Mtotos (Babies) in Tanzania

Location: The Maternity Ward of Sekou-toure Government Hospital, Mwanza, Tanzania

As we neared the ward I could already tell that it was the maternity suite by the sea of women with watermelon bellies pacing the outdoor corridor. The bleak exterior masks the hustle and bustle that occurs inside. The building is divided into three areas. To your left is the pre-delivery room. Beds line the wall but most of the space is taken by women squatting on the floor or walking back and forth in an attempt to quell their labor pains. Every so often a nurse walks through the ward and immediately the women lie on the beds as the nurse checks to see how dilated they are. Only when a woman is fully dilated at 10cm is she permitted to waddle to the delivery room. Until that time she walks, squats, and grimaces trying to bear her labor pains in silence. In the delivery room women lie virtually side by side on metal tables. As they enter, they carry kangas, large brightly colored swaths of fabric, with them. One kanga is laid down on the metal table as a mat, the second set aside as a towel for clean up, and the third is used as the only identifying mark for the babies when they are born.

No pain medication, no water, no moral support, only the nurses voice repeating breathe, breathe. Within minutes of lying on the delivery table the baby is out and placed immediately on the mothers stomach. No APGAR score is taken, no suction is performed. Instead the nurse waits for the baby to cry to assure that it is breathing.

The baby is removed from the warmth of their mom's bare belly and the umbilical cord is cut. Carried by one arm, the new baby is weighed on the cold metal scale using the discarded packaging from sterilized gloves as the sanitary protection. The weight and approximate time of birth are noted and the baby is swaddled in the vibrant kanga, their mother brought, and left to fend for itself on the tiled counter-top.

The nurses attention turns back to the mother. She clamps the remains of the umbilical cord and extracts the placenta. Using experienced hands she massages the woman's abdomen to help reduce the flow of blood. The dirty kanga and other waste is placed into a bucket on the floor. The new mother then sits on the same bucket and is instructed to continue massaging her own swollen abdomen to push out any remaining fluid.

It is now 12:05 pm. The baby was delivered at 11:58. Mom is hustled to get up off the bucket, wrap herself in her kanga, pick up her baby and walk out of the delivery suite to post-partum recovery. Efficiency at its maximum.

Still wearing the same pair of once sterile gloves the nurse pours water on the floor and metal table. A mop sized window squeegee, squeaks across the floor, leaving muddy streaks in its path. The table is not even dry before the next woman has launched on top, ready to deliver.

After watching a day full of births I can't help but remain amazed at the strength of the women. With no pain killers or moral support they are off the delivery table minutes after their new baby arrives into the world. The nurses eyes are kind but her words and gestures are matter of fact. She delivers at least 40 babies a day so one woman's pain blends into the next. With no crash cart or resuscitation equipment, I wonder what happens in emergencies. Maternal and infant mortality are still extremely high in this area and after seeing the labor and delivery conditions in the “best” hospital, it is hard to not feel somewhat disheartened at the conditions. The uplifting part is that I can truly see how wonderful the new birthing center that International Health Partners has built will be for the women of this community. It will be revolutionary.

Safari!!!

One week has already passed since we left on our safari, but all the details are still fresh.

Friday, 8:30 AM anxiously awaiting the arrival of our already half an hour late vehicle we begin to wonder if we have crossed the threshold of African Standard Time. Urged to call our agent, Amit reluctantly agrees to drop 300 of his remaining 600 shillings in order to find out the ETA of our driver, Vincent, and cook, Bosco. Minutes later the souped up excursion sized, Landcruiser arrives: massive tires, three rows of paired captain seats, a built in fully powered mini-fridge, electrical outlets that don’t work, and best of all, the type of sunroof that would make a convertible jealous. Stocked with M&Ms, our saving grace, we’re off!

Crossing the gates into the western Serengeti, the landscape quickly changes from rows of Coca-Cola and Sprite faced buildings to endless straw shaded fields. We are all excited by our first sightings of zebras, wildebeests, and gazelles, but soon grow anxious to see the rarer animals. Priyanka’s wish list: 1. baby elephant, 2. male lion, 3. lots of giraffes. The landscapes are incredible. Herds of wildebeests are everywhere as the timing of our safari happens to coincide with their annual migration through the western Serengeti. Interestingly, just like humans trying to escape the heat, they often cluster in groups in the shade of some of the bigger trees that happen to spring from the occasional spot in the otherwise flat plains. Midday, they group directly under the trees, but as the sun looks sideways in the late afternoon, the groups slowly seep out from under the branches in pursuit of the slowly elongating shadows.

Only three hours past the western gate we happen across a water source, and with it a gathering of animals. In dry season, the dwindling number of rivers and streams funnel the herds in. Perfect bait for hungry lions. Just seeing the lions is a gift, but Vincent believes they may be preparing for an attack, so the engine is turned off and we become part of the scene. Female and cub arise from their slumber, ears point, shoulders tense, head lowers. Such a contrast, from our six bobble-heads, looking every which way trying to grasp what she senses. We click away knowing something is amiss, and then she shoots out from under the tree, through the brush and around towards the back of the car. Within seconds her jaws are clenched around the neck of a wildebeest and she is joined by the regal male, all of us had failed to even notice. The site is astounding. Just ten yards away from our vehicle. Male, female, and cub, with dead wildebeest are all that are left of the scattered herds.

We were more than spoiled on our first day, but nonetheless continued to be awed by the beauty of the landscapes. The grandeur of fifty plus elephants controlling their stomping ground and families of giraffes careening their necks to enjoy their balcony view over all the action were only a couple of the memorable sites. And interspersed throughout the weekend, lion spottings never failed to spike the adrenaline. On our last night we even enjoyed a special visit from the neighborhood elephant. Tired from a long day we had gathered at our campsite expecting only a mix of tents, tired safari goers, and a peaceful evening. Instead we found a crowd gathering near the fenced in cooked stations. Word was that one of the older wiser elephants had figured out how humans keep their water year round. Having departed from the toil of finding water in ever changing streams, he had made it a habit to just take a stroll in our campsite over Ngorongoro for a daily sip from the communal reservoir, haha!

By Priyanka and Amit

Habari!!!

Sorry it has taken me absolutely ages to get a blog posted. Between extremely slow and spotty internet and adjusting to a new routine, I just haven’t had a chance. But here goes...

I have been here for just about three weeks and I feel quite at home. Nyakato, where we live, is located about 15 minutes outside of the city of Mwanza. We live in a compound which houses the Nyakato Health Center, the home for the IHP directors, our house (the bungalow), Lucy’s house (where we eat dinner every night), and the start of the IHP hospital. Currently the hospital consists of 3 buildings: the isolation ward, birthing center, and eye center. Ultimately the hospital will have a surgical unit, pediatric unit, women’s ward, men’s ward, x-ray suite, and dental clinic. Until the hospital is built, the Nyakato Health Center only sees outpatients. The clinic operates from 8-5 on Monday to Friday and from 8-12 on Saturdays. There are three wonderful Tanzanian physicians (Dr. Bon, Dr. Msengi, and Dr. Victoria) who see all the patients (on an average day between 80-120). The clinic also has an operating room although currently there is no surgeon so the only procedures are tooth extractions, circumcisions (seen more of those than I ever want too!), lipoma removal, and fixing up various cuts and scrapes. The clinic also has its own pharmacy, run by Fridah, and lab, run by Jimmy, who does everything from blood draws to looking at the slides under the microscope. Everyday I am amazed by the staff at the clinic. They are some of the warmest and kindest people I have ever met.

My daily routine is fairly set by now. I try to get up and run the one mile lap around the compound a couple of times with a few of the other students who are here for the summer. This is one of the first times that I have traveled and been in a place where simply by my looks you can tell that I am a foreigner. All of the kids here are fascinated by us running around the compound and village. More often than not I feel like the Pied Piper because after our first lap we will have a trail of kids running behind us shouting “Mzungu, mzungu” which means white person or foreigner. All of the kids here are absolutely adorable!!!

Breakfast is at Paula’s at 8. I should just pause for a second and tell you about Denny and Paula. They are amazing!!! Denny is a retired pathologist and Paula a nurse. They are the on site directors of International Health Partners. I have never seen a more active and enthusiastic pair. I think Paula adopts every student here as if they were her own children. She is so much fun to be around. A week ago she taught me how to make homemade bread and last night it was biscuits. She and Denny have lived and worked internationally for the past 20 years so they are filled with all kinds of interesting stories.

After breakfast we all split up for the day and either go to work at the clinic, work on our health education presentations, or visit other health sites in Mwanza. Our day wraps up between 4-5. Since the World Cup has started we have been walking into the village most days after work to catch at least one of the games at the only “restaurant” that has a television. Dinner is at 7 at Lucy’s house. She makes the most delicious food. Tanzanian food is similar to Indian food but definitly less spicy. My favorite dishes are the homemade chapatis and samaki (fish) that comes in fresh from Lake Victoria. Post dinner its back to the bungalow to read, play cards, chat, and regroup for the next day.

Aside from work we have had a chance to do a little bit of exploring in Mwanza. Because we live a little far away it takes some planning for us to all go out together. My first weekend we had dinner on Lake Victoria at a place called the Tunsa. We arrived just in time to catch the sunset over the lake! Off for another presentation on STDs. Kwaheri!

PS: Since Amit and I are both here for the summer we thought we would include you on both of our writings. Read more about Nyakato and life in Tanzania at:

http://theguptaman.blogspot.com

Tanzania!!!!

And I'm off. I depart this afternoon for Mwanza, Tanzania where I will spend my summer working as an intern for International Health Partners (IHP), a health care non-profit whose mission is to provide health care services and education to bridge the growing health care gap.

The first 9 weeks of my summer will be spent in Mwanza, working with IHP. During my final week I will travel across the country to Zanzibar. As an undergraduate I worked with Students for Students International (http://s4siunc.org/), a non-profit that works to provide educational opportunities for high achieving students in the developing world. Since 2006, these efforts have been focused exclusively on female education in Zanzibar, given the acute problems these women face in gaining access to higher education. In my last week in Tanzania I am going to meet the current S4Si scholars and work with other current and past S4Si members to put on a health education workshop for the students.

More from Tanzania!

"Pack a blanket and pillow and go, see the world. You will not regret it." - The Namesake

Adios Ecuador!

Just wanted to write a quick post to let everyone know that I am home and that this will be my last update on the Ecuador blog. I still can't believe how quickly time flew by. I finished my semester on May 15th and celebrated the end of my program with fellow classmates and professors that same evening. Bright and early on the 16th I ventured out of Ecuador for the last time. Two wonderful college friends (one who also has a Rotary Ambassadorial Scholarship and the other studying on a Fulbright scholarship) currently reside in Bogota and I figured there was no better time to visit Colombia. Luckily, the visit also coincided with visits from two other friends from the States making us quite the motley crew.

Bogota is an amazing city. Although quite large compared to Quito, I loved the diversity of the different neighborhoods and of course, it is always great to visit a new place with friends who already know the way around. We spent the majority of our week exploring the city of Bogota but also enjoyed a quick trip to Villa de Leyva, a beautiful colonial town where we ventured on a night time horseback ride, hiked to waterfalls, and enjoyed the sleepy nature of the town.

I arrived back to Quito the morning of May 25th for a whirlwind two days filled with packing and goodbyes before heading to the Quito airport for the last time the morning of May 27th. I have been home now for just about a week and I know I am still experiencing reverse culture shock. Leaving is always bittersweet, sad to leave but at the same time, happy to be back home. I have decided to return back to Iowa, at least for the next few years, as I am starting medical school in the fall. Thanks for reading my blog throughout the year and I hope to hear from everyone soon! Hasta pronto!

April!

I can't believe how quickly the month of April has slipped by. Exactly one month from today I return home to Iowa! After living in Ecuador for eight months, my life here seems completely normal and routine.

• I no longer wake up to the gas truck that drives around the neighborhood at 6am honking its horn so people can run out of their houses and flag it down to replace their gas tank
• I know to always wear a variety of layers because the weather changes about 20 degrees on a daily basis
• Whenever I buy something worth more than $5 I try to break a $20 bill because I know that otherwise I won't have change for the bus
• I now have the ability to walk and pretend that I don't hear all of the horrible "piropos" (cat calls) made by every single male I pass (from 12 year olds to 80 year olds....no joke)
• I love walking around the corner from my apartment to the "Almuerzo" restaurant where a full plate of rice, chicken/fish, salad (which consists only of onions and tomatoes), lentils, and juice is only $1.40
• I hear myself using all kinds of "Ecuadoriaisms" when I speak in Spanish...

And these are just a few examples. I really and truly have enjoyed my time here but as it comes to a close, I am excited to return home and start on a new adventure. But before I start down that path, how about a quick recap of what have I been up to for the past month.

April started with two world cup qualifying soccer games where Ecuador played against Brazil and Paraguay. I have to say, they were two of the most frustrating soccer games I have ever watched because Ecuador played so well, but could not seem to score a single goal. Despite the frustration, I still enjoyed immersing myself in the ambiance at the soccer stadium which was full of thousands of bright yellow jerseys and extremely animated fans. Following soccer in Ecuador, I proceeded to watch Carolina win the basketball National Championship (Go Heels!) with a motley crew of gringos and feel extremely nostalgic for Chapel Hill when I walked outside after the game, and there were no fires in the street.

The day after the Championship we started our week and a half long vacation for "Semana Santa" (Holy Week), and I was off to Chile and Argentina. I spent the first part of the trip in Santiago catching up with Shepherd -a current Rotary Scholar in Chile and good friend from Chapel Hill- and Grace - a good friend from Iowa City. Upon arriving in Chile, I felt like I had entered an entirely different world. Everything was so clean and organized. Cars obeyed traffic signals, buses had official stops. It was extremely different from Ecuador. I enjoyed a few days exploring the city with Shep and Grace which included a visit to La Moneda -the presidential palace where Allende was shot- and La Chascona -one of Pablo Neruda's beautiful homes. For the weekend, we met up with Hudson and Amit, who were on the tail-end of their travels, and went to Valpariso, the UNESCO world heritage site known for its fishing culture and brightly painted buildings. I said goodbye to Hudson and Amit after the weekend and took the overnight bus to Mendoza, Argentina. Despite the 1 am wake-up call to go through customs, the journey was uneventful, and I arrived bright and early at my sister's host family's home in Mendoza.

Mendoza is a beautiful city with tree-lined streets, a gorgeous park, and many outdoor cafes and restaurants. My sister Anita had been in Mendoza for about a month before I arrived and she was a lovely tour guide, when not occupied with classes. I spent my days sipping mate in the park with Anita and her host sisters, taking a "Bike and Wine" tour with fellow Carolina students who are studying abroad in Mendoza, and enjoying the company of Anita's wonderful host family. After having Anita visit me in Ecuador, it was great to have the chance to visit her and see what her life in Mendoza is like.

After a week and a half of vacation, I am back in Quito once again. Sadly my arrival was met with the realization that I have two weeks of class left, and many final projects and exams to complete. My semester officialy ends on May 15th and there is much to do, so I must be off! I hope to write again soon!!!

From Quilotoa to Machu Picchu

As promised, I am attempting to update my blog more often this semester. After an amazing trip to the Galapagos, I returned to Quito to a very interesting set of midterm exams. Although I am at what is supposed to be the one of the best universities in Ecuador, I am still amazed at the difference in the quality of education. My classmates, who are extremely intelligent, and are all already involved in the professional sphere ( as doctors, lawyers, sociologists) cheat on exams and copy/paste entire paragraphs of text from articles into their papers without citing the original article. I think a lot of them spent their high school and college years learning my rote memorization and the masters program is structured really differently. It just makes me so thankful for the great educational system we have in the States.

Aside from more educational realizations, I also enjoyed one of my favorite weekends since I have arrived in Ecuador. For Carnaval, instead of enjoying parties on the beach, I spent the first part of my weekend in a small community about 2 hours from Quito called Langulo with my public health classmates. We went as part of a group of doctors who gave free medical exams while we provided a variety of public health interventions. My specific group was in charge of teaching children about hygiene. Each child made a sock puppet and then we taught them how to take care of their puppet and themselves by brushing their teeth, washing their face, washing their hands, etc. After Langulo I headed directly to Quilotoa to meet up with Amit, Hudson, Angella, and Ingrid. Quilotoa is volcanic crater lake and is known as one of Ecuador's "most staggering sights". It is a bit off the beaten path so it was a great place to get away for the weekend. We spent one day hiking around the rim of the crater and the following day hiking down to the water and back up. We stayed at an amazing little hostel called Cabanas Quilotoa where we recieved a delicious breakfast, dinner, and room to sleep in for $10. The views and company were spectacular! After arriving back in Quito I had about a week and a half of normalcy before my parents and friend from college, Jamie, arrived.

My parents visit was wonderful. I had a great time showing them my favorite parts of the city, enjoying my Mom's delicious Indian food, and listening to my Dad attempt to speak Spanish. Following a week in Ecuador, we headed to Peru to meet up with my little brother Nikilesh, and hike the Inca Trail. While the altitude in Cusco and on the trail proved to be a bit of a challenge, especially for Nikilesh, we enjoyed our 3 day hike (about 30 miles in total) to arrive on the 4th morning at the Sun gate with a spectacular view of Machu Picchu. We hiked in a group of 14 people from the US, Canada, and Japan. Our two guides (Ruben and Hugo) were extremely knowledgeable and encouraging throughout the trek. Ruben, our main guide, had an amazing accent and funny phrases that he loved to repeat in English over and over again. We trekked with the company SAS Travel(http://www.sastravelperu.com/) and I highly recommend them.
The food was delicious with hot tea every morning in our tents, garlic bread to snack on when we arrived at our campsite, and an amazing variety of veg and non-veg options at every meal. Despite the fact that we were hiking during the rainy season, it only rained for about 45 minutes throughout the four days. We were all pretty exhausted when we finally arrive at Machu Picchu, but I think that hiking for 3 days and being able to see other Incan ruins and absolutely breathtaking scenery along the way made the arrival even more amazing. For the last two days we were hiking on the actual Inca trail that has been used for hundred of years and has never been refurbished. If you are thinking of making the trip, I think trekking is definitely worth it!!!

Looking down on Machu Picchu with the Rao family

Machu Picchu!!!

The entire group after arriving in Machu Picchu

I arrived back in Quito two days ago and I think I have finally caught up on my missed sleep and lots of school work. Things are going to be quiet around here after having so many visitors but I know there are more adventures to come. Much love!