postheadericon Breathing Easier at ALMC

The first bronchoscopy with the new bronchoscope was performed at ALMC with a crowd of enthusiastic participants learning a new skill!

Early in the week Dr. Sato provided interactive training using videos and hands on practice for the new bronchoscope and light sources provided to ALMC and then they had the opportunity to use and practice their skills.

A patient with a chronic cough was admitted who could benefit greatly from a bronchoscopy.   Dan and Connor quickly hooked up the equipment and the medical team and students were able to participate in the procedure.

They were able to rule out any significant pathology including cancer.  Previously, they would have had to subject the patients to more tests and may not have been able to rule out several possible causes.

Connor is now covering the proper set up and cleaning of the scope to ensure it is ready and safe for future patients.

 

postheadericon Thank You!

Sister Paulina  and Sister Tumaini give thanks for the supplies we brought!

Videos:

 

 

 

postheadericon Solidarity In The Struggle

To be in solidarity with others requires first that we know them, and then together in that relationship, we join in their struggle for the things that they value.

As we neared the end of the first week, we spent time reflecting on our greatest personal accomplishment in the past few days. The common theme was the relationships that we built and nurtured and what was accomplished through working side by side for our common values.

We saw everyone, including physicians and facilities, pitching in to get the old x-ray system out and the new one in. Students were brought in from the technical and brought their joy and enthusiasm for being involved. Kevin got to witness the transformation of quiet and shy students to empowered and proactive participants and experience “the teacher in him coming out.”

Members of our team that had travelled in the past have seen the culmination of clinical skills previously taught in practice and are able to focus on building and adding competencies versus teaching the same skills again.   This is through the relationships they have established and are now seen as “part of the community of ALMC and Selian.”

Training classes have been packed and day by day the numbers have grown, the enthusiasm is contagious. The collective solidarity is shown through people travelling from Selian and the nursing school daily to learn and work for the common good.

Technology projects that were started 18 months ago are being completed in collaboration with the local IT team.

There have been many meetings focused on patient safety and planning to address opportunities to improve the quality of care. This is a breakthrough from previous years because of the alliance in the teams and the joint passion for patient safety.

Personal accomplishments came through simply doing something they did not think they would be able to do and pushing themselves to build relationships because Tanzanians are relational beings. Some were very apprehensive about coming to Africa but met people that have touched them in some way and now feel that kinship and a sense of comfort. Growth comes sometimes just in walking through the door of a patient room or a home with a hospice patient. It is recognizing that poverty can look different than we expect and that we are all poor in some way, whether it be material, physical, spiritual, or systemic poverty.

Accomplishments come through random acts like playing with the children at the Plaster House knowing that the care and infrastructure we are all working together to build will have a lasting effect on the lives of children that are sometimes the most marginalized in our society.

We come as a team from the US and struggle together with our Tanzanian brothers and sisters. This is the only way we will be able to succeed as a whole.

postheadericon A Meeting of Friends

ALMC has a nursing school dedicated to teaching students that will hopefully one day support ALMC and Selian hospitals. The first class of 19 graduated a few months ago after having 100% of their students pass the government exams. This is so exciting for a hospital where the ratio of nurses to patients is 1 to 27.

Currently the school operates in an old pesticide testing facility and ALMC has been working on finding the funds to move the school to a permanent location so they can expand and girls that attend the school can have a safe place to stay. Both girls and boys attend the school but it is not safe for girls to travel back and forth to school daily and many times when they travel outside of Arusha to their home for a period of time, they are not able to return because they have been married and a few have become pregnant.

We recently partnered with the girls school on submitting a grant to USAID but unfortunately, we were notified in December that we did not get the award.

The hope is that someday the school will be able expand to over 100 students with teaching facilities, housing, a kitchen, and a place for guests to come stay and teach.

During the last visit Dr. Chase and Dr. Sato asked Lillian, the director at the nursing school how they could help the nursing school. There was one student that she told them about who was going to have to return home because her father recently died and she could not continue to pay the small tuition.   Dr. Sato and Dr. Chase began sponsoring this student and she was one of the 19 that graduated! She is now working at ALMC and they finally  had the opportunity to meet her and congratulate her on her incredible accomplishment.

Not only is her life significantly improved through having economic means as a woman, but the support she will provide at ALMC will improve patient care, in turn improving the care in the communities. The ripple effect of this blessing will be at least one hundred-fold! What abundance!

postheadericon Faces of Hope and Hospice

postheadericon Connor’s Craft Project and IT’s Captivating Work

Connor wins the excellence in innovation award today (well the day is not over… so he wins as of 1:00 pm anyway).  Tim Nock, a RT who was a volunteer on a past trip, shared that there is a significant problem with dust in the filters of the ventilators which causes them to overheat and stop working.  Connor was determined to solve this problem by visiting his local craft store.  This is true, but it was after a lot of research, contacting the manufacturer, and figuring out possible solutions to a pretty serious problem.  Here is Connor working on cutting his felt squares to improvise a ventilator filter. Zach is wondering if he will start gluing on macaroni later today.

In other exciting news, the files are downloading! Ryan and Richard (from ALMC), are watching them download. Yep, they really are, and you can see how happy they are by the smiles on their faces.  Edit by Ryan:  We were testing failover configurations on our storage system to verify redundancy of the RAID controllers with the equipment we installed.

 

postheadericon Companionship for Compassion

This day was characterized by true companionship with each other and in the community.

After a morning of shopping for a collection of cables, tools and pipefittings (and a new shirt for Kevin) in the “hardware district” (which is way more interesting than Home Depot!), crate after crate was unpacked at Selian on Tuesday revealing many pieces of the new (to Selian) x-ray system. Doug led the deconstruction of the over 40 year old x-ray system that has been broken for 2 years with some serious muscle power! The IT team partnered with several students, including two girls, from the Arusha Technical School and joined in the fun helping to open crates, disassemble and carry out the old x-ray system piece by piece and move the new air compressor to its home. They were so excited, joyful, and thankful to have this opportunity to practice their skills in a real world setting. Several of them said it was the most fun they have had since they started at the school 2-3 years ago. I kind of think it may have been Kevin’s coaching on the proper use of a drill as one after another drill bit was stripped. Or maybe it was the distribution of David’s Jolly Ranchers at break time.   One student even expressed that he wanted to be just like Dan, his hero Biomed Director.   As usual, the team demonstrated excellence in innovation by using the old x-ray table as a dolly to move the heavy pieces. And when it started bowing in the middle, they reinforced it with pieces of the crate and it still supported the 1300 lb. C-arm.

I had the very special role of being in charge of garbage…..and trying to convince and reason with the facilities team that burning hundreds of old x-ray films next to the hospital was really not a good idea! The good news is that they were actually throwing things way in spite of a culture that believes “it could be of some use” – see video.

The medical team spent the morning at Selian and experienced an interesting case of cutaneous anthrax, cause unknown but possibly from eating a goat that had been infected or being bitten by a bat.   Note to friends of team…we are officially banning cooling off in the pool at dusk when all the bats are flying around.

Carol and Amy taught the nurses good oral hygiene of a ventilated patient, including how to make a brush with tongue depressor and gauze, an advancement of their current practice. A Selian nurse was practicing on a Maasai woman while the woman’s son was present. After the training, the son left and came back a few minutes later with a toothbrush and toothpaste. We pray for patience, with ourselves and those we encounter, and trust that goodness comes in the future when we are no longer physically side by side. It is such a blessing to receive a simple grace like this, knowing that we have in some small way, addressed the needs of our Tanzanian community. They also taught how to perform a 12-lead EKG with their machine and reviewed the use of some the meds they have. Connor was the star of the oxygen delivery device training, a much desired skill. He was asked back for an encore performance to learn more about patients with tracheostomies.

Pat and Mike had the opportunity to round with residents at Selian, one who had just been there for a week from Minnesota. When I met him later in the day, he told me how thankful he was that he was able to spend the time with them and it significantly reduced his time to acclimate just by being able to bounce a few ideas off them. Mike was also able to send him several articles later that day. What abundance! Pat also taught aspiration pneumonia to over 50 physician and staff members at Selian, what a turnout!

We ended the day with some shopping from the Widows Might, a project that Linda Jacobson is working with.   It is a project that has empowered a small group of women to learn skills that enable them to create handicrafts and sell them to support themselves and orphans. It nurtures their ability to represent themselves, calling attention to their amazing power and intensity.   We all ended up with a lot of beautiful baskets, rugs, scarves, jewelry, and empty wallets. And I am absolutely sure if there is anyone at home who wants anything – please let any of us know and we will be honored to go shopping for you!

Finally, we shared some incredible companionship with each other and Mark and Linda Jacobson at their home where we shared our thoughts, reflections on the day, and on our mission. It is humbling to be welcomed by a couple that have achieved so much through their ministry and lives.

Video link describing why we can’t throw ANYTHING away.

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postheadericon Ready, Set, Go …. Pray ….and then Go Fast!

Our first day was a whirlwind day with lots of projects started, people met, plans made, patients seen and knowledge shared!

The day started with chapel with the ALMC caregivers where over 100 people gather every morning at 7:45 to pray for those whose lives they will touch that day and give thanks.

Chapel was followed by orientation with ALMC and Selian leaders. Dr. Mark Jacobson, who runs ALMC, shared the story and the history of the hospital and talked about the critical role it plays in the country, providing service to 4 million people in Northern Tanzania. ALMC serves all races, religions and ethnic groups in an area historically termed Maasailand but is now more varied and diverse. ALMC is striving to be an example of what is possible in one of the poorest nations in the world and suffers from a dramatic shortage of health resources and personnel. The doctor to patient ratio is 1 : 20,000 and in the hospital, the nurse to patient ratio is 1 : 27. In contrast to the diseases of affluence in the US, Tanzanians suffer from diseases of poverty like trauma and violence, HIV, burns, fluorosis, diabetes, and hypertension.

ALMC is part of the Evangelical Lutheran Church of Tanzania which provides 50% of care in Tanzania and are sharing and living the Gospel through healthcare. Their vision is to be hope for the future and a Center of Excellence.

As soon as orientation was over and schedules (that will inevitably) change were built, Dr. Chase jumped into training the eight surgical residents in acute coronary syndrome. Connor tested the ventilator system, one of our primary goals for the visit and happily confirmed that it is working properly. We were thankful the ventilator was tested early because by the first afternoon a patient was admitted who required intubation. The patient was successfully “tubed” and ventilated! Another nice bonus, we also saw that skills that were taught on past visits like suctioning an intubated patient were being comfortably used.

Amy and Carol began their Basic EKG training. Nurses are eager to learn and soak in any knowledge that is provided. Again, the training which was completed was immediately put to use as a patient was admitted with extreme tachycardia and hypertension. The teaching was able to be applied immediately for proper medications and treatment plans.

The IT team, Ryan and Zach, worked on installing the storage hardware that will be used to store x-ray images. They got the network prepped and worked with local IT staff to get everything cabled and powered up. The existing X-Ray and CT imaging systems are both antiquated and running on failing hardware, so the new system will not fail and provide years of data storage going forward. This allows the staff at ALMC to provide better and continuous patient care. Historical images will now be available – So when patients come in with broken bones and then again in 6 weeks for follow up, the clinician will be able to see the original image to ensure progress and healing! ALMC clinicians are currently working in the dark as there are no radiologists.   Another huge advantage of the system is that they will be able to transmit images to other locations around the world to be interpreted by people with radiology expertise.

The Biomed Team went over to Selian to perform an assessment of what needed to be done to start installing the compressor and x-ray over there as well.

All in all, it was a great and abundant day with an incredible jump start on what we came to learn and achieve! Needless to say, everyone dispersed and headed to their rooms early knowing that we are working as a strong team together with our volunteers and the hospitals.

 

postheadericon A Goat in the Herd….

Amy Kreeger, a volunteer on our trip, recalled a sermon that was shared on a past trip during the morning chapel service where all caregivers at the hospital gather to start their day. The Pastor thanked the “goats” for coming into the herd of sheep.

The Pastor went on to explain that sheep eat with their heads down and would eat through a field of grass until they have cleared the entire field to the point when they would eat the last blade of grass and starve to death. In contrast, goats look up when they eat, they eat from the bushes and trees and look for new and fertile places to graze.

The Maasai tribes in Africa have learned to that by putting a goat in their herd of sheep, the sheep will also look up. They will look for other nourishment beyond what is directly below their eyes. They will move beyond their current location and migrate to new fertile land and continue to thrive and grow.

The Pastor called the SCL group the “goat” in the herd. They help the hospitals look up, see opportunities for improvement, learn new skills and improve the level of patient care.

As we prepare for our first day in the hospital, we recognize the value of being the goat in the herd.

postheadericon The Most Impactful Trip Yet!

This is what has been said of this trip and what the team will be able to achieve because of the incredible amount of groundwork the previous teams have laid.

As we have looked over the past projects and performed the assessment of what needed to be done in partnership with the leadership of Arusha Lutheran Medical Center and Selian Hospital, we are all justifiably proud to be part of this organization that has been able to significantly improve the health and overall well being of so many people and families in Tanzania.  We are so grateful to Joel Sigdestad, who has been leading this mission since its inception, whom is not able to attend this year but has coached, guided us, and shared his knowledge and passion!

We are in our final stages of preparation with calls, texts and emails of who has items for last minute additions to training,  extra convertors, and who may even have a bit of space left in their bag for another team member to use.

The team has spent months discussing the focus of this trip and ensuring that the projects and training that we will complete are aligned with the capabilities of the hospitals, that all the projects are sustainable so the impact will be carried long into the future, and that we are building capacity in Tanzania (teaching people to fish!)

Past participants have joined us to share their experiences, best practices and key learning.  They have shared how their participation has had a life changing impact on the way they think, work, and for those involved in clinical care – the way they interact with patients.  We had a Tanzanian Priest come spend time with our group to build our cultural competency and teach us techniques and best practices to help us build relationships and be effective  (including the practice of shaking hands with every person when a meeting starts and if anyone joins late, then we have to shake hands with every person yet again!)

We have spent time in discernment about what we can and cannot do but sometimes want to do!   We have worked closely with CHA to ensure we are adhering to the Guiding Principles for Conducting International Health Activities.    We have very lofty project goals that will have significant impact and long lasting benefit.

Our Guiding Principles:

Prudence – Don’t just do it

Authenticity – Know thyself, know thy partner

Honesty – Trust is earned and learned

Patience – Build capacity, not dependency

Excellence – Best intentions do not equal best practices

Humility – We all have something to learn

 

We are excited to share our stories with you throughout the next couple weeks!