Morning Beach Runs

 Morning Runs!

I've been wondering about running in Dar since I found out I was going. Having recommenced giving some Running technique trainings in Utrecht and aiming to run 1000KM in 2021 I was curious to see if I'd be able to keep to my goals and my commitments. The first week went by too quickly. Or rather it seemed quick. This is partly because while locals are jogging (albeit slowly) at all times of day. The only time for someone like me who tends to flounder in humidity to run is in the mornings before the sunrise. You might say, hey! Arent runners always morning people? My answer is no I actually prefer to run after stressful or stagnant periods, as a cleanse, for my body and mind. Running in Dar is to Running in Utrecht what Bikram or hot yoga is to a simple hatha yoga class. SWEAT PUDDLES. Needless to say it took a couple days before I had worked up the motivation to wake up at 6 am and lace up. Meeting Inga a fellow researcher who is in Dar from Norway also helped to motivate. Not having to choose a route to run and following her is one less obstacle to get moving. Its amazing the mental blocks we place in our own way sometimes.

 First run down to the Fish Market along Barack Obama drive.

Leaving the house at 6 am the usually bustling city is quiet but not silent. The chirps of birds fills the air with the occasional crow of a nearby rooster. A couple of people are already on the roads trying to avoid the morning commute traffic on the way to work. A lack of infrastructure can make short commutes (30 minutes) in the city take up to 2 hours. We make our way to the coast. I tried to go the previous week but got lost. We take a left where I had taken a right and make our way to the beach. Incredible how close to the shore the house I am staying in actually is. One moment your in a busy african metropolis the next you are on the Swahili coast looking out over the Indian ocean.

Sleepy Sunrise over the beach

   Halfway point smiles

 

 Sunrise, The Heat starts to build aka 6:30 am 

in this heat 7km feels like 14km even in the morning. Time to head home and get ready for work.

A couple days later I asked Inga to show me another route. This time we headed north to Oysterbay and the neighborhood of Masaki, known for its dense population of expats and consulates. This area looks quite different from most of the city. The coast is equally if not more beautiful with the small coco beach located right in the city.

3km almost half way, the sun starts to peek out from behind a big cloud lighting up the coast with an orange pink tropical hue.

 

 

 Sweaty but smiling we reach coco beach and turn around to finish this run.

A kilometer further the sunrise starts to pop gleaming over the azure waters. We pass an abandoned first aid station. Quite random and ominous. Lucky that nobody needed first aid on this run.

        

 

 

While the pollution in the city freaks me out a little bit for long distance runs or running in peak traffic times. Running in the morning offers a little escape from all the noise and hustle in Dar. It offers spectacular views, I hope to keep enjoying these weekly as my stay continues. I even think its helping me adjust to the heat. While struggling with just existing the previous week. After two runs in the morning heat and humidity my body seems to to be convinced that it should conserve more water.

As I get home I realize my shoes are ripped! NOoOOOooOO all my good intentions, should have checked the first aid station for sutures. I will have to find a shoemaker before the next sunrise run can occur.

Seven Days – Settling In

 Its been one week since I landed here. If one thing has become clear its that the perception of time is relative.. to culture, energy, emotions... you name it! This week has been spent in the following ways

    1. Trying (and failing) to not sweat through my work clothes before 9 AM

    2. Introductions and meeting the PICU team of Doctor's and Nurses

    3. Transporting the medical equipment and donations to a safe place in the hospital.

    4. Giving a short presentation on the RSVGold III study to the staff

    5. Getting used to getting stared at, a lot

    6. Getting used to staring myself (observation)

    7. Getting my own white coat #official

    8. Learning the local protocols, names for medications, and general PICU workflow

 

Needless to say there has been some discomfort looming. From the climate, to the culture shock, to the language barrier, to the necessity of meat and animal products in meals over everything else –  I have been taking a good hard look at my boundaries. In this regard, at times it feels like I'm on a sandbank and the tide is encroaching from 360 degrees while I desperately try to hold onto what land remains. I then remind myself that I chose to go outside my comfort zone. I'm not on a rapidly vanishing sandbank, I'm on a tropical beach in the Indian Ocean. Then its all Poa (cool in Kiswahili) again. Just like the ocean, however, emotions have tides and come in waves. I know that the coming period will demand much open mindedness, patience, and understanding but it will also offer beautiful reflections, lessons, and experiences. Underneath it all I can't hide my excitement. It will be over before I know it.

The PICU is located on the first floor of the Muhimbili Pediatric building. At only 2 years old the PICU itself is in its infancy and is the most modern part of the pediatric building. *sponsored by Dubai and the UAE* this means that patients inside and the population of Tanzania have access to emergency intensive care with state of the art beds, ventilators and other medical devices. Anecdotally it is said in the hospital that before the PICU was built child mortality was as high at 90% and that this has dropped to ~30%. When I ask for which disease or patient population I don't get a straight answer. But the message is clear, life saving devices and care saves lives. 

After my short presentation about the trial I will be helping to set up everyone thanked me for a lovely presentation. Colleagues are respectful and thoughtful before business. In honesty at first my paranoia almost felt like there was sarcasm but all respect and compliments are genuine. The lack of critique and sharpness feels quite different from medical environments I have known before. I pondered the pro's and con's of Tanzanian vs Dutch vs American medical professionalism as I hung up small RSV information sheets around the PICU.

 

 

 

At times it can feel like I am useless. The disease prevalence is different, patient populations are different, medications are different, medication names are different – in short its very different from what I was trained for in my accelerated medical program. I remind myself about my reasons for coming, my priorities while being here and that it isn't my responsibility to save the world. Just take it one day at a time Marc. 

 

The staff is friendly and its easy to make friends. Hassan comes by all the wards to deliver home cooked meals for 1-2 euros every day. I asked him to make mine without meat and with veggies. Just like in the Netherlands (see similarities!) before the green wave this means they just take the meat out (and sometimes not even that entirely). I'm not being to picky the pilau spice mix they use for the rice is quite delicious. I'll have to search for my protein and my amino acids elsewhere...

 

 

 

 

 

Unpacking again? Yes you thought correctly. I was so happy to have extra space to bring medical donations. This also makes me feel slightly less useless as I get my bearings at Muhimbili. Acquiring and organizing these donations was an adventure in itself. Most of the materials were disposables (1-time use) medical items that had just expired or were going to expire this year and could no longer be used in the Netherlands. Instead of throwing them away I checked with Dr Yasser beforehand and collected these from my old hospital Gelre in Apeldoorn. Much of it was poorly or not organized. I had also never organized medical disposables before or was familiar with 80% of what I had received. I did my best to pack it neatly and upon unpacking Dr. Yasser and I spent some time figuring out what everything was and how to best put it to use.

 

       

 

 

 

Additionally, I got to organize and set up the diagnostic device we will be using for the RSV Gold III study to identify RSV infection in patients. I was happy to see that with the smooth journey and proper care it still worked in perfect condition. Next step training local doctors to run their own diagnostics!

 

 

 

    

Free Time

Just as time is relative. Free time is relative too ;) I spent the first week not feeling like I did much at all. Looking back it is filled with productive moments. I guess it just depends on what metrics you are using to measure your productivity. I spent the weekend indoors mainly doing computer work as I had for the past 8 months intermittently getting up to do Yoga, eat, or go for a run. It became clear my lockdown mindset was still in place even in a place where there was no lockdown. For this I am lucky to have great colleague, among them dr. Yasser, who take joy in showing me the beauty of their country. Everyone cares about the study and reaching our goals. Working here its clear that everyone equally cares about those around them.

There is an African idiom "Ubuntu" loosely translated it means I am, because you are. Even in just my first seven days its clear how much value is placed on togetherness in Tanzanian culture. The current vibe is We will get there but we will get there together.

 

First Impressions: Meeting Dr. Yasser, Muhimbili, Mtitu House

 Soundtrack: Greener by Nyashinski (for the spotify users out there)

 

My feet on the ground... my head is still in the air or stuck somewhere at customs.

Disbelief is the presiding feeling during my first moments on Tanzanian soil. 

Deplaning was simple and upon entry the Tanzanian security agent checked my temperature and took a form I had filled out on the plane stating that I was not sick and had not been in contact with anyone that was. Straight on to collect my two suitcases filled to the brim with medical equipment, both for the studies and for donation. Whispering to myself "I hope everything is still there". As is to be expected with a relatively empty airplane all of the 40 or so bags were waiting neatly for us in the baggage hall. I grabbed my suitcases and within 5 minutes was walking towards the door. How did I get this... lucky? or rather here? with all my stuff? I silently thought to myself. As I nonchalantly made my way to the "nothing to declare" section I was beckoned over to scan my luggage to leave the terminal. Compared to the smooth sailing I had had up until this point a small hint of stress reared its head inside me. I placed everything on the x-ray machine and waited patiently for the guard to speak his mind. I glanced over into the arrivals hall and saw Dr. Yasser at the door chatting with a fellow security guard. 

"Sir, what are all of these devices in your bags?" the guard asked me slightly surprised and worried. I quickly went to my bags to grab the documentation for the study and for the donations and mentioned that I was a medical student with medical donation for Muhimbili National Hospital. The guard looked at me with a confused and slightly suspicious stare as I desperately pressed the papers into his hands. I pointed at the Muhimbili letterhead and mentioned that I was from the Netherlands and that these were strictly for donation. He scanned me once more for suspicion looked at the length of the letters and let me go. As I gathered my things from the belt I felt 3 pairs of eyes watching me to see my reaction. I don't know if they saw my relief but its safe to say I was a little relieved as I had passed the final potential checkpoint of trouble. I passed through the threshold and greeted Dr. Yasser. Without hestitation he extended his hand to greet me. Faux-pas in the Netherlands I thought. But deciding first impressions were more important than my newly acquired Corona boundaries I heartily shook his hand. I was happy to see him and to be here.

I packed my bags into his Safari truck relieved that I had made it from here it would be a short ride to my lodging.. or so I thought.

We made small talk about the medical profession and differences between cultures, my previous trip to Tanzania a decade ago. We were still getting to know eachother but it was pretty clear that we would get along. Hesitantly I broached the subject of Corona and shared my experience coming from a country in  lockdown and being in relative isolation for 4 months. As we made our way into the heart of Dar, with all of its smells and sounds, a familiar feeling started to settle in.

"Have you eaten yet?" Dr. Yasser said to me calmly. I responded that I had on the plane but that I was up for a bite. Glancing at my watch it was already 10:30. "What do you like to eat" he kindly asked me. I told him I'd take his best recommendation and he smiled. 

We turned the corner and pulled into a small well lit lot with two soccer fields where people enthusiastically were playing football in the humid heat. I think I may have been staring as if I was staring into the past jaw slightly agape.

 

In the back corner was a small building with a barbecue and juice bar. As we got out of the car I realized that I was unsure about mask etiquette and about my own boundaries concerning it. I had been enjoying the 20 minute drive since the airport mask free, following Dr. Yasser's lead. I grabbed my mask just in case but didn't put it on, we were outside after all, I'd keep my distance. Before I could blink people descended on us with hands (and smiles). CORONASTRESS! It was Dr. Yasser's cousin Zacaria the operator of the small cafe. After a short introduction to Kiswahili we were beckoned over to the tables. With my phone and my hand sanitizer I ventured forth.

Dr. Yasser told me that he was the owner of Soka Park. He had built the turf fields almost a year ago in an unused lot as a gathering point for the community directly on the border of Kariakoo (his neighborhood) and Upanga (the neighborhood Muhimibil was in and I would be staying in). It became clear that we were on friendly territory and why I was being treated as VIP. We were served delicious tea sweetened with fresh milk from his farm outside of town (a man with many hats), fresh made juices, and a typical Tanzanian meal. While eating together he told me that he wasn't just going to open a snackbar on his sport terrain he wanted the freshest and tastiest ingredients. While eating a man approached the table with his child. Without hesitation Dr. Yasser greeted him and took the small child on his lap taking a short history from the father. The child had ear pain. And I got to witness my first impromptu consult in Tanzania while eating the last bites of my dinner.

Mtitu House

When I arrived there was but one thing on my mind rest. The next morning at the request of my family I snapped some pictures of my lodging an AirBNB owned by another doctor at the hospital. One of Dr. Yasser's colleagues. Here I would be staying for the coming 2 months. This is my home base. Far above the standard for an average Tanzanian.

 

It was time to unpack my carefully constructed tetris of work clothes, trekking clothes, casual, medical devices hidden away. I had packed the most important one in the bottom of my daypack for Kilimanjaro. One suitcase pictured on the right was completely filled to the brim with the remaining devices and medical disposables from the hospital in Apeldoorn. Its not often that the volume of my packing supersedes the weight limit of international flying. Packing these light disposables in the most efficient way for international travel and safety for the study was an interesting spatial challenge.

 

As I checked to make sure everything was still where I had put it I realized that I had prioritized the donations and devices over my own packing list forgetting to pack some items in enough quantity. At least I had enough underwear. I'd have to purchase some local work shirts. Hakuna matata.

I prepped my medical accoutrements scanned the first pages of my medical Kiswahili guidebook and packed my bags for my short introduction at the hospital. I didn't know what to expect, so I decided to not expect anything.

Muhimbili National Referral Hospital

Time to go to work! I decided to forgo getting picked up and brave the streets of my neighborhood to find my way to the hospital on my own. Finding the hospital was easy enough. Its laid out campus made finding the pediatric department a different matter. The lack of English speaking security guards and signs made increased the level of difficulty. After asking several confused Tanzanians – with broken Swahili and some english – I found some medical students who pointed me in the right direction. Pediatrics was found but now for the PICU and to find dr. Yasser. As I walked the halls and stairs of the pediatric many eyes fell on me. It was clear I was an outsider, a 'mzungu' as westerners or people with pale skin are called here. But more importantly it was clear I was lost. Eventually I was able to find a pediatrician who told me the PICU was on the first floor next to the entrance. What an oversight. I don't know what I had expected, flashing signs? beeping machines? I guess I had tried to not expect anything.

My first day was a short one, consisting of meeting the team I would be working with on my research project for the RSVGold III -ICU Network Study and also the skilled team of doctors, nurses, and students maintaining the watch on day and night on Muhimbili's pediatric ICU. Everyone was overwhelmingly friendly and welcoming. I was able to attend rounds and to get my bearings for what a day on the PICU looks like.

Despite its length, the day was quite tiring, I'm not used to the heat yet and in general I fare better in a moderate climate. Thankfully the PICU is the only ward in the building with air conditioning, small blessings. It will make the transition getting used to these temperatures nicer. By Dutch standards of timing and organizations the day was chaotic. We can quickly judge this to be better or worse depending on where we come from. My goal here is not to judge but to learn cross-culturally. It was clear the learning curve would be steep. More to follow later... for now rest, recover, and rounds!

 

Parting Is Such Sweet Sorrow

 This post is intended to be read while the track "Where is My Mind" by the Pixies. If you want to take a second to play it on your streaming app I'll wait :P

Where to begin? Maybe the end – as beginnings always come after endings and hello's always follow the goodbyes. The past two weeks have been a whirlwind of stress and emotions. 

An unexpected opportunity knocked on my door: to return to Tanzania, 10 years later, as a medical students to help set up an research trial that had been paused due to the pandemic. Upon hearing about this internship my mind raced to find all of the things that could and might go wrong. Underneath it all lay a certain feeling of serendipity. I took some time to think about all of the risks and unknowns involved but in my heart I already knew what my answer was.

The study is RSVGoldIII – An ICU network study looking at a common respiratory virus (RSV) in low to middle income countries. My role would be to get the analytical device to the Pediatric ICU at Muhimbili National Hospital in Dar es Salaam and to train and support the staff while starting including patients in this international randomized control trial. 

 Upon meeting the team at Muhimbili it became clear that my feelings and desire to go were justified. A major reason I had selected to join my medical masters program in Utrecht NL was research but also to gain international experience. To be able to return and do both of these things in Tanzania was a golden opportunity. My friends and family sympathized with these feelings and supported my decision to go. Convincing my university to allow such an experience amidst a global pandemic and lockdown in the Netherlands was another story....

 

 

My mind had been made up. 10 years ago I took months to prepare for a similar trip (see http://teachermzungu.blogspot.com/), this time I had two weeks to prepare everything necessary: visa, CV, letters of introduction, training for the RCT, medical donations, technical gear for the wild, medications, vaccinations... the list goes on. I started to sprint.

This brings me to today the day of departure. Everything has been arranged. Somehow I cant help but feel like I've overlooked something. I run down the list of most important items and everything seems to be in order. As I pack up the last couple things my best friend Conor shows up at my door bright and early to wave me off on the trip. And soon after my sisters also stir after having offered to relieve some of my stress by dropping me off at schiphol.

 

 

I say a quick goodbye to Luna. She knows something is up and has been curiously poking around the piles of stuff in my room for the past week. She seems a little upset and doesn't want to say goodbye. I cant leave without giving her a hug so I lure her out from under the couch with some treats and say my goodbyes. I wish there was a way to tell her I will be back. I can only hope she'll understand.

 

 

Before I can blink we are on the road, and in typical Mazur fashion 15-30 minutes later than planned but still on time ;) I still have a lingering feeling like some deus ex machina is going to swipe the entire trip from me but I try to relax as Natalie plays some Afrobeat music and Sophie hands me some snacks that she bought for me for on the airplane <3

Were about halfway to Schiphol when the car starts to act weird and before we know it the engine dies and we pull over to the shoulder on an exit overpass.  As the trucks pass us as highway speeds my stomach drops and I feel sick as I will probably miss my flight. In my mind I say well "we got so close", or "at least we tried". My sisters being the amazing people they are don't waste anytime before calling me an emergency taxi to bridge the remaining distance to the airport. Not the goodbye I was expecting but I gave them each a quick hug transferred my luggage to the taxi and they waved me off from the side of the highway.

 

 30 minutes later I was checked in and through security and sitting at my gate. The airport had an eerie feel. It was mostly filled with dutch people leaving for the dutch antilles. My boeing 747 heading to Dar would have just 40 people on it. But I could finally stop sprinting to catch my breath. All the preparation had led to this moment. The experience was about to begin.