Appreciative for what we have.

Brace yourselves, it's a long one.
Side note: the aggressive kid with the nails I talked about in my last post...he actually cut my skin with his nails, I have scabs healing from it.

FRIDAY

Today has to be the most interesting day at work since we started. We went in and one of the PTs from Norway did a presentation on pain. We were supposed to go to the school of a little boy to do classroom interventions (as per my last post), so after the presentation I ask Amina when we’re going to the school and she looks at us blankly and then says that she completely forgot. WHAT? How do you forget that you have to go to a school to see a client…especially after we asked her every day this week if we were going. Mylene was right once again, she always has gut feelings saying things won’t happen and they turn out true every time. Anyways, still so blown away by how unstructured and laid back things are here; if that happened at home, you’d probably be put on some sort of warning.

Because we aren’t going to the school anymore, the head PT asks if we want to go with them and see the wards in the hospital, which we’ve never seen before because PT/OT have their own building next to the wards and OT stays in department since the patients come to us. One of the Norwegian PTs, Anna, pulls us aside and quietly tells us that we shouldn’t go to the big rounds now because the conditions are so horrid we might not be ready for it and she can take us on her own another day if we want. But since we had no excuse to not go at the moment, we went anyways.

Walking towards the orthopedic ward, we pass by the “X-ray room” and the ICU. Outside there were probably around 30-40 people waiting around, which later was explained that some people were waiting to visit family members, but others were waiting to see a doctor…some even wait overnight for a visit. That’s unheard of in Canada. Walking through certain halls there is a very strong, pungent scent of urine in the air and Anna and Karen (the other Norwegian PT) tell us to close our noses and sometimes our eyes. We get into the orthopedic ward, which is really one large room with 25 beds along the sides of the walls. Although not every bed was occupied, there were at least around 15-20 patients in the room. Since we missed the big rounds, which are supposed to start around 830, but we didn’t get there til 9, the PTs decide they’ll just start treating and we can observe. Anna has patients in the burn ward and says one of us can go with her, so Chels goes. Both her and Mylene say they have an interest in burns so Anna said she can take another one of us next week. I knew from lectures that I wouldn’t be able to handle burns so I opted out.

Mylene and I each followed a PT in the orthopedic ward. It was mostly mobilization of the patients. I saw a patient with spinal cord injury and it was interesting because the PT student was doing a test to see at which level the lesion was at. He explained that the nipples were at T4, and the width of two fingers under would bring you to T5. At each level they pinch the skin looking for sensory input, when they can no longer feel the pinching, that is where they assumed the level of lesion is. I don’t know how accurate it is, or why they don’t just check the charts to be sure, but it was a pretty cool method. It was a really sad case, the guy was only 20 years old and he was a complete lesion at T5; the reason got the spinal cord injury was because he fell off a mango tree during harvest season. I can see that being a very common accident that occurs here, but he was so young and he definitely wouldn’t get the intensive rehab he would need to become as functional as possible! It was pretty heartbreaking.

Afterwards, we went to the stroke ward with Karen and observed more. The PTs are lucky because there are PT students that speak Swahili and can translate for them when they want to talk to the patients and their families. Although, it seems like the transfer methods used here are very different from home. The PT wanted to shift the patient onto the bed more and the PT student was going to just grab the shoulders of the patient and yank him up. The education system here is just very different, the PT student seemed very knowledgeable theory wise, but practically they seemed a little uncertain. I have never worked with SCI or stroke patients before so it was interesting to see even though it wasn’t on an OT level. It made me realize how little experience I have with physical OT and my last placement will definitely need to be in this area with adults so I know it well enough to work in this field if I need to. The bizarre thing about this hospital is that the PTs barely treat pediatrics, regardless of need, and OTs ONLY treat pediatrics, but mostly outpatients.

The conditions of the wards…I don’t even know where to start. First off, there is no AC anywhere in the hospital and since I’ve been here it has consistently been 40+ degrees including humidity. The OT room is small and has two huge fans and looks out into the ocean so there is constant breeze coming through and isn’t too hot. But inside the wards where there are only small windows next to each bed…it’s insanely warm. We had to wear white lab coats when we went in to the wards to be more professional and I was actually dripping in sweat; it was probably the most I’ve ever sweat since I’ve been here and that’s saying A LOT. The heat is definitely not healthy for patients with open wounds, surgery, etc. And on top of that, because the windows are opened with no screens there are tons of flies everywhere. Open wounds + flies + heat…that’s a deadly combo. Even if you weren’t that sick before, you’d probably get more sick from being in there. The beds all looked ancient; they were extremely simple metal framed beds that were all completely rusted and peeling. Some of the beds you are able to raise/lower the head of the bed by turning a metal spool at the front of the bed, but some of them didn’t even have that option. The PT student explained that a lot of the mattresses are brought in from home by families and linens had to be brought in as well. The linens don’t get changed unless the family does it. And the patients only get bathed and fed if the family comes in to clean and bring them food, the hospital doesn’t provide food for the patients. For patients that are incontinent, they simply place a plastic sheet on top of the linens to prevent soiling. Most patients lie in bed all day topless, with a blanket covered their lower half, and if they aren’t pushing themselves to mobilize, no one will help them except for when the PTs come in. The family also has to bring in a fan for the patient if they want to. There are old dishes and water bottles lined on the floor, no one seems to pick up the garbage for patients who can’t mobilize. And nurses? What nurses…I think I saw one nurse actually doing something productive the 3 hours I was in the wards. Majority of them can be found in the break room sleeping or watching tv. Mind blown. What’s even worse though, is that when we were in one of the break rooms there were around 25 BRAND SPANKING NEW mattresses just sitting there. Completely wrapped in plastic and being sat on by the nurses watching tv. If there are new equipment available, why aren’t they being used?! Why are patients using old, dirty, stain covered mattresses????

As we were passing through wards, Karen showed me the bathroom facilities the patients use. It was beyond appalling… the shower was a room with a rusty, thin shower head coming out of the wall. The bathroom was basically a hole in the ground with a rusty bar for patients to hold on to. Out of all the places, why are there not proper toilets in the hospital?? The conditions were unsanitary and overall unhealthy. I’ve never appreciated Canadian health care so much. We’ve been told by a lot of people since we’ve been here that Mnazi Mmoja is not a well kept hospital and if they were ever sick they would never go there. I can definitely see why now, I feel like I would be better off sitting at home than going there for medical care. As with a lot of developing countries, the problem Is not that the country doesn’t receive aid or have the funds to improve conditions, but it’s that the people who run everything…the people on top are pocketing the money and the funds never get put towards where it needs to go.

Chels saw a completely different side of the hospital. She almost cried and almost fainted during her time in the wards. She said in the pediatric ward, one of the little girls had at least 50% of her body burnt and was running around the ward with no bandages on!! That is completely absurd. And when it was time to put her bandages on, because they don’t use pain killers here, they just dump saline on the wounds and then wrap it in gauze. I can’t even imagine the pain this child was in, Chels said the girl started to squirm and squeal at the top of her lungs and multiple adults had to hold her down so they could continue bandaging her. I don’t quite understanding how her burn will heal if they’re using gauze since gauze STICKS to open wounds, so when they take it off it’ll basically pull off whatever skin has started to regenerate and that would be extremely painful. It’s insane because at home patients with major burns are practically sedated since they are given so many pain medications. Although I have no interest in burns, I am really curious to see these wards that I didn’t get to see this time. I think it’s important to see how  the conditions are because I will never get another chance. We knew coming here that things would be different and the conditions would not be good, but seeing in person really took a toll on me.

After our morning at the hospital, we came back home before lunch because Rod had come back from Dar for the weekend. Mylene wanted him to try to vegetable coconut curry at Lukmaan, but Chels didn’t want it so the two of us went to eat at Amore Mio instead. We ordered pasta and enjoyed the view of the ocean from the restaurant. The pasta was good, but what we were looking forward to most was the ice cream for dessert! I ordered a scoop of coconut and a scoop of passion fruit ice cream. They were soo delicious! Chels ordered the Amore Mio cup, which had “cream ice cream”, chocolate cake and chocolate sauce. It was good too, but the cake was a little bit dry.

yummmmmmmmm.

Hand propelled bike, so cool! OTs, isn't this awesome?

Following lunch, we went to Madeira Tours to book our Spice Tour and we finally got to meet Tony, very close family friend of everyone we know here. He said Mary (his daughter) had told him how much we were paying for rent at our place and said it was too high and our landlord was ripping us off. He said he could help us look for another place for cheaper and we’d all have our own rooms!!!!!!!!! The luxury of having my own room and bed…I can’t even imagine how great that would be. The only issue is that we’ve already paid our landlord here, so we’ll have to see if he gives us our money back…hopefully! Then we just explored more around that area, going to different shops and Chels did more souvenir shopping. I bargained on my own this time without Chels helping me and I was pretty happy without the amount I ended up paying. We also found the liquor store in town!  We had to be home by 3:30 cause the cleaning ladies were coming, but then they never showed up and we call our landlord and he says he forgot to tell us that they weren’t coming. I spent the rest of the night reading the book “Sarah’s Key”, which I really liked, it was interesting.

SATURDAY

We booked our Spice Tour for 2pm today, so Chels and I slept in. We left around 12:30 to go get lunch at the only Chinese restaurant on the island called Pagoda. On our way there we ran into Mylene and Rod, who then also came for lunch. The place was empty except for a table of Chinese tourists and one guy at another table. It was decorated pretty typical Chinese, red everywhere with Asian lanterns hanging from the ceiling. Our waiter was Zanzibari and it was the weirdest thing being served by an African and speaking Swahili to him in a Chinese restaurant! We put in our order, not knowing what to expect and waited..and waited…and waited. Our food didn’t come until 1:40, 40 minutes after we ordered!! It wasn’t busy at all, we don’t know what took so long. But we ate really quickly (and for anyone that knows me…that’s a very difficult thing for me) and asked for the bill and take out boxes since we had leftovers. The waiter tells us that it costs 200TSH for a takeout container…what the hell, who charges for that. Anyways…we just paid the bill and left, basically running home to get our stuff for the tour cause we were already late.

The Spice Tour was interesting. It was a 10 acre farm with various fruits and spices that are grown in Zanzibar. It’s cool to be able to see the spices in their original form and how they grow since when we buy them from the stores they’re already processed. And Zanzibar is known as the spice island, so we had to see all the spices. We spent around 2.5 hours walking through the farm with a guide who was fluent in English AND French, that was a shocker and another guy who was sort of an assistant to the guide, climbing trees to get fruits and spices and making us various items out of coconut leaves. At each tree we were asked to guess what the fruit or spice was and we got to smell the leaves and taste certain spices and fruits. The three most interesting things to me were: 1) seeing a guava tree and trying the fruit, I love guava juice but have never tried the actual fruit 2) COCOA TREES! They had two different kinds, one that is a red fruit and one that is green and they use that to make chocolate. My favourite thing ever. I was really sad when the guide said the fruits weren’t ripe yet so he couldn’t let us try the seeds in the tree that are really sweet and locals eat them as candy 3) coffee trees. At home we see whole coffee beans, but seeing the original form of green fruits on trees was really cool. Other than that we also tried lychee from here, we saw a fruit called lipstick which locals use the seeds as lipstick and as dye/paint, papaya trees, avocado trees, etc. At the end of the tour we got to eat some of the fruits grown there. A guy peeled and cut each fruit in front of us, he had really good cutting skills…I know that sounds stupid haha but he actually just held a pineapple and cut the outer shell with a knife so easily. We got to try oranges that are grown here, the oranges aren’t orange! They’re green on the outside, but orange inside, so deceiving. Then we got to buy spices collected and prepared at the farm. We knew this would be possible, but the spices were more expensive than I expected. Mylene said that for each individual pack of spice at the market it was 1000TSH, but at the farm it was 5000TSH. We justified the price that it was more fresh. They had an overwhelming amount of spices, teas, and coffees to choose from. They also had vanilla extract, which I thought was really neat since I use it to bake a lot and this was definitely the real deal. All of us bought lots of spices as souvenirs and spent way too much money. Chels had brought 100,000TSH with her and didn’t have enough to pay for her items!

 Massive jackfruit growing on tree. 

 Lemongrass.

 Lipstick fruit. They mush the seeds inside and use it.

He makes a pretty lady wearing lipstick fruit.

 Guava tree.

 GUAVA!

Like cotton but falls from a tree, used to be stuff it in mattresses, but stopped using it because of new technology.

 Red cocoa.

 Green cocoa.

 First coconut leaf jewelry: a necklace of a frog?

 Zanzibari lychee. Slightly different from what I'm used to.

Coffee tree.

 Cinnamon tree, they use the bark to make cinnamon.

 Cloves in its original form.

 Pepper; bit into it and it was really strong.

 Second coconut leaf present.

 Vanilla.

 Nutmeg.

 Turmeric, dyes things yellow...including my hand.

Third coconut leaf present, a ring.

 Starfruit. 

 Pineapple tree.

 Rod sporting his new tie.

 Papaya.

 This is where almonds come from!

Seed of the fruit that gets produced into almonds.

 The amazing fruit peeler peeling grapefruit.

 With our tiaras.

 Check us out.

 We're so cool, all decked out with our new shades.

 Endless rows of spices.

All the coconut leaf presents we got, handmade during the tour.

Spending the night in today, doing some much needed laundry. I’ve never done so much laundry in my life…I still haven’t had a chance to wash the clothes I wore on the place here because they’re of low importance and I need to keep washing the other clothes first. But we did wash our bedsheets today! I still have at least two more loads to do, but it’s hard to get them all done since there are so many of us sharing one machine and there is only so much space to hang the clothes after. I think I may start to bring my towels to get washed at the hotel across from our apartment. Our landlord had mentioned that it’s only 200TSH per item and I only have 3 towels = 600TSH, which is about $0.33USD/week. I don’t want to wash it myself is because we don’t have a dryer and the towels get so hard and it feels scratchy on the skin even though we use fabric softener. The other style isn’t so bad, I can deal with it, but the towels I can’t stand. After a shower I want to be able to use a soft, fluffy towel!

Anyways, this post is already way too long and I’m starting to get tired. We’re going to the beach tomorrow, we’re going to Matewa, which is north east, just a bit past Nungwi. It’s going to be a longgggg ride on the dala dala and the last bus comes back at 4:30, so we’re going to go early and come back early. 8:30am departure tomorrow, hopefully that means less people and less chickens haha. Or I might just have more interesting dala dala stories.