Explanations for yesterday's Blog-- MEPI, Hats, Visitors , Hash Lots of "splaining" to do

Re-reading yesterday's blog--some explanation necessary

As I read the blog I posted over again, I realized that most of the readership would have no idea what I was talking about, thus I hope I can provide a brief explanation of the previous blog. 

The first part of the blog was referring to the MEPI close-out.  MEPI stands for Medical Education Partnership Initiative.  This was a five year grant awarded to several medical schools, most of which are located in Sub Saharan Africa.  KCMC college was one of the lucky medical schools, the only one in Tanzania to receive the award. Careful planning had gone into the grant, and our grant was the only one looking at shoring up the curriculum and maximizing faculty by building infrastructure, improving internet technology so that every student would have access to fast, reliable internet, bringing in Macbook desktops, the top of the line, and for the first three years giving each student a tablet.

A well recorded success story in Singapore involved maximizing  a small faculty by introducing Team Based Learning or TBL as it came to be known.  Two senior faculty at KCMC were sent to Singapore to watch TBL and to have tutorials in TBL. They were sold on this method of teaching.  Thus, when they returned and Singapore Faculty came with them to have intense instructions with other faculty, these two faculty were the cheerleaders.  The success of TBL was based not just on faculty take up of the system, but of a new Learning Management System, or LMS, which involved faculty loading their lecture plan, reading materials, and back up information on the tablets so that students would be able to easily prepare for classes before hand, and even to move ahead so that they were ready for classes in the future.  The beauty of this system, is that the faculty really only had to be present once/week if that is what they chose.  Most were present much more frequently.  The discussions regarding the particular class were led by a so called expert who helped to divide the students into teams to discuss the on-line questions.  There was lots of discussion and then each group presented their answer.  Opposing answer groups challenged them, they defended their answer and the expert would somehow manage to steer them to the right answer.  Usually this was the faculty teacher, as they were so enthralled with the process.  Students moved from sleeping, texting on their phones, coming in late leaving early, to coming early and being actively engaged.

All exams were “on-line” exams and this gave faculty the ability to grade and get the grades back to students 3x earlier that other schools.  The students had a new first line “wet lab” to work in and a trainer who could see every student from some kind of video camera to see that they were comfortable with the equipment with which they worked.

The results of this five year grant were astounding.  KCMCco went from the 4^th Medical School in the country in ranking (that is how many medical schools they were at the time) to the 1^st.  Students are engaged, take on responsibilities, beg to get in, and often their parents try to persuade friends who work at the college to help them be accepted.  The changes are astounding.  The faculty pictured in the previous blog were those granted awards for teaching and mentoring and are only a few of the outstanding faculty who walked through this whole new way of college/medical school learning.  It was definitely rough at first, but the pay off has been amazing.

Another positive about MEPI is that it brought the other awardees together once a year to discuss what they were doing and how it was working.  No one was doing the same thing, each had their own approach to the funding.  Possibly KCMC had been the least developed college so their approach meant using the most creative strategies to raise up the entire school.  It has been fun.  And it has been especially rewarding to see young graduates being retained at KCMC to work on the wards and to be on the pathway to be specialists.

So that is MEPI. After five years there was not an opportunity to renew the grant and thus we closed it out with a big party.  It is important to note that our Provost Kessy believes so strongly in this concept turned into real concrete successes, that he has taken over nearly all of the programs and is paying for them out of the College budget.

I don’t think that there is any reason to explain our house.  It most certainly has been the same for 12 years, with little additions here and there.

The fabulous baby hats refer to several women who knit and knit and knit.  If you have ever visited southern Africa anywhere, you will always see young babies with warm hats on, even when it is boiling hot outside.  It is just something that mothers do…put hats on their babies and wrap them tight.  Our studies involve mothers and mostly infants.  As HIV medicines have largely ended mother to child transmission, we continue to look at other infections for those mothers and babies, how to prevent that, low birth weight, how to prevent it, medication interactions, what is the best medication to prevent transmission, and of course adherence adherence adherence. There are obviously other studies.  Our nurses are dedicated and have been with our study site for years, some since I first started coming to Moshi 12 years ago.  It is illegal to give big compensation for the mothers and babies, but we do provide travel money and for undernourished moms (which are many) a meal.  I thought some time ago that a little gift like a little knit cap would just give a lift to these HIV-infected mothers who are trying to make the best out of a difficult life.  I had seen it work at my old NGO in town, and how happy these mothers are to receive a pretty knit warm hat.  So knitters, THANK YOU!

We have lots of visitors to KCMC, mostly because we are always cogitating on new grants.  We have garnered several that have been successful as team efforts with other schools and even other countries in East Africa.  So, it is important that everyone understand each other’s programs.  Welcome visitors.  A-5 is waiting to greet you.

Finally, the 350th Hash.  The Hash House Harriers are a world wide group that has traditionally gotten together because they love to drink and to run.  Our fearless leader Greg Emmanuel had gone to a number of these, in particular ones in the US when he was living in Maryland.  When he returned, he decided that it would be great to start this group in Moshi.  But ours is different, it is a family Hash, and that means walking and running and it means that the fellowship is as important as the walk/run and definitely the bites and drinks figure in after a long usually hot hike or run.  They are set in different parts of Kilimanjaro, and most in beautiful sites that we have rarely seen before.  There are many stories of daring in these hashes, some really hard ones as we do after all live on the side of a mountain, and others that are just beautiful and relatively gentle.  The hash trail is set with flour and there are always checks to throw you off.  The "hare" sets the trail (a different person each Hash) and provides the drinks.  It has become a huge tradition here in Moshi and all of us are grateful to Greg for his leadership.

I hope this explanation is helpful and supports in some way the pictures I tossed up last night as I really should have been in bed.

As always the mountain stands tall and though with less snow, still magnificent.

Explanations for yesterday's Blog-- MEPI, Hats, Visitors , Hash Lots of "splaining to do

-->

Re-reading yesterday's blog--some explanation necessary

As I read the blog I posted over again, I realized that most of the readership would have no idea what I was talking about, thus I hope I can provide a brief explanation of the previous blog. 

The first part of the blog was referring to the MEPI close-out.  MEPI stands for Medical Education Partnership Initiative.  This was a five year grant awarded to several medical schools, most of which are located in Sub Saharan Africa.  KCMC college was one of the lucky medical schools, the only one in Tanzania to receive the award. Careful planning had gone into the grant, and our grant was the only one looking at shoring up the curriculum and maximizing faculty by building infrastructure, improving internet technology so that every student would have access to fast, reliable internet, bringing in Macbook desktops, the top of the line, and for the first three years giving each student a tablet.

A well recorded success story in Singapore involved maximizing  a small faculty by introducing Team Based Learning or TBL as it came to be known.  Two senior faculty at KCMC were sent to Singapore to watch TBL and to have tutorials in TBL. They were sold on this method of teaching.  Thus, when they returned and Singapore Faculty came with them to have intense instructions with other faculty, these two faculty were the cheerleaders.  The success of TBL was based not just on faculty take up of the system, but of a new Learning Management System, or LMS, which involved faculty loading their lecture plan, reading materials, and back up information on the tablets so that students would be able to easily prepare for classes before hand, and even to move ahead so that they were ready for classes in the future.  The beauty of this system, is that the faculty really only had to be present once/week if that is what they chose.  Most were present much more frequently.  The discussions regarding the particular class were led by a so called expert who helped to divide the students into teams to discuss the on-line questions.  There was lots of discussion and then each group presented their answer.  Opposing answer groups challenged them, they defended their answer and the expert would somehow manage to steer them to the right answer.  Usually this was the faculty teacher, as they were so enthralled with the process.  Students moved from sleeping, texting on their phones, coming in late leaving early, to coming early and being actively engaged.

All exams were “on-line” exams and this gave faculty the ability to grade and get the grades back to students 3x earlier that other schools.  The students had a new first line “wet lab” to work in and a trainer who could see every student from some kind of video camera to see that they were comfortable with the equipment with which they worked.

The results of this five year grant were astounding.  KCMCco went from the 4^th Medical School in the country in ranking (that is how many medical schools they were at the time) to the 1^st.  Students are engaged, take on responsibilities, beg to get in, and often their parents try to persuade friends who work at the college to help them be accepted.  The changes are astounding.  The faculty pictured in the previous blog were those granted awards for teaching and mentoring and are only a few of the outstanding faculty who walked through this whole new way of college/medical school learning.  It was definitely rough at first, but the pay off has been amazing.

Another positive about MEPI is that it brought the other awardees together once a year to discuss what they were doing and how it was working.  No one was doing the same thing, each had their own approach to the funding.  Possibly KCMC had been the least developed college so their approach meant using the most creative strategies to raise up the entire school.  It has been fun.  And it has been especially rewarding to see young graduates being retained at KCMC to work on the wards and to be on the pathway to be specialists.

So that is MEPI.

I don’t think that there is any reason to explain our house.  It most certainly has been the same for 12 years, with little additions here and there.

The fabulous baby hats refer to several women who knit and knit and knit.  If you have ever visited southern Africa anywhere, you will always see young babies with warm hats on, even when it is boiling hot outside.  It is just something that mothers do…put hats on their babies and wrap them tight.  Our studies involve mothers and mostly infants.  As HIV medicines have largely ended mother to child transmission, we continue to look at other infections for those mothers and babies, how to prevent that, low birth weight, how to prevent it, medication interactions, what is the best medication to prevent transmission, and of course adherence adherence adherence. There are obviously other studies.  Our nurses are dedicated and have been with our study site for years, some since I first started coming to Moshi 12 years ago.  It is illegal to give big compensation for the mothers and babies, but we do provide travel money and for undernourished moms (which are many) a meal.  I thought some time ago that a little gift like a little knit cap would just give a lift to these HIV-infected mothers who are trying to make the best out of a difficult life.  I had seen it work at my old NGO in town, and how happy these mothers are to receive a pretty & warm hat.  So knitters, THANK YOU!

We have lots of visitors to KCMC, mostly because we are always cogitating on new grants.  We have garnered several that have been successful as team efforts with other schools and even other countries in East Africa.  So, it is important that everyone understand each other’s programs.  Welcome visitors.  A-5 is waiting to greet you.

Finally, the 350th Hash.  The Hash House Harriers are a world wide group that has traditionally gotten together because they love to drink and to run.  Our fearless leader Greg Emmanuel had gone to a number of these, in particular ones in the US when he was living in Maryland.  When he returned, he decided that it would be great to start this group in Moshi.  But ours is different, it is a family Hash, and that means walking and running and it means that the fellowship is as important as the walk/run.  They are set in different parts of Kilimanjaro, and most in beautiful sites that we have rarely seen before.  There are many stories of daring in these hashes, some really hard ones as we do after all live on the side of a mountain, and others that are just beautiful and relatively gentle.  The hash trail is set with flour and there are always checks to through you off.  The "hare" sets the trail (a different person each Hash) and provides the drinks.  It has become a huge tradition here in Moshi and all of us are grateful to Greg for his leadership.

I hope this explanation is helpful and supports in some way the pictures I tossed up last night as I really should have been in bed.

As always the mountain stands tall and though with less snow, still magnificent.

Graduation Weekend KCMCollege, Moshi Tanzania

Dedication of 3^rd Floor of the College to John, MEPI team party, Night of Inspiration

Plaque Veiled

Plaque unveiled

I could write a long blog here, but instead will mostly post pictures.  Yesterday was a full and amazing day.  My heart is full yet again for the friendships that John and I have developed here in Moshi over the past 10 years (for John 13).  We have a marvelous team in the Collaboration with the leadership of Dr. Blandina, we have the best accountants in Frank, Francis & Vera, and team of researchers and lab research team, students and staff are skilled in handling the Standards of Practice that are required by the National Institutes of Health.  It is not easy to handle dollars converted to Tshillings when the conversion rate changes daily.  It is not easy to provide excellent quality control quality assurance when the research protocols add amendments, require drugs that come in the milligram sizes not available anywhere in this country, lab results when the power surges fry even the best surge protectors, the browser corrupts and looses data for months, the toilets break, the mud is thick, the best vehicles have a hard time getting to the field sites, the babies are born at midnight, and some staff are injured in motor vehicle accidents.  This group laughs hysterically and then puts the hard work of figuring out the way around.  What a blessing.

John with collaboration and MEPI Team

John with Plaque

Black dots are Nairobi Fly

At the presentation, there were so many of these horrible Nairobi Flies that they were falling from the ceiling and like a moving carpet on the floor.  In my sandals, I had to walk on my toes to try to avoid any of them crawling across my feet and wash my sandals when I got home!

The Bishop gives a short word of thanks to John

Ahaz and others in the dedication

The young MEPI gang

Something funny at the end keeps us laughing

Just what is going on?????Sijui (I don't know)

Carol our fab driver takes the MEPI Bus for students to go to the field

Then the MEPI (medical education partnership initiative) team, led by Ahaz Kukulanga the DeputyVice Provost is just amazing. Most are young and energetic.  They grew up in the age of the internet,and that gives them something the rest of us could only dream of. The older folks had to learn after years of hand-writing or if lucky, typing.  Raised during or just after colonialism, they were forced to work harder, prove themselves more, and know what it was to deal with struggles every single day. I am quite sure that thoughts entered their heads of giving up, but they did not.  To see them celebrating again, and to be in some way the focal part of it was really incredible, and humbling. 

A Toast to the MEPI team members who are missing

Because some team members are studying abroad, or busy winning the "best poster award" (AKA Charles) the team toasted them saying "Mitwara" for the best beef sausage around!

Each department in MEPI described John in relation to their speciality

Ahaz notes he bought penny loafers to look like John

The cane award

John and I had a happy day

Our lovely MEPI team

I even got a Kitenga and toast!

 The changes at KCMC College are equally astounding.  It is true that the MEPI NIH grant supplied the cash for much of the infrastructure development, but it was the vision of the Provost Kessy in particular and Professor Shao in the early stages that allowed the dream for the college to become a reality.  Their sometimes brutal honesty is actually a huge relief in a world that often puts roadblocks in place for more transparent people.   

Ha--It is time to start + 30 min.  The platform is not yet built!

As usual timing is everything in Tanzania.  It all started 2.5 hours late!

The MC's were great--even though they broke the steps to the platform

John, Kessy & Shao discussing.  Note Sprite bottle

Dr. Mallya, Blandina and William will debate specialities soon!

Rose and Dean Deo sharing a word

Prof Lavina shares life as she studies in Russia!

Prof Shao shares life as he studies in Cuba

Provost Kessy's Chagga Name "Kazi Ngumu" Work Hard!

 The first speaker Provost Kessy, shared his life as boy in Mamba in a one room hut with 8 brothers and sisters, school barefoot and being caned for nearly everything, but his passion for Math and Medicine.  The second speaker Prof Dr. Msuya spoke of her growing up and her training in Russia where she had to learn the language, and cope with the cold and her passion as one of the first female MD's in Tanzania.  The third, the Honored Guest Professor Shao, spoke of many challenges from boyhood to adult, but each with a message of hope and determination.  "What I learned, What message can you take?"  I am so eager for someone to write a book about the life of Professor Shao.  His experiences are incredible, unique and ground breaking.  Life in Castro's Cuba, life in Uganda, experiences with Apartheid Africa and Steve Biko.  Just incredible.

The medical students and the faculty who spoke at the Night of Inspiration were both hysterical and seriously amazing.  The Rappers, also medical students were creative and funny.  Whether you like rap or not, you would have to be impressed by their ability (even while secretly thinking that their parents are so glad that they finished medicine and have a great career ahead of them). And the MC’s were perfect, playing off each others’ strengths and providing just the right amount of humor.

The MED Boys Dream of the Night of Inspiration

The MED girls describe the first autopsy

 Faculty Prof Mallya, Prof William and Prof Blandina nearly took the house down describing why they deserved the one parachute as their theoretical Indian AirLines plane crashed.  Their ability to think fast is legend, but we were all astounded!

Children will lead tomorow

You have to walk to run (fix the broken bones)

I am the one up here who took care of the Pope

My John gave an equally inspiring talk, using parallels from his parents and us, and as well the love of Global Health and seeing the changes that have occurred despite the challenges.  I agree with Ahaz, that his ability to put the perfect “spin” on something that seems impossible is unique.  And, if he promises something, he will deliver, and if it is bad news, he will give it honestly but kindly.

Ahaz introduces John

The screen for the slides is behind--No slides

 Note that the screen for the slides was made from 4 sheets pinned together and as the wind blew the sheets billowed, the slides disappeared. Not to mention that as the wind blew, the projector reverted to "input A"

John really inspired

So the day of the plaque, and the night of inspiration were an event that even as I become more forgetful, I know will be with me forever.

Coffee plant near picking time

Week Two in Moshi

Brandon Kathleen Neha & ME

How has the week been?  Very very busy.  Week two passed and in what seemed like a whirlwind.  I met with the DGHI students Kathleen and Brandon...Great work completed, and with Neha from Duke Engage.  Being involved with them at some level reminded me of how lucky we are to be at Duke where these young people are so smart, and were able to accomplish amazing work this summer.










Our Dean of the School of Medicine arrived with her family.  We had a fabulous dinner at A-5, thank you Melinda, and the Duke/KCMC collaborative presented their work.  That day was followed by presentations by the MEPI team and a trip to Kibosho Hospital.  Full days all around

Ahaz and the MEPI team

The MEPI Team each showed their talents by discussing how our MEPI--Medical Education Partnership Initiative is geared to maximizing the small faculty with excellent learning.
 

Lucy shared her information from the Duke Program Blue Docs which stresses Team Based Learning.  She does a little of everything.

We discovered  an engineering Duke Engage Student at Kibosho Hospital.  In fact there are two, but one was in Moshi.  These young engineers are repairing equipment that is vital to the ongoing work at the hospital, such as x-ray equipment, surge protectors, and masses of other electric things.  They have apparently been invaluable to the hospital.

Dinner at our dear friends the Emmanuels was enhanced even more by the presence of Greg and the Kimaros.  I always feel that I have been transported in time when we go the house in Machame.  It is relaxing and delightful.

At the table with the Emmanuels.  Delicious food wonderful company with some of the stalwarts of our community.

John walking the walk

We volunteered to set the hash at Kibo Farms.  This is a place that has an incredible coffee farm that covers 100's of acres.  The road has been worked on for over 4 years, and it is still treacherous at times.  We watched buses and motorbikes dodging one another as they did a slalom through the big rocks in the road.  At one point, a near miss made John lean on the horn of our pathetic car.  Only a squawk came out and I could only imagine the driver of the bus laughing all the way to Moshi!

John is scouting where to put the check as we walk between beautiful coffee bushes.  The whole walk was lovely, though were to put the crosses and how to stay out of the begger weeds was another matter again.


There was quite a bit of coffee being picked and we were able to watch the trucks going up and down the paths.  The pickers were happy as they would be paid at the end of the day.

The view at Kibo Farm is terrific.  The day was not particularly clear, and was cold, but I could still see many kilometers and loved the red in the house below the corn fields.  Part of what makes "hashing" fun, is the ability to get out and see areas of the countryside we have not seen before.  Thank you Africa!  (and of course Greg for starting hashing here.

Without giving too much away, suffice it to say that road crossing and water crossing are part of the usual fare with a hash and this one will be no exception.  I love the truck filled with corn stalks and the ladies carrying sticks and branches on their heads. And one of the highlights of this hash in particular is the huge turtle named Tom.  When he saw me with camera held, he woke up and started after his food.  Apparently I stood between him and the food and he was not happy.  All the workers at the farm know Tom and care for him.  He may be one of the oldest turtles in Tanzania.

This is what happens when you set a hash.  We could have been considered one of the road hazards as we were picking these things out of our socks all the way home.  Disgusting.
Dinner at the pastors led to a conversation about Palliative Care, one of my favorite topics.  Turns out that they have been trying to help Mama Pulchra.  I hope it works out!