Special Sightings while on Safari

Tanzania’s National Parks were teeming with colorful birds and unique wildlife.  From the massive African Elephant to the agile Thomson’s Gazelle and thousands of wildebeests on their annual migration south, there was a lot to see.  In my handy pocket notebook I tried to record down each and every species.  There was a large population of some animals while others were less common to encounter because they are mainly nocturnal, endangered or typically very shy.  We were lucky to see and get a good look at some of these creatures.

The leopard is one of East Africa’s most common cats but very hard to spot as it is nocturnal and spends most of its day sleeping , camouflaged in trees.  While in Lake Manyara National Park we got a glimpse of one jumping out of the tree as it was startled by our sudden noise and burst of excitement.  It had dark orange fur with scattered brown irregular spots and short, muscular legs.  The leopard had killed and dragged a dead warthog high up into a flat topped acacia tree.  It is then out of reach from other predators and can be eaten when the leopard desires.  This showed us that even though the leopard is not usually seen, there are important signs that prove to us that it exists and is truly a wild animal.

The serval is a beautiful, small cat.  With only half of its body above the long grass in the savannah habitat, we watched it slowly make its way towards the calm river.  It had a small head, large ears and light brown fur with random markings of black dots and lines.

While on a short informative walk around Ndutu with an armed ranger named Moses and his son, we had the chance to get very close to family of 5 bat eared foxes.  The parents ran away while the 3 babies peered at us curiously from the safety of their home.  They have a fluffy, grey coat, large rounded ears and a delightful personality.

The African wildcat is mainly nocturnal and a distant ancestor of today’s domesticated cat.  It has light brown fur and light green eyes.  We were lucky to get a good look at it before it quickly leapt across the plains and into it’s cosy den.

We were all very keen to see a Topi.  A Topi is a large antelope with short, glossy patches of dark, chestnut brown fur and bluish black on his upper hind legs resembling knickers.  The horns are heavily ringed and curve backwards at the tip.  While in the Serengeti, amongst a harem of impala a solitary Topi stood up and came out of the crowd.  It seemed to be posing for us and enjoyed the attention.

Near our campsite, a Steinbok (rock goat), laid peacefully in the shade.  It had a slender body with a reddish coat and big triangular ears.

One of our favourite sightings was the stocky Honey Badger.  It had a long body, short, sturdy legs and a skinny tail.  The top part of its body had a grey fur and the underside was black.  It was fun to watch it scurry across the plains, stopping to dig for snakes and look for small  rodents.

The birds we spotted throughout the National Parks were spectacular!  Ranging from the gigantic Maribou Stork to the neon, lime green Fischer’s Lovebird, we were always on the lookout for interesting birds.  The elegant Crowned Crane strolled across the open plains as the Grey Headed Kingfisher chewed furiously on a squishy caterpillar.  We listened to 2 White Browed Coucals sing in unison and watched the bright orange African Hoopoe hide in a nearby bush.  The colourful Lilacbreasted Roller was perched on a dead tree as the cheery Little Bee-eater hovered overhead.

We had an amazing experience while on safari and learned lots about the different animals and their behavioral characteristics.   It was neat to see so many unique species in their natural habitats.

A Tour of ORs in the Machame Area

Visiting other hospitals while here in Tanzania has been very worthwhile.   We thought it was important to know how anesthesia was being given elsewhere if we were to make some suggestions for the anesthetists in Machame to consider.

While in Nkoaranga, where the Underhills spent time working last fall, we paid a visit to the hospital and met Paulina the nurse anesthetist there.  She was able to show me around the operating theatre and explain what services she could provide.  They had received an anesthetic machine from Milwaukee Wisconsin, where Nkoranga’s sister Lutheran parish is located, earlier in the year.   They were unable to use it yet however, as it was in need of some parts and repairs.  She was hopeful that would be possible this December when a health care team was scheduled to visit.  She had questions about spinal anesthesia that she uses frequently as well as ketamine (an analgesic / hallucinogenic drug that is the workhorse of much of the developing world) and it was interesting to meet her.

Arusha Lutheran Medical Center is a beautiful new facility where I spent a day with Dr. Nnko.  He was raised and lives in Nkoaranga but was working as the only anesthesiologist in the larger hospital about 30 minutes away.  He directed a team of nurse anesthetists and together they covered 5 operating rooms.  A variety of cases were being done the day I went including a laparoscopic gallbladder resection.  The anesthesia equipment there was much better than I had seen elsewhere but they still were challenged by a limited supply of medications and some monitors that were not working and might not be for some time.  An intubating camera known as a Glidescope had recently been obtained however and some of the hospital’s physicians had recently received training in the use of portable ultrasound.  This is commonly used back home now but was another sign that ALMC is trying to obtain and utilize the latest technology in Tanzania.  They had also put into use a Surgical Safety Checklist (which included a preoperative prayer) as recommended by the WHO and they had a small recovery area, both signs of good organization.

Kilimanjaro Christian Medical Centre (KCMC) in Moshi is the largest hospital in the region and serves over 10 million people.  It is a teaching hospital that was built in 1971 and is now overseen by a branch of the Lutheran Church.  It has 450 beds but typically around 800 patients. In October I attended a one-day seminar on acute abdominal conditions at the invitation of Dr. Tan, a general surgeon who also did some work in Machame.  This was attended by physicians and medical officers from across Tanzania and was very worthwhile.  Subsequently I was able to spend a day in the operating theatres.

When I arrived, the power was out, and it was a challenge to negotiate the change room.  I met Josef the lead nurse anesthetist who kindly introduced me to people and explained the OR setup.  He was overseeing a large number of nurse anesthetists who were completing the 1-year training program at KCMC, including Thandiwe from Swaziland, who was thrilled to meet someone else who could only speak limited swahili.  Options for training are limited in Africa and we have met people here doing so from across the continent.  A variety of procedures were taking place and it was interesting to go from room to room and observe.  The equipment available was quite variable from older manual ventilation only machines to a brand new German donated electronic gas machine.  This more complicated device was plagued by the issue that it relied on electricity and a reliable supply of piped gases (oxygen and air), both of which weren’t reliable.  As a result, one of the alarms was constantly going off and the machine would
fail when the oxygen tank ran dry.  Mwemezi Kaino, a second year anesthesia resident was giving an anesthetic for the removal on a huge goitre (enlarge thyroid gland) and having some challenges with this new machine as well as a partially blocked tracheal tube and I felt useful helping him trouble shoot these.  Dr. Hellar, the chief and only anesthesiologist in the hospital, was occupied with an infant having a cleft lip repair in the next room who was providing some difficulties for the nurse anesthetists.  I also spoke with John Namung’ang’a, an anesthetist from Mumias in western Kenya.  He was at KCMC completing a fellowship in critical care for which he had received financial support from an aid agency in the Netherlands.  He showed me around the ICU and we discussed how piecing together donated equipment made for use in another setting, used equipment that was missing parts or not wanted anymore somewhere else and old equipment that was often unreliable was the norm in Africa.  John impressed me as someone who was very resourceful and able to accomplish a great deal when given the opportunity to do so.

These visits provided the chance to meet and talk to some very knowledgeable and motivated Africans and helped put in perspective how the anesthesia services in Machame compared to those elsewhere in northern Tanzania.  They also offered some ideas to suggest Machame consider for the future.

Mbuzi Update

Our goat Mbuzi is one of a kind.  While other goats behave properly on a rope eating grass, he sits on the porch and patiently waits for a chance to sneak inside our house.  When he gets in we quickly find a soccer ball and scare him out by bouncing the ball.

While in the Serengeti, Mbuzi escaped from his pen for a day.  Some of the children that come to play with us and eat the peaches accidentally left the side gate open.  He escaped into our neighbour Marcel’s yard.  He was later found and returned to his pen.  I am thankful he is safe because Christmas is coming and goats make a tasty meal.

He loves eating peaches from our shady peach tree that are full of squiggly, transparent worms.  He chews on the sweet, juicy fruit and then spits out the hard pit.  Mbuzi also jumps up on his hind legs so he can eat the fresh, oval leaves off the tree.  In a large plastic bowl we give him maize from the local market and cold water to drink.  On our back porch he looks for dried banana peels that are lying around.

He jumps up onto the rusty, tin roof of his pen and makes a big racket.  Once I woke up to see him looking curiously into our bedroom window!  Sometimes Mbuzi licks the screen on our front door and tries to eat our clothes and books.  He poos and pees on the porch which makes Dad angry.  To train him, we push him off the porch or hit him gently with a stick.  He can be a nuisance sometimes but he is a cute, friendly goat that I love very much.

When we  return to Canada, he will be a Christmas gift to Mr. Nkya.  We will walk him 7km down the mountain to Mr. Nkya’s shamba (farm).  I am sad to see him go but know he will have a good home with Mr. Nkya and his 3 other goats.  Mbuzi is a unique African goat that I will never forget.

Ugali

Boiled, finely ground corn, known as ugali is the staple food for most Tanzanians.  The majority of the people have a small plot of corn growing on their shamba (farm) which they eventually use to feed their families.

Twice a year the corn is harvested after drying on the stalk.  The kernels are stored in bags and brought to the mill every couple of weeks.  At the mill, they are ground into unga wa mahindi, a thin, soft flour. The flour is also sold in 1kg sacks at the local Kilali market for 1,300 Tsh. (85¢).  Ugali is a relatively inexpensive meal, easy to make and very filling.  It is served in all Tanznaian restaurants in the shape of a bowl with some sauce for flavour.  We’ve enjoyed eating this traditional dish for dinner and learning how to make it with Mr. Nkya.

Ugali recipe:  First, pour 1.5 L of cold water into a large pot.  Add 2 cups of unga wa mahindi and heat on high – stir frequently.  After a couple of minutes cooking, take 1 cup of the liquid out of the pot for later use.  Continue to boil slowly.  Add teaspoons of unga to the pot until the mixture is very thick.  Then, turn the temperature down to low.  Next, pour the cup of liquid you took out earlier back in.  Stir the ugali until it becomes difficult to stir and you can flip the pot upside down without anything spilling out.  When finished, mould the ugali into a rounded shape like Mount Kilimanjaro and serve on a plate with sauce or beans. You can cut it into pieces like a cake.

Though a little bit bland in taste, ugali is a healthy dish.  Learning how to make ugali has given us a special taste of a typical Tanzanian meal, that is eaten daily and enjoyed by the local people.

Shule Kushureye – English Medium School

On weekday mornings we went to the English Medium School about 200 meters up the dirt road near our house.  The school is called Kushureye, the same name as the church close by.  The school is taught in english because it gives the students a head start for secondary school which is also taught in english.  It is more expensive than the government school which is taught in swahili.

We walk in and everyone is playing games such as hangman and tic tac toe which we join in.  When the teacher enters the room everyone rushes to their seat and stands up.  They say “Good morning teacher”.  The teacher says “How are you today?” and the students reply together “We are fine thank-you teacher”.   Finally the teacher will say “You may sit”.  This is the routine every morning.

The classroom is clean with a few posters on the wall.  There are no lights but there is lots of light from the large windows at the sides of the room.  There is a blackbord at the front of the room that the teacher writes questions and lessons on.  The desks are wooden with a bench attached to them.  The top surface of the desk lifts up so the students can put their notebooks and pens inside. Heidi and I sat together and shared a desk.

We are in a standard 4 class with 30 other students.  Their uniform is brown with a cotton hat, a white shirt with a sweater overtop, a skirt if you are a girl, and pants if you are a boy.  There are different teachers for different subjects.  Some of the subjects are english, civics, kiswahili and science.  The teacher usually teaches the lesson then assigns work to do.  Sometimes they take a stack of books to the marking room with their mini portible radio.  The students do their work and then they play games or draw which they like to do.

At 10 in the morning the students line up and walk down the road to the residence for a drink of ugali.  It is warm and made from corn flour with some sugar.  They say a prayer before drinking it and return to the school after.

Every Wednesday they have games day.  They are allowed to wear track suits on this day. On games day they do runing races, potatoe sack races, and parachute.  They also like to play soccer.

Many students board across the street from our house in the school’s residence.  This means they sleep and eat there.  In each room there are 4 bunkbeds.  Early in the morning and after school they sing which we could hear from our house.  They also like to call our names when we walk past.  Students as young as 6 come from places far away including Dar es Salaam and Mwanza.   Some live closer and walk or take the daladala home.

All across Tanzania, the standard 4 students have exams in the last week of school.  75 % of the students pass and 25 % have to repeat the year.  The exams have questions from the whole school year.  In late November the school year ends and the students go back home to be with their families for Christmas.  They begin a new school year and hopefully a new  grade too in January.

School in a different country was a neat experience.  I enjoyed going to Kushureye school here in Tanzania but now I appreciate Mountainview school even more.

Geography of Tanzania

Tanzania is located in East Africa.  It is bordered by Kenya, Uganda, Rwanda, Burundi, Democratic Republic of the Congo, Zambia, Malawi and Mozambique.  Zanzibar, Pemba and Mafia are islands off the east coast of Tanzania in the beautiful blue Indian Ocean.  Dodoma is the  capital city and is located in the centre of the country.  Dar es Salaam is on the coast and is the largest city.  Moshi and Arusha are the closest cities to Machame where we are living.  The three main lakes in Tanzania are Lake Victoria in the northwest corner of the country, Lake Tanganyika in the west on the border with the Congo, and Lake Nyassa (Malawi) in southern Tanzania.  Mount Kilimanjaro, Mount Meru and the Ngorongoro Highlands are volcanic mountains in northern Tanzania.  The Rift Valley runs through the centre of the country from Lake Natron in the north to Lake Nyassa in the south.  It was formed by the earth’s crust  separating.  Tanzania is interesting and very different from where we live in Canada.

Sikukuu Uhuru

December 9th, 1961 Tanganyika gained independence from Great Britain and a new country was born.  Today, 50 years later, we journeyed to Arusha, the largest city in Northern Tanzania, to mark this important anniversary.  We had spectacular views of Mount Kilimanjaro and Meru as there was not a single cloud in the bright blue sky.  The Tanzanian climbers taking the Uhuru (Freedom) torch to the summit picked the perfect day.

Some shops were closed for the holiday but otherwise there were no real celebrations.   The market was a busy blur of colours as usual with most people doing the work they do every day.  Students from local schools spent the morning at the Arusha Declaration Museum which we also visited to learn more about Tanzania.  We bought a special edition of the local paper which has interesting stories about Tanzania’s past and future.  Though it was a very important day for the country, for most Tanzanians daily life continued on.

Wagonjwa (Patients) wa Machame

The time we have spent at Machame Hospital has been very interesting and worthwhile.  Most of our experience has been in the orthopedic clinics and the operating rooms and the staff and patients have been very kind.  We have seen how Tanzanians cope with illness and accept what comes their way.  The underlying theme here is ‘Mungu akipenda’ – ‘if God is willing’.

Most of the orthopedic cases are either done for traumatic injuries, infections or growth abnormalities.  Unfortunately the now ubiquitous ‘piki-piki’ or motorbike, a new addition to the roads of Tanzania in the past 3-5 years, contributes more than it’s share.  Roads are narrow and often in bad condition, cars and trucks often don’t give way and alcohol can be a factor like at home.   Falls from trees and severe lacerations from the ‘panga’ (machete) also lead to long stays in hospital and trips to the operating room.  Dr. Lyimo, the orthopedic surgeon here, is very kind and well respected and thus patients are sent from all over northern Tanzania to Machame.  Many wait days or even weeks though before seeking care, with fractures that need operations, hoping they will wake the next day with their pain gone.

The other condition that we rarely see at home which is common here is osteomyelitis or infection of the bone.  This affects young children primarily and is referred to as a ‘disease of poverty’.  Many cases are quite advanced by the time they receive a diagnosis and treatment, some weakening the bone so much that a fracture results from the severe bone destruction.  Children also receive operations due to severe malalignment of the lower limbs secondarily to nutritional problems, prior injury or abnormal development and growth.  Many don’t receive treatment until far later than they would at home.

We have encountered infectious diseases such as anthrax, leprosy and a variety of parasitic worms (hookworm, liver fluke and ecchinoccal cysts) that have all presented opportunities for us to learn that we are lucky to live where water quality and living standards make these conditions rare.

In spite of their illnesses, the people and their caregivers, who must stay at or near the hospital to cook and help care for their sick family members, are always in good spirits and go about their days patiently and with a smile on their faces.  We are always greeted with ‘Karibu’ (welcome) when we enter the rooms.  It has been rewarding to see some of the patients come for their operations and recover enough to go home.  Many who are still in hospital wait for their chance – ‘Mungu akipenda’.

Drafti

In the past week we have been going to the hospital and visiting some of the children who are patients.  We made a checkers game which in Tanzania they call ‘drafti’.  We used cardboard to make the board and bottlecaps for the checkers.  The 3 boys who have been playing the most are Eriki who has an infection in the bone in his leg, Charles who had surgery for crooked legs and Paulo who had a bad snakebite on his hand.  It has been fun to play and the kids really enjoy it too.

Jambiani

Long white sandy beaches, tall skinny coconut palms and thick coral stone homes line the bumpy streets of Jambiani, a cheerful village on Zanzibar’s eastern coast.  We had the pleasure of staying here for four nights and learned lots about the local people’s way of life and their friendly village.

A Stonetown to Jambiani daladala dropped us off near our quaint guesthouse.  We stayed right at the end of the village, which is 5 km long and has about 5000 inhabitants.  Coconut trees swung in the cool wind and kids played in the soft sand next to the spectacular turquoise/blue Indian Ocean.

To get a better idea of how the people live we took a guided walk through the village.  Children were running around barefoot greeting us repeatedly with ‘Jambo’ and the breadman biked by on an upright Chinese bicycle honking his horn.  It was extremely hot  and we focused on walking from shade patch to shade patch.  The homes are built out of coral stone, which was once old coral and has now hardened into rock.  Many homes are unfinished as families are low on money or are looking for more building materials.  Other traditional homes are built out of palm leaves and sticks.  The palm leaves are weaved into tight mats which are used for the walls and fence.  The roofs are thatched and tied down with coconut rope.  Inside the fenced area there is a small inner courtyard with an open space to go to the washroom, a storage hut and another hut for cooking.

The coconut is very important to the people of Jambiani.  The children use the green ones found on the ground as a ball.  It is the men’s responsibility to climb the trees and knock them down.  They use a strong coconut rope to tie their feet together so that they won’t separate during the climb.  Using a technique like an inchworm, they quickly make their way up the tree’s long trunk, which can be over 15m tall!  At the top, they hack the coconuts off the tree using a ‘panga’ (machete).  The hard outer layer (husk) is then removed using a sharp metal pole stuck in the ground.  The husk is put under a pile of coral stone in shallow salt water for 7 months to soften. After collecting and one day of drying, it is put on a log and pounded with a round piece of wood.  This gets the dirt out of the husk’s fibres which women wind into a strong, tight rope.  The leftover brown coconut is cut open with a sharp ‘panga’.  People drink the sweet, tasty milk inside.  The white layer remaining in the coconut is scraped out on a special chair with a blade.  The flaky shavings are used for cooking or eaten raw.  The empty coconut shell is used to make serving spoons and cups.

At low tide, we walked out across the tidal pools towards the sparkling blue Indian Ocean.  Women were working, backs bent over their colorful seaweed plantations.  A kind lady named Ayisha welcomed us to look around her seaweed and taught us a bit about the work.  She had  wooden stakes stuck into the white sand and seaweed tied onto a thick rope between the stakes.  She was expanding her plantation while wearing a long gorgeous flowery dress. My mom squatted down to help.  They pulled little bits of seaweed off full grown plants and tied them to a new rope to re-grow.  After 3 weeks of growing it is harvested, brought back to shore and dried for 3 days.  It is then bundled into large sacks and sold to the government for around 400 Tsh. (25¢) per kilogram.  It takes nine 25 kg bags of wet seaweed to make one 25 kg bag of dry seaweed.  The seaweed is shipped to the Far East and Europe for food flavoring, seasoning and clothing material.  Jambiani’s lagoon was dotted with a rainbow of bright seaweed plantations and women laboriously working on them in the hot sun.

From the beach we could see dhows anchored in the lagoon and sailing in the distance.  A dhow is a wooden boat with a single large canvas sail.  They are the traditional sailing vessel of the Indian Ocean.  For shorter distances, the boats have a narrower hull made out of mango tree and two wooden outriggers on either side. Locally they are used for fishing and excursions to a nearby reef.  One morning we went sailing on a dhow across the gorgeous light blue lagoon to the coral reef.  The colours in the water were stunning.  Part of the reef was above water and fisherman were scattered around the fragile coral looking for octopus.  We were led across the reef by our dhow’s captain Pandu.  A local fisherman showed us an octopus he caught with his spear.  It suctioned its wet, pink tentacles onto my arm and I had to pry it loose.  We also saw some large bright red starfish with round green spikes.  They stood out between the purple spiny sea urchins and the crystal clear waters of the ocean.  We enjoyed snorkeling on the submerged part of the reef.  There were many beautiful species of fish and small eels.  The living coral was very beautiful and full of marine life though unfortunately some had been damaged by boats and people.  The experience showed us the challenge in protecting the environment when people are trying to survive.

We spent an afternoon at Jozani National Park, just outside of Jambiani.  On a guided forest walk we saw the endangered Zanzibar Red Colobus monkey.  A clan of monkeys was perched in a cluster of mature trees.  They have a small, black, round, face, white tufts of hair on their heads and an auburn back.  Their long tails are used for balance and they have four fingers and five toes.  It was fun to watch the Mamas feed the babies, the children play among the thick branches and the fathers howl.  They were very curious creatures and came down from the trees to get a closer look at us.

We enjoyed local cuisine at ‘Karibu Restaurant’ owned by a kind man named Hassan.  He and his wife prepared us spiced rice, ugali, octopus masala, coconut fish and a delicious baobab fruit juice.  He was very friendly and encouraged us to try lots of different Zanzibarian dishes.

Jambiani was an enjoyable place to visit.  We watched the sunrise over the magnificent Indian Ocean, made friends with some local children, played soccer on the sandy beach and learned lots about this fascinating Zanzibar community.