Day 14- Heri Ya Krismas

Sun 25th Dec 2011

Today is Christmas! Another year away from the gorgeous family...away from the routine of getting up, opening pressies and then going to Nonna's and Babcia's house for the best meals ever! As much as I miss it...experiencing a traditional Christmas in Africa is a once in a lifetime opportunity. Don't worry gorgeous family, I'll be home next Christmas.

After waking up without that damn rooster crowing...I can only assume it had been killed and cooked. What a great morning! But unfortunately for us...we had no food in the house. Only milk and the Swedish girls cornflakes.

The Sweeds and Dutchies went off to a local Xmas party (yes, we were specifically rejected from their exclusive invite list)...we decided to have a traditional African Xmas, starting with a church service. 500 Tanzanians and 2 Australians filled the pews of the massive church. The 3 hour long service, completely in Kiswahili was entertaining. Lots of singing and over 3 collections for donations. There were no Xmas hymns and no communion...I was dying for some breakie but I guess not this morning.

So after church we had a great Xmas lunch at the hospital with the locals...yes for only $1. I'm starting to love this pilau...which is just rice, meat and spinach. After the hearty meal we set out on the dalla dalla for this resort close to Machame- the Protea Hotel. It was recommended by Mr Mushi...and this place was amazing. A massive swimming pool, live band, and a bar made of straw! We laid by the pool for several hours before retreating into the African style hut to have Xmas dinner...surf and turf with salad (which I was not going to eat). Although I do feel bad about wasting food in Africa.

Today was such a great day to spend Xmas...nice and relaxing. Even though we are without family...we are in great company. Oh and our families did call today which is nice. I guess you don't have to be on an exclusive Swedish guest list to have a great African Xmas.

As we have already mentions, we are picking up heaps of Kiswahili. Really all we know is how to great someone. When we say 'hujumbo', 'habari', or 'mumbo' (all of these mean 'how's it going')...everyone thinks we speak really good Kiswahili. The only problem is when they start asking us questions...we just say asante (thankyou) and walk away. A polite way of saying 'hello' to an older person is 'shikamoo'. This actually means 'I'm at your feet' ...or 'I'm below you'. The reply is 'marahaba', which means 'you may come up'. When we say this to people their eyes light up...because they don't expect a foreigner to know the phrase. I guess we have the Sweeds to thank for that!

After an amazing dinner, we waited about 30 mins for the dalla dalla...but because they were all full, no one would pick us up. We did have a few conversations in Kiswahili with the locals.

We spent the rest of the night avoiding Yatzee...by far the worst thing ever invented. After an hour of sitting, staring blankly at the wall, we succumbed to the temptation and played one game. As always, I lost!

What an amazing Xmas!

Heri ya Krismas (Merry Christmas)

Justin

PS- Michael particularly enjoyed the amazing Lionel Ritchie covers played by the band. I hated it.

We're Going on Safari

I had the privilege of spending a few days on safari in some of the world's best national parks- Lake Manyara, Ngorongoro Crater, Mto wa Mbu and of course the Serengeti.

Planning on meeting my tour a day late, I travelled to the Arusha Snake Park. I got there at 1pm as my tour was arriving around 3pm. I got an awesome burger for only $1.7. As my tour arrived around 7pm...I had a long wait. Luckily the bar had everything I needed, lots of beer and tourists.

I met some amazing people while waiting at the bar...and they bought me heaps of Safari lager. The beer here is great and dirt cheap...as in $2 a pint! Even Guinness is $2!

After way too much to drink, I went to meet my tour and put up my tent. The gang was made up of 7 other Australians and an Egyptian. They were all so much older than me, had jobs and families. I felt really out of place- but over the week we had all become besties (sorry Dana).

I woke up at 6:30am after a terrible night sleep in a tent, on top of a rock. We packed up and headed to Mto wa Mbu (means river of mosquitoes in Kiswahili)....and yes I got heaps of mozzie bites. On the way to the mosquito infested valley, we stopped off at St Judes School. St Judes is a school for poor and extremely clever children. Set up by an Australian, Gemma started with only 3 students in 1997 and now the school educates over 1500 students. Every year, 4000 students apply, sit an exam, and depending on the result of their exam will be invited for an interview. Because one of the criteria for entry is extreme poverty, the school goes out to the homes and determines if the child really is poor, or if the parents are faking. They even go around the village and ask the locals if the parents have jobs (as the parents have to be unemployed) and if the house they live in is really theirs. As only 250 students are accepted every year- it is tough competition. The reason the school is so strict about the child's socioeconomic status is because St Judes is one of the best schools in Tanzania, it's completely free, and lots of well-to-do families lie about their income.

We then travelled west to Mto wa Mbu, which is close to Lake Manyara. I went on a walking tour of the village- and just as I expected lots of mud huts, people carrying stuff on their head and banana trees. I also tried the local speciality banana beer. It tasted amazing but unfortunately I can't take any home with me. I also stumbled across a shop which sold Tanzanites...sorry Mum they were too expensive!

The next day we packed up our tents, bags and cameras and headed off to the Serengeti. As we were driving, Africa by Toto came on the radio. The entire tour group were ecstatic, making heaps of ironic references of listening to Africa while in the Serengeti- yes I got it the first time.

We stopped for a short lunch break just outside the national park. Our tour guide warned us that baboons run amuck around this area so we all closed our windows. A troop of baboons entertained us during our short stay, by climbing inside an American's car and stealing their food. Unfortunately the dad and children were still in the car, so the mother thought a good way to get the baboon out of the car would be to close the door and bang over the windows and roof. Ah that rabid baboon went nuts! Luckily a person who was not mental-not-normal opened the door and let the baboon out. I guess that's Tanzanian baboon 1: US tourists 0

Driving into the Serengeti was breathtaking- I watched the sun set over the savannahs, filled with animals amongst a bonfire with so many rafikis (friends). We did also go on a game drive...and I saw the big 5 (leopard, lion, elephant, rhino and buffalo...I think). Over the 3 days in the Serengeti I saw 4 leopards, about 20 lions and cubs, a cheetah, heaps of zebras, giraffes, camels, wildebeests, elephants, pumbaas, flamingos, rhinos, buffalo, hyenas, and so many impalas. We also got to see the Tanzanian president! Pumbaa means foolish in Kiswahili- in fact the wild pumbaa is pretty stupid. When it gets chased by a lion...It will run 50 meters, forget why it's running and eat some grass. The lion will then have his lunch!

The Serengeti is filled with animals, and we spent hours on game drives. Surprisingly I managed to get mobile coverage out in the Serengeti on my new phone with Airtel. I couldn't even get coverage in the most built up national park, the Flinders Rangers with Optus. Damn Optus!

On my first night in the Serengeti, I was awoken by a herd of giraffes. One of the tour members got his camera out and chased after them. Little did he know that the kick of this giant feline could kill a lion. All the animals seem to come out at night- I woke up so many times by the sound of an elephant, roar of a lion, or loud American tourists.

We then again packed up our stuff and headed to Ngorongoro crater. On our way we stopped off at a Maasai village. After a good old dance with the locals, we were shown around their village. A fun fact for the day- their diet consists of cows meat, cows milk, and cows blood. No fruit or veges. I guess this is pretty much what my brother eats...so he would fit right in.

When we got to the crater we set up camp again. There was a man with a massive semi- automatic walking around the camp site. Our tour guide told us he was there to protect us against animals. Apparently 2 nights ago, a pride of 10 lions were hunting wildebeests at the campsite. After an amazing pasta dinner that my Nonna would be proud of, I went back to my tent freaked out! Fortunately lions didn't kill anyone tonight, but I did wake up to several elephants outside my tent. Our tour guide told everyone to stay in their tents. I laid awake for hours, hoping the elephants did not step on my head and kill me....but I could hear them walking within centimetres from my head. I guess next time I go on a camping safari I probably shouldn't keep food in my tent.

So if you meet a lion in the wild what would you do? Well apparently 2 important things. Firstly always make eye contact. Secondly you need to stay still and not run. The lion should back off. But if this doesn't work and the lion attacks you...play dead and protect your neck and maybe you will survive. Otherwise you can pull some jpat taekwondo moves out!

The next day we travelled the long journey back to Arusha- and so my safari adventure came to an end. The 9 of us spent the night at the Maasai camp in Arusha, had a few celebratory drinks and played some pool. It was a great way to end such an amazing safari. I was not expecting anything like this at all. I thought it would be like Ace Ventura...as in a rhino gives birth to a human like Jim Carey.

When I got back the Swedish girls commented on my tan I somehow managed to get while on safari. But after a long awaited shower, the brown pigmentation covering my skin turned out to be dirt. I was pleased however to get back into a bed...even if it was built for a short Chinese female.

Justin

PS- I know this is a long blog...but I spent less time writing it than Michael did reading an email from Ally.

Day 12 - Nakwenda kula mbuzi

Fri 23rd Dec 2011

Okay, so today ended up being absolutely incredible!

It all started inauspiciously with chapel as usual, but this time they had a full Eucharist for the first time we've been here. The most unique thing about this service was that after blessing the wine, they poured it into what could only be described as stainless steel shot glasses and then handed them around after the wafer. It was most unusual to see everyone gathered around the altar downing shots. It felt a little inappropriate for a church, but I guess that's communion Tanzanian style!

It seems like today was brought to you by the word 'church', because the next stop for the morning was down to the big parish Church for another service. All the young Lutherans from Machame who are going for confirmation get confirmed on one day each year at a big service and today was the day! Mr Mushi had invited us to come as his guests to the church, because his two nephews (George and Calvin) were getting confirmed. This was quite an honour, so of course I said yes.

Unfortunately, what I didn't realise was that there were 163 other children who also had to get confirmed today as well. They had to use four priests and an assistant bishop just to get through all the laying on of hands. It was the longest church service I've ever been two, lasting at just over three hours. Worse, it was all in Kiswahili and I only understood about 10 words, most of which were 'amen' and 'hallelujah'. The hour-long sermon was probably the low point. Plus, I got lots of weird looks as I was the only mzungu (white person) in the whole church.

Thankfully, going to the service was quite an awesome musical experience. If we thought the chapel singing was impressive, this was something else! There was an organ, keyboard, guitars, brass band and many choirs, all used at different points in the service. There was also much clapping and cheering and general joviality. Tanzanian women have this unique way of cheering, as they make this 'ololololololo' noise, which reminds me a lot of the sound that American Indians make when about to launch war on the cowboys. It's hard to describe, but certainly sounds impressive when about 500 women are doing this at once!

The service finished about midday, but what I didn't realise was that things had barely begun! Over here, confirmations are treated with the same importance as weddings, so we now had to head to the reception! We did this by driving through the streets of Machame in a massive convoy, with horns blaring and loud music playing. People were dancing on the back of moving utes, which looked fun (although probably showed exactly why so many orthopaedic surgeons are employed up here). Being the guest of Mr Mushi had its extra benefits, as he is a highly respected elder here at the village and church. I rode in the front seat of his car at the head of the convoy and he really got into the spirit of horn honking. It was quite amazing to hear the type of tunes he could coax from a solitary, highly irritating note. It seems there are no bounds to this great man's talents.

So we drove like this all the way to Mr Mushi's brother's house, where a huge party and banquet had been set up for the two boys. The front yard was full of tables and chairs, all facing a kind of stage where George and Calvin sat as the guests of honour. I was lucky enough to sit on Mr Mushi's table and got to meet his wife and one of his daughters. I really feel like an honourary Mushi now, which was potentially the greatest and proudest moment of my life. Right up there with the time I beat Benjamin's high score at doodle jump.

The party was a lot of fun, with the highlight definitely seeing Mr Mushi in a conga line. I joined in too and thoroughly enjoyed my first taste of being part of a real African conga!

The next stage was this kind of ceremony, where they wheeled in a freshly barbecued entire goat (mbuzi) complete with vine leaves stuffed in its mouth and slices of cucumber for the eyes. The goat was then theatrically carved in font of everyone, before George and Calvin had to embrace each important family member and put a piece of goat in their mouth. First came his parents, then godparents, then aunts and uncles including Mr Mushi. But then to my complete surprise, I heard my own name called out and so I had to come up onto the stage in front of everyone while I awkwardly mimicked the kind of shoulder pat/hug thing everyone had done and had some goat fed to me by these young boys. It was so cool, and a massive honour to be one of only a small group of people who got to do this.

Next, the banquet started. There was so much food including potato, which was so good as I haven't got to eat one since leaving Australia! Yum. It was an amazing meal, except for the course of boiled cow intestine. This was slimy and disgusting and make me want to throw up. Mr Mushi saw that I was struggling with this, so he kindly gave me a massive glass of Tanzanian cognac to wash it down. This made for a rather unfortunate combination and I thought I was about to die. Luckily I survived without making a mess and moved on to eating the rest of the goat instead.

I have discovered that Tanzanians absolutely love making speeches. They normally seize any little moment they can get, but clearly a big celebration such as this was interpreted as a licence to go for gold. There were so many looooong speeches and much shaking of hands and women making that ololololololo noise. Much hijinks was had by all.

The night progressed with much fun and dancing, until it was time to go home. This was an amazing day and I still can't believe it all happened. Best. Day. Ever.

Kwa heri,

Michael Mushi

Things that went wrong: Day 10 edition

- Basically, that it all had to end!

Day 11 - Galloping consumption

Thurs 22nd Dec 2011

Next stop in the list of horrible foreign diseases you don't want to get is tuberculosis, which just so happened to be the clinic I went to see today at the hospital.

In typical Tanzanian style, I discovered today that patients aren't given an appointment time for any of the hospital clinics, but an appointment 'day' instead. The way it works is that the patients turn up whenever they feel like it on they day they're supposed to come and the doctors wait until the room looks pretty full before they start seeing the patients. So basically this is the worst possible system imaginable for organising a clinic. Today, it wasn't until about 12pm when the doctor decided the critical mass of waiting people had assembled and he could then bring in the first patient. I'm never complaining about waiting for a doctor in Australia again.

Once the clinic had actually started, it was nice to see that TB is diagnosed and treated pretty similarly to back home. The main difference over here is that all the newborns get the BCG vaccine though, which means I now have a matching shoulder scar with most of the locals :) The other big deifference is with the directly observed therapy. Here, directly observed doesn't mean having a doctor make sure you take your medications. It means, nominating a friend to help remind you that you should take it. Probably not the most effective of systems.

One unexpected bonus of living in Machame is that there is no need to conserve water up here, because being on the slopes of Kilimanjaro means that the water is plentiful and fresh from the mountain, so hopefully not too contaminated. We still rely on bottled water (which is ironically also taken from Kilimanjaro) and have avoided getting sick yet, which is a plus!

What isn't so clean though is people's hands. Apparently, a lot of the locals use their left hand as toilet paper, so we've been warned never to touch anyone's left hand. Although I heard this second-hand from a Dutch person, so clearly it must be true.

Speaking of hands, one cultural thing here that has been a little bit unusual is the way the locals hold hands. I've noticed that if people are walking somewhere together, they will often do so hand in hand. So it's not uncommon to see two men walking around holding hands. I think it must be considered something like an extension of a handshake. Either that or there a lot of gay people in this village! I've even noticed that if I ask for directions to another part of the hospital, people will often take my hand and lead me there (I'm pretty sure they've all used their right one's thankfully!). Weird at first, it actually is kind of a nice gesture.

Until tomorrow (the day of goat-eating!),

Michael

PS I discovered today that Machame's clinical school passed it's accreditation this week, so it's nice to finally be able to say that I've studied at a fully-accredited medical school!

Day 10 - Pass the scalpel!

Wed 21st Dec 2011

I spent today in the actual operating theatre observing surgery and it was quite an experience! Although this does mean that today's blog is mostly boring surgical observations unfortunately. You have been warned...

Every case starts with the entire surgical team gathering around and praying for the patient on the table. Although a nice touch, the unfortunate thing is that these prayers often seem highly necessary.

By far the biggest difference was with the anaesthetics side of things. There are apparently only about 15 anaesthetists in the whole of Tanzanian and Machame is certainly not home to any of them. Instead, the role is performed here by a single nurse, who performs exactly the same duties as a consultant anaesthetist would in Australia, by cannulating, intubating, anaesthetising and monitoring the patient. Except with far less equipment and access to far fewer drugs than at home.

I discovered the challenges of dealing with these sparse resources within about ten minutes of being there when the mechanical ventilation equipment broke before the operation had even started. Luckily the patient hadn't been put to sleep yet! It eventually got repaired with a piece of tape and the show went on. Who says gaffer tape can't solve anything?

As mentioned above, all ventilation is done by hand by the nurse, who has to do this throughout the whole operation at the same time as doing all the other important things to stop the patient from dying. Not ideal. She probably works the hardest out of anyone at the whole hospital (Mr Mushi aside). Also, there is only the base basics of monitoring equipment, with the only information available being O2 sats, blood pressure and heart rate. Very different to the space-age gadgets available in Australia!

For a general anaesthetic, pentathol is used as the inducing agent and halothane gas is used as the maintenance drug. There is no separate analgesic given, so the doses of halothane have to be really high to get a semi-decent pain relief effect.

The other big omission is that there is no oxygen cylinder to give the patient. Instead, there is a great big machine that is designed to concentrate the oxygen in room air, but even this can only give a maximum of 50% O2.

Luckily at the moment, there is an anaesthetist from Canada visiting the hospital and he has been very friendly. He looks exactly like Lloyd Christmas from Dumb and Dumber, complete with the hairstyle. We've met his wife too, who is clearly a massive Jim Carey fan. Luckily, he's quite a bit cleverer than Lloyd and his expertise is highly valued, so much so that at one point in the operation he had to rush off to see another patient and I was left to monitor and manually ventilate the patient with about only 5 seconds explanation about how the machines actually worked. I was very glad those prayers had been said!

From the surgical side of things, it was all fairly similar. The main difference was that they had to be really frugal with everything and there is far less waste than back at home. For example, all the sterile equipment needed for the week's operations (such as drapes, gowns, packs and so on) are not individually wrapped but placed in supposedly sterile big stainless steel containers in the corner of the operating theatre. Then, before the start of the procedure, what is needed is taken out using a pair of 'sterile' tongs and put on the tray. It would seem that the risk of cross-contamination of the remaining sterile stuff is very high.

I had a chance to look through the sterilising room before we began and was able to take my scrubs fresh out of the autoclave. Unfortunately, there are only about fifty pairs of scrubs for the whole hospital, so sizes are extremely limited. I wore XXXL pants and an XXS shirt and looked like my top half was being squeezed out of my legs.

At the end of the operation, there is no count of the instruments used, which is brilliant because here the scrub nurse doesn't spend half the procedure counting things, like at home. Instead, all the packs have long a long blue cord on them, so that it is (hopefully) clear when one is left deep inside the body.

Similarly, there are no dressings. The wounds are just covered with iodine antiseptic, covered with a couple of pieces of gauze and taped down. There were also no drains inserted and the sharps are disposed of in a yellow cardboard box.

It was quite an eye-opening experience today to just see exactly how so much is done differently here when compared to back home.

Things that went wrong: Day 10 edition

- I initially tried to do the paediatric ward round again, but found out that the doctor had briefly come in really early in the morning to see a couple of patients by himself and had now gone into town for the day. Worst. Doctor. Ever.

- In fact, a lot of things don't really happen here. Going to theatre was about Plan E for today, but it seemed like nothing else at the hospital was actually happening. There were no patients in the ICU, so I couldn't go there and the pathology lab, which I thought I might check out, was not open. I then went to see if there was a ward round in any of the other wards (general men's, general women's, surgical men's, general women's and obstetric) to no avail. I was beginning to wonder if there were in fact any doctors working today when I stumbled upon someone in a white coat. He was going to operate, so I came along too!

Day 9 - Nataka kisongo!

Tues 20th Dec 2011

Today I thought it might be time to experience the surgical side of things here at Machame. So, with anti-retrovirals in pocket, I wandered over to the operating theatres for today's list. It was the Minor Procedure Room in use today, which was a nice gentle introduction to surgery, African style.

I guess it might be wise to start with what is similar to Australia. For instance, surgeons have exactly the same personality here as back home (unfortunately) and wear the most fashionable clothes of all the doctors.

Other things are quite different though. Like instead of putting gloves on your hands when putting in a drip (as I thought was a pretty standard manoeuvre), they tie the glove around the patient's arm for a tourniquet and cannulate with bare hands. Apparently both gloves and tourniquets are in short supply, so this has been deemed the most economical use of resources (even if it does look slightly ridiculous).

There were only three cases today – surgical toileting of osteomyelitis in a young boy, toileting of septic arthritis in an old lady and uterine evacuation after an incomplete miscarriage. As we are becoming used to, there is no pain relief used for any of these, although they were given some ketamine for mild sedation. People are just told to suck up the pain, which impressively enough seemed to work.

The first patient today was a Maasai boy, one of many Maasai patients that we have seen. The Maasai are the most famous tribe up here in the Northern Tanzania region. They are a traditional warrior people and instantly recognisable due to their characteristic dress and, in the women, jewellery (especially the earrings). Unlike most of the Tanzanians we've met, the Maasai have resisted westernisation and still live a semi-nomadic life, moving about to the best grazing fields for their cows. They are a subculture here and highly respected, kind of like the Maori in New Zealand, except about a third of the size and probably not quite as adept at rugby.

Also, Swahili is not everyone's first language. Chugga is the local language here, as well as the name of the local tribe. Swahili is used by many Tanzanians in the same way that English is used by Europeans – a common second language that can be used to communicate with people from other areas. So we've met quite a few people who can't speak Swahili at all, which was highly confusing at first as we just thought our accents were too atrocious to be understood. I may try to learn a few Chugga phrases, but I think I'm going to start forgetting English at the rate of trying to learn all these new languages!

One of the endearing things about English here is that the locals are unused to words that end in consonants. To overcome this, they tend to add the letter 'i' to the end of these words, often with amusing results. Like hearing people instruct ”take the bloodi pressure” or when they report the gender of a patient – ”the patient is Maria Africana, sexi female.” It's highly entertaining.

Kwa heri,
Michael

Things that went wrong: Day 9 edition
- I'm starting to get really sick of playing so much yahtzee. It's the most repetitive game ever! I don't get why the Swedes like it so much.

Day 8 - Attack of the hernia

Mon 19th Dec 2011

Back waking up in Machame again! Often, the mornings here are quite cloudy because we're at such altitude and the top of Kilimanjaro is shrouded in white. But it was perfectly clear today and the twin peaks rose beautifully above the hospital as I walked to chapel. I don't think it's possible to get tired of that view.

Luckily for us, most of the medical discussions in Tanzania are done in English (except for actually talking to patients unfortunately!). Although this usually makes things a lot easier, sometimes the strong African accent can cause problems. Like with the case presentation today. At first, I thought the patient had a simple hernia. But when she started talking about how the hernia had attacked and bitten the guy, it slowly dawned on me that maybe all was not as it seemed.

To my horror, I suddenly realised that she was actually talking about a hyena! This turned out to be quite a horrific case. The patient was a ten year old boy who got mauled by a rabid hyena while trying to protect his family's goat. So as well as having his head and hand bitten to shreds, he now most likely has rabies.

I went to visit the boy in ICU after the meeting. He was all bandaged up and thankfully doing okay. Unfortunately there is no pain relief given here, but the people are admirably stoic. Even when being examined and having his dressings changed, this boy barely let out a sound!

I'm still not entirely sure what the difference between the ICU and a normal ward is here – they look the same except for an oxygen cylinder in ICU that looks like it has never been used! The ICU has no monitoring equipment at all; the patients are not intubated or sedated and there's no pain relief. I think a lot of the post-major op patients come here for a bit, so they can have closer observation by the nursing staff. And by closer observation, I mean one nurse to four patients as opposed to one nurse to twenty patients in the other wards.

Although often tragic, we are certainly getting to see a lot of things here in Africa that just wouldn't occur in Australia. I had never seen a case of rabies before and it is interesting to learn more about it and how to treat it. This is why we're here after all!

I later found out that the boy's father had managed to kill the hyena while rescuing his son, which everyone was rather pleased about because an autopsy can now be performed to determine conclusively if the animal was definitely rabid or not.

After the visit to the ICU, I went on a ward round through some of the general beds. The first two patients I saw were motor bike accidents, which is hardly surprising considering how the locals drive here. Also, I am yet to see anyone wear a helmet. The orthopaedics department is thriving!

Interestingly, many of the patients we see have similar conditions to what we get back at home, except they are sometimes treated differently. This can either be due to a lack of resources (for example, treating everything infectious with amoxycilin because there are no antibiotics available) or just plain wrong (treating suicidal depression with omeprazole to prevent 'stress ulcers' of the stomach).

But just when you think that things are so limited, I often get surprised by what can actually be done here too. I spent some time in surgical outpatients today and saw a man with dysphasia. He is to be investigated with a barium swallow and endoscopy, which was pleasantly surprising to discover that both could be done at the hospital.

Conditions here for the patients are tough though. The beds are essentially rudimentary steel frames with only a thin layer of foam instead of a mattress. There are no pillows for any of the patients either, so sucks to be you if you have heart failure. Plus, there is no ambulance, so people have to make their own way to the hospital even if they've been involved in a nasty road accident.

I then spent the afternoon exploring the village of Machame. It's really spread out, with a few clusters of houses and shops here and there with long stretches of rainforest or farmland in between. There are some really big, nice houses with manicured gardens, but lots more small huts that are considerably more humble.

There are heaps of animals in Machame, although disappointingly they're all farm animals like what I could see back in Australia. Lots of cows, hens, roosters and donkeys (no sheep though!). There are even dogs and cats, but no cool African animals in this part of the country. Apparently there are some monkeys who live in the forest around our house, but I'm yet to see one unfortunately. You have to go to one of the national parks to get proper African animals. Justin's probably seen heaps by now!

Baadaye,

Michael

Things that went wrong: Day 8 edition

- My initial plan for the day at the hospital was to spend today in the paediatric ward. But when I got there I was told that the doctor who normally sees the patients was a bit tired after a late night and decided not to come in today. As outrageous as I thought that was, it does kind of fit with the typical Tanzanian outlook on life that nothing is too urgent that can't just be done tomorrow. Hope none of the kids were too sick!

Day 7 - Wimbo time!

Sun 18th Dec 2011

Today marked the end of our short stay in Arusha. Most definitely, the hardest thing about leaving this hotel will be the breakfasts – for two days I have been gloriously reunited with my beloved milo and weetbix. It's been incredible! I have missed them both very much (despite only being here for under a week).

Unfortunately, today also marked the start of a couple of days apart for Justin and me. Justin is seizing the opportunity to fulfil his lifelong dream of going on safari, while I'm heading back to the hospital for another week. So we checked out of our hotel, jumped into a taxi, dropped Justin off with his tour group and I headed back to Machame. We even managed to avoid all types of major collision this time, so things were looking up!

Back at the hospital, I finally met the two Dutch fifth-year medical students, Analie and Daniel ("Daan"), who are living in the unit next to ours. They had been at one of the hospital's remote outreach clinics all last week and came back only yesterday.

So the five of us in Machame (Anna, Emmy, Analie, Daan and me) cooked up a feast to share together as a group for dinner. We even managed to source a beer each, having discovered the hard way how unexpectedly complex it is to buy one here in Tanzania. You can't just walk into a shop and buy a beer – there's a whole process behind it. You must already have an empty glass bottle, which is a bit like the chicken and the egg because unless you've already bought a beer, you don't have any empty bottles. It's taken the two Dutch students six weeks to find only five! Once you have these bottles though, you can take them to the shop and exchange them for full ones. I imagine it would make being an alcoholic highly inconvenient.

After a delicious dinner, we went along to a party at the hospital hosted by the local students for all the young people (plus this really old dude with a walking stick. He actually busted out some pretty impressive dance moves though! Respect.) Everyone lined up in the pews of the chapel and there was lots of choreographed dancing and singing of Swahili gospel hymns (wimbo). It was a lot of fun!

After a long day, I went to bed in anticipation of another interesting and exciting week ahead!

Michael

Things that went wrong: Day 7 edition

- Nothing much actually! We're clearly getting better at this whole living in Africa thing.

- It was a bit of a shame to part ways, but this way we might not get sick of each other for a little bit longer yet!

- Interlude in the blog -

Today we leave Arusha behind (and therefore also the Internet).

We're not going to be able to upload any more of our adventures until sometime next weekend, when we have for Christmas with Mr Mushi. He's invited us to help eat his goat, which of course we were honoured to accept.

Until then,
Asante sana!
Michael

Day 6 - Mental not normal

Sat 17th Dec 2011

So today we awoke in Arusha! After a sleep in and complimentary breakfast we decided to check out this gateway to the Serengeti! Arusha is one of Tanzania's most developed and fastest growing towns... known as the safari capital. It is filled with tourists and hecklers - it's so hard to walk down the street without someone coming up to you asking us if we want to buy something or need help. Its so annoying... but as Michael won't let me swear on this blog, I won't say any more!

We went in search for US dollars and a mobile phone....although it was a long and painful struggle....we did end up getting both! After going to 5 different banks we gave up trying to get US dollars and got Tanzanian shillings instead. So much for Tanzania's most developed city! Along the way we met a lovely South African couple who also needed US dollars! We shared their taxi around Arusha and many memories!

After a hectic day of running around this town, we settled for lunch at a small restaurant in the back streets of Arusha! A fun fact for the day - all the soft drinks here are around 1000 shillings, which is about 65 cents! But the downside is all the bottles are recycled, refilled and sold again to another lucky person! Recycling to the max!

So you must all be wondering what 'Mental not normal' means. Basically it's a medical term used here to describe every psychiatric and neurodegenerative disorder. It's become my new favourite phrase.

I guess today was quite short.... As we wasted so much bloody time!  We have checked back into the hotel, and although the electricity is a bit mental-not normal, we are now enjoying some local brew Safari lager in the dark. We have been sober for almost 6 days... I think this has so far the most impressive achievement since we landed!

From your favourite mental not normal,
Justin

Things that went wrong: Day 6 edition
- Michael broke his watch.
- Spent about 4 hours looking for somewhere to take out money.
- Michael couldn't find a weekend safari to go on :(
- Hotel room number three didn't work either with frequent blackouts, a TV that wouldn't turn off, broken shower, holes in the mosquito net and mental not normal air conditioner.

Day 5 - Pole Pole

Fri 16th Dec 2011

So we stayed up most of last night playing yahtzee (except in Swedish,  partly why it took so long) and slept right through chapel this morning. Whoops. At least this was a surprisingly effective antidote for the rooster alarm clock :)

The big plan for today was to head over to Arusha, which is the major city up here in the Northern Tanzania-Kilimanjaro region. We had meticulously planned an almost minute by minute itinerary for our day, but foolishly failed to budget for the increasingly notorious distortion of time in Tanzania.

We got Mr Mushi to call up one of his taxi driver mates at about 10 in the morning and went back home to pack for our weekend away. By 3:30, the guy finally arrived. The Swahili phrase 'pole pole' (pronounced pol-ay pol-ay) means 'slowly, slowly' and encapsulates Tanzania perfectly. The concept of rushing doesn't exist. This is normally very nice, as the people are always relaxed and always happy to stop for a chat. It just becomes a little frustrating when we have places to be! I sincerely doubt there is a Swahili phrase for 'hurry up'.

So we ended up spending much of the day in our apartment, not playing yahtzee. Although quite basic, it's rapidly feeling like home. Essentially, the hospital's student accommodation consists of two self-contained apartments side by side - one that's been taken by some Dutch students who we haven't met yet and the other which we are sharing with the Swedes. Justin and I have one room, the girls have the other and we have a common kitchen and bathroom. Happily, there's a proper flushable toilet and a shower, although shower is probably a slightly generous term for what is essentially a glorified hose. Nothing here is particularly clean unfortunately, although we've been told by the girls that the place was absolutely filthy when they came and they had to spend most of last week cleaning it. So we timed arrival pretty much to perfection!

In spite of the delayed departure, we eventually got to Arusha. The taxi driver was pretty hopeless though, as we almost had two head-on collisions in the first 5 minutes of driving, he didn't know where the hotel was once we arrived in Arusha, he asked for basically all our money for the fare, and then ran over a pedestrian outside the hotel. Luckily she was okay though. Worst. Taxi. Ride. Ever.

Coming to places like Arusha and Moshi helps make us realise just how lucky we are to be in Machame. Machame was one of the first areas the Lutheran Church came to, so the people there are mostly well-educated and wealthier (relatively) than in other areas. We feel so safe there, because everyone is incredibly friendly and used to mzungu (white people). It's hard to describe, but we've been able to relax a lot because we just get the sense that no one is going to try and rip us off or steal from us. Everyone we walk past smiles at us and says jambo (hello) or habari (how are you) or karibu Machame (welcome to Machame) and then patiently corrects our mispronounced Swahili replies. Everyone is super friendly and always chats to us about Australia.

It's a different matter in the big towns though. Here, there are so many people and lots of dodgy characters. People are always trying to sell us stuff and we have to be so much more vigilant with our bags and money belt. We're always looking over our shoulders for fear of being robbed or raped, potentially even simultaneously.

Anyway, we checked into our hotel, which was selected largely because it came with a proper shower. Unfortunately, there seemed to be something wrong with each room they gave us and we changed through three rooms before we just gave up on it all and chillaxed.

The promised shower was a bit of a let down too unfortunately. Looks were deceiving, as it worked much like an old man with prostate the size of a watermelon. I could have had a better shower from the river of tears I cried when I discovered it wasn't going to work :(

Unfortunately, this was a bit of a wasted day, as we didn't get a lot of what we needed to done, such as finding a safari to go on for tomorrow. I'm going to have to rethink my plans for the weekend now. The only good thing was that it did give us plenty of time to brush up on our Swahili though! Although disappointing to discover this is a language without any swear words, it was heartening to learn that 'hakuna matata' is a genuinely used phrase here. Other Swahili from words from the Lion King include rafiki = friend, simba = lion and pumbaa = foolish. Even the English phrase 'mambo jambo' is taken from Swahili - jambo is hello and mambo is what all the cool kids say, meaning something lame like whassup bro.

Pleasantries are such an essential part of the Swahili language. Every greeting has a response that must be said in return. Like if some says 'jambo' to you, you must reply with 'sijambo'; if someone says 'mambo', you must say 'poa' and so on. The Tanzanians are very polite and they always say thank you very much (asante sana) multiple times per conversation, sometimes even half a dozen times in the same sentence. If we're ever in doubt of a word to use, a few well-placed asante sanas tend to do the trick. Even better, if we don't know what to say, the locals will usually say it for us. In effect this means they often have full conversations with themselves, saying both their own and our parts. It makes talking very easy!

The one weird thing though is that everyone has this idea that Australia is full of sheep. I've had about five conversations now about Australian sheep and keep disappointing people when I say I don't have any. One guy did ask me to bring him a kangaroo next time I come, so that's a bit more like it!

We're definitely staring to get the hang of Swahili, although this has been been made much more difficult by trying to learn the language using only a Swedish phrasebook as we couldn't find one in English. Needless to say, we're picking up a bit of Swedish too! Because butchering just one language is never enough...

Baadaye,
Michael

Things that went wrong: Day 5 edition
 - Losing Swedish yahtzee.
 - Sleeping through chapel.
 - Taxi being five and a half hours late.
 - Taxi ride taking an hour longer than it should have because the driver had no idea where he was going and then using up all our money paying for it. On the plus side, the long drive gave us plenty of time to listen to trippy Tanzanian radio.
 - Hitting a pedestrian.
 - Not having time to book a safari for tomorrow, throwing the weekend's plans into disarray.
 - Having to change hotel rooms twice.
 - Shower turning out to be the biggest letdown since The Lion King 2.

Day 4 - [insert generic Swahili title]

Thurs 15th Dec 2011

Well this is our 3rd day waking up in Africa, and we have developed quite the routine. Getting ready for uni here takes forever.

Firstly we take our anti-malarials, then we make our beds with our mosquito nets. After this is the simplest of breakfasts...usually cornflakes. We put on our money belts, and wear the same, dirty clothes we have worn for the last 3 days with a white coat over the top. We always bring our own gloves and face masks to the hospital as they have none. The only nice thing about waking up here is that we walk to hospital with a gorgeous view of Mt Kili and the sound of an African gospel choir.

We have been all talking a lot about what we take for granted in Australia. Apart from a car and the Internet, the next necessity I miss is clean water. Although bottled water is cheap here (1000 shillings for 1.5L), we have to use it for everything - like brushing our teeth, washing our hands, and cooking rice and vegetables. This process becomes so tedious especially in the mornings when we are in such a rush.

Again we started the day with chapel, and then waited to go on the outreach clinic. We have learnt a lot about 'Tanzanian time' by being here. If someone here is planning on picking you up at 9:30, they mean 11:30 or hours later. No one here has a watch or any concept of time. So we waited 2 hours for the outreach service to pick us up from the hospital. Luckily it gave us some time to talk to the locals... and yes (ndio) in Swahili!

The outreach service is a sort of domiciliary care - and although like in Adelaide you can't do anything for geriatric Dom patients, here you really can't do anything for them. It consists of a nurse, volunteers, and a driver with no equipment or supplies. We went to people's homes, and basically they tried to convince the patient to come to hospital for simple things, like checking blood pressure. It would be much easier if they had a portable BP cuff and sphygmo to take take with them. And getting to the hospital was not easy, especially since most of these patients either, (a) had no car, (b) all their relatives were dead, or (c) were too sick to walk for miles through a rainforest.

The roads in the rural area of Machame are all dirt, narrow, steep and windy which lead around the rain forests and cliffs. There are still people walking the long journey from their mud huts to the local markets.

We went to 5 homes today. Most of the patients were old, frail and bed-ridden. One lady had a stroke 4 years ago and has been in bed ever since. We saw lots of patients with severe heart failure, one with oedema up to his thighs and hands. But there was nothing we could offer them - there is no echocardiography to check their ejection fraction, no warfarin or INR measurements to treat their AF, and certainly no interventional angiography to help their angina.

Most of the homes are mud huts and slums without a toilet, electricity, kitchen or garden. An entire family would live in a small, dark hut with mosquitoes flying everywhere and chickens running around their house. Although these patients had very little, they welcomed us into their homes.

An interesting case we saw today - we went to the home of a 38 year old male, who is HIV positive. He presented to the hospital with a CD4 count of 1 and is now doing well on antiretrovirals. His wife is also HIV positive and because of the stigma here of having HIV/AIDS, she refused treatment. Fortunately their daughter is not HIV positive. Although over 6% of Tanzanians are HIV positive, there are so many people who refuse to be tested and treated because of this stigma.

Next we went to a local market. It was a typical African market - full of people, and all the merchants on the dirt ground with their fruit and veggies to be sold. It was hectic, and we stood out like a white person with a white coat at an African market. Then we went to a dairy farm... although there were no cows, we did get cheese and butter for pretty cheap! As in 5$ for 1/2 a kilo of gouda cheese! Omg.

It's strange to see a different culture living in such a primitive way. Back home if we need food or other necessities, we drive our European car down a bitumen road, in a safe neighbourhood to a supermarket where we can find anything we want. Here, you have to leave your mud hut, walk miles and miles through dirt streets, under the harsh African sun. Then get to a busy market and spend your only 1000 shillings for the day on a few tomatoes and bananas. This is every day for them, unlike at home - they have no job to give them money, no TV to keep them entertained, and no family to talk to as most of them have died of AIDS.

On a happier note we had a great dinner - pizzas made by two hot Swedish girls!

Today was incredible.

Asante,
Justin

Things that went wrong: Day 4 edition
- Growing old waiting for the outreach team to arrive.
- Learning that the hospital patron's surname means 'vagina' in German.

 Picture: A busy northern Tanzanian market.

 Picture: One of the mud hut homes we visited today.

Day 3 - Asante sana, squashed banana

Wed 14th Dec 2011

After a few crazy days of travel, we're starting to settle into a bit of a daily routine again - wake up at 5, go kick a rooster, get ready for the hospital, go to chapel, then head to the daily doctor's meeting and student presentation.

Once this was over, we went in search of the previously elusive Mr Mushi. Mr Mushi is the hospital patron, although I assume this doesn't mean he's a saint. He is pretty cool though. He helps look after the students and gave us our timetable for the placement, which is good because we've had no idea what we're supposed to be doing until now. In summary, Mr Mushi was a delight. His deep soothing voice could tame the fiercest of lions. If our jet lag does not improve, we may end up having to invite him over to dinner to read us bedtime stories to help us sleep. He is basically Mufusa in human form.

We then decided to spend today in the hospital's HIV clinic, largely because Mr Mushi recommended it. This is perhaps the single biggest health problem affecting Tanzania, with estimates of 6% of the population being infected with the virus. So unsurprisingly, the clinic was super busy with about a hundred patients to be seen by just two doctors. We sat in with a daktari (doctor) from Germany, who was stereotypically really efficient (unlike most of the Tanzanians we've met, who generally treat the concept of time as a bit of an inconvenience).

Until now, our trip has been all fun and games, but spending time with these HIV patients was a particularly sobering experience. We were fortunate enough to see a great variety of presentations, ranging from the  well-controlled, to one girl who was only our age but with a CD4 count of 38 and basically dying. Sadly, we saw lots of children there as well. By far the most confronting case we have seen was that of a two year old infected baby boy. The baby's mother had already died from AIDS and the grandmother had brought him in today because she wanted an injection to kill the baby because he had become so sick. He had already lost 30% of his 10 kilo body weight in only the last month and cried and cried the whole time we saw him. This puts our own lives in perspective, as our biggest problem at the moment is not being able to find any Internet to email home.

The one good thing about the HIV epidemic is that the government provides anti-retrovirals free of charge, which really surprised us. Unfortunately, there is a general reluctance to seek treatment when asymptotic and there is still a large stigma associated with being HIV-positive. So many obstacles remain to prevent infected people from getting treated. This is particularly unfortunate considering how effective these drugs can be - for example, vertical transmission from mother to baby is usually 40%, but goes down to 6% with treatment during pregnancy and 6 months of breastfeeding.

The other big problem that the hospital faces in general is limited options for investigations. HIV viral loads are not possible to do at all. Other things we noticed being done included ordering a chest x-ray as the only way to diagnose heart failure, or not being able to order an albumin to determine liver function in an oedematous patient.

After this quite depressing morning, we went in search of some food. The hospital cafeteria is amazing! We got a fully cooked meal for US$1. It was rice and some miscellaneous meat (the menu is in Swahili) with some spinach (which has hopefully helped with our constipation). Plus, they gave us complementary locally-grown bananas! Win.

Apart from the bargain price for lunch, the other really cool thing about the money over here is the  outrageous-sounding sums of cash that we are casually carrying around, like the 50,000 shillings I've got on me at the moment. I feel so loaded! Unfortunately, this only works out to be about $30 though :(

I'm also staring to acclimatise to the weather in Machame, despite daily sweating out my body weight in fluid. It is much cooler up here than Moshi or the airport, which are about 700-800 metres lower down. And it rained today too, although being in a rainforest I guess that's not particularly surprising. The countryside is so lush and green, it's really quite picturesque. There are lots of tropical trees about the place, like bananas, mangoes and pineapples. We've eaten a lot of the local produce and it's pretty tasty!

The biggest drawback to life here is trying to avoid catching malaria. Sleeping with mosquito nets is a massive pain; I almost die on a daily basis trying to get into my top bunk through the stupid net. And putting on the repellent so frequently is unpleasant. One good thing is that being about 2000 metre above sea level, there aren't too many mozzies up here, so we might just be okay!

Happy birthday to Matthew back in Adelaide!

Cheers,
Michael

Things that went wrong: Day 3 edition
 - After spending a three hour round trip yesterday for the sole purpose of finding a computer with Internet so we could let the world know we're still alive, we then spent the majority of the afternoon and then evening today trying to get the hospital Internet working. When we did, we spent two hours to send about two emails because it was incredibly slow (1kb per minute) and kept dropping out. I feel like I've been robbed of the best years of my life. There will be no emailing tomorrow.
 - After two nights taking advantage of Swedish hospitality, we decided it was time to branch out and cook for ourselves. This resulted in the genesis of the single most disgusting thing I have ever tasted; a creation that makes even Frankenstein's monster look sexy.  As anyone who is familiar with Justin and my previous cooking exploits, it is unsurprising that the dish is heavily tomato based. Unfortunately though, the rice we bought from one of the locals came with bonus tree bark and dirt, which certainly didn't add to the texture or flavour. We are looking into going to the cafeteria for dinner tomorrow...

Picture: Our room.

Day 2 - Karibu to Machame

Tues 13th Dec 2011

Today was our first day at the Machame (ma-cha-me) Hospital. We woke up at 5am to the sound of roosters crowing. This did not help our jet lag.

After a lovely breakfast at the house, we set out to start our day by finding and killing those roosters. As we were walking to the hospital, the sight of Mt Kilimanjaro was in view off in the distance as we could hear the gospel choir singing in the chapel... incredible!

Every day starts with chapel. Just as I expected from an African style service, everyone was singing a cappella, harmonised hymns. It was inspiration and so far a highlight of the trip! The entire service was in Swahili, so we had no idea what was being said. This was until the priest said the word "Australians"... So we were made to introduce ourselves to the hospital staff. We said our introductions in Swahili, and although everyone laughed at us, we received this ritual clapping blessing to welcome us....I'm assuming this is a good thing for defiling their language. But seriously it scared the crap out of me.

We're picking up heaps of Swahili, which is good. The Swedish nurses have taught us a few things, but it is going to be tricky getting our tongues around such a foreign thing.

One difference we have noticed since being here is that everyone is so friendly compared to Australia. Everyone greets us in Swahili, saying 'jambo' (hello) or 'habari' (how are you?) as we walk through the corridors. I guess we fooled them with such perfect Swahili introductions (which we asked a local nurse to write for us).

As for the medical side of our placement, we are currently studying at a large hospital in Northern Tanzania which has associated medical and nursing schools. This morning we had the privilege of watching a local Tanzanian medical student give a presentation on congestive cardiac failure. It took forever.

Then we had an hour off to chill out at our new house before starting our first ever ward round in Africa. I was not sure what I was expecting, but I was hoping it would be completely different to the 'shifting dullness' of an Australian ward round. I guess not. It's nice to see that some things are universal! We did the rounds with about 15 local students, who were asked heaps of questions, but they decided to let us off the hook.

I guess another similarity is the types of patients we saw today. We spend the day in the obstetric wards, mostly women with PROM, PPH and obstructed labour. We did see malaria in pregnancy and I would assume some of these woman would have HIV.

So the standard of hygiene is shocking. If my car were a room in the hospital, it would be the cleanest room. The floors are wet and dirty, the ceiling, if not caving in, would leak a green liquid. No one washes their hands, there is no aquium or hand basins in any room, and gloves are as rare as the tanzanites (the rock, not the people... they are everywhere). Also there is no oxygen by the bed and nothing to monitor saturations. Basically the infection control staff at the RAH would die if they stepped into this place.

After a $1 lunch at the hospital cafeteria, we caught the $1 local bus (dalla-dalla) for he hour-long journey to Moshi. It was a normal minibus that could only properly fit 10 people, but these guys cram almost 30 people on.  Just when you thought they couldn't fit anyone else, they would find room for them hanging off the side or back or sitting on the window.

After finally getting to Moshi, we set out to email our parents. Both Internet cafes had no internet connection. So we eventually asked the tourist information guy to use his computer, who still charged us 50 cents for 30 mins. What a rip-off.

There are a lot of tourists in Moshi, and so there are also lots of people to heckle us trying to either sell cheap safaris, or visit their art gallery opening. Although Michael was keen to check out this local Tanzanian's art work, we had to decline his offer as we're not in the mood to be raped today. Although it would be the closest I've come to a date in a while. We eventually found an ATM the tourist info guy didn't know about, and got out of that god-forsaken hell hole!

Although reading back on this it does sound negative...we actually had an amazing day, stuffed with fun-filled memories.

Asante,
Justin

Things that went wrong: Day 2 edition
 - We were late on our first day!
 - Internet broken in Machame.
 - Internet broken in most of Moshi's Internet cafés.
 - Tourist information guy who couldn't speak English, had no idea where anything in Moshi was, had no maps or brochures and was spending his time browsing dating websites.
 - ATM that didn't accept our card - standing in Moshi with no money!
 - Guy who caught dalla-dalla carrying machete sword.
 - Random security guard in Moshi carrying a shotgun.
 - Burnt hands on green 'cold' tap, while the red 'hot' tap was freezing.
 - Justin has discovered several holes in his mosquito net.

Justin's welcome speech:

Jambo - habari za asubuhi. Jino langu ni Justin. Nina miaka ishirinina mbili. Ni mwanafunzi daktari mwaka wa sita. Nimetoka Australia. Hipo hapa kwa wiki tatu. Asanteni sana.

(Hello and good morning! My name is Justin. I am 22 years old. I am a sixth year medical student from Australia. I am here for three weeks. Thank you all very much.)

 Picture: Us outside the hospital entrance.

Day 1 - Jambo from the Tanz

Sun/Mon 12-13th Dec 2011

Success! We are very pleased (and moderately surprised) to announce that we have safely reached the Machame Lutheran Hospital in Tanzania, a good 38 hours after leaving dear old Adelaide.

Having traversed three continents and far too many time zones, this achievement is particularly noteworthy considering our adventure got off to a less than ideal start when we realised only hours before we were due to leave that we had inadvertently booked ourselves onto different flights to Melbourne. I like to think that we were just getting the inevitable disaster out of the way early, so hopefully this bodes well for the rest of the trip :)

The next step was killing time in Melbourne Airport. This proved to be somewhat trickier than anticipated as the place is wasteland, although Justin kindly gave us something useful to spend the time doing by leaving his jacket on the other side of customs.

Despite our flight out being delayed by 45 minutes, we have come away super impressed by Qatar Airways (the official 2011 airline of the year). We've been given so much food on these flights, I feel like I'm about to explode. Serving whiskey for breakfast was also an nice, yet unexpected, touch and may have contributed to the fond memories. Justin was particularly sold on the multi-coloured ceiling lights that soothingly changed colour. These annoyed me greatly.

Flying over Qatar itself, the country is basically one massive beach (except with no water or bikinis. At all.) In fact, we discovered that Qatar is the only country in the world that is completely desert, with 0% surface water. Unfortunately, with our plane being a little late, we didn't have any time to look around the airport in Doha. Although this may have been a blessing as all the signs were written in Arabic and no one spoke English.

We then kept on flying to Dar Es Salaam, where we went smoothly through customs and boarded our connecting flight to Kili. The undoubted  highlight of this flight was seeing the  peak of Mt Kilimanjaro rise majestically above the clouds. This was the moment when it suddenly hit - I'm in Africa!

Touching down at Kilimanjaro Airport from our fourth and final flight, we then had to find a taxi to take us to Machame. This proved more challenging than expected, as it turns out we have been pronouncing Machame wrongly this whole time and so the taxi driver had no idea where we needed to go. This was particularly embarrassing considering I spent a great deal of time at the Quiz Night correcting people who it now turns out were saying it properly. My bad.

After eventually spelling out where we needed to go, we started the hour long drive to Machame Hospital. This was really good, as it was our first chance to check out the countryside and observe the locals going about their daily activities. No one has cars, so people have to walk  everywhere. It was quite bizarre driving along the highway to see hundreds of people walking along it. The highlight was driving past rows and rows of women balancing massive bundles of stuff on their heads, just like in the documentaries. It borders on the ridiculous the amount they can carry this way and amazingly never lose their balance. I want to learn how to do this before I leave. It'll make backpacking around Europe sooo much simpler.

The other interesting observation about Tanzanian heads is that no one (and I mean NO ONE) has any hair. The men have all either shaved their heads bald or cut their hair really short. I'm yet to see someone with hair more than 5 mm long. Even the women shave their heads, although some have corn rows or, in a few extreme cases, hair as long as me.

Pronunciation aside, we eventually made it to the hospital, which looked exactly like the photos from google. Unfortunately, no one had any idea what to do with us, as all the people we had been in contact with were out of town. It took about an hour until we were able to find someone to show us to our accommodation, but we made it!

Luckily, we're staying with two Swedish  nursing students, Anna and Emmy, who have already been here for a week and were able to settle us in to life in Machame. They even cooked us a delicious dinner after our marathon journey. It was so good! Exhausted, we then crashed and had ourselves a well-deserved early night.

Kwa heri kesho,
Michael

Things that went wrong: Day 1 edition
 - Accidentally booking separate flights to Melbourne.
 - Having way too many carry-on bags for the Qatar Airway flight.
 - Losing Justin's jacket in customs.
 - Customs confiscating Justin's aquium.
 - Mysteriously setting off all the security sensors in the airport shops.
 - Flight to Doha delayed by 45 minutes.
 - Michael spilling orange juice all over jacket (different jacket this time, just to share things around).
 - Not bringing Justin's contact lenses.
 - Discovering that both the hospital contacts who were supposed to be looking after us were away.
 - Discovered that we've been pronouncing Machame wrongly this whole time.

 Picture: The view out the plane window of Mt Kilimanjaro.

We are alive!!

Unfortunately the Internet is broken at Machame Hospital, so we won't be able to upload our daily blog until a later date. We've been writing all our adventures down and will be able to share them hopefully sometime soon.

We are both well and arrived without any major disasters, so things are going pretty good!

Will keep in touch,
Justin and Michael

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