Here is a picture with the headmaster and following it, a picture with her KIWKAKUKI monitor Verynice Monyo.

Remember that this headmaster took Jacinta into his home so that she would have role models in parents, and that his chldren would have role model in someone who had undergone so much trauma in her life. This young woman appeared in the KIWAKKUKI office almost 1 year ago exactly, in tears. She had run away a great distance from Mawanza (Lake Region) to escape being sold to an old man in marriage. All she wanted was a chance to finish school. Her parents had both died of HIV. She had not been tested but at that point couldn't even contemplate it. I worried about the motivation of the headmaster, but on three separate private conversations, she firmly states that he is wonderful, like a real father.

Verynice Monyo is in charge of keeping records for over 1,000 children and nearly as many donors. This is a real job!

At the same school however are two children who are also supported by a different donor. There is no money left for new uniforms, extra clothes, extra food etc., unlike what Jacinta has because of what Marilyn and Phil are doing for her. What do you do about this inequity. Because the children are funded by a large donor source, they don't pay for "social support". But who will? The community? The community cannot pay for their own food this year and line up for vouchers for Maize (Corn). How can they buy new sweaters for these two children whose parents are both dead. Neither child smiled. They probably know that Jacinta gets special treatment, but not them. It is an ethical delimna. Here they are.
We met after this visit and decided that all donors are going to be asked to allow set asides for children who do not have any social support. Even 10,000 Tsh/week would particularly help the girls. So new policies are slowly slowly being put in place after some time. What is the point after all in going to school if you are just going to be tortured for being ragged, hungry and cold. Some of the chldren overcome it. Here is one.

This boy arrived to KIWAKKUKI in tears. His parents are dead, he lives alone and has no one but a few neighbors who give him some food now and then. He was very thin and anxious about coming. After Verynice talked to him, he calmed down a bit as she told him that he would be sponsored for School by Verynice. She asked him about other things, and at this point, the Mawenzi clinic is paying some. But his whole class is going to Lake Manyara, one of the national safari parks next week and he has no money to pay.....Oh well, I didn't really need that extra kanga...right? We found a pair of tennis shoes that fit, and he was crying for joy.

Judith has been featured before, but she is another survivor. Her father ran away to Tanga with another woman when he found that his wife was positive (he refused testing). Judith had boils all over her body from the time she was a baby. After starting ART, they improved and she is now doing physically well. Kathy and Don picked her up and she is really thriving, although she shared her HIV status with her school and now the whole school discriminates against her. The backfire of disclosing her status, has caused her to want to move to a new school where no one would know about her, but that isn't possible. KIWAKKUKI decided to send out the Life & Living and Education Teams to the school to do a teaching regarding HIV education. They have "sensitized" the teachers, but obviously that didn't sink in. Despite that, Judith is doing well in school and very grateful for the supplies we brought and the extra money for her doctor's visits.

You would think that all the matatas would be over, but just that last afternoon as we were crying over trying to get this darn grant loaded on line (while the electricity repeatedly went off and on) we found that the housekeeper of KIWAKKUKI (Eli) on the far left (with Chrissy and Melkizedik) had some horrible thing in his stomach that would require surgery. Since he barely makes enough to eat and support his wife and 2 children (barely) there was no money for the surgery, and he said that he would die. Once again, you think....for about 30 seconds-that extra wood carving?...Eli? Oh well, no contest. He is the sweetest guy. Just ask Chrissy. So that was that. Send precious thoughts for this young man as he has the surgery in a pretty scary hospital.
Saying goodbye to Mr. Shah the senior, his manager, Omari, Cipe, Simon, Shafiq, the electricians across the street, Sana Zetu, Ladik Kanji and his workers, turned me into a blubbering fool, but I managed to get home just to start over again with Rose and Pauli.
So now I ponder working on a plan for these lovely folks who have the mountain of dreams each morning and each night shining upon them.

See you again next time Terrie Nikoli and Greg!

MOSHI TOWN September 2009

Our 3^rd day in Moshi began with a clinical conference entitled Ethical Considerations. Despite that the presenter had not used powerpoint in the past, (the words ran into the layout, the fonts changed so drastically that they ran off the page, and none of the speakers had given presentations before and therefore practically whispered in the microphone) the discussion was actually quite lively and spurred several MD’s to recommend that one of the next presentations had to be for a discussion of proper end of life decision making.

I was quite sure that it was going to be an awful presentation, and if it had not been for the material…wow.
Anyone who has been to Tanzania understands the difficult issues that people are faced with. The first case was regarding a woman who had undergone a c-section and had low blood pressure but was getting post-op meds when another patient next to her had a spontaneous delivery. The nurse gave the meds to a student to give the c-section to help emergently with the birth. (of course it was at night and she and the student were alone.) When she returned to the c-section patient, she had stopped breathing because the injection of pain medicine had gone in too fast.

Fortunately, she was able to revive her and all was well. The second was more difficult with a 13 year old arriving from Tanga with her mother. She had been unconscious for some time with eyes open but not seeing (not fixed and dialated). She was breathing but stopped, and was sent to ICU placed on respirator where she remained unchanged for a week. One night the MD came in and said, she is brain dead, take her off vent. The nurse was very uncomfortable but did as requested. So, it was a very lively conversation about how to determine brain death. Way Crazy!

So, for the first 3 nights we have had no internet and it has been quite frustrating, but now at last we are here with it again like a miracle. I moved around the house to take a few pictures.

We also hashed 12 hours after arriving. Somehow we had enough energy for that and really looked forward to seeing all our friends. The hash was at Sara and Simon’s land in Mweka (near the Kilimanjaro National Park) and beautiful. We had a crowd of mostly young Scandanavians (beautiful girls) and a few of the regulars.

What a great time. The weather is quite cool in the evenings and mornings, but it has been very dry. No long or short rains for the last year and everyone is suffering.

The next day wasn’t so easy. Little sleep, and tossing and turning. Our house is now in the hands of a lovely medical student from Stanford. Very smart! And she is enjoying her stay so far. She is a very positive person which counts for a lot.

Downtown Moshi looks the same, with some building and some tearing down. I already had all my hair cut off because it only costs $5. Pretty good I would say.

Well that is about all from me for now. This will be a quick trip and we are already figuring that it will be over before we know it!