Christmas in Tanzania

 Christmas in Tanzania

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So the festive season is approaching a close, and this one has been a very different Christmas to my 32 previous ones!  Whilst it has not been my first xmas away from home, it has been the first one for a long time where I have not been working, and certainly the hottest Christmas I’ve ever had!

Christmas in Tanzania is nowhere near as big as it is in the UK, those local families who celebrate Christmas here (many are Muslim so do not!) do so by going to church then having a meal with their families. It is mainly a low-key affair, with none of the big build up that starts in September and very few of the customs we are used to in the UK.. No Christmas trees, tinsel, crappy Christmas music, silly paper hats, or the Queen’s speech (which I heard was in 3D this year??!)

Saying that, us wazungus still managed to have a semi-traditional Christmas but with a Tanzanian twist!  The Nyangao volunteers (Sandra, Claire and myself) went to Mtwara to meet up with the other volunteers who are based there (Kayley, Paul, George) and Louise who came down from Dar-es-Salaam for a Tour of the South.  

 We stayed at “Cliff Bar”, a lovely secluded bar and guesthouses surrounded by trees and close to the beach, and is run by Mama Mtupa, a fantastic lady originally from Poland but has been in Tanzania for decades. 

Guest house at Cliff Bar

Christmas Breakfast

  Christmas Eve was spent swimming in the tropically warm sea followed by drinks and food at another bar close by.  For Christmas day, we started with homemade bucks fizz (Sparkling wine from Dodoma mixed with passion fruit juice), scrambled eggs and some fresh mango.  Our Christmas dinner at Cliff Bar consisted of prawnsi, kuku, wali, chipsi, mchicha na kachumbari (prawns, chicken, rice, chips, spinach and salad) washed down with a generous helping of Safari Lager.  Like all good Christmas dinners I ate about 3 plates full and felt uncomfortably full!

Christmas Dinner.. TZ style !

 

VSO Christmas.. .(Silly Hats Optional)

BAH HUMBUG !

 After the traditional post-dinner lull, we went to the local ex-pat hotel to steal their Wi-Fi and Skype home.  It was great to speak to my friends and family on Christmas day and made me wonder what previous volunteers did without the wonders of technology we have today!

In the evening, we all went to Kayley and Pauls house in Mtwara and had a bonfire (because it wasn’t hot enough already!), much to the puzzlement of their Tanzanian neighbours (Chizi Wazungu!).  And the highlight of the day……..CHEESE….. Bought down from Dar by Louise, and washed down with a good bottle of Dodoma Red wine.   There was a shared silence as the cheese platter was bought out and held aloft like a holy grail….. but the silence was soon replaced by mmmmm’s and aaaaah’s as we tasted our first cheese in months.   If you ever need to make a volunteer happy…. Give them cheese!!

Cheese, Crackers and Wine..... must be christmas!

Louise enjoying the Cheese!

"Oh my.... cheese"

Standing around the cheese altar

My boxing day was spent in a similar fashion to the rest of the holiday, swimming, relaxing, and a few beers.  I did miss our traditional Boxing Day get-together at my house with all my friends, but I did manage to Skype them, so it felt like I was there.  By the looks of it, it was a good party but obviously not as good as it could have been as I was not there ;)

After a great 3 days in Mtwara we all headed back to Nyangao to show the delights of village life to the “city folk” of Dar and Mtwara!  I’m not sure Nyangao was quite prepared for 6 wazungus wandering round the market, but I’m sure we gave them something to talk about for weeks!  Everyone wanted to be introduced to the “Wengi”, and especially to Paul, the “Mzee” with a big beard (think Santa!). 

As no Christmas is quite complete without a Christmas Pudding, Claire (The new volunteer in Nyangao who arrived a week before Christmas) kindly bought a Christmas pud and some custard with her!  Thankfully the electricity held out long enough to cook it but went off as we were eating…. So another Tanzanian twist to Christmas… pudding by candlelight!

Christmas Pudding by Candle light in Nyangao

Now it is Christmas..... pudding and custard!

For New Year’s Eve we are going to Lindi, to have dinner in the Italian restaurant which serves probably the best pizza in Tanzania!   (more cheese!).

So that’s been my Tanzanian Christmas!  Hope you all had a great time with your family and friends… it has been a bit strange not to see everyone, but on the other hand I have had a fantastic time here with a bunch of lovely people, and lots of sunshine!  Wish you all the best for the New Year, I hope you all have a happy and productive 2013.

Well I'm not usually one for christmas carols......

As you probably know, I'm not the biggest fan of christmas... and yes, I have been known to turn the lights out and hide when carol singers come to my door.   However I did open my door to these kids who were singing "Silent Night" in kiswahili at the top of their voices... it was rather special, if only for the strangeness of standing in the baking sunshine and being sung carols!

(Bah Humbug) - had to get that in somewhere! 

MaKuYa Traditional Dance Festival

Makuya Traditional Performing and Cultural Arts Festival

 In November I went to Mtwara to the MaKuYa traditional dance festival.  Organised by a local NGO, it's aim is to promote the traditional dance and culture of the local Tanzanian tribes in the South.  Groups of dancers from the Makonde, Makua and Yao tribes performed their traditional dances dressed in their traditional costumes.  The dances all told a story, as this was the traditional way of passing knowledge through the generations of the tribe.  Unfortunately I do not know what the stories were, except there seemed to be one about chickens (well, they were all dressed as chickens!).  Also on display were some fantastic hand carved masks, some of which were over 300 years old, and a babu giving a demonstration of how they are made. 
It was great to see this side of Tanzania which is slowly being eroded away as "western" cultures invade even into the smallest of villages, and it is good that an event like this can spread the traditional cultures to the younger generation of Tanzanians.

Improving the Transfusion Service at Nyangao Hospital

 

Improving the Transfusion Service at Nyangao Hospital

Another work related post, to tell you about what I have been doing for the last few months! 

When I first arrived here at Nyangao I could not quite believe the transfusion service provided by the laboratory.  It is such a contrast from the clean, efficient, safe and extremely tightly regulated systems in place in the UK.  Therefore I have made it my mission to improve the service and to make it safe and reliable.  It will never be as “good” as the service in more developed countries, and in practical terms it does not need to be as tightly controlled as CPA and MHRA would have you believe!  As long as there is a supply of safe blood and it can be transfused safely, that is all that matters.

However to get to this standard, there is a lot of work to be done, and so for the last few months I have been very busy!

I started with the office and paperwork, which was in quite a state and took a few weeks of organising and filing.  Next was the quality system.. SOPs, documents, recording controls results, fridge temperatures etc.  Although the previous volunteer did a fantastic job of introducing many of these things, over time they have lapsed and so I have tried to motivate staff into filling in the temperature charts, maintenance logs etc.  As for SOPs, there are good SOPs for most of the laboratory sections, but Blood Bank had just three SOPs which were outdated and did not reflect the work done, and so I have been writing many new SOPs and updating the existing ones.  I’ve also created a document control system to ensure that SOPs are regularly reviewed and updated.   Eventually I aim to translate them all into Kiswahili so that the staff can understand them easier

In addition to the back office tasks I have been doing direct training with the laboratory staff.  Only three of 13 staff are qualified laboratory technologists, the rest are assistants and so their knowledge of the theory of blood banking is quite poor even though they are working in the blood bank lab.  I have given tutorials on blood bank theory, starting from the basics of antigens and antibodies blood group systems, blood grouping techniques, blood safety and transfusion reactions.  These have been received well by the staff who are keen to learn and improve the service, and although I am not quite fluent enough in Kiswahili to do a whole presentation by the use of pictures and a few key words I have got the message across (I hope)!

Most importantly, (and the most rewarding for me), I have been doing practical training in Blood group techniques.  Currently, blood groups are performed using a fingerprick blood sample and using antisera on a ceramic tile, a method that the WHO recommend not to be used as it often gives false positive reactions thus determining an incorrect blood group.   Infact in the short time I have been here I have heard of three cases of incorrect blood groups, including one of incorrect blood type transfused to a patient (luckily the reaction was spotted and the patient suffered no further ill effects), so there is a definite need for change and the lab staff agree.

Blood groups using the tile method..... can you guess what it is yet??

Training in the new method

So I have been teaching the staff to perform tube grouping techniques.  I managed to salvage a centrifuge that was gathering dust in a store cupboard, and we are using some expired vacutainers as test tubes (which are washed and re-used ).   For the training, I explained the theory of forward and reverse grouping (The reverse group was a new concept to many people), and held practical demonstrations and practice sessions with the staff.  All the lab staff picked up the technique quickly and all agreed it was easier to determine reactions than the tile method (hooray!) .  I followed up with a competency test of five samples and a theory test of ten reaction patterns (including some tricky reverse groups… and was pleased when almost all the staff spotted these!)

Training in the new method

Compentency test... or "Blood Bank Testy"

Last week we “went live” with the new method, which also included a re-organisation of the working bench, a better recording systems for blood groups and the introduction of a “group and save” system for samples and again I have been very pleased with the results so far. 

Re-organised working bench... with wall charts for easy reference, and fridge temperature charts!

New method in action

New Method in action

My next aim is to introduce crossmatching!  Currently, for patients who need transfusions, blood units are only issued as group specific, and not crossmatched in any way.   (Gasp, I hear from the UK BMSs).   I have managed to find a waterbath in the storeroom, and have ordered some albumin and some AHG reagent!  Antibody screening as performed in more developed countries is impossible here as there is no way of getting screening cells or a panel of cells, however with an IAT crossmatch we should be able to detect incompatibility due to antibodies.

Also there is the ongoing battle with supply of blood from the BTS which shows no sign of improvement, but I do aim to increase the reliability and safety of the blood donations collected at our hospital through introducing a donor questionnaire and improving the donation collection method.   Another ongoing battle is the supply of reagents and consumables, which is a problem for every department in the hospital (I’m still waiting for delivery of products I ordered three months ago, and it’s hard to run a laboratory without tests and reagents), but again this shows no sign of improvement.

I’m also aiming to do clinical transfusion training for the doctors, medical officers and nurses introducing theory of blood safety and transfusion reactions.

However, like many things in Tanzania this will happen slowly, as although people are generally receptive to changes they need time to adapt and accept them as routine practice so that they continue after I leave.  Pole Pole as they say in Tanzania.

Overall, the work is challenging but very rewarding, seeing staff adopt the new methods.  I have been thanked by a few staff of the staff for the training, and one even asked for handouts of my presentations to read at home! I'm certainly fulfiling the VSO motto of "sharing skills".  

Well, I hope this work related post has not bored you all too much!  I will keep you updated on how it progresses.

In other news, it’s hot here.  Really hot.  And getting hotter.  HOT.  It was 37C in the lab today (not nice when you are in a labcoat), and stepping outside is like putting your face in an oven!  Everyone says it is going to rain soon, but we’ve only had one day of rain since I’ve been here.  I’m off to Mtwara at the weekend for a traditional dance festival where many Tanzanian tribes come and perform (I’ll take my camera). And next month is the Annual Volunteer’s Conference in Dodoma so I may have some pretty pictures and epic tales of adventure for you.  (although I’ve heard what goes on at AVC stays at AVC!)

I must also thank my former colleagues at PHT for being very helpful sending me information (I’ll be asking for more though as you are so good!).

 Stay in touch,

James

Blood Transfusion in Tanzania

Well what a busy few months I’ve had- hence no blog updates, sorry!  I expect you have had enough of stories of my fun times so I will explain a bit about what has been going on at work.. after all I am here to work, not just to sit on the beach.

In October I visited the Mtwara regional Blood Transfusion Centre (Damu Salama).  It is housed in an impressive purpose built building in the grounds of Mtwara’s Ligula district hospital and I was shown around by the very helpful Mr Msanja.   The centre has excellent facilities for collecting donations, the laboratory is modern, clean and well equipped with new equipment that some UK labs would be jealous of, and their policies, SOPs and systems are complete and thorough.  Only one slight problem, there is no blood!  When I visited there were only 3 units of blood in the bank fridge to serve the entire Mtwara and Lindi regions.

Recruitment and retention of donors is the major problem for the Tanzania BTS and this is due to many reasons.  Generally there is a lack of awareness and education about the necessity for blood donations, and the process involved and there is also some stigma and false information such as donating blood can give you diseases.  There is also the issue of HIV status as many people do not want to know their status and so will not donate blood as the BTS will tell them.  They do have an advertising and education campaign, but like most things in TZ, it is pole-pole (Slowly).

 The main source of donations is from college or university students and the BTS runs a mobile donation clinic during term time visiting locals institutions (I visited during school holidays hence there was no blood).  Collecting from students also helps to reduce the risk of Transfusion transmitted infections (TTI) as the HIV rate is lower amongst the younger generation.  Whilst the BTS does screen donations for TTI and has a comprehensive pre-donation exclusion questionnaire, the risk of TTI is still higher than in more developed countries due to the high prevalence in the community.

Given the erratic supply of blood, most hospitals in the region including Nyangao still rely on donations from patient’s relatives collected at the hospital.

Whole blood is still the main product used in Tanzania, although the BTS has the facilities to separate packed red cells and produce FFP and even platelets.  However, there seems to be a lack of education about blood components and their uses amongst medical and laboratory staff, as well as transportation and storage constraints which prevent the use of platelets and FFP in many hospitals.  (What use is an FFP freezer when there are regular power cuts?  And platelets stored at room temperature?  Well, RT is about 35C here!). 

Before I left I donated a unit of blood, bringing the grand total number of units in the region to 4!

Zanizbar

 Zanzibar

The ferry from Dar to Zanzibar only takes two hours.  Quite a civilised affair really compared to the mass bundle of people trying to sell tickets to mzungus outside the ticket office.. I wonder how many tickets are actually real?   Once they realise I know what I’m after – a discounted resident ticket – and I’m not your run of the mill tourist, they seem to become dis-interested and point me toward the actual ticket office with a slightly disappointed look and turn towards the nearest other mzungu.

Cheap ticket in hand (20 000TSH or £8.. try getting a Dover-Calais for that price!) ,I board the ferry with my friend Kay, another VSO volunteer based in Dar, and prepare for the worst.  .  We opted for the more reputable ferry operator, and climb aboard the clean, tidy and relatively new Kilimanjaro III ferry.  There is also a Kilimanjaro I ferry,  but no Kilimanjaro II .  I try not to think about this since only last month one of the ferries from another operator sank, with the tragic loss of many lives.  We sit at the back on the open deck, easily jump-overboard-if-you-need-to-able , just in case ;)

 

The crossing is reputed as one of the roughest stretches of water with strong currents and winds, sick bags are handed out as standard.. but thankfully they were not needed for sea sickness, although I almost needed to use one as they were playing Home Alone on the TV screen….Enough to make anyone chunder.

Two hours later we cruise into Stone Town harbou­­r, and it is as lush as expected, Blazing sunshine, crystal blue water, traditional dhow boats moored alongside modern ferries and ships and a view of Stone Town’s open seafront plazas.  (Try getting that on a Dover-Calais) 

  

We were met by Kelly, another VSO volunteer based on Zanzibar, and whisked through the swarm of taxi drivers, street sellers and chancers for an insider’s tour of Stone Town.  Winding through the narrow alleys of the town was exactly how it’s described in the guide books, with smells of incense, spices and coffee wafting past, the sound of the mosque somewhere in the distance, the tall buildings and balconies overhanging the alleyways a­­­­­­lmost blocking the light, accessed by intricately carved and ornately decorated doors and frames.  One can almost imagine stepping back in time a few hundred years…………….Except that almost every shop sold tourist-tat, the locals all speak English “welcome, come inside, buy my tourist tat” and the motorbike riders in the narrow alleys seem to think it is a game of mzungu skittles.

Stone Town Castle

 

Alleyway in Stone Town

Doorway in Stone Town

 

We stop for coffee in one of the many small plazas in Stone town, and get a small cup of thick black rocket fuel from the street seller.  A fantastic place for people watching as all the old men of the town congregate here for a chinwag.. (The Zanzibar equivalent of the allotment sheds)   I wish I understood a bit more kiswahilli, and then I could join in their bitching sessions.

Having a local “in the know” is handy we avoid the tourist traps and head for Mbweni Ruins hotel – set in some lush botanical gardens and with a private beach, mangroves and a pier, perfect for swimming in the warm ocean.  We spend the day relaxing ad sipping on cold Safari Lagers. Handily the pier faces due west, perfect for watching the sunset. Sunsets never get boring, no matter where you are in the world.  We didn’t actually see the ruins - an old chapel and school from the 1800’s, so will have to go back sometime soon (good excuse) !

 

Mbweni Ruins Hotel

Relaxing, Reading and sipping on a cold beer

Sunset - 'nuff said

The next day we take the daladala (local bus – which was just an old Leyland DAF minibus) to Jozani forest..  The journey takes just over an hour, although we wished it could have lasted longer as the daladala was pumping out old Bob Marley tunes and videos on a small LCD screen gaffa-taped to the ceiling.  Jozari forest is a protected forest, one of the few remaining patches of natural jungle that once covered the island – most has been felled over the centuries for fuel and agricultural land.  It is also home to the native Red Colobus monkeys (Interestingly, being isolated on an island they have evolved to have only 4 fingers on their hands – no thumbs… no other monkeys have this).  The chap at the visitor centre at the conservation project was somewhat surprised we arrived by bus, most mzungus arrive by 4x4 on a package tour and pay an extortionate price for the pleasure.  Our guide led us ten minutes into the forest, and we were amongst a troop of monkeys.  I was amazed at how they were not at all bothered by our presence, and carried on with their monkey business literally within touching distance.  One of the monkeys ran right in front of me (slightly disconcerting as they are pretty big buggers and all muscle!), and another sat on a log next to Kay!  It certainly beats paying a tenner to peer through a greasy glass window at Monkey World! 

Just hanging out

Monkey see Monkey do

Hey Hey, We're the Monkeys

Monkeying Around

Run out of monkey puns

After the monkeys, our guide took us to the nearby Mangrove forest.. Kay on the back of a pikipiki and me on a rickety old pushbike.  I discovered it's quite hard to ride a bike with a flat front tyre and dodgy brakes along a potholed gravel track.   The tidal saltwater mangroves are breeding grounds for many types of fish, and are another endangered habitat on the island as mangrove wood is good building material.  

As easy as riding a bike

Swampy

 

Just 1km down the road is the Jozani butterfly sanctuary – another conservation project which has taught local villagers how to farm and collect the pupae from the fifty or so species of exotic butterflies found in the forest.  The pupae are sold to collectors worldwide which provides income for the villagers and ensures that the forest is protected and the butterfly populations continue to flourish.  Part of the forest has been enclosed in netting, and you are free to walk around with the butterflies – one of them even started eating the sweat off my hand..  yummy !

Pupae Farming

Ever been licked by a Butterfly in the pale moonlight?

It's not a butterfly, it's a praying mantis

 

After 4 days relaxing in Zanzibar I returned to the hustle and bustle of Dar, and then the long drive back south to Nyangao.  It seems I was missed in Nyangao, as the next time I walked through the market there were many cries of “Mr Jamesy, You back now!”.   Yes Nyangao,  I’m back.. ...And I bought Cheese and Mince with me!   I will buy your tomatoes and make them into spaghetti bolognase, Chilli con carne and Shepard’s pie !  Mzungu in Africa!!!