Back in Moshi again

Suzanne misses Moshi, and Moshi misses her...and of course Tom. Come back come back!!
After a rather harrowing experience coming to Moshi, we are settled in our little house once again. Because of the one-way price differential, we flew British Airways and learned to our dismay, that the communication between Precision Air and British is virtually non-existent. As a result, despite our best attempts, we were unable to board the Precision flight and had to spend the night in Nairobi. The problem remained unresolved on Saturday when again Precision could not see our new reservation. Without the help of our friend Shafiq at Emslees we would either still be in Nairobi, or have arrived via bus from there. We found once we arrived that this is not an uncommon problem-British and Precision have a failure to communicate, and even when you present them with the electronic ticket or hard copies, they refuse to accept it. What a complete mess!All is forgotten (though not forgiven) when we arrive in Moshi and find that our house is green outside and loaded with flowers and immaculate inside as only Rose can make it. The weekend was on. We headed downtown—argh. Rats (panya) had taken residence in the car, and the urine smell was disgusting. My nose is particularly attuned to such smells, and it was pretty overwhelming. Thank goodness Aleem had odor sticks and one quite alarming lemon one is currently stuck to the front of our car. One unfortunate panya didn’t get out quite quickly enough and we found him partially churned up in the driveway when we returned from shopping. (sorry no picture, too disgusting)
So, here are the salient issues that we are dealing with now:
1. Rose and Pauli are fine. Pauli’s lady friend Lucy is adorable and still here! Anjela is tall, and all of a sudden speaking English…thanks so much Dana and Malavika! Her teachers cannot believe the progress that she has made. Imagine…96’s and 98’s on English tests.
2.The Panya (rats) are back. Sadly, Pauli and Rose say that there are many because it is cold outside and wet—so, Pauli climbed upstairs with the poison because we find that the panya are eating the chicken food as well. The chickens are fine even though the panya have been practically living in our car and their food.
(Pauli taking Panya Poisen Up to the roof this evening.)
3. Speaking of chicken food….my chicken food fundi who was cured from diabetes in Loliondo, now is unable to walk again because of her diabetic neuropathy and her daughter tells me that she is really struggling to control the diabetes and hypertension. We hear of many people who are dying because they gave up their medicines when they went to Loliondo.

4. We have corn! Our sweet corn is a tiny bit past, and as tall as I have ever seen the corn. Remember the tractor? It seems to have given the garden a boost.

5.Avocados are falling 10 a day, limes begging to be picked, lettuce everywhere and delicious.

6. Other plants are happy--like the cactus!

7. It is cold. We are happy to have sweaters and warm blankets at night, but it is easy to forget that we are south of the equator and this is the coldest time of the year here. And it is cold.
8. We have a nearly dead tree hanging over the house. Will we get permission to cut it down? Only time will tell.
9. We have very little power. The biggest problem seems to be the power, umeme. There are now so many power outages that particularly on Tuesday and Friday there will be no power at all. We are contemplating a generator especially for the arrival of the visitors. But, they are so expensive, smelly, and dangerous that we are very nervous about it, and are looking for other alternatives.
10. Our car has many matatas, not the least of which is the brake light and the screeching of them when you brake and come around the curve. Argh It is grim.

9. We have not seen Kilimanjaro yet and are hoping that our pharmacist’s sister who is a seer will be able to wish the mountain out of the clouds by next week.

10. Friends can be screwed in the US and in Moshi. People lie, and the best people believe them!
11. Pauli has completed his masterpiece in the chair--the table is like everyone's so I won't include it, but the chair...great!
Sadly, the cushions seem to be missing!
We did have a good Sunday. Nikoli set the hash along with his dogs and dad Greg went along just to make sure that they didn’t get lost. He set a brutal hash. We all got lost about 10 times. He set so many crosses and then put the new path totally off the path. It was crazy. We went across the river twice and down steep paths, through corn, sunflowers and beans. Nikoli was laughing when we came running back from the wrong direction and totally exhausted. What a day. I cannot tell you how good a beer tastes after that kind of afternoon. What great fun though to catch up with Greg and Terrie, to see Sylvie and Nick, and chat with new people.

Staff meeting brought us around to the issues in Tanzania-Some lab equipment is down, a freezer is on the blink and poor Shanette is just back from leave. But, she worked on the problem even from the states. Great Scott! The staff are working like crazy to get multiple protocols through the long time consuming regulatory process. Hopefully, things will speed up as deadlines have been put all around. We prepared people for our visitors from Global Health and our Duke President who will be coming next week. Stay tuned. Of course they arrive on “Saba Saba” Day which is a National Holiday (7th month 7th day) We hear it isn’t as big a holiday as “Nane Nane” Day (8th month 8th day) but nonetheless people will be taking time off for the day. We have begged our own staff to stick around and hopefully we will have a group there. I did massive shopping and dropped off clothes to Furaja who is just has happy and sweet as she can be. She was very excited about Lyriella’s hand me downs, and tried to eat them with her two brand new bottom teeth.

OU--Mukesh says the car needs about 5 medium jobs. None of them a surprise, but we will tighten our belts....and no Umeme!

,

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.