Archive for May, 2015

postheadericon Wednesday, May 20, We start our long trek home

It has been a great 3 weeks.    We leave the safari park for the 6 plus hour drive back to the Ilboru Safari Lodge in Arusha where we can shower and collect our bags.  Most of us came with 3 bags each full of mission oriented supplies, toys for the kids, gifts for hospital staff and a little space for our clothing.   Most of us are packing 3 bags back home, many are full with our purchases from our various shopping trips.

Dr. Joel Sigdestad is our mission/travel leader for these trips  He has been to Arusha many times and knows a lot of people.   I appreciate his hard work keeping us organized.  He is our energizer bunny.  He loves this mission work.

The drive back to Arusha was more dirt road than paved.  The route includes a drive back up to the crater rim as it is just on the way.  This day it was again in the clouds and no view from the rim was available.

We passed the farmlands and bomas of the Maasai.  The tall men wrapped in their bright red shukas are seen everywhere we go.  The women are brightly adorned with their often white bead collars and long ornate earrings.   The men usually carry long sticks to aid them as they whistle and guide their livestock to the pastures and watering holes and then back to the bomas each day.

We passed some camels that were provided to the Maasai from Heifer International according to our driver Urio.    Some of our own team donated money to buy goats for the widows.  This is a sustainable gift that will help them long after we go home.  The goats will have offspring and will give milk.  They can be easily kept at their homes.

The paved roads from the crater to Monduli Junction, from Arusha to Tarangire and beyond Tarangire to Singita were built by Japanese, French and Chinese.  They are very nice roads.   The town of Arusha has seen several new paved roads in the past few years.  More traffic and many more motorcycles are in use now.  The motorcycles are used for hauling supplies and grass to feed cows and are used as taxis.   Motorcycle related injuries are on the rise and keep the hospitals a little busier now.

Swahili is the national language.  English is the business language, and each tribe has its own language.  There are 120 tribal languages.  There is an effort to keep the tribal languages alive in the household but not every household does this.

We drive to the airport to begin our long trek home.  We fly out Wednesday night around 8 pm and most of us will be home  Thursday between 5 and 6 pm Colorado time.

We are ready to be home.

There are 20 Photo Galleries.  Please take a look at them.  Click on a picture and the slide show for that gallery starts.  Click on the “i” and the captions will show during the slideshow.

postheadericon Tuesday, May 19, The Serengeti drive

Our early morning start rewarded us with some great giraffe pictures and soon a fresh lion kill.  The lions had hidden the kill in a small tall grass area.  They were laying around in plain view guarding it.  The line of storks and vultures waiting for their chance at it was long.  The jackals and hyenas were numerous.  All stayed around the perimeter waiting for their turn.  An impatient jackal would approach, the lion would stand up and the jackal would move back to a safe distance.   The jackal kept testing the lion, it was funny.

The Serengeti was large and flat at the beginning of our journey turning into gentle rolling hills and occasional rocky outcroppings called Kopje.  Large monolithic rocks rise as if out of place.  On one such rock cluster sat at least 5 lions.  They were up pretty high and could see far.   It reminded me of the Lion King.  Below them ran a single file line of zebras.  Nearby at a small pond was a family of elephants.  Three baby elephants wide with adults at both ends.  They formed a line at the waters edge.  The parents appeared to be teaching the young to bathe.

Soon we were driving through an area of tall grass.  Lions may be lurking here out of sight.  No telling what else was.

We are on a quest for the leopard as we continue driving north.

We came to the Seronera river.   Maybe we will see a Nile crocodile.  This part of the river had very little water.  We are headed to the visitor center where all three of our vehicles will meet up for lunch.    The visitor center had quite a few hyrax and some banded mongoose walking around between all the picnic tables.  They were mostly friendly, looking for handouts.

Just before lunch, the drivers heard that a leopard was nearby.   So we followed the lead and sure enough on the 2nd lateral branch up in a yellow acacia tree was a leopard and her cub.   We were fortunate to see this according to the driver.   Nearby, huddled under another acacia were a family of elephants seeking shade.

After lunch we took a stroll up the trail of the wildebeast where the history of the Serengeti is told with placards.  It was interesting and the dedication of the people involved was inspiring.

Our next stop was the river again and the crocodile was there.  The top of his back and head visible and caked with mud.   The rest of the croc was hidden in shallow muddy water.  A short distance away were two very muddy hippos.   Muddy buddies.

The tall regal acacia trees found here are the Tortilis acacia and are the favorite food of the giraffe in the Serengeti.

We have not seen very many monkeys here but we did pass a monitor lizard meandering down the road.

We are headed  back to the Ndutu Safari Lodge for our last night in Africa.  It has been a long day.  From the turn off it says 28 Km to our lodge across a large flat plain with several 2 lane tracks mostly running parallel and disappearing over the horizon.  Road signs are few and far between.  It is not the kind of place that you fly into, rent a car and find your hotel.  It is as far from city life as can be.  You have to have a guide in this area as it would be very easy to get lost.  Having a guide is a stress free (or stress less) way to do Africa.  You would NOT want to be caught out here in the dark on your own.

We are all hanging around discussing the last few days, sharing pictures and relaxing.   The food here is great and the lodge provides a small campfire and seating out on the terrace for the sunset viewing each night.  The genet cats watched us from the rafters.  What a great day.

postheadericon Monday, May 18. Going to Serengeti

We are headed to Serengeti.  We will stop off at Oldupai Gorge first.   Made famous by Louis and Mary Leakey for their individual archaeological discoveries.  Mary’s discovery was the footprint bed from the earliest homonids preserved in volcanic mud.  A father, mother and child.  They are from the same  species as “Lucy” (she is from Ethiopia and named after the Beatle’s song of the same name)  The gorge is named for the sisal plant found here.  The gorge is  bordered by 3 volcanoes, one of them is the Ngorongoro.  The different layers of soil here are called beds created by volcanic eruptions and wind.  Different species of homonids were found in different bed layers.  The remains and footprints were exposed by wind and rain over tens of thousands of years.

We have not seen a paved road since Sunday morning.  The rain is mostly gone so the washboard and pitted dirt roads connect all the places we are now going.    The dust has replaced the rain.

Ndutu is a safari park that lies at the edge of the Ngorongoro Conservation area.  We drove through a large flat area where the great wildebeast migration is just getting organized.  There are thousands of them.  The make an almost cow like mooing noise as we drive past them.  The are all over the road but they part ways as we drive through.

We noticed the buzzards circling not far off.  We drove over to the remains of a wildebeast swarming with every kind of flesh eating bird imaginable.  There were many and they were fighing over it.  The squawking and hissing that came out of these birds was interesting.  It looked like the wildebeast was not a lion kill, maybe natural causes.

We are staying at the Ndutu Safari Lodge tonight and tomorrow.   A charming place with an open air central lodge.  The Genet cat is thier mascot.  Several hang around in the lodge on the upper timbers.

We are not far from the Serengeti.  A short distance and across the dirt road.  No fences or signs mark where it starts.   Tonight we will see zebras in camp.   The animals are all around us.   A lone guard will see to it that we get to our stone cabins safely after dark.

This afternoon’s game drive produced a wealth of great photos.  We drove to a somewhat dry riverbed to view a lioness and, to our driver’s surprise, a magnificent cheetah was lying within 30 yards.  Very unusual as Cheetahs are afraid of lions.  He speculated that the cheetah had cubs nearby and was keeping watch.  Both of these animals let us get within 20 feet.  After a few minutes it was as if we weren’t there at all.   The only noises were the click’s of our cameras.

Tomorrow is a full day game drive in the Serengeti.

postheadericon Sunday, May 17, We leave for the Crater

Ngorongoro.  Our next stop.

We said goodbye to our lovely cabin tent at Tarangire Safari Lodge.  It really is a great place to do a safari.  The tent had a nice comfy bed and a large attached bathroom with a great shower.   The front porch of our  tent overlooked the river that ran through the park.  The tent allowed all the sounds and breezes to flow through.  Sometimes we could hear a lion roar or the elephants trumpeting off in the distance.  Great experience.   This is one of my favorite places ever.

As we drove away the elephants, giraffes and impala watched from a short distance.  This time of year the baobab trees have leaves and fruit that the monkeys feast on.  Soon the leaves will drop revealing the famous silhouette that we are so familiar with.

Once out on the highway traveling towards the crater we passed a number of herds of cows, goats, donkeys and sheep on both sides of the road kept under the watchful eye of their Maasai warriors.

On our way to the crater we drove through a town named Mto Wa Mbu.  The Maasai name means mosquito river.  It is our traditional stop for red bananas, a great snack for the road.  This town is a farming town and also has many roadside art stands.

We passed a large area of whistling acacia.   This shorter variety of acacia developes a gall that ants live in.  Thousands of them.  When the wind blows the pods whistle.  It sounds like when you blow sideways on the top of a pop bottle.

As we climbed to the higher elevation of the crater rim we ascended into the clouds.  Very wet and thick as soup.  We could barely see enough to drive.  The winding road around the top of the crater is lined on both sides with dense jungle.   The road is narrow and when encountering oncoming trucks it looked so narrow that we would hold our breath.    Not a problem for the drivers however.  It was slow going as the road was really muddy.

Starting down the steep road into the crater the clouds cleared away and we could see the floor of it, a vast expanse of grasslands and a large shallow lake.  It is big.  The purple and yellow colors of the wild flowers, green grasses and animals was remarkable.  There were so many animals. We came across zebras first, they were mingled with the livestock of the Maasai.   Then wildebeast, many birds large and small, ostrich & flamingo.  So many flamingos were in the lake it looked like wide bands of pink.  Soon came warthogs and cape buffalo.  Later we came to a hippo pond with some very active hippos.  Always a favorite.  Then lions, elephants, a lone rhino, several jackals and foxes.

On one edge of the crater floor is a forest and swamp.  The yellow bark acacia is here.  It is referred to as the fever tree.  It was blamed for giving people fevers from camping under it.  The reality is that the fever was generally from malaria.  The mosquitos also lived in the same area.

We spent the night on the rim at the Sopa Lodge overlooking the crater.  The sunset was not visible because of the clouds.   Normally the sunset is really beautiful as the sun sets over the opposite side of the crater.  This place is incredible.   The rooms are very large and they put hot water bottles under the covers to keep our feet warm.  Nice touch.

postheadericon Saturday, May 16, Safari at Tarangire


Saturday morning early start, rolling by 6am for a morning game drive.   Just enough time for a half cup of coffee before we leave.  The sky was  just starting to lighten when we were able to see the first birds, Impala and elephants in family groups.  There are quite a few baby elephants now.  We observed a nice weaver bird nest, Guinea Hens and Waterbuck as the morning grew lighter.  Then we saw a heard of Impala take off running back in the distance followed by the eerie bellowing of the lion that disturbed them.  Our drivers listened for a little while and decided that they knew where the lion was.  So we headed back to almost the same ground we had just covered and there she was.  A young lioness casually meandering down the road in clear view.  She did not seem to be the least bit bothered by our approach.  She glanced back at us then kept going, her long tail with the little black furry end weaving back and forth as she walked.  She crossed the road in front of us a flopped down in a sandy spot.  We took many pictures.  Soon she got up and disappeared down over a little slope into the tall grass.   One of the drivers, not to be outdone, soon spotted her climbing up a tree quite a little way from us but not out of reach of our camera lenses and binoculars.  My first tree climbing lion experience.  Oh yeah.

I for one did not sleep all that well last night.  The animal noises were many and nearby.  Since I did not know the source of many of them my mind wandered as to what they were and it was hard to ignore.   I hope to sleep much better tonight.  I’ll be more relaxed since I found out the creepiest noises came from the Impala.   If the Impala is near the lion is not which is good for sleeping.    We are sleeping in a large tent on a concrete pad, palapa roof, covered porch equipped with 2 chairs and a coffee table.  There are tents for each of us.  Ours is the last one way out on the end and closest to nature.  The view from our vista overlooking a lower river basin with wild animals, birds, monkeys, trees and grasses is gorgeous.

The food here is really good.  The stone terrace overlooking the lower basin is large and open.  The sounds from the animals echo pretty loudly here.  It is a symphony of birds, elephants, monkeys, Impala and others.  The large palapa open air bar/lounge features large furniture made from petrified timbers from 900 year old sunken dhow boats.   It is impressive.

This afternoon the baboons had a family feud right in front of our tent.  The Impala herd hangs out within a few yards of our tent.  While out on the afternoon drive we saw 2 lions, 2 jackals, ostriches as well as the others already mentioned.

We spent the entire day here, morning and late afternoon game drives and the middle of the day just hanging out and comparing pictures, sharing, swimming, snacking or napping.  The weather was awesome.  It was a great day punctuated by a rainbow.

postheadericon Friday, May 15, 2015 The Handoff


Our last day at ALMC is one of excitement and goodbye.

We started the day in Chapel.   One of the topics was are we sheep or goats?  We meaning everyone.  The sheep go to the right hand of God and to his left hand goes the goats.   He also said that everyone will be held accountable.   The rest of the message was in Swahili so……

We met with Dr. Paul Kisanga in the conference room.  Our entire team and the various department heads of the hospital met for the the final debrief.   Everyone in our team had a chance to report their findings, give positive feedback where it was deserved and also give advice and recommendations for areas where improvement is needed.   This meeting brought up goals for the future, how those tied to our mission and commitment to help ALMC continuously improve healthcare to it patients.

We did a lot here.  We had a big team with many tasks.

The ICU is implementing 5 new initiatives.  One of them is ICU rounds.  Wendy the director of the surgical training program asked for our help in setting that up.  The ICU team participated in ICU rounds for the two weeks.

Education was provided by Tim and Pat on adult ventilation.  They ran 2 formal sessions on ventilator management.

Catherine gave a presentation to the residents on pharmacology and antibiotics.  She also worked with Robert the only pharmacist at ALMC to organize and computerize the inventory.  It is important that the doctors and ICU nurses know what is available.

Pat & Mike gave presentations on peri-operative assessment and management and heart disease.  Mike did a case conference on severe hypertension.  Pat gave grand rounds on sepsis.  Pat and Mike participated in medicine rounds and teaching on problems with patients in the hospital.   They saw three cases of Malaria and one case of tetanus along with the normal issues seen regularly.

The skills fair was very successful.  The high participation rate was what they hoped for.  The old monitors were removed and will be redeployed to Selian.  The new monitors were installed in ICU by the biomed team.    Our ICU nurses trained the ALMC nurses on them.  They were actually using them on a couple of patients as we left

The medical air system for NICU was built and deployed.  Ultimately 2 oxygen blenders which can manage 4 babies is ready for use.  Staff was trained on operation of blenders and maintenance of compressor.

Draeger Babylog ventilators were set up, tested and deployed.  Pediatricians and nurses were trained on ventilator therapy for infants.    Mark and Tim produced an educational video showing the set-up of the infant ventilator circuits.

An updated endoscopic system was tested and deployed by the biomed team utilizing Olympus CLV140 technology and scopes.

Some needed equipment was sent to Selian.

The network is new.  Six new access points were installed with the rest ready to be installed by the hospital IT department.

50 computers were delivered, activated and tested and are ready for deployment.  A new UPS system was installed and is fully operational.

We have a great team and cooperated well with the ALMC  nurses, biomed and IT teams.

Off to Tarangire we go…….

postheadericon Thursday, May 14, Day 9 Wrapping Up

Mike Chase gave a case conference on a new patient admitted to ICU with hypertensive urgency.   Mike and Pat had an early start today.

Surviving Sepsis Campaign.   Pat Sato taught a class showing differing studies and data on Sepsis survival rates depending on when treatment begins and treatment type.  EGDT is there value?  Early Goal Directed Therapy.   Yes EGDT improves survival rates.

Several of the computers have been deployed.  In the Accounting office and library……  46 more are ready to be deployed

Kristie and Dan delivered 2 vital sign monitors to Urgent Care at ALMC.  Kristie went over the functions with several of the nurses there.

Tim and Mark made the video on the operation of the blender today for NICU.  The housing for the air compressor is ready and in place outside of the NICU.

IT…… the new network including VPN access is up and running.  The UPS is working (uninterruptible power supply).   The IT team has rearchitectured the network infrastructure to include replacement of all switches, routers, firewall and wireless access points.  Six access points have been deployed already.

postheadericon Wednesday, May 13 Day 8 of work

Today the Skills Fair was a roaring success.  It was crowded, the ICU nurses had many participants.   Dr. Joel addressed the staff at sala and “encouraged” them in a non subtle way to attend the fair as our team had put a lot of effort into it and traveled a very long way to be here.  They got the message.

The NICU team has been able to mount the third blender with an air supply.   We had to visit many hardware stores to find the right fitting.  Finally we did and increased capacity to the NICU.  Now 6 babies can be on the mixed gas if needed.  Pure oxygen is damaging to newborns.  It can cause blindness.  The mixed gas will provide what they need without the danger of blindness.

Dr Joel, Pat, Kristie, Piper, Catherine and Kelli went to Mt. Meru Hospital to tour ICU and teach CPR.   They had a chance to meet the regional department managers.  They discovered that this hospital was missing items that we had spares of.  Another trip that afternoon was made to deliver the items needed.  Among those were scrubs, stethoscopes, watches, a refrigerator to keep insulin cold, pulse-ox monitor and some other items.

Mt Meru is a government subsidized hospital in the heart of Arusha.  It is about a mile from ALMC.    Our medical staff were impressed by how clean, bright and well run this facility is.  The pride shown for Nurses Day was fantastic.

Half of our group boarded the safari vehicles and headed out to Monduli Girls School.  The girls there are from the surrounding Maasai villages, some are from Arusha.   Some of them are attending the school against the wishes of their fathers.  In the Maasai culture the daughters are property and have no voice in their own future.   Some of them are supported by their family which is a more modern non-traditional way.   All of the girls have big goals set for themselves such as doctors, nurses, lawyers and other professions.  They all want to help Tanzania and her people.    Dr. Joel is already sponsoring a girl  at this school.    Sponsoring a girl here is done through “Operation Bootstrap”.   There have been 650 graduates since it started and several doctors have been produced from these graduates.  Our tour of the school was relaxed.  Each of us was paired with a student who told us a little about their life as they walked us around the school grounds pointing out the dorms and classrooms.  At the center of the campus is the open air chapel.  The roof is the shape and painted like a giant Maasai shield.  The actual name of the school is the Maasae Girls Lutheran Secondary School.

After that we headed back towards Arusha to have dinner at a favorite place of  our returning mission teams.  The Snake Park.  It is a small zoo whose inhabitants are various snakes and other critters.  Constrictors, Black and Green Mambas and other venomous as well as harmless snakes are safely behind glass.  Some other occupants are an owl and vulture and a very friendly baboon which was confiscated by the authorities and placed here.  You can’t have a pet baboon.    We had a good up close look at a few Nile crocodiles, monitor lizards, leopard tortoise, beautiful birds, and a really long pointy snouted crocodile whose name I missed.  We snapped some pictures of the creatures and then sat down for a dinner of various grilled meat, veggies, cheesey potatoes, bread and salad.  It was pretty good.   This place was built by some people from South Africa 22 years ago.    This is an Aussie style pub that is host to many a trans-African traveler seeing Africa via the Overland Express or other tour carriers.

Back to the lodge for some card games and laughter.  A good way to unwind after the crazy busy day of work at the hospital.

postheadericon Tuesday, May 12, Day 7 of work

The Skills Fair was poorly attended today.  The team was disappointed.  They decided to try again tomorrow and increase attendance.   In the meanwhile they knocked off early to go to the Monduli girls school.

Of course no afternoon is complete without a little more “shopping”.    We laugh about that but shopping here is a competitive sport.   Speed and quantity are signs of a great shopper.  Not really, as I am a slow shopper but feel that I do quite well.  And I probably buy way too much stuff.

IT and Biomed are just about done with what they can do.    Not everything ended up here.  An important password and a key piece of equipment missing made it necessary for that all important “Plan B”.  Thankfully we are pretty good as a team at Plan B.

This post is 2 days delayed as I spent so much time trying to get pictures up.  Only so much bandwidth to work with.  That and my limited knowledge of blogging (although I have learned a lot) …..  I have James.  He has been so helpful and patient with me.  Thank you James.

This afternoon Carlos wanted to go to the open market, and we needed to hit some hardware stores so a few of us piled in one of the vehicles and went downtown.   By the way driving in Arusha is not for the faint of heart, it is crazy driving, frequently over the center line into oncoming traffic.   I’m glad we have our drivers.   Even with that we have had a couple of close calls.

One thing about open markets here is that a lot of people are hawking their goods and competing for the tourist dollar.   Should you find yourself on the receiving end of a “hard sell”, they don’t take “no” for an answer and they don’t care if you are still sitting in your car.   Just sayin’.

postheadericon Monday, May 11, Day 6


Monday morning refreshed and ready to go.

Mike & Pat have spent many hours preparing for the class this morning on Peri-Operative Cardiac and Pulmonary Assessment & Management.  Mike created a Power Point presentation.   The surgical residents were very engaged and attentive.

Kelli, Piper & Kristie held a workshop to teach the ICU nurses how to operate the new monitors that we have just finished installing in ICU.  The class went well, the nurses were able to learn the new features and nurses in OR will come for the next workshop.

The teams have been prepping for the skills fair that will take place tomorrow.  The Skills Fair will feature 7 stations for the following skills:  CPR, Intubation, EKG rhythms, heart & breath sounds, naso-tracheal suctioning, identifying & preparing for intubation through recognizing respiratory distress and modes of oxygen therapy, ventilators, Bipap.    Pat, Mike, Tim, Kelli, Kristie and Piper will be teaching the nurses these skills.  Upon completion of the skills fair the participants will be given a bag with various supplies and small gift items.

Our progress is not as fast as we had hoped.  The internet has been a really big problem with electricity in and out, and not enough bandwidth to do it fast.  So were are getting it done albeit very slow.

IT has finally found the missing boxes of computer mice and keyboards.   The computers are being initialized and readied for deployment.  The internet access points are being installed in key areas throughout the hospital.

The NICU infant ventilator project is proceeding.  The rails are up, the blenders are mounted. If we can’t get the extra parts from the hardware store we will have 2 blenders for 4 babies.  Ideally we will have 3 blenders for 6 babies.  The famous compressor will supply the oxygen to the blenders.

A small group of us went up Ilboru Road to the container to pull out several much needed items designated for Selian Hospital.   They are an overhead infant warmer with bilirubin lights, a surgical table, a blanket heater, plus many boxes of syringes, patient gowns and surgical towels.  All of this was loaded into a lorry which showed up with about 8 men who were needed to lift the heavy equipment into the truck for transport.   A forklift wasn’t available so the men took care of business.

Various donated surgical items were delivered to OR.