Archive | November 2011


Kiswahili (Swahili)

  • Key language of communication in East Africa
  • Bantu group from Niger-Congo family
  • Proven to be present in 1st millenium AD
  • Widely spoken but only the 1st language of 4-5 million people with ~45 million using as second language.
  • National language of Kenya & Tanzania, Common in Uganda, Rwanda, Burundi, Zanzibar, Comoros, eastern Congo, southern Ethiopia, southern Somalia, northern Mozambique, northern Zambia & NW Madagascar
  • Heavily influenced by:
  • Arabic (‘coastal’ –> ‘Swahili’)
  • Europeans spread the language inland
  • Persia
  • Portuguese
  • English (baisikeli – basically,  penseli – pencil, kompyuta – computer)
  • Standard Dialect = urban Zanzabar City
  • Used in Kenya & Tanzania during Precolonial times for missionaries & colonial governments to interact with locals, then used in adminstration, which led to it’s official status in the post-colonial period.
  • First written by the colonialists so it is based on a Roman alphabet and spelled exactly as it sounds.


Alphabet / Sound English words with equivalent sound Alphabet
a father a
ay may  
e   ay
ee bee  
i   ee
o   oh
oh role  
oo moon  
b big bee
c   see
ch chilli  
d din dee
dh this  
f fun ayf
g go jee
h hat ay-chee
j jam jay
k kick kay
l loud ayl
m man aym
n no ayn
ng sing  
ny canyon  
p pig pee
r run (more like a d) ar
s so ays
sh ship  
t tin tee
th thing  
u   oo
v van vee
w win dab al yoo
y yes wa ee
z zoo zayd ee


Articles a ___  = ua __ some ___ =  ___ watu   or   watu ___


Am/is/are  =  ni    Am not/is not/are not  =  si


I = Mimi  We = Sisi


Nouns:  person or animal – singular = m-,  plural = wa-

object – singular & plural n- / j- / no prefix


Nouns –> Adjectives:

  • person or animal – singular & pleural = wa ___
  • object – singular = ya,  plural = za.


Doctor = Daktari

Student = Nafunzi


I am a student doctor  Mimi ni wa nafunzi daktari.
We are student doctors Sisi ni wa nafunzi daktari.


Samahani = Excuse Me        (most useful word!)

This has been your (& my) primer in Swahili. I still don’t understand most things said to me but, Thanks for watching.


Apple Pie in Africa

I made apple pie in Africa. Well … it was kind of like apple pie.

See, pie requires shortening or lard to get that flaky pie crust we know and love & as best I tried I couldn’t find it here. Nor could I find ready made crust or even a ‘pie plate or tin’. But TIA, I adapted. Butter pie crust in the bottom of a large casserole dish with fresh apple filling did the trick.  Even better, Brian bought some ice cream (1/2 vanilla, 1/2 chocolate being the best option available) to put on top of the warm pastry.  I’m sure my grandmother would have been shaking her head and possibly even been embarassed at this poor looking attempt at pie but it was still a big success.

Dessert is kind of a foreign concept for Africans.  They don’t really have any desserts and generally they’re food is not sweet. By this I mean they may say something is kind of sweet when they describe it to us and we try it and it’s very bland.  Even their version of the doughnut is just fried flour dough without any sweetness other than the natural sweetness of bread.  So you can imagine when they tried this dessert (which was not even as sweet as it usually is) it made quite the stir.  The first reaction of every African after tasting it was to look at me with complete surprise and say “It’s Sweet!”.

Now everyone wants the recipe and it’s a sensation, especially since there is a second one sitting in the refrigerator to be baked within the next few days.   I’m so glad too, it was quite the experience.  Cooking in Africa has been similar to Medicine in Africa – a exercise in adaptation, ingenuity and patience.

The idea to make apple pie came up as we were playing cards with Phares, the elective Africa coordinator & Godwin, the Arusha Elective Africa Transportation contact person on the day before Thanksgiving.  We were telling them all about the holiday’s history, the story of the Pilgrims and Indians, the food and preparations & the fanfare of Thanksgiving.  It was then suggested that I could and should make some of the Thanksgiving delicacies the next day for everyone to try and celebrate with us.

Unfortunately when we woke up the next morning Brian & I were sick with gastroenteritis.  I tried to fight my way through it and still went to the market down the road and bought the supplies that I would need for at least and apple pie and a vegetable dish as well.  But by the time I got home I was vomiting so badly and spiking fevers with rigors & just over all felt so terribly that despite my best intentions I couldn’t be out of bed for more than 10 minutes at a time over the next 24 hrs or so.  So apple pie didn’t happen until the following Monday afternoon when I set about trying to cobble together the thing as best I could.  Luck would have it that this was Mama Lydia’s birthday! What better way to celebrate a birthday than a special treat of dessert.

Lab Day

Brian & I returned to work at Kaloleni Clinic today, from a glorious safari weekend (if you ignore the intense sickness, which I will).  Finding the clinic pretty deserted of practitioners but ever populated with patients, we made ourselves available to simply pitch in where ever needed.  Brian observed and assisted in the HIV counseling area of the Know Your Status project & I worked in the Lab.

Kaloleni’s lab is a picture of adaptation to resource availability. One lab technician in specific was Brian & my best contact, whom we met on our tour and bonded over the sharing of common interests and language. He is the most knowledgeable lab technician I have ever come across in any country.  While the majority of my day in the lab was spent logging in patients tests and organizing flow I did get to witness & participate in some sample collection, processing & resulting of samples taken from various patients. This gave me a unique opportunity to view the patients chart, interact with them and then see their results on their way to the patient and provider (& the clinical area that I typically participate in).

Here are some of the things I saw:

– Blood Typing. This was done for pregnant women all day & done the “short-cut” way according to the technicians. 3 drops of blood on a slide are mixed with Anti-A, Anti-B & Anti-D (or Rh status), if the blood clumps in that spot then it’s + if not it’s -.  So +, -, + = A+ blood type and so forth.

– Urine Microscopy. Urine is collected by the patient in a glass container then it is placed in a centrifuge and spun down (this makes the heavier elements like cells or bacteria to fall toward the bottom of the sample) then the bottom portion of the sample is viewed under the microscope to provide the result.    This was added to a UA strip test that’s done in the doctor’s office.  Urine cultures can be done from the remainder of the urine not spun down by placing them in petri dishes and incubating.

– Widd’s Test – Test for Salmonella, a common contaminant of water in the area and cause of Typhoid (we were told that we may have suffered from a bout of this bacteria the week before but Cipro to the rescue when I could hold it down …).  This is done by placing drops of blood from a patient onto a piece of paper with anti-typhoid antibodies on it and a reagent that changes color when binding occurs and is compared with a control of binding antibodies.  (You might have to see this one while being explained it to get what I’m saying … polle (sorry))

– Blood Smear.  Looking for parasites like Malaria.

– TB sputum stain.  1st get sputum from presentation to the lab and then from 1st thing in the morning upon waking. Then take the sputum and spread a thin layer on a slide and heat gently with open flame. Then line up slides on a make-shift rack over a sink. Pour Carbon fixant die on each slide and heat. Wait 5 minutes and wash the slides well with straight sulfuric acid & then water. Pour methylene blue over the slides and wait 5 minutes. Wash the slides with water and set to dry.  Make sure you sterilize your tools with phenol.  – TB shows up on microscopy as Red Bars on a blue background.

– Blood glucose testing

and lots of other blood draws that were sent out to other laboratories.

Arusha “Hospital”

Today we started working at the Kaloleni “government hospital”, it’s really a multi-specialty primary-focused outpatient clinic, in Arusha, Tanzania.

We started our orientation in the Family Planning clinic.  Here women learn about birth control and receive preventative gynecological counseling and services. The tables for this years’ services depict a predominant use of condoms and IUDs, then Depo-Provera & OCPs. All of these forms of birth control and counseling are provided for the patients free.

Next was the laboratory. Later today we saw a patient’s urine who was suffering from Schistosomiasis.  I watched the Schistosome on the slide as it attempted to ‘hatch’ from the capsule, according to the technician the organism moves within the capsule as they attempt to hatch. I was very impressed as I’ve never seen a schistosome before and Brian tells me he’s only seen them on fecal smear slides.  Later on Brian saw a Giemsa stained blood smear of a patient suffering from malaria with the smear ‘chock-full’ of parasites.

There was a small triage area, a minor theatre (minor procedural room) & clinics for: Diabetes & Hypertension, dermatology , eye, ante-natal, TB, HIV & a vaccine clinic. Anyone who can not be stabilized at the clinic in <24 hrs is transferred to either the district, regional or local private hospitals.

Patients over 60 & under 5 years of age receive all care, meds and vaccines free of charge as well as anyone’s treatment for pregnancy, Diabetes (oral Rx & DM1 insulin), Hypertension, HIV, TB & generally most chronic diseases, as well as the afore-mentioned family planning. All other treatment must be paid for at the governmental clinics but this covers most of the needs.

The major public health project of the hospital is “Know Your Status”. Funded through the US, this initiative aims to test everyone who recieves care at the hospital for HIV using a rapid reactivity screening test. Screening is free to all patients and done maximally once a year. Patients are allowed to refuse the test and continue to receive care however there seems to be many who are willing to be tested.  This initiative started in August of 2011 and so far to date they have found 25 patients with HIV who were not previously diagnosed.  After screening the patients are counseled about their status privately and anonymously with well trained nurses and an overseeing physician in small offices at the back of the compound. Overall this seems to be a very positive program.  Those patients who have been found positive have had their CD4 count taken and are seen back 2 days after counseling to discuss treatment plans and results.

Unfortunately the places that we can really spend time at in the hospital are limited by language. Tanzanians speak Swahili almost exclusively with only some English speakers amongst them and at far more varied proficiency than in Kenya.  (Kenya secondary schools, middle & high school, require English language & the medical school is in English with some Swahili.) So we’ll be working on our Swahili.

Today I had greetings drilled into me because EVERYONE is SO POLITE and nice. My usual Jambo is not cutting it here.

A: Karibu (Welcome)

M: Asante sana (Thankyou very much) – remember this from the Lion King, rafiki’s little song: “asanti sana, squash ban-ana, wee di wee di, wee di oh ana” – Shh don’t tell anyone but I have to think of that song every time I panic thinking “which one do I say back again?!” and now even when I’m not, lol.

A: Habari (Hello/How are you?)

M: Nzuri, Asante. (I’m Fine Thankyou.)

Today I spent my clinical time in the Eye Clinic.  The Optometrists were very interesting to watch and speak with.  We saw many patients with miopia, some with overlapping allergic conjunctivitis, cataracts & “lazy eye”. One of our patients was a ~17 year old African male, acutely post-blunt trauma to the eye resulting in prolapsed iris & both prolapse & subluxation of the lens (in otherwords the colored portion of his eye appeared to be bulging out of the white globe of the eye and the black center of the colored portion was misshapen and showing the lens to be displaced from it’s typical position). Don’t worry though – he was not in a lot of pain unless you uncovered the eye and shown light into the pupil, which causes it to constrict and … well HURT! He was immediately referred to a local eye hospital where an opthamologist could perform pretty urgent surgery to replace the lens and reduce the overall pressure within the eye.

Because my sneakers are still damp from pushing the van through the creek in Masai Mara the other day I wore my Vibram Five-Finger shoes to work today (I think it’s better than wearing flip flops which was the alternative). But what a stir I caused. EVERYONE was looking at my feet and commenting on my shoes (a similar stir was seen in Kenya but many more people seemed to notice here).  Perhaps I should buy stock in Vibram or they should think about establishing stores in Africa as I’m sure they would be VERY popular very quickly, if only they weren’t so expensive. I wish I could get away with wearing them to the hospital or with my uniform in the US – I’d be so so comfy. 🙂

Kwa heri (Bye)

  • Mchele/Mishel (uncooked rice – or the way that most people spell my name here, I guess I am just that white ;-D )

Pictures part 2

Pictures here. This is the second installment of pictures mostly from Mombasa.

Kachumbari – our favorite Swahili dish

Sliced & quartered Tomatoes

shaved carrot

diced peppers

finely chopped parsely

red onion – cut up the onion into slices then rub it down with salt and rinse it out twice again. Dice onions and put into salad.

Squeeze a lemon over all

Mix and leave to sit in refrigerator in covered dish for a little while.

Serve cold and ENJOY!  (may season to taste with salt or pepper but we didn’t)