Safari Day 1 pt 1

Finally, the much anticipated summary of Day 1.

We left around 7am. The first 2 hours consisted of exisiting Mwanza and heading east. The road was paved, and every 15 or 20 minutes or so, we had to slow down for a large speed bump. At these sites were small towns, with shacks extending back from the road, people bartering, and daladalas lining the street. It was early, even for Mwanza, but the roadsides were still densely populated. Many would see us drive by and glare; others would of course yell out Mzungu.

As we moved away from Mzungu, the buildings became much more simple in construction, eventually regressing into mud forms, often with straw based roofs. The dress looked the same, and even in these areas mobile phones were often visible.

We hit the park around 10ish. The gate was littered with small monkeys, playing with each other, jumping on our vehicle etc. After a short break for our driver Moshaka to show the gaurds our approval paperwork, we went into the Serengeti park.

We first saw wildebeasts, far off in the distance. We were quite excited by this, but we did not know they were so common ;)We also saw some gazelles. Baboons were next. And then we saw our first Giraffes. They were far off, but we stopped to watch. Little did we know that before we knew it, they would be standing 5 ft from our car.

We stopped by a small waterpool to watch some crocodiles and hippos. Then Moshaka announced we would be eating here, and we drove around to the other side of the pond, with just a thin line of trees separating us from the crocodile pool. We pulled over, still in awe of the vastness of the Serengeti, and the number of animals we had seen, and ate lunch.

To Be continued....

Tourista!

So, as I am sure many of you are aware at this point, I have fallen behind on my declared goals of posting about my safari this week. I unfortunately am recovering from a wicked bout of Tourista, otherwise known as Traveler's Diarrhea. It started on Tuesday night, and left me incapacitated most of Wednesday. After much immodium without success, I finally broke open the seal on my emergency Norflox, and today am feeling a bit better. Finally ate some food (first meal in > 24 hours) this afternoon and so far, so good.

So I apologize for not being able to write more about my travels over the past weekend. I should be able to post more pictures this afternoon, however, and then tomorrow post about Day 1 of safari.

Sorry again for the delay. Also want to start writing about some of my other experiences here and post them as I prepare to leave; if there are any topics or questions you have, please post now as I will def. answer them.

Safari Survivor

Habari asa bui! (Good Morning!)

Just returned from Safari late last night. Sorry there has not been post, but electricity was scarce on the Serengeti and in Ngorongoro crater ;) It was an amazing experience, I have never seen anything so vast in my life, except perhaps for the Grand Canyon. Seeing so many animals in their wild habitat was breathtaking.

So you probably want details. And details you shall have! But patience will be required, as the internet here is quite polepole (slow) today.

I figure the dissemination of information should have something of a time-table, to satisfy my type-A personality. Plus things got unexpectedly busier in the hospital making it difficult to post

So, it will go something like this:
-Hopefully later today Ill post about day 1
-then tomorrow or the next day ill write about day 2
-then hopefully by saturday Ill have posted day 3

In addition, I plan on throwing up 10 pictures or so per day. I took over 200, some suck, many are good, and none of them capture the actual scope! I also took about 20 smallish movies, and flickr now supports streaming video; I don't think I'll be able to post them until I am in Dar Es Salaam on Tuesday (after a few days of sun in Zanzibar, where I figure internets will be slow)

Safi Sana! (very good)

Kwaele (Good bye)

T.I.A.

Not to be lame and quote a Leonardo DiCaprio movie, but knowing the phrase "This is Africa" actually has some utility here. It helps to set the mood, to generate a basic ruleset for all sorts of interactions and operations here. Most things here, inside and outside of Bugando Medical Center, happen at a speed that can be a bit numbing for an east-coaster such as myself, and many of my colleagues here. Time slows down. Things that should happen tomorrow take four more days (laundry instantly springs to mind, as I just finished counting the remaining pairs of boxers I have, hoping that I will have enough pairs to get me through the safari this coming weekend). The exact reasons for this are unclear. Perhaps it is the synergy of the oppressive daytime heat, the often-lacking infrastructure, and an intentional slower pace.

Regardless, knowing the phrase TIA to help us mzungus cope in times of stress has proven vital, as we try to re-arrange flights, check luggage, book hotels, etc.

--

On to more personal news: I am still waiting for more information to trickle in about the drama back home at Cornell Medicine. It sounds very serious, however. I don't know how much I am allowed to talk about yet, and as soon as I get word that it has become public knowledge, I'll be sure to discuss my feelings on the issue.

Safari in the Serengeti and Ngorongoro are this weekend. We are spending 3 days, 2 nights. the travel will be by a HUMVEE-looking jeep that seats up to 8. At night we will be staying at two lodges. The first night will be at Seronera Lodge and the second night will apparently be at Crater Lodge. Looking forward to it.

Finally, as I approach the last 1.5 weeks of my time here, I am trying to figure out how to plan out my trip to Zanzibar at the end. I think I will end up flying into Dar Es Salaam on March 22nd, try to check my luggage at the Kempinski hotel, then catch a ferry out to zanzibar during the day there. I figure from there I will try to spend one to two nights, likely in Stone Town, then head back to Dar on Tuesday, March 24th. Wednesday March 25h, I begin my trek home from Dar to Dubai.

Time flies, even if this is Africa.

Trouble back home.

There is major badness brewing back at my home residency program that i just got wind of. Don't know how much I am allowed to talk about. Will write more later.

A Day in Mwanza

I've received a few messages asking what my day to day existence is like here inn Mwanza, so I thought it might be useful to talk about my schedule at the Bugando Medical Center.

My day starts around 6:30 am when I wake up. I'll usually lay there for a bit (it's only over the past 4 or 5 days that I've finally started to sleep ok here) before getting out of bed and showering. I usually eat at house next door. Breakfast is on our own to prepare, so I usually will make some toast and throw some peanut butter and jelly on it. Around 7:45 we walk into work.

Morning report starts at 8 AM. It is on the 7th floor of the hospital (the ground floor is the 3rd floor). It usually consists of the interns and residents on call from the night before presenting any of their admissions. The amount of discussion on these admissions is highly variable, determined by the number of attending (supervising) doctors presents. Sometimes there is a presentation on a topic after this. Morning report ends at about 9 AM.

The visiting Medicine residents then head down to the second floor to round in the ICU. The ICU team here consists of an AMO (AMOs are equivalent to PAs or NPs in the US), Dr. Peck (a member of the faculty here and at Cornell, and the director of our visiting program, a pulmonary fellow who is visiting from Cornell, and 3 medicine residents. It is here in the ICU that the limitations of the facilities and services here si most acutely felt. Intubation is rare, medications available are limited, central venous access is not available. There are two pressors for blood pressure support in the setting of shock, and both the families must pay for in advance. It is a constant struggle for the Bugando residents to do they best they can with these critically ill patients, and they deserve so much credit for accomplishing what they can. ICU rounds typically end by 10:30 or 11 AM.

After that, we head to Major Ward rounds. My ward is back on the 7th floor, so I climb 5 flights of stairs to get back there. The ward team consists of 1 intern, 2 MD5s (senior medical students), a third year Bugando resident, and a visiting medicine resident. We round on a huge number of patients. There are 4-5 large rooms on each floor, each with 8 beds, and we walk from bed to bed, talking to and about patients, examining, performing procedures if emergent. Most of the time the wards are full. At the end of the large rooms, there are usually several smaller private rooms as well, which only have 1-2 patients in them (which is more akin to the layout of most american hospitals these days). Ward rounds last until about 1 PM.

We all head back to the Guest House for lunch at 1pm, and usually stay there until about 2pm. Lunch is prepared, it usually consists of a tomato + cucumber salad, plus some sort of carb. After lunch, we head back around 2pm.

In the afternoon, we primarily teach the medical students. We return to the wards to see if there is anything they need help with. We then usually give a case-based lecture until about 4pm. After that, we usually go back to the wards briefly, then head to the library. There we try our best to use the internet there to check email, work on future lectures, etc. It's often not very effective :/

I'm usually back at the Guest house by 5:30 or so. Several of us usually will go for a run every other day around then, 3-4 miles long. Dinner is at 7pm. Our nights usually consist of working on lectures +/- watching some dvds that people brought on one of our laptops. Occasionally there is a bottle of Kili or Castle or Safari thrown in there.

The weekends are ours for the most part- Saturday mornings us folks from Internal Medicine go to round on the ICU patients for an hour or 2, but then head back. Sundays are off.

I hope this helps to give you an idea of what my daily schedule is!

A night in Mwanza proper- The Stone Club.

This past evening we decided to head in to town with one of the local Bugando medical residents to see some of the local nightlife. Previously we had been to a few places up on Bugando Hill, and to several restaurants, but we had not yet been to any of the local bars or clubs. What a night it turned out to be!

We started at a local Mzungu hangout, the pizza restaurant in town. I had heard their pizza was fantastic, and I was certainly not disappointed! The 6 of us ate 3 12" pies, my personal favorite being the Banana pizza. There was also a very small pepper on one of the other pies I had not seen before, and it had a significant amount of kick to it!

We left there around 9:30pm, and walked across the street to a locals bar called "Rumours". We had been advised to be very careful there, that there were often fights. I guess 9:30 was a bit too early for any of this ruckus, as Rumours was empty. We all had another beer, and supplemented our previous pizza with some Chips (french fries) Masala (indian seasonings and sauces are ubiquitous here). Then we left for the main attraction of the night.

To say the Stone Club was a unique experience would be a significant understatement. We had asked several people in town over the previous two weeks where the best nightclub was in town before last night, and uniformly the answer was Stone Club. What a cultural mash-up. The spot was lit in blacklight throughout, with graffiti as decoration all over the walls. The dance floor was about 1000 sq ft, and empty when we got there around 10:30, but quickly filled. The music started as mostly african, and later transitioned into US R+B and hiphop, with the crowd going nuts and singing along with each song. People dressed in anything from more traditional party dresses to full-on hip-hop garb to the nines, from the flat-brimmed yankees hat to the long t-shirts. We planned to stay until about 12MN before it got too shady, but we decided to stay later because we were having such a blast dancing. we also met some people from the Netherlands and the UK there as well.

We ended up getting home around 3am. I don't think I'll be doing that again, but it was definitely worth it!