We are a group of seven medical, dentistry and nursing students at the University of Western Ontario, in London, ON Canada. We provide primary health care and education to underpriviliged communities in and around the city of Arusha, Tanzania over the summer.
Memories Back in Canada
Our Tanzanian adventure has officially ended and classes have already begun. Tanzania was such a short time ago but the old familiar life has managed to take hold again. I would like to commit a few more memories to paper before they fade behind the pile of textbooks that await me. For this, I will begin at the end, and the end for me was the foot of Mt. Kilimanjaro. Most of the team took a week or two extra after our work period was over to explore the many landscapes of Tanzania: the lush rainforests, the turquoise water and white sand paradise of Zanzibar, the baobab-studded plains of safari, and the dusty villages of the Maasai. 
A few of us decided that climbing Mt. Kilimanjaro should be the grand finale. Known as the ‘roof of Africa,’ it erupts suddenly from the green terrain of the North with its flattened top and surprising cap of snow. Like a magnet, it attracts tourists and tourist money from all around the world. With its gradual and walkable incline, it is supposedly one of the easier tall mountains to climb. Maybe so, but climbing it was the most physically challenging thing I have ever done in my life. A mountain, whether ‘easier’ or not, is still a mountain and there was 5895 metres of this one that took six days of camping in the cold and dealing with the effects of low oxygen to climb.
I am writing about this not to emphasize how hard it was or even how beautiful the view was every step of the way, but because of what I saw up there that I didn’t expect to see. I thought that climbing the mountain would be like stepping out of Tanzania for a moment; that above the cloud-line there would just be nature and some scattered trekkers from around the world. That was before I realized the small army of porters, cooks and guides necessary to get people up and down this thing. In climbing with them as well as watching them work for those six days, I was able to observe in a more distilled manner what I had been observing for the past seven weeks on level ground. First of all, the hospitality and kindness of the Tanzanians became even more evident to me in our uphill struggle. The support that these men provided got us to the top of that mountain. Our guide made sure that every step of the way we were well hydrated, fed, and not showing any signs of altitude sickness. The porters, in addition to effortlessly carrying all of the equipment, food and water for us, would help us out by carrying our day packs if they saw that we were particularly struggling. On the way down when we were clumsily trying not to fall while willing our legs not to collapse, they would offer their hand to run us down the mountain safely. There was also something very collegial about the atmosphere created by constantly trading smiles, greetings and chit-chat. As on the ground, I felt supported and welcomed even in this remote location.
In addition to unexpectedly seeing this Tanzanian spirit so far above the clouds, I witnessed another reality true to Tanzania: how much hard work is necessary just to survive. For six days as we wheezed and struggled to take painfully slow 
steps reminiscent of an astronaut on the moon, the porters would race by us with heavy packs, tents or even chairs balanced on their heads. On the way down the mountain they would run by us with the same incredible weight on their heads while we gingerly chose each step. As I mentioned, this was the single most physically exhausting thing I have ever done in my life and these men, who carried much more and moved much faster than we did, did it for a living. In many ways it reminded me of scenes I had seen often in Arusha. For example, a young boy pulling a large, weight-laden cart uphill, or perhaps a woman in the middle of nowhere carrying a heavy bundle of sticks on her head to an unimaginably far destination. Simply put, Tanzanians know what it is to work hard, and likely for very modest wages. This reality was just as visible above the clouds and this is something I was not expecting to see. 
Climbing Kilimanjaro was one of the most painful yet one of the most rewarding experiences in my life. More than just a physical or personal challenge to see just what I was made of, it was a journey to observe what Tanzanians were made of and there is an undeniable strength there.
Learning AIDS and Teaching AIDS
In the last half of our program, MedOutreach spent a lot of time working with AIDS organizations or observing AIDS in the hospital setting. We also spent a week in a handful of secondary schools teaching about various health topics that included HIV/AIDS. This gave us a very insightful view of the HIV/AIDS situation in the country.
Compared to my preconceptions, Tanzania has some remarkably advanced programs in place as a response to the epidemic. In Arusha, antiretroviral (ARV) drugs are provided free of charge to anybody who has tested positive and qualifies for treatment, and to prevent mother-to-child transmission. This program has been running for just over a year now. Medicine for many opportunistic infections is also supposed to be provided for free. Various counseling and education programs are available to people. Tanzanian health workers are working very hard to increase knowledge, condom use and decrease misconceptions and stigma. Though some of the initiatives are still in their infancy, much of the framework for fighting HIV/AIDS has been set up in Arusha.
On the other hand, there is still a long way to go in order to adequately respond to the approximated 8.8% adult infection rate in the country. Though ARV’s are theoretically available to everybody, proper medical attention may not be because of too few doctors for too many patients. In particular, many patients go untreated for various opportunistic infections because medical attention is too difficult to attain or the drugs may be out of stock. Also, stigma is still a massive deterrent for people to get tested, treated or even to take appropriate precautions. Stigma scares people away from hospital waiting rooms, it prevents them from using condoms for fear that they would appear as HIV positive, and it keeps families from accepting their loved ones. The result is that many people with HIV do not know that they have it because they are reluctant to get tested. They often do not find out until they wind up in the hospital with the clinical signs of AIDS. The internal medicine wards are filled with such cases. In one visit to the women’s ward at Mt. Meru hospital, I observed that more than half of the inpatients were women newly diagnosed with AIDS. Keeping in mind that from the time of infection with the HIV virus it can take as much as 10 years before the clinical manifestations of AIDS appear, these women had gone a long time without ever having been tested.
Even once people have taken the step to get tested and they have been diagnosed as HIV positive, there seems to be a barrier keeping them from coming into hospitals and clinics for appropriate medical treatment. Perhaps it is still the stigma of appearing publicly to seek treatment for complications of HIV. Perhaps it is the long waiting periods to see a doctor and then to get medication. Or maybe it is that, though ARV’s seem to be readily available, other medications that are supposed to be free are simply not on the shelves and this means that people have to pay out of their own pockets. Many people simply cannot afford to do so. Compounding their already difficult financial situation, some individuals may be facing additional costs due to HIV. Some may have lost their jobs when it was found that they were infected or some may have been forced to quit because of illness. Not to mention that people facing illness may have increased or more strict nutritional demands, and taking ARV’s is known to increase appetite. In addition to medical treatment or medications for opportunistic infections, food was one of the most common requests that we received from HIV/AIDS patients. Programs do exist that address this demand for food. For example, there is a United Nations initiative that provides people with bare necessities like rice and oil approximately once a month. A local group that we worked with called UHAI has a more sustainable project that provides individuals with goats that they can raise themselves. Many international groups similar to MedOutreach also come in and help relieve some of the demand for food. During our time there, we distributed care packages containing items like rice, sugar and vegetables to the Upendo HIV group that we worked with as well as to some individuals being assisted by UHAI. As a group, we agreed that this was a temporary solution to a long-term problem and we will be trying to help the Upendo HIV group put together more sustainable projects that would allow them to have a dependable source of income and food. 
The strength of the barrier that prevents people from getting testing or treatment seems insurmountable at times. The internal medicine wards in the hospital were proof of this, but we were even more shocked by the reluctance of the people who already knew their HIV status. One man in particular provided a dramatic illustration of this barrier. We first met him when we were doing basic medical and dental screenings on the Upendo HIV group (this is the neighbourhood group of 55 HIV positive individuals that was organized for the purpose of mutual support and ease of health care delivery). We were doing so in order to figure out the magnitude of the medical problems not being addressed by the public system and to flag any individuals that required more urgent medical attention. When this man first walked into the exam room, we noticed right away that he was extremely disoriented. He had a fever, chills, decreased consciousness, laboured breathing, a heart beat of over 200, diarrhea, dehydration, a left leg that had swollen twice the size of his other one and the worst ear infection we had ever seen. We sought Dr. Mhando’s assistance immediately and the man was admitted into the hospital for urgent treatment. We learned that he died only a few weeks later. Of course I expected that some people would die of AIDS, but I do not understand why this man who knew his status, was in a support group, was on ARV’s and who at least theoretically had free medical treatment available, could have gotten to such a point without having sought medical help. Whatever that barrier was, it killed him.
This is just an example of why, along with Dr. Mhando, we decided to set up a sort of back-up medical plan in Dr. Mhando’s clinic where we have provided the money and resources for the care of the Upendo HIV group. Hopefully they will come here if they feel that they cannot get the full medical attention they need in the public system or if they want to have a little bit more anonymity than they would have in the busy waiting room of a government hospital. Any treatment that they receive from Dr. Mhando will of course be free of charge to them. We do not know how far the money and resources that we have provided will stretch, but we hope that it can alleviate some of the burden for these individuals.
We also got an opportunity to work with an AIDS organization called the UHAI group. It is a community based organization in Arusha that provides many services to HIV positive individuals including education, treatment, funding for AIDS orphans, and various other financial and social support programs. One of their projects is to visit HIV positive individuals that live in remote areas in their homes and make sure that they have the medical, financial and social tools to deal with their illness. We were lucky enough to have the opportunity to join them for a day for several such visits. Six of us piled in the back of a pickup truck and took a very bumpy and equally dusty ride outside of the city to the hilly area surrounding Ngaramtoni village. The setting was rural but each individual that we visited lived in a unique manner. In our first visit, we arrived at a traditional Maasai hut made of cow dung and sticks. We were met by a skeleton of a woman who greeted us weakly from her bed. She was a 38 year old widow with 7 children. She was one of three wives. Her husband had died of AIDS 6 years ago, and the other two wives followed soon after. On the day that we met this woman, she had not eaten and her ARV’s had run out. She had not gone to get more ARV’s because she could not afford the bus fare to Arusha and back. It would have cost her less than a dollar to do so. Though we had brought care packages to leave with each individual we visited, we suddenly felt how meager the offering was and so we gathered up the money we had in our pockets to give to her as well. It still didn’t seem like enough but we also knew that it wouldn’t take simple money to help this woman.
The stark image that we saw on this first visit was in sharp contrast to some of the other visits. For example, another woman that we went to visit lived in a rented home in the village. She was young, plump, cheerful and in good health. The ARV’s she went on three years ago when she found out her status had improved her health dramatically. The UHAI program additionally provided her with some goats and chickens that helped her maintain herself. The volunteers at UHAI also helped her to deal psychologically with her illness. At the time of our visit she was quite open with disclosing her status. Her neighbours were aware of her situation and they seemed to be quite accepting. The volunteers explained to me that a case such as hers was quite hopeful for reducing stigma in the community because it allowed people to see that there was life after HIV. 
The home visits were extremely educational in terms of showing us a range of ways that people’s lives could be affected by HIV. What we learned from the home visits complemented what we learned from our time working with other organizations, clinics and hospitals. However, our experience of teaching secondary school classes about HIV was educational in a completely different and unexpected manner. It revealed to me the assumptions I had made coming to Tanzania without even realizing it. When you hear that a country has such an alarming number of HIV positive individuals, it is easy to assume that the infrastructure is lacking somewhere along the way in the healthcare and educational systems or that financial or social barriers stand in the way of prevention and treatment. In many ways, some that I have already discussed, this is true. But in many ways, the Tanzanian government and Tanzanians have made incredible progress that it is condescending not to recognize. The free antiretrovirals provided by the government or the programs provided by the UHAI group are just a few examples of this. The education that the new generation is receiving in schools about HIV is undeniably impressive as well. When we went in there, I think most of us expected to be picking up where maybe the school system had dropped the ball or it was just hesitant to approach. But the young audience that we got was a highly educated one with sharp questions that touched on social as well as scientific aspects of HIV/AIDS. At the beginning of the sessions we handed out scraps of paper so that students could ask questions anonymously. What we got back was extremely thoughtful inquiries and comments like this one:
“We know that HIV/AIDS is only educated in towns because we watch the TV. Many people come to us, but how about the villagers who tend to be more affected because of polygamous family. They don’t have even radios. I know you are not our government but please help us.”
Where I think that MedOutreach really helped in the education of these young minds is in providing a judgment-free forum for them to ask any question they wanted to ask. Like any adolescent, they were bound to have questions about sex that they were likely a bit embarrassed to talk about. And in addition to the solid knowledge that they had about HIV/AIDS, there were still some intermingled rumours from unreliable sources that had to be dispelled. For these reasons, I think that teaching HIV/AIDS in the schools, far from being redundant, was a very valuable exercise for both the students and for the MedOutreach team. I will also come away from the experience being reminded that it is important not to make cultural assumptions. This is something I have always known, but it is a mistake that is especially easy to make as an international volunteer; to feel like you are the helper and they are the helped. This is largely a myth. We provide money, resources and a spare set of hands where they are lacking, but that does not mean that Tanzanians have not already put in an incredible amount of hard work into improving the situation in their communities. I am touched by the dedication of the individuals that we worked with while we were in Tanzania and I would like to thank them for allowing us to join them in their efforts for a brief while. 
The education that we have gained from our experiences this summer could not be replaced by any classroom or textbook. As I settle back into Canada and my school routine, I am appreciative of how lucky we are to have had this kind of education.
Olga
Posted by owrezel2009 on September 6, 2006 | Permalink | Comments (0)
long overdue...
So I always knew I was bad at keeping journals but this confirms it. I apologize that this is my first, and probably only entry, however I do share the sentiments of many of the previous entries and I know that others have said it far more eloquently then I could ever have written.
As this trip draws to an end I am
left with a mixture of emotions. I feel joy and thankfulness for the
experiences and people we have met, the learning we have done and what help we
could give. 
I feel proud of the work we have spent so much time on, the love
that we have put into this project and steps we have made for Medoutreach. I
feel humbled by the generosity we have seen here from people that have so
little, and love for all those people that have helped us along the way. I feel
fear for those we are leaving in situations that are less than ideal, for those
that we cannot help and who cannot help themselves. There is excitement for
what the coming years will bring, and what changes that are being made within
Medoutreach for the future. There is also sadness that we are actually finished
- that we have to say goodbye to these people that over such a short time have
touched me more than I even thought imaginable.
I have found myself in tears and in
fits of laughter (don’t worry more laughing than crying) all throughout the
trip however this week has been especially bad for ups and downs. Although I
have enjoyed all of the things we have done in the last 7 weeks I think that
the things that have touched me most are the groups that we have done
screenings for and provided some medical care. Our work with 
Upendo HIV group
has given me a small glimpse of a life that I can barely fathom. I see such
hope in their eyes even though there seems like there should be no reason to
hope, and I see happiness when it seems there is only loss. They are an
inspiring group who has impressed me time and time again. They have so little,
and are so thankful for the small amount we have done. I wish there was more we
could do. I feel so inadequate sometimes – that we are here and although the
work we do is helpful, I cannot help but feel they deserve so much more. The
stigma of HIV resonates everywhere in
The other place that has touched me
probably most deeply in my time here is our work at CCF. Even now as I write
tears come to my eyes when I think about how I am going to have to say goodbye
to these boys in only a few days. From the first day I got there I knew that I
would grow to love this place and since then I have spent not only our working
time there but most weekends and spare time I have had. The 29 boys at Maji ya
Chai have found a place in my heart
and they will stay there forever. After all
my time there I still find it hard to imagine what some of these kids have had
to go through. In hearing each of their stories my heart breaks over and over
again at the pain they have endured, the love that has been deprived from then
and unfair circumstances life has given them. When you hear why they left home
– their mom could not support all 8 children so he left to lighten the burden,
he was beaten by his father, he was abandoned when his mother remarried, etc –
it really makes you ask why the 8 or 10 or 12 year old boy is the one who suffers.
However despite all their hardships, these children are the people that have
made me laugh the most and the ones that have reminded me to stop and enjoy the
moment. There is a refreshing desire to learn, to love and to play in each of
them that make me smile and I wish that I could give them all the things that
they desire.
As a final note I want to say thank you to everyone at home who has supported us throughout our journey and also say a special thanks to those here who have been key in our work. Throughout the summer I have seen so much passion from all of this year’s members – each of us in our own area and each with our own ideas – and I’m eager to see where next year will bring our program.
Anyway that is a few of my thoughts
for the trip. I’m sorry that this is so long overdue!
Melissa
Posted by mymchan on August 3, 2006 | Permalink | Comments (0)
Jess-isms
I cannot offer much more insight into the overall framework of what we have been doing here as Olga and Dave have so eloquently done in their last two posts; what I can offer here are some reflections from Jess on our time here. Three weeks from today our project time here in Tanzania
Scholarships, screening, streetkids + selfishness?
Scholarships:
One initiative that MedOutreach has been continuing with over the past couple years has been secondary school teaching and an ever-expanding scholarship program. Through money raised in Canada MO is able to send a student to secondary school for 50 dollars a year… for 4 years it costs about 200,000 shillingi to cover the expenses of tuition, books, and the lunch program. With a conversion close to about 1000 shillingi to 1 dollar it is pretty humbling to realize that there are many children that don’t continue on with their schooling because they cannot afford to after primary school. Beyond that, many attend secondary school but do not eat at home given the expenses incurred. The students we were able to meet were so thankful for their opportunity to study but obviously the meeting was more for us than for the students who seemed mortally embarrassedJ I am waiting with anticipation for our teaching sessions to start tomorrow at local secondary schools, as we pull together our teaching resources the night before the excitement is building! This is one area of our work here that I am looking forward to and have been able to learn a lot from the teachers I have been talking with so far.
One school really made me stop dead in my tracks, nestled amidst honestly a garbage dump. I first arrived at this school at recess time with honestly over 600 students playing outside, kicking around litter, sublimely unaware but aware all at the same time. How easily I see our weekly food expenditure here or how much we pay for photocopies of our medical charts or other administrivia and can’t help but feel remarkably guilty. With every street corner there is a new request for money or your business to buy a certain souvenir or handicraft; if only I could respond to each demand, or any one without opening floodgates. Sometimes it makes me wonder if I’m too selfish to just give of myself, not caring what repercussions I will get from others in need… I want those of you back home reading this to know that your donations and support have been invaluable, because I truly this week have had the work of MedOutreach affirmed in the scholarship students I have met and the thankful medical patients that receive treatment due to your generous assistance!
Upendo screenings:
As the weeks have rolled by I can say on behalf of the medical students we have mastered the art of the physical exam in Kiswahili and have really seen the face of HIV and the reality of how it is to live with it. Living seems to be the imperative word; many of whom with the disease seem so at peace with it and have such a great faith despite their poor follow-up care for opportunistic infections. In some cases it makes you wonder what has kept some patients from not pounding down a doctor’s door for some of the ailments they presented to us with. Then you see the government hospitals. With some hospital beds with more than 2 people sharing you realize why. I have also come to hear the stigma and fear many hold for presenting themselves to a clinic and being shepherded into the HIV ward where your status is shouted from the rooftop from the entry doors of the hospital. Inspirational and heartbreaking accounts have inspired our team to address their treatment for opportunistic infections. The Tanzanian government provides free anti-retrovirals but we are hoping to provide centered care that would give HIV patients a more tangible access to opportunistic infection medications. Honestly, there are several programs in place but their shelves are often bare or consist of one general anti-fungal to cover everything. We are working on putting together teaching sessions for some local HIV support groups that will also have care packages put together for their monthly food to help with their increased appetite on ARVs and nutrition needs to keep their bodies strong. There is a lot of enthusiasm our group brings to this project and I hope it to be something that future teams can help build up as a sustainable support that enables local HIV patients to sell their handicraft, raise their own food etc.
Streetkids = sweet kids:
As my time passes here I fall more and more in love with Children for Children’s Future here in Arusha and the residential home in Maji yachai. If there is one thing that has been a hardship it has been seeing an organization with such an amazing goal to pull kids off the street and help them thrive to be riddled by dirty politics. Due to past management indiscretion the financial situation there really has hit the children the hardest. With no shoes to go to school, and often no food for several days you see need with these kids. But more than that you see a resilience of spirit that is unlike anything I have ever seen before. On the streets of Arusha we see streetkids whose eyes look so sullen and dead to the world, they don’t seem like children and it can make you shudder… at CCF after being recruited off the streets and shown another option these children have been given back the gift of childhood.
After doing screenings on these children, doing wound dressings for typical tree climbing childhood accidents, and ample afterhours of dancing, football, coloring I can say that these children have engrained themselves in my heart to a level I could never have imagined here. With every spare moment I find myself wanting to spend more time and getting more to the root of how we can help CCF even when we are back in Canada
As I sat in church this morning with a group of the kids from the Arusha center, one child was singing and clapping to himself as the beautiful African choir sang their 4 part harmony and others strolled by the tented area in anticipation of the next service I could not help but feel such hope for the children I was with. Their eyes were lit up with excitement that I have no doubt can be attributed to their strength of character and potential. It can often make one stop and wonder, if only this child was in Canada
In the next weeks as we wrap up our time here I hope we can wrap up some loose ends for these kids like where we can find glasses to help them from having killer headaches and follow up for their dental work if they are dealing with pain… Also, we are hoping to work in a First Aid workshop for Maji yachai. Being out of town and having no money to employ a nurse matron to care for simple wounds, infections abound there. The older kids have been so keen to help us with our work there that our plan is to enable to care for each other. It is extremely beautiful the sense of community there and their natural tendency to lift each other up that I find myself going back there every spare moment I get. Although at times they have little there, they have the warmest hearts and most welcoming arms I could have ever dreamed of encountering.
Thank you for the blessing of being a part of this, and I hope I can do you proud!
Posted by jessicawylie on July 24, 2006 | Permalink | Comments (1)
Nkoaranga village
This last week was our first taste of rural
As for the rest of us, we took the forty
minute drive to Nkoaranga on last Monday morning. It is a small village that
rests on the volcanic slopes of 
scenery. The village is more lush and tropical than Arusha and
gives off a rainforest vibe (as the picture shows, taken near the village).
Thankfully, the air is much cleaner than the city
where the street smog made it difficult to walk around. Coffee and maize seem
to be the major crops of the area which grow well considering the rich soil.
It is in this setting where we found
In addition to the medical facilities,
there is also an orphanage on the hospital grounds. This is a place for kids up
to age 5. These kids may have had their mothers die during delivery or simply
abandon them so the hospital gives them a place to stay until they can go to
school. These children are very needy and starved for attention as we found out
on our tour. Within the first few minutes, children were clamouring around us
to be picked up and held. It was a little bit of a surprise but something we
got used to quickly. We all spent time there through out the week but I think
Melissa was there every day playing and laughing with the kids. She definitely
enjoyed their smiling faces
although it meant getting a little dirty as well. Here you can see one of the little guys.
The rest of our time was spent working with and following the medical/nursing staff of the hospital which was different from our previous two weeks of health assessments. We followed Dr. Mbise, Dr. Sam, and Dr. Julius through their daily rounds and got a feel for African medicine (Leyla got a feel for African nursing). The differences can be huge like using only local anaesthetic for a tubal ligation and swatting fruit flies away during minor surgery. Although this may seem improper, the staff does the best they can with the resources available and provide the best possible care to patients. We saw many interesting cases including a severe case of malaria resulting in a semi-conscious patient, a protein-deficient child, and a patient with abdominal metastasis. The three of us also saw the live birth of a healthy baby boy.
During our time in the village, a team of German surgeons arrived for a three week work term. The team comes every year from the Nuremburg area and provides free, specialized surgery to Tanzanians. As we did earlier in the week, the team introduced themselves at the Wednesday morning chapel. They began their assessments that day and began surgery on Friday. Melissa and I were fortunate to spend all of Friday with them and see three surgeries, two orthopaedic and one skin graft. The skin graft was especially interesting as the patient had been living with a terrible burn across the abdomen and right arm for several months. The plastic surgeon, Dr. Peter, was able to successfully graft skin from the thigh and cover the affected areas. While healing will take a while, I am confident that this surgery saved the patient from much more agony and possible infection. The whole team was very friendly and allowed us to learn a lot from their experience and expertise.
So such was our time at Nkoaranga. It was
more of a learning week but these are experiences we will take back to 
Posted by DavidDudok on July 14, 2006 | Permalink | Comments (12)
Our new home
Three weeks have passed already and I feel like we just got here yesterday, yet at the same time it feels like we’ve been here for months. I’ve noticed that everyone on the team has started to refer to Sister Sophina’s as “home.” Testament perhaps to the hospitality of our generous hosts here at the hostel as well as Tanzanians. People here always seem to take the time to stop and chat with you. Smiles and small talk are more important than rushing through your day - pleasantries have never been so pleasant. And though our rudimentary Swahili seems to be laughter-inducing in those who are subjected to it, most people are extremely patient and willing to help us stumble through it.
The things that I have seen here in this short time have been incredible and there is so much to say but it feels like there is a lack of words to say it. I wish my eyes were cameras, though I am trying my best with my more bulky digital version. In a few words (or paragraphs, more likely), everywhere I look, Tanzania is bustling with life. It seems that plants, animals and people are growing out of every pore of the earth. The flowers here belong to made-up planets from science fiction novels and I’m positive that seeing them would make my mother think she had gone to gardener’s heaven. The multiple layers of fabrics that people drape themselves with are folk art collages. I never know where to look because everywhere is so beautiful and everywhere is a story. From the barefoot kids rolling heavy carts behind them down the street to the women carrying gigantic bags of rice on their heads (gracefully as well as sweatlessly), each is a snapshot of a life completely different from anything I have known.
As for our work here, it is interesting and there is a lot of it. I have been surprised by the things that have brought me joy and the things that have been most difficult. To keep this weblog less than novel-sized, perhaps for now I will just share a few things that have struck me most at the various organizations we have worked with:
CCF Arusha – This is the temporary home for street youth in Arusha where they are provided food, shelter, clothes and an opportunity to get off the streets and return to school or receive vocational training. We did medical and dental screenings here on the kids in the first week and will return in a few weeks time to continue our work. This was the first project we started and our introduction to the realities of Tanzania. Most of these children have lived lives that no child should have to. They have been physically, mentally or sexually abused. Many have known what it is like to starve and to beg and have been lured into various combinations of substance abuse. And as hard as street life can be, most choose it because it is better than what was at home.
When we arrived there, I expected the atmosphere to be more sombre, but amongst the dusty faces were smiles and a willingness to welcome us to their makeshift home. In between the medical and dental screens, we played games of soccer, cards or got Swahili lessons from them. I was really impressed by their openness, but also by how much they all supported each other, with the older kids taking care of the younger kids.
One child that struck me in particular was a very sad little boy that was sitting on his own and not taking part in the other kids’ activities. When we did the medical exam on him, not only did he appear completely depressed, but we found he had a myriad of health problems. The dental exam was similar and the dental students decided that they had to take him, along with some others, to the dental clinic the following morning to get some of his teeth extracted. The next day, when they returned from the dental clinic, it was as if they had brought back another little kid. He came back grinning and joined all the other kids in their play. The dental students told me later that on the dala dala (local bus) ride home, he and the other children made a protective circle around them and insisted on holding their heavy bags loaded with dental equipment. This particular little boy proudly carried the heaviest bag for them. When we left to go back home that day, he ran out to the front of the building waving and smiling until our taxi was out of his sight. It was extremely touching to see the dramatic change in affect that we saw in this little boy. Though we knew that not every problem could be fixed so easily in our short stay here, it was incredibly encouraging to know that something could be done to help.
CCF Maji Ya Chai – 
This is the more permanent, out of town centre for street kids that have shown a certain responsibility and desire to improve their lives at the Arusha Centre. Half of our group spent the last week here along with the Upendo Leprosy Home. We also decided to do medical and dental screens here. What was most striking here was the incredible environment that was completely different from the CCF centre in town. This is a generous piece of farmland with lots of space for children, cows and dogs to roam. Instead of concrete it has green grass for a floor and Mt. Meru and Kilimanjaro for walls. Aside from the natural beauty of the place, there is the atmosphere of mutual support among the kids. And the individuals here who help run the centre are volunteers and act as teachers and role models to the kids. They also took the time to act as personal guides and translators for us during our visit. To say the least, we were pleasantly overwhelmed.
The other side of the story is that though this seemingly wonderful haven exists for the kids, the centre seems to be barely holding itself together. Often, there is no food and the kids return to the streets because they can at least find something to sustain themselves there. The day we arrived, there were very few kids around precisely for that reason - they had run out of food the previous day. Luckily, they received donations the following day for the rest of the week. However, even when there is food, it tends to be starch laden and vitamin poor. Though MedOutreach traditionally waits to give donations until the end of the trip when we can more fairly judge where the resources we have should go, we decided to bring in some fruit and more varied foods throughout the week. Sadly, these meagre donations are a far cry from helping the centre become financially stable and self-reliant.
Upendo HIV/AIDS group – This is a group of 55 HIV positive individuals that was organized for the purpose of mutual support as well as ease of health care delivery in that particular neighbourhood. When we first met with them on the second week of our stay, they were all seated on a sunny hill, waiting somewhat apprehensively to greet us. As we introduced ourselves and gradually explained that we were basically there to figure out how we could best help them, the group slowly warmed to us. We decided that we could offer them medical and dental screens to try to pick up where the government left off – though they have access to free antiretrovirals, the story of medicine for opportunistic infections is a little bit different. Throughout the week that we did the screenings, we learned some incredible stories from this highly marginalized group of people. Many had lost their families, whether due to an AIDS-related death or because they had been shunned. Many were still the sole source of financial support for their children, though they had no source of money themselves. Food was often a greater issue than the illness itself, and frequently it came before healthcare. One woman that was screened even had a deformed arm from an old fracture of her humerus - she had not been able to afford the open reduction surgery which would have costed her about $40 US, and it had long since healed improperly. Our screens in these individuals revealed many issues worthy of medical attention and there is still much left to do in order for us to help them as we would like to.
Upendo Leprosy Centre – this centre is based outside of town around the corner from CCF Maji Ya Chai. The group that spent time at CCF this past
week split their time between CCF and the Leprosy Centre. In a few words, the centre is impressive. It is essentially a self-reliant farm that happens to be a residence for leprosy patients and their families. Since leprosy is rare to come across in Canada, we found ourselves learning a lot about the illness from both the residents and the health officer there, Elisante Simon Kaaya. Leprosy is essentially an illness of the past. These days, it is easily caught and cured, not to mention that transmission of the disease is extremely low. However, once neurological and certain tissue damage has occurred, it cannot be reversed. The residents at Upendo are individuals who received treatment too late to reverse the effects of the disease. Most had limb amputations and severe vision impairment for which little could be done. Admittedly, at the beginning of our time here, I felt somewhat helpless and the medical screens seemed more like confirmations than discoveries we could help with. But slowly, as I realized that this was a valuable learning experience for us, I began to look at my surroundings in a different light. Then I saw that though many of the patients sat confined to their wheelchairs, the children at the centre would run and play around them and if they fell, they would come running to be comforted by these communal grandparents. One man even got up with his oversized crutches and started shaking them in the air, dancing and asking us to take his picture, just to make all the children and residents laugh. In the same courtyard, one of the younger adults would work an ancient loom, weaving beautiful fabrics that would be sold to help sustain the centre. Just outside, others would be collecting eggs from the chickens, milking the cows or planting vegetables in the garden. Soon, we began to focus on helping with dressing changes for wounds, doing more targeted exams on anybody who approached us with a problem, and of course, playing with the adorable children. The Upendo Leprosy Centre was probably the biggest surprise for me in terms of what I expected to see there.
Last but not least, Dr. Mhando’s Inpatient and Outpatient Clinics – Basically, without Dr. Mhando, there would be no MedOutreach. He is our contact in Tanzania who donates incredible amounts of time to our various projects and takes us into his clinics to educate us about his work. I also have to acknowledge Sister Kupaza, the Nurse Officer behind the scenes that helps run everything and has been a wonderful help and translator several times for us. The rest of Dr. Mhando’s staff have been equally amazing in helping us, from the drivers that have helped us find our way around Arusha and the various organizations we work with, to the clinical officers who share their expertise with us. I’m very thankful that there is such a group of individuals willing to help us.
I guess that’s it for this weblog entry (or should I say novel after all). Thanks to everyone who is following our experiences in Tanzania.
Olga
Posted by owrezel2009 on July 7, 2006 | Permalink | Comments (3)
The dentists
The past week has been really busy for everyone. From the dentists’ perspective, we have learned a tremendous amount performing screenings on the Upendo HIV group of 55 and carrying out dental extraction surgery on a variety of patients. The extractions have been mostly on the CCF Arusha children, but also on Dr. Tekle’s (a local dentist) patients.
I don’t really know what week of the trip it is, but either way the next two weeks are shaping up to be really exciting.
We just came back from the Children’s for Children’s Future (CCF) camp in the region of Maji Ya Chai. Of note, CCF Arusha is the downtown equivalent of CCF Maji Ya Chai and was one of our first missions two weeks back.
Our method of transport was in a relatively nice car that just barely fit our group of five. In addition, the car had no business being on the road that accessed the CCF camp. A Range Rover, or perhaps, a hummer would have been ideal to traverse the rocky 10 km path (NOT road). Since idealism was long evacuated from our vocabulary, we’ve decided to use the same form of transport to reach CCF Maji Ya Chai tomorrow (July 4).
As an aside, the CCF organization is a valuable and essential tool in aiding people in developing themselves, in theory. It facilitates the development of “street kids” that would otherwise not have much of a future. However, in practice, a contradictory tale is evolving. We are finding ourselves consistently going back and forth during nightly group meetings attempting to elucidate what exactly about the CCF organization is awry. I leave this topic alone for now until we have a better handle on how to tackle the challenges we face in providing aid to the children of CCF.
Today, Jessica, Olga, and Emily performed medical screenings on CCF Maji Ya Chai children while Yasmin and Ramez performed dental screenings. The soccer ball, colouring markers, and paper were a big hit with the 13 or so children at the camp. In the afternoon Yasmin and Ramez (and the rest of the group) performed extraction procedures using instruments and medications donating by Londoners and UWO dental clinic. The kids were very happy!
As for the dentists, we will continue to apply and enhance our UWO dental education to perform dental extractions on the Upendo HIV patients and CCF children.
Posted by Ramez Salti on July 3, 2006 | Permalink | Comments (8)
Greetings from Tanzania!
Hi this is my first post and I apologize for waiting so long to do it but if you see how little I keep up with writing in my journal you would understand. As Dave has already mentioned we've hit the ground running and as of today we will have finshed giving full medical and dental screenings to 23 children at the CCF home for street kids and 55 for the UPENDO HIV group. Although the experince has been great thus far it can at times live me mentally exhausted. The need here is so great but there is such a frustration in logistics and getting the help to where it is most useful. That is why we have agreed to wait until closer to the end before we give out donations that were given to us so generously. At times I personally get confused because they call Nurses sisters here and they call me sister for the fact that I'm black so when someone says sister I don't if they need a nurse or just want to make conversations. It has made for many awkard moments. On a more cultural note the city is cought up in world cup fever and there was nothing better than watching the kids at CCF celebrate Ghana's win against the US. I think i'm going on a little too long plus I have 1 minute left on internet time but just to finish up I would like to thank the MEDOUTREACH group whose individual personalities have made them my family away from home.
Thank-you,
Leyla
Posted by Leyla Suleiman on June 30, 2006 | Permalink | Comments (0)
The Work Begins
Habari (how's it going) everyone. After acclimatizing ourselves to the local surroundings, we we're able to get our work underway the last two days. On Wednesday we met with the Upendo (Love) HIV/AIDS support group in Arusha. It is a group of 55 people who meet every week to share and help each other with their various problems. They are based out of a Roman Catholic church which we traveled to in the morning. At first, the group members seemed a little reserved, but as our discussion and conversation with them continued they began smiling and laughing with us. We had thought that our purpose that day was to arrange physical screenings for them but the meeting evolved into much more. We were able to educate them on complications and transmission of HIV (through an interpretator of course, give us a few more weeks to learn :) ) as well as answer a myriad of questions ranging from "How does HIV go from person-to-person?" to "Why is the HIV problem so much worse in Africa?" I believe all our group members were deeply impacted by the strength and resolve of these people considering the trials and tribulations many of them have been through. At the end, we were able to arrange physical screenings for them next week. Here is a 
picture of us with the group.
Later that day we went to CCF (Children for Children's Future) Arusha. We have had a relationship with them for many years through Dr. Mhando. This is a place for street kids, orphans, and abused/poverty stricken children. The children are asked or brought in to the centre and stay here 4-6 months. If they show good behaviour (no drinking, smoking, swearing, daily chores etc...) they are then transferred to the larger CCF centre outside of town. These kids have had difficult pasts and many have been physically or sexually abused. We met with the director, Ndonde, and discussed some of the problems with the children and the center. The place relies on generous contributions from outside sources and does not have established funding thus there is a constant need. We decided to begin helping out by doing full medical, dental, and nursing screenings on these kids. Yesterday these were started and the amount of problems we have seen already is huge. Almost all of the children have cavities, some of the kids have 3 or 4 medical problems that on their own would receive immediate medical attention in Canada, and the family/social histories dispose them to many problems in the future. Hopefully our screenings will be able to uncover more and allow us to send them for proper treatment. Today, we will be going back to do more screenings.
However, despite these problems we found the kids and staff very friendly and inviting. Some of us played soccer with them, taught them some English as well as learned some Swahili from them, and just generally had fun being with them. Wherever you go, kids are kids and we saw that through them. On a sidenote, the whole center went crazy (as well as the rest of Arusha) when Ghana beat the US 2-1 in the World Cup. If we've found out anything about Tanzania in the past week, it's that soccer (soka) is king. I have attached a some photos of the dental screenings at CCF, us in our tra
nsportation 
(Dr. Mhando's van) 
and the street by Dr. Mhando's house. Take care all.
Posted by DavidDudok on June 23, 2006 | Permalink | Comments (0)
We've Arrived
Hello from Tanzania everyone. We officially arrived yesterday in Arusha and began our time in Africa. I"m not sure if it was the lush vegetation, cool mist, or flowing grasslands, but it definitely felt different when we stepped off the plane; different in a good way that is. 
Upon arrival, we were greeted by Dr. Mhando's son Thomas, Amani his driver, and Baltazar. Unlike previous teams, we did not have much hassle at the border and got almost all our supplies through save a few boxes of sutures. We took the 45 minute drive into town and soaked up the surrounding countryside. Afterwards, we met with Dr. Mhando at his house and enjoyed some tea and conversation. Everyone was very welcoming and made us feel at ease. We then made our way to Sister Sophina's, our home for 7 weeks. The accomdations are comfortable although definitely a change from our Western lifestyle as you can see with Ramez behind a mosquito net. 
Today we are orientating ourselves around the city and getting a
feel of the culture. Personally, I have the found the lifestyle similar to my family's native Serbia and thus has made the transition easier. Tomorrow we meet with Dr. Mhando to begin our program and start the work we came to do. I'm sure we will have many more stories and posts as the weeks progress. Tutaonana (goodbye) for now.
Posted by DavidDudok on June 19, 2006 | Permalink | Comments (1)
Leaving Soon
Today was the last official day of classes for the MedOutreach team. After months of planning, fundraising, and anticipation, we are finally close to departure. We leave this Wednesday for a short stopover in London and then direct to Arusha, Tanzania where our 7-week work term will commence. Contacts and all the necessary arrangements have been made in Tanzania. We are all very excited to get going and start doing the work that many of you have been sponsoring all year. Also, we've had many supplies and items donated from antibiotics to hand-made dolls. All of these things will be put to good use and allow us to have an even greater impact. Thanks again to all our supporters (we're very close to our $50000 goal) and keep checking the weblog as periodic updates from different team members will be posted all summer. Feel free to post comments and let us know your thoughts on the project. Asante sana!
Posted by DavidDudok on June 10, 2006 | Permalink | Comments (0)
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