The wonderful week of MEPI

Kilimanjaro Christian Medical Center with Mount Kilimanjaro in the background

Duke Medical Center, Duke North Hospital

There are some things for which I am eternally grateful, but few can compare with the friendship and collegial relationships that have been built between some of the Duke faculty and staff and the Kilimanjaro Christian Medical Center faculty and staff over many years. One of the things that I love about being in Moshi, Tz, is the ability to walk to and through the hospital and meet friends and colleagues, and greet one another as if we have not met in years. This warmth extends up the ladder to the Executive Director who is always greeted with a "Shikamoo" Professor. (formal greeting for someone either older, or wiser, or in a position of leadership) I hope that when our Tanzanian colleagues come to Duke, they feel the same friendship and warmth.

The MEPI leadership Team and John Bartlett
The most recent exchange has been between the MEPI (Medical Education Partnership Initiative) KCMC senior staff with a big visit to Duke this past week. The trip was long and hard, and the week packed with meetings, lectures, and events. Each person knew that they had specific tasks to be completed by week's end and discussion that would develop into specific plans for both sites to complete to make "MEPI" an excellent program. For me, the week was filled less with hard work, and more joy as I had the opportunity to entertain these truly amazing people, and to follow the events of the week through my husband John, and to finally say "Kwaheri" (Good bye) with them at the all time American Sport, a Durham Bulls Baseball game.

Durham Bulls Game

For the Duke and KCMC team, the work was endless, challenging and hard, but the results at least for the trip, were palpable as a real team feeling extended all around.

Provost Ebgbert Kessy, EDR Moshi Ntabaye, Dean Kien Mteta

Provost Kessy, EDR Ntabaye, Dean Mteta, Head, Community Health Department, Rachel Manongi

EDR Moshi Ntabaye, Dean Kien Mteta, Head of the Community Health Department Rachel Manongi, Director of Clinical Laboratories, Balthazar Nyombi, Director of Information Techonology Phesto Namayala, and Director of the Kilimanjaro Clinical Research Institute Gibson Kibiki

Everyone agreed that our administrator Charles deserved the big "Hongera Sana" and "Asante Sana" (Congratulations and thank you) for coordinating the week and, coordinating eight high ranking guests with different backgrounds, specialties and hopes. A daunting task, to say the least, but Charles managed in his usual graceful, charming and joyful way to make everyone feel at home and to find commonality with all the partners at Duke.

Charles even cooked a goat for the occasion, and over rounds of juice and sodas, the Executive Director (EDR)from KCMC gave a cheer for all that Charles had done.

EDR Moshi Ntabaye gives a cheer for Charles Muriari's hard work.

Deputy Provost for Administration, Ahaz Kulanga seconds the "Hongera"

Provost Ebgbert Kessy enjoys the talk

IT Director Phesto Namayala hardly looks jet lagged!

Community Health Department Head Rachael Monongi
What is amazing to me, is that our thoughtful KCMC EDR came to Duke with the other members of the team, fit right in with the others, each of them leaders in their own right, and got right down with them doing hard work to make this grant work. So, while we ate barbecued goat and beef tenderloin, ate delicious greens, ugali and fruit, the talk was all about personal beliefs, and moving forward: What would be expected, what would be hoped for and what could happen at the end of the grant. These leaders each provided valuable insight into how they believed that things could work at KCMC as compared to other institutions, and other countries, opinions that provided John and I with a new world view.

Despite "jet lag", these leaders met with students all week, met with the leaders at Duke, gave talks worked on plans endlessly, and suddenly the week came to a close.

Group Lunch with Students

EDR Ntabaye engages others around him at Duke luncheon

Provost Kessy at Duke Luncheon

Dean Mteta earnestly making a point

KCRI Director Gibson Kibiki

Clinical Laboratories Director Balthazar Nyombi at Duke Luncheon

Deputy Provost for Admin, Ahaz Kulanga, as always, thoughtfully listens

Charles Muriari, Duke Side MEPI Administrator, Gibson Kibiki, Kilimanjaro Clinical Research Institute (KCRI) Director, and IT Director Phesto Namayala

MEPI team at Duke Luncheon
At the end of the day, the one passion was clear: KCMC would be a better place because the medical students would be more motivated, involved, and prepared to begin a life in medicine, or surgery, or dermatology, or women's health, or public health, or community health, but as a medical provider.

John Bartlett entertaining MEPI Leadership
Of course, much of the praise for the week has to be given to John for his inspiration and his respect for his colleagues. I have often said that I never see him as happy as I do when he is in Tanzania with his Tanzanian colleagues. Definitely, he misses his patients at Duke, but the joy that he has for these friends, some new and some he has now known for over seven years is not comparable, and that brings joy to me.
And by the way..... we really missed you Oneko!

Olola Oneko, Former Chair of KCMC Obstetrics and Gynecology, Co-PI of AIDS Malignancy Grant

Special Thanks for the pictures of the Duke Luncheon to the Duke Global Health Institute

Back in NC?

Here we are at the Cancer Symposium at KCMC
The Ying and the Yang…..Moshi to Abu Dhabi

I guess it is easy to forget that there is another world beyond Moshi. Or another world beyond North Carolina and especially Durham or Boone. But, I have to say that at least, North Carolina isn’t unlike Kilimanjaro in many ways. Of course NC has big fancy cities with stop lights that work, power that is usually on, stop signs and a fairly effective police force that doesn’t operate on bribes; however, NC also has very rural poor areas where people are so desperate that they believe in faith doctors, local healers and also drive without licenses, car seats, seat belts and helmets. Suddenly, an uncomfortable flight away from Tanzania, we found ourselves in Abu Dhabi soon to be gone to Dubai.

We had some wonderful last days in Moshi. Our visitor stream continued in Moshi
and we had a wonderful time with the first annual Sub-Saharan African Cancer Symposium.

A toast at the end of a hard day one
Perhaps the most poignant moments were from Domminista Kombe, one of the directors of the Dar Es Saalam Ocean Road Cancer Treatment Center. This is currently the only treatment center for cancer in Tanzania. Other sites are doing chemotherapy, but nothing like the amount that is done at Ocean Road. This lady, works day and night….Why? Because her mother had gastric cancer while Domminista was in school, and did well with her surgery, chemo, and radiation treatment. Now because of her mother, she has specialized in cancer treatment, a surprise, and works constantly. There were other special situations. What a great scene as specialists from East Africa talked together without the turf of any American institution. The conversation about multiple issues of cancer….types , help and whatever. It was an inspiring conference.


Day One Cancer Symposium
In addition, we had the “nerds” from Duke who were trying to get the internet cable hooked into the KCMC campus. After an amazing amount of troubles, they felt that they had at least got everything ready. Let’s see. The celebration at the end of the day was Cuban cigars and a cookout with John’s new Weber grill and electric light (suggested by Greg).

Charles, Dan, Bob and the cuban cigars.

Bob and Dan with their fought for limes for gin and tonics

The new Weber grill hauled from Boston, and the fancy lighter
And then there were my “dada’s” at KIWAKKUKI. Each time I leave, a few tears spring up, but we all agreed that the return to Moshi will be practically in the blink of an eye and I will be communicating with them throughout the time that I am in North Carolina. Work is never done there and good work it is as well, so that means that mine will be extensive as well.

Egla Mtechi, the acting coordinator of KIWAKKUKI

The Dadas through thick and thin
Suddenly we are here in Abu Dhabi. My story is that I was seated next to a terrified Kenyan or Tanzanian young woman. She had never flown before, and was clearly going to Abu Dhabi for work. She had plastic bags rather than suitcases, which she didn’t know to stow under the seat. Though we had that treasured seat on the window and she could have moved from the middle, she was terrified and held my arm the entire 6 hours. I showed her how to put on the earphones for “Tangled”…..hummmmm, . And, when we left the plane though we were going to a different city, she clung to me and said, “help me please”. We got her to her gate and said, “ please, good luck”. Hopefully, she will find some Kiswahili speaking folks to speak to on the way but this was going to be a smaller city, and I would feel that she was going into a very bad situation. SAD… Also, just another interesting sidelight, there were lots of coughing people on the plane from Nairobi….. and John actually changed seats because of the coughing person next to him. Apparently, TB is one of those diseases that is very common in laborers. Gulp!!!

Now we are in Abu Dhabi and everything is fancy. We have toured briefly and visited some wonderful sites. One has to switch one’s view from East Africa and the difficulties there, to shiny fabulous places that also needs. Fortunately I am not the person to be dealing with it. What an interesting experience….

Skyline of Abu Dhabi

The Grand Mosque

There was a heritage village and an old familiar camel who posed for pictures. All I could think of was Chrissy and Katrina on the camel to the tomb of the Aga Khan. Ha.!

John still wants his Zanzibar Door
Stevie Wonder was just in Abu Dhabi and not only that, but he apparently was near our hotel so much that people who live here came to this very hotel to stay so that they could go to the concert and not have to drive back. Apparently Eric Clapton came too. There was also a place where you could go to rent a Ferrari and drive it and where they have Formula 1 races. I know Greg and Nicoli would love it. It was right next to our hotel, and you could hear the Ferrari's racing around the track.


We learned a lot in visiting the various sites here. One thing is that we learned that though there are many hospitals, only a small percent of the medical staff are actually citizens of the UAE. Most are expatriates. The leaders would very much like to find a program that would encourage the UAE citizens to become involved in medicine and empower them to be the leaders. In addition, we learned that all persons including expatriates (including the working force—Pakistanis, Philippines persons, Africans etc) have health insurance under the country laws. The oil certainly helps, but if they can do it and find that it is cost effective, why can we in the US not figure this out.

So, it has been a very interesting time. Yet another adventure.

Moshi Only 5 more days

njuci on wall of KIWAKKUKI

One of the cooks for good friends, has started her own business. Mama Betty makes the best "watu" (food for the people) food I have ever had, and on top of it, she is nice and dedicated to her children and the lives of others.

As with all things related to time, there is suddenly not enough of it left to accomplish the things that need to be done, and to say goodbye once again to Moshi and Tanzania.

This trip has been incredibly hectic. John has had to come and go from Moshi, most recently the crazy trip to Boston in the freezing snow and then to South Africa with pretty much heat. His return brings just six days before we start an incredibly complicated return to the United States, Abu Dhabi and Dubai being stops along the way.

We have had visitors after visitors coming to help with the start of "MEPI". The real truths of living in Tanzania have been offered up. (no power, poor water pressure--though we have not run out, dust beyond belief, our rooster waging crowing contests with the neighboring rooster at all hours of the day, bumpy roads.......name it!)

Ed and Colleen on their departure night with no power
Oneko (our great OB/GYN MD, Ed, Guido and John at Mkulima, our favorite bar)

The time here however has been pretty wonderful. Even the “This is Tanzania” adventures, now that most are behind me, have been stories, and a good story is worth a whole lot in this world. Perhaps my favorites have been the attempts to “boot” my car, the latest of which was last weekend when I had the engine running and was in it waiting for 30 seconds while the “cushion fundis” loaded previously purchased lovely green, boiling hot velour cushions into the car. I am not one to completely lose my temper, but on this occasion, I went completely kichaa and just screamed at them. Because everyone on the street knew me as well, they and I “persuaded” them to remove the boot and with no bribe!

We’ve had the hashes that John has set, and the lovely hash that Adrian set.

Entrance to John and Dana's hash in Kilema

after the hash with bites and beer

walkers during Adrian and Ruth's hash at the KIBO Coffee Estate
We’ve had the Kilimanjaro marathon, and my great friends sharing the experiences.
Marathon down main road
Back of Rick and in distance, Adrian and Ruth with their dog watching the marathon
Family shot with Terrie and Maracella at marathon
Simon Mtui, the "gentle giant" world famous for marathons
We’ve had a dada’s (sister’s) where my friend Lydia had her birthday celebration with an accordion player who could only play two chords played and played in the rhythm of Happy Birthday. We didn’t know how to tell him to stop, so it was a bit noisy and strange, but …. Oh well.

I discovered a small palliative care unit in a small ward of Moshi, where the Clinical Officer (sort of doctor) has a very clean little house all set up with oxygen, locked cabinet, staff, and dedicated persons ready to take care of the dying. They just need to get some permission for pain medications and certification from the Tanzanian Palliative Care Association. I believe that by the time I return, they will have it.
nice courtyard
doctor and assistants, beds

Oxygen Concentrator at First Health (They have two huge back up oxygen tanks for times of power failure)

I’ve been up to my ears in work at KIWAKKUKI, and I can say that I have edited 4 reports, two project proposals, and one master’s assignment.
KIWAKKUKI Volunteers and World Food
Some I must say have been of better quality than others, but again, that is the nature of things. I have one to go. I have become closer to most of the staff, and the ease of our relationships at KIWAKKUKI is really great.

Verynice, me and Jacinta who are sponsored by our great friends Phil and Marilyn Best
We even celebrated “nane tatu” day (9th day 3rd month) International Women’s day.
(Women's Day)
Chair of KIWAKKUKI Immaculate, and my sister Lui at International Women's Day

Some children sponsored by KIWAKKUKI and Bernard vanLeer Foundation
I’ve attended two Community Advisory Board meetings for our Clinical Trials Unit, and WOW! This Board is just astonishing. They are so devoted, volunteer for things, and attend with zeal. New representatives were chosen, and a new vice-chair. With each nomination, each of them had to give a speech about what they hoped to accomplish in their position, and they were absolutely grilled about their reasons for wanting to run. I was stunned. We now have a facebook page, and will be working on a blog together.

Agnes, our new GCAB rep at her organization's new building, Pamoja Tunaweza

Agnes Urassa and CAB

Dr. Elizabeth and CAB chair John Mwita (two great people)
I have visited one Duke Engage project that is set, and four potential others, two of which are located in lovely but very rural areas. And, I have almost finished the reports for them (gulp).
little boy pulling water up hill in Shimbwe
I really did come on this trip
Vera and Mama Nancy in Mwika
The whole Kilimanjaro from Mwika
Pamoja Tunaweza Celebration

I even attended Ash Wednesday services at our little Anglican Church here, St. Margaret’s. Currently, we have a fantastic pastor. He makes those of us heathen’s really think about things, and I for one hope that there is some way found to keep him on for a longer period of time. He and his wife are dynamite.

Our Priest Adrian and wife Ruth's lovely spaniel. Not that the dog is what makes them so wonderful!

Our Duke project staff meetings simply cannot be described. As JC, the perfect straight man, runs these meetings and all of the “This is Tanzania” issues come out, one or two of us are barely able to keep from completely losing it. My favorite issue that is now solved to some degree of acceptability is the way that the air conditioner in labor and delivery had to be tilted for the water to drain out of the window and outside rather than inside onto the ward. And, connected to this solution is how a cable will be run from one electrical area up to the labor and delivery ward with a type of thermostat on it to measure the high and low temperatures in the ward. Apparently, the cable that was made available is long enough, in fact as John said, long enough to pass all the way from the hospital to the Indian Restaurant, El Rancho. There have been equally interesting things. Our pharmacist, the ever creative and bright Salamon, apparently has a sister with some “second sight” and she is able to predict quite a few of things and do it very effectively. Generally, an ending for each meeting is, “Salamon, has your sister given us any information that we ought to know about?” He dramatically pulls out his cell phone. I find the collegial nature of this group quite wonderful, and will miss it when I leave.

For my daughter, this is a picture of a leech and maggot breeding area for dermatology. They are looking a terrible wound debridement problems and are embarking on leeches and maggots as last resorts when antibiotics and traditional debreidement does not work


My little Faraja has grown so big as well. She is the friendliest baby with a grin that just lights up the world. Cipa and Omari have done a wonderful job making this little girl a terrifically social baby, and one that all the “Mzungus” who come to the shop admire tremendously.

The big news is that the hole in our roof is finally getting repaired today and it is Saturday. I cannot even imagine that the “fundi’s” would come on Saturday, but they did and the roof looks much better.

Hole in Roof Day two. Each day more and more of this nasty stuff fell on the porch floor. Yea, now all fixed and boring.
Suddenly as the fundis are finishing the roof, a huge rain storm has come and the first hail storm I have ever seen in Moshi comes down all over, bouncing ice balls, just like little marables. Wonders never cease.

So saying goodbye to Moshi again, until the next time is always hard, but I must say that my mind will hold some wonderful memories until we return again. (and maybe I will get to Arusha National Park again the next time. !!!!!!

beautiful lily blooming at our little house after an afternoon rain

Some crazy kind of Tucan Birds who decided to live in our trees for about 2 weeks. Now they have moved on.