June 10, 2015
By Dr. Cindy Mailloux, Sarah Brozena, Erica Chambers, Kelsey Feinman, and Ariel Velez
Tonight is our last night at Nyakahanga Hospital. We sit and reflect on the global experience we have just been privileged to be a part of. When I think of the Sister of Mercy charisms of service, mercy, justice and hospitality, we have experienced and lived them here in Tanzania. The people of Karagwe have been so welcoming and appreciative of the small things that we have done for them. In reality they have given us so much more. They have taught us that it is not what you have but what you do with it. This hospital is full of life and the people that we have worked with are inspiring.
We think of the children whose education is supported by the efforts of Dr Linda Winkler and Wilkes University who without them life would be much different. These children are given the opportunity to become leaders or to obtain jobs to provide for their families. We admire the efforts taken by many with the Mavuno Project and the Baramba School for Girls whose focus on the empowerment of woman and sustainability is a paramount focus in bringing change to this area. As we leave we thank all of those individuals who gave up time to help us understand health care in Tanzania.
June 10, 2015
By Sarah Brozena
At Wilkes, the various roles and opportunities of a pharmacist are frequently discussed. Pharmacy is advocated as more than the “count, pour, and stick” stereotype. I have found this to be true in the Nyahahanga Hospital in Tanzania. My experience began in “the dispensing room” of the pharmacy. Most dispensing areas in hospitals or retail settings in the United States have hundreds of medications. This pharmacy has significantly less medications and most are antibiotics. All the drugs are stored in an adjacent room with only about ten medications readily accessible by the staff. All medical equipment is ordered in through the pharmacy and distributed once a week. The computer system is new and not frequently used. The inventory is done manually and there are no available patient records. Some of this information is only available if the date of last admission is known. Patients must also pay for their medication in advance at the billing area next to the pharmacy.
One of the most interesting aspects of the pharmacy was the production of IV fluids. I am shown here helping in this process. In the United States, these solutions are specially produced and sold in plastic bags. In this hospital, the IV fluids are made by the pharmacy staff. This includes 5% dextrose in water, normal saline, and Ringer’s lactate. The production area is three separate rooms with small windows connecting them to push the materials through. The IV fluids are sold in glass bottles and returned after each use. The first room is where the bottles are washed, and the second room is a clean room. The chemicals are mixed in large metal buckets and pumped from a metal drum through a filter into the bottles. The bottles are then sealed with rubber stoppers and sanitized in an autoclave. No part of this process is automated; two or three technicians prepare everything by hand. Even the filter cleaner is prepared on site using pure chemicals and a triple beam balance. The pharmacy staff hope to expand their practice to include compounding when adequate resources are available. My experience at the Nyahahanga Hospital shows how pharmacists around the world have varied and sometimes unexpected roles.
June 10, 2015
By Kelsey Feinman
During my time in Tanzania at Nyakahanga DD Hospital, I had the opportunity to see and be a part of the daily activities in both the pediatric ward and the post-operative ward. While in the pediatric ward, the majority of the cases admitted were malaria and pneumonia. Many of the cases brought into the ward are treated symptomatically. Since many diseases have multiple symptoms, many of which overlap, their treatment goals are typically broad. I found the malaria cases to be very intriguing because in the United States malaria is a disease we come into contact with very infrequently. It is so prevalent in the area we worked in, especially since it is malaria season in June. I got to learn about the testing and treatment steps followed for malaria. Another issue that accompanies malaria when it is left untreated for an extended period of time is anemia. When the children diagnosed with malaria, they do a blood test to check the hemoglobin levels. If it is exceedingly low that indicates anemia and the child usually requires a blood transfusion. The blood is collected directly from a family member and transfused after testing to ensure the match and that the anticipated transfusion is free of blood borne diseases.
I can be seen here in this picture with Cecilia Kazaura at the hand sanitation station. She was an excellent mentor during my time in the post-operative ward.
June 10, 2015
By Erica Chambers
Over these past two weeks I’ve had the privilege of volunteering at the care and treatment center at the hospital in Nyakahanga. This center specializes in treatment and counseling services for patients with HIV/AIDS and TB. Like most clinics that specialize in these areas, its mission is to detect and treat early signs of TB. This clinic also provides a lifelong treatment plan for patients living with HIV/AIDS. Their goals are to boost adherence, counsel in family planning, and reduce the stigma associated with HIV. During my visit, my job was to do patient intake. I would measure the patient’s body weight and sometimes height in order to help the nurses to perform the nutritional assessment. I am working on charts with one of the staff nurses in this picture. Over 70 patients come to this clinic on a daily basis, so I was always able to keep busy. I greatly enjoyed my time at the clinic because I was able to learn a lot about various medications for HIV treatment. I will miss my time at the clinic because I made extraordinary connections with the nurses and I was able to practice my Swahili.
June 10, 2015
By Ariel Velez
During my stay at Nyakahanga district hospital, I have been working with the staff at the R.C.H healthy baby clinic. It has been a wonderful experience. At R.C.H, my day usually starts by getting all the vaccinations we anticipate to need for the patients. Once all the vaccines and syringes have been packed, we walk over to the maternity ward. In the maternity ward, we would vaccinate newborns for polio and tuberculosis. While I draw up the injections, Dennis Chilolo (shown in picture with Ariel) and staff would be educating the mothers about the diseases and why it is important to vaccinate the infants. After the education counseling is done, we administer the vaccinations and document the records. Then we would walk to the rest of the wards and administer Tetanus vaccines on patients who had accidents and injuries. I was very surprised by the volume of patients who came in for vaccinations everyday. On some days, some of the staff of R.C.H went to rural villages to vaccinate and weigh babies. I was so happy I had the opportunity to attend. Overall, working with the staff from the R.C.H healthy baby clinic was a rewarding and fulfilling experience.
June 9, 2015
By Dr. Cynthia Mailloux
Today we went to visit the Ntimba family. Dr Winkler became friends with Jonathon Ntimba when he was the accountant for Nyakahanga Hospital in Karagwe. We were delighted to receive an invitation to their family home in a rural village. We arrived and were welcomed into the home with many of Jonathon Ntimba’s family members present. Family is incredibly important in Tanzania. Family members live near each other and maintain many traditions, and ties within the extended family. We met almost all of Jonathon Ntimba’s siblings starting with his eldest brother and the oldest member of the family. This man, Mzee Pastor Ntimba is held in very high regard. He delighted us with a story about bringing a light to a new neighbor to enlighten their stay in rural Africa.
Tanzanians are noted for their hospitality. We were offered water or soda, prayed and sang songs in Swahili. We then were given a tour through the grounds of the family Shamba (gardens) taking in the beautiful landscape, coffee bean plants and banana and papaya trees. We returned to the house and enjoyed tea and coffee with many African delights such as peanuts, goat meat, pineapple, sweet potato and white potato chips. Loyce, Jonathon’s wife had prepared a heart cake symbolizing the love between the two groups. We sang again and exchanged brief words among each other. Loyce then offered each of us a small decorative mat with our name and date of the visit weaved into it. They were beautiful and we were all really touched by this gesture of kindness. Each mat required two days to make. We exchanged good byes and left with a memory of the hospitality that is continuously experienced by us in this wonderful country of Tanzania.
June 6, 2015
We spent Saturday traveling through the countryside and a wildlife preserve area to the Rwandan border. Our main destinations were Baramba Secondary School for Girls and Rusoma Falls along the Rwanda-Tanzania Border. Rusuma Falls marks the point along the Kagera River where the river enters Tanzania. The Kagera River is the ultimate source of the Nile River, winding its way to Lake Victoria between Tanzania and Uganda where it feeds into the headwaters of the Nile. Historically, Rusoma Falls marks the point where the outside world became aware of the genocide in Rwanda in 1994 as bodies floated down out of Rwanda into Tanzania through Rusoma Falls. Wilkes pharmacy student Sarah Brozena can be seen here on the bridge over the falls and the Tanzania-Rwanda border.
Baramba Secondary School is testimony to the incredible value of investing in the education of girls. As in the past, our group was warmly welcomed by Father Bambara, who founded the private boarding school for high school girls and the Head Mistress Irene Matovu. The vision of Father Bambara is shaping the future of this region. East Africa is experiencing both economic and population growth. The young women that we met at the school will be the future leaders of their countries. Equally (or perhaps more) important, in the local cultural tradition, they will be the primary care givers in their households for their children and the next generation. Their education provides a critically important investment in the future. And, as in many parts of East Africa, the past is linked to the future with traditional dance being included in the school activities at Baramba. The secondary school girls here in this picture are doing a demonstration of a dance from nearby Rwanda as part of a program to welcome us.
Our two+ hour trip took us along the edge of Rigiri Wildlife Preserve, providing us a mini-safari at no cost. We spotted monkeys (nyani) over and over on the road ahead of us and shared binoculars to get a better look before they scatted into the grasses as we approached in the vehicle. Then, we were all delighted when our driver spotted a pair of giraffes (twiga) directly along the road. They placidly grazed while we watched and took pictures. I have taken this road several times before but have never spotted giraffes before. We all took it as a sign of positive karma and a safari njema kweli (truly fine trip).
June 3, 2015
by Ariel Velez
Mavuno is a non-governmental organization in the United Republic of Tanzania. This NGO was started about two decades ago by a group of local men who wanted to make a difference in their community. Mavuno’s aim is to provide support to vulnerable and needy families in rural areas of Karagwe and Kyerwa. They do this by working with families in development through a cooperative with the aim of identifying their socioeconomic problems and empowering them to find solutions. Over the years, the Mavuno project has developed a variety of programs to assist the community. These programs include farmer training, farmer enterprise development, bee keeping, rain water harvesting, supplying basic school needs for poor children, the construction of an all girls secondary school, and a microfinance program which provides small amounts of credit for women to meet their needs.
Recently, I had the opportunity to visit the construction sight of Mavuno Girls Secondary School. It was astounding. So far, the campus consisted of several beautiful houses for the teachers, a large storage building, several large classrooms, about eight large water tanks (see photo), and a gas production system using agricultural product decomposition. The houses were built to attract good teachers and their families. Each house includes two bedrooms, a large living room leading into an outdoor space, a kitchen and dining room, pantry and bathroom. The classrooms were spacious and had beautiful mountain views. This secondary school will offer forms one through six. Each form will have a maximum of forty seats, which equates to a total of two hundred forty students. Another great part of the secondary school is the water tanks and gas production system. The water tanks harvest rain water from the roofs, filter it with a flush system, and store it. The gas system uses kitchen waste, manure, and banana leaves to create methane gas, which is then used for cooking.
One of the most attractive features of Mavuno secondary school in my opinion is the big storage building. This building is used to store all the crops of the campus, and sell them by bulk for a better price. Mavuno means outcomes in Swahili. Over the years, this organization has spread from one village to nine. This demonstrates how much the name Mavuno fits the project.
June 2, 2015
By Dr. Cynthia Mailloux
Africa is a place of creativity and recycling of things large and small. In the USA, one can only imagine using a ship cargo container as storage for patient records. In this photo, you can see how archived patient records were stored at Nyakahanaga Hospital in Tanzania. On the clinical unit, files were kept in a brown folder without sections with the possibility of things being lost or misfiled. Labs were attached to pages of notes. Unlike in the US, there was not a binder neatly holding patient information.
However, this District Hospital has moved into the Digital Age and is changing over to an electronic medical record format. Who would have ever thought I would be assisting with the updating of information into the electronic medical record in Tanzania? After an orientation from the IT person (Mr Vivian Iromba) I was off to help the nursing staff enter patients into the new electronic record system. My first job was to help the nurses who were working on the pediatric unit. There was one computer for 40 children. The good thing was that most were already entered. The next day I assisted the ordering of labs and supplies for patients seen in the Diabetes Clinic. Nothing ever goes without a glitch so there was the need to upload new software before we could get started.
As we know United States nurses usually struggle with change and it is no different in Tanzania. Needing to understand the connectivity to all departments and who was doing what was similar to the challenges nurses experienced at our local facilities. The nurses were eager to learn. However, as everywhere, when the technology did not work, there was frustration.
June 2, 2015
By Kelsey Feinman and Linda Winkler
Coffee has become an extremely important cash crop in northwestern Karagwe Tanzania in the last five years. The expansion of the coffee market has led to several new coffee processing plants in the area and interest from international coffee buyers. Prices can range from 30 cents to $1.00 a pound depending on the quality. This is a fraction of what the ultimate coffee beans bring in the developed world, but nevertheless coffee is a very important cash crop here in Tanzania. The income pays for school tuition, telephones, electricity, bicycles, and medical care among other things. Local grass-roots cooperative organizations are working to try to improve coffee quality and yield by exposing local farmers to market use in Europe and the USA.
We were able to visit the Mavono Project run by Mr. Charles. His father and others started his foundation 20 years ago to serve and provide area farmers with the opportunities to better themselves and attend school. One of the lessons he shares with his coop of 350 farming families is quality control. His demonstration method involved a very high tech espresso machine from Europe. Like most rural farmers here, he grows his own coffee beans in his shamba (garden). He then brings them into his office to test out different combinations and methods of brewing to find the best one. This helps in the process of quality control. He allowed our group to sample some of his coffee. It was very good but slightly different than American coffee since it was made with Robusto beans. It was bolder and had a much stronger and more distinct taste, but it was still very delicious.