A Pilgrimage with the nuns

Today I went on a pilgrimage with the nuns…. 

I could just leave it with that sentence and let you all jump to your own conclusions… but because I’m nice I will explain!

A group of about 12 trainee Sisters (novices) from the Benedictine order came to visit Nyangao this weekend to go on a pilgrimage.  The sisters were from as far afield as Namibia and India, and were joined by sister Regina, a German sister who lives in the mission at Ndanda.  The pilgrimage was about an hour’s walk in to the bush near Nyangao, with the nuns singing sweet sounding hymns in Kiswahili, and the mzungus, (Clare and I) tagging along behind.   

The nuns.. .pilgrimizing

 The destination was to the to the site of the death of Sister Walburga, a German missionary nun who founded a health clinic in Nyangao in the late 19^th century, and was killed near Nyangao in 1905. 

The shrine to Sister Walburga

  At the site is a small shrine where the sisters had a service led by the Father of Nyangao’s mission and the story of Sister Walburga was told…. It went a little something like this….. (I’ve added a few factual bit’s to make it a little less biased, but kept the important - but maybe not quite true- bits as well!)

 

Father Michael... doing his thang!

Sister Regina from Ndanda

 

























Sister Walburga and other missionaries from the German Benedictine congregation came to Tanganyika (as it was called before it became Tanzania) in the late 19^th century, and set up a small mission in the village of Nyangao.  In 1905, the indegenous tribes started to rebel against German colonial occupation in a bloody war known as the maji-maji rebellion.  German outposts and garrisons were attacked throughout the country by tribes armed only with spear or knife fighting against German troops armed with machine guns and many thousands of locals were killed, as were those Germans that were caught. 
 News of the rebellion spread to the mission at Nyangao and the Sisters and Fathers there fled the village.  They were helped by sympathetic locals who hid them in their houses a few miles away from the village deep in the bush, but they were found by the rebels within days.  The Fathers tried to fight the rebels using their guns (yep.. Fathers with guns) and held them back for a while until one of the Father’s was wounded in the shoulder and was unable to fight.  The group realised they were defeated and so the Father stood and made the sign of the cross over the group to protect them.  Upon seeing this rebels thought this was some kind of witchcraft and stopped attacking, giving the Germans time to flee to safety across the bush toward the port of Lindi.  However, during their flight they realised that Sister Walburga had been left behind but they were unable to go back for her.   A messenger boy later told them that he had seen sister Walburga lying wounded, and she had been given water and ugali by some local people, but then later her body could not be found.  A rebel leader had claimed the blood on his knife was that of the Sister that he had killed twice over.

And so there now stands a memorial to sister Walburga on the site where she fell, and it is visited regularly by the sisters from Nyangao, and the current Hospital at Nyangao is named St Walburg’s in her honour.

Once the service was over, the rain started – surely a sign ? (of something) – so we all got a little soggy on the walk back, but once it stopped we soon dried out in the 30+ degree heat!   

What do you call a wet nun?...... (answers on a postcard)

Spot the nun

On the walk back through the reservoir in Nyangao some of the nuns paused for a photoshoot! 

Photo shoot with the nuns!

How many nuns can you fit on a bridge?

Once back at the convent in Nyangao, we were led to the grave of another famous sister – sister Bernadine, who was instrumental in founding the current mission and hospital in Nyangao.  After all of this walking the nuns had worked up an appetite, so we were treated to a great lunch in the convent (those nuns know how to eat!).  

The grave of Sister Bernadine

So it was a nice day, and it was good to learn the history of the mission in Nyangao and meet the nuns properly – but I don’t think I’ll convert just yet!!

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!