See me talk about Elective Africa while in Arusha, Tanzania. These were taped in a garden though it may not look like it with the cement and all.
(These were off the cuff and without much direction of planning so be kind, plus water pressure is awful and I was funning out of clothes and balancing on a poorly positioned chair so … all in all we rose above to make a halfway decent video … )
- 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
- 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|
|r||run (more like a d)||ar|
|w||win||dab al yoo|
|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.
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 )
During our last weekend in Mombasa, Michelle and I decided we needed to do a tour of the city. We have been staying in a beach suburb of the city called Nyali (say it like there isn’t really a y there – N’ali). It’s just a few km from the heart of the city… but think it’s pretty much the Bev. Hills of the area. I’ve spotted quite a few mansions and Range Rovers here that I normally wouldn’t expect to see in Africa. Nyali is tucked away from the sewage, trash, smoke and hustle of the city and we have been frequent guests of its beautiful beach. We needed to venture out and see what Mombasa had to offer because who knows when we should ever come back to this part of East Africa again.
Here is some background info on Mombasa before I get into our tour. Mombasa is the 2nd largest city in Kenya with an estimated population of 940,000. The city is actually set on Mombasa Island, which is connected to the mainland to the north by the Nyali Bridge, to the south by the Likoni Ferry and to the west by the Makupa Causeway, alongside which runs the Kenya-Uganda Railway. It is a major port and serves as the main site for coastal tourism. The city is mainly occupied by the Muslim Mijikenda/Swahili people. Over the centuries, there have been many immigrants and traders who settled in Mombasa, particularly from Iran, the Middle East, Somalia and the Indian sub-continent, who came mainly as traders and skilled craftsmen.
Our tour was set up by Benson (Elective Africa coordinator) who accompanied us on our half day trip. The first stop was Fort Jesus, which reminded me a lot of St. Augustine, FL. The Portuguese built Fort Jesus in 1593. The site chosen was a coral ridge at the entrance to the harbor. The Fort was designed by an Italian Architect and Engineer, Batista Cairato who uniquely designed it in the shape of a man, Jesus, lying down. You actually would have entered the Fort by boat through the head and the arms reached out toward the Indian Ocean. The views of the ocean and old port were beautiful. The Omani Arabs eventually ran the Portuguese out of the Fort and it was interesting to see the different architectural designs they added. The Arab style doors were much larger than the Portuguese and had carvings symbolizing scriptures in the Koran.
After the Fort, we walked through Old Town Mombasa. There were a lot of historical facts that I’ve already forgotten but it was neat to walk through the narrow streets and see the old buildings on the water. There was a building in particular that had a cool wooden balcony with detailed carvings which Michelle and I would never sit out on as it looked like it could collapse into the street at any second. The Old Town had a very Arab flavor and you could tell it was frequented by a lot of tourists because the shops had all the same crafts. We went to a delicious Swahili restaurant for lunch and had the best food of the trip thus far. Our next stop was at the south side of Mombasa Island and saw the ferry. We were both surprised there wasn’t a bridge connecting the mainland to the city on this south side because the distance really wasn’t far. The ferry was free for pedestrians but charged vehicles a fee.
Probably the highlight of the day was going to the Akamba handcraft market. It is an ‘artist co-op’ on the outskirts of the city (on the way to the airport actually) where up to 4,500 people (mostly men) created all the wood carvings Africa is famous for around the world. The artists were so proud of their work and would tell you about what type of wood or materials they were using and even showed you the different stages of their pieces. My favorite type of wood they used was ebony (surprisingly the most expensive) but they used Rosewood, ‘Pinca’, Teak and others as well. If you can think of an African animal they carved it… some were so large they seemed close to life size. The nice part was that the men could not sell their work while you toured, so sharing their work came purely from friendship and pride. At the end there was a huge show room with the most African wood crafts that I’ve ever seen. It was overwhelming to shop because of the amount of things that caught your eye but I still managed to pick out the best crafts I’ve seen in Africa.
The last stop for the day was at Mamba Village. It was a crocodile farm with a varietyof other animals to see. The farm had thousands of crocs of all different sizes being raised for both their meat and skins. The guide told us they harvest the crocs between the ages of 5-7 years old. You need to be there by 5pm when it’s feeding time for a swamp full of crocs which was pretty uneventful. We tried a skewer of croc tail, which tasted a lot like gator and I thought it was way too chewy. You can also do a photo shoot with baby crocs, tortoises and pythons if you desire. The nasty smell of croc shit infested swamps brought me right back to the alligator farms in FL which I used to frequent as a kid.
I really enjoyed being a tourist in Mombasa but honestly don’t think I’ll ever come back unless for medical work. It’s pretty here but I prefer the high altitudes and savanas of East Africa . Mombasa looks and feels a lot like FL. to me so maybe the lack of variety is why I am not a huge fan of its ambiance. We are so excited to leave for Safari this Thursday… hope we get to see all the Big 5!!
Our work at CPGH continues. There is a large group of students here from Drexler University CoMedicine and they easily fill up the van Elective Africa uses to ferry students back and forth from the hospital to the housing facilities. So Brian & I go into the hospital an hour earlier than them, ~ 7 – 7:30 am & work until ~ 1 – 2pm when we leave, usually later than them to return to the house.
When we arrive in the morning it is before the hospital has truly opened. Despite this Brian & I went about our day, checking on patients, reading through charts and results, etc until the clinical officer arrived. The clinical officer or intern (in their 5th & last year of post-secondary training prior to independent practice) is assigned to a ward & is responsible for patient care, orders, etc on that ward for the entire year.
The clinical officer would then round on his/her patients in the ward and generally would be followed by a cluster of ~10 medical-officers-in-training. A medical officer is a person who has received 3 years of schooling post-secondary school and is then allowed to practice medicine, including prescribing medications, etc, without supervision in the community in Kenya. They are not doctors or nurses and based on what we saw of these “senior” medical officers knowledge base & clinical expertise, I certainly worry despite the obvious need of community practitioners. We would encounter some “doctors” in the community in future events & emergencies, who were in fact medical officers with years of clinical practice. I’m sorry to say that our fears were confirmed.
Often in the midst of this pre-rounding, the consultant would arrive & Consultant Rounds would take place. Consultants are similar to Attendings in the US, a boarded medical doctor with many years of experience and seniority. Invariably the number of medical officers would instantaneously & insidiously double or triple at this point. This would make rounds look like a crowded spectacle with ~25-35 people tightly clustered around a rusty metal cot in a large rectangular room of more than 30 tightly crowded & occupied rusty cots. The crowd would be joined by the patients family members & often the neighboring patients & their family members as well. The heat would soar & the body odor would be overwhelming, especially since the habit of speaking quietly would require all of the students to tightly crowd together & jostle in order to hear. Thankfully we became more familiar with the patients & could therefore separate from this crowd, standing further back while still participating.
Consultant rounds would proceed with each patient presented to the consultant in English (this with the low speaking volume being the only privacy really afforded patients) wrapping up with the diagnosis, plan and current status of the plan. At this time these rounds would proceed either with either ascension of the plan, advisment or teaching. We most often worked with Dr. V, a cardiologist by training and a good & practical teacher. He would ask questions of the crowd regarding basic science and escalating to clinical science and finally treatment & management. Early on a system established itself as to whom & in what order these questions would be answered. First the medical officers were given the opportunity, then the clinical officer and finally he would tilt his head back & in the direction of where we would be standing signaling for us to answer. At first both Brian & I felt very self-conscious in this practice, as if we were being forced to showing up the others (be ‘gunners’) or were being objectified like “See the White Americans know all the answers”. This was particularly disturbing for us with respect to the clinical officers whom we worked most closely with and thought of as our superiors & supervisors. However, in all but one case, they quickly put us at ease. They seemed to admire our knowledge & experience, especially in areas of non-communicable disease. They eagerly sought us out during work-rounds & began many interesting discussions with us about various aspects of medicine, global health and medical culture.
The clinical officer with whom we mainly worked seemed to project a sense of pride even, that we were all working together and gravitated to her ward. She is a truly good clinician and a great person. Brian & I both enjoyed working and talking with her very much and admired her resourcefulness & the resilience of her compassion for her patients despite the many daily obstacles she faced and the generally bleak & thankless nature of the environment in which she labored.
Today we went to Coastal Provincial General Hospital, the second largest hospital in Kenya.
I’ve never been around or in a ‘third world’ hospital before and neither had Brian so it was very interesting. 3 floors with multiple buildings connected with covered outdoor corridors, etc. Total of ~ 700-ish beds. The minor trauma/procedural ER area was enclosed and without a breathe of air – therefore so very incredibly HOT! The Wards are like a very long open room with windows on both sides and about 25 stationary (not mechanical) beds plus several in an outside (river-facing) patio.
A cultural quirk we encountered today was “the whispering”. Generally people do not speak very loudly and during rounds, especially with about 15 other medical students it’s absolutely impossible to hear any of it.
The pathology in just one general ward was amazing. We saw:
- “CCF”= Congestive Cardiac Failure – in US C-Heart-F,
- Lymphadenopathy the size & shape of lemons,
- Anasarca (REALLY bad swelling and third-spacing of fluid outside of the veins),
- Ascites that was so bad that the umbilicus inverted and stuck out like a balloon about 5 inches from the swollen belly,
- Cerebral Palsy,
- Upper GI Bleed
Patients & patient’s families supplied food and water, there was almost no-one on IV fluids and the blood drawn for labs were handed to the family member to bring to the lab themselves.
More updates to come.
teaser: Monkey’s like skittles.