I have been enjoying my final few days in Tanzania. I meet up with my classmates in Paje and then went with them to Matemwe.
In Matweme we got into a routine of buying water and eggs and avocado and mangoes from two vendors up the street (they were pretty much out only option). We went on a great snorkeling trip to Mnemba Atoll, off the north east coast of Zanzibar. We swam above dolphins and then went to the reefs and saw many small fish among the coral.
Swimming about eight meters down
One of the nights in Matemwe we went to a restaurant that served the best octopus I have ever had. It was part of a seafood platter that also had fish, shrimp, and calamari – all of which were great.
Prepped my own coconut post bad sunburn
Beach outside our compound
My classmates leave today and I have one more night in Dar before flying home. Time to go back home and finish my last rotation of school.
I spent the weekend in Stonetown in Zanzibar. On Saturday morning I arrived at the Ferry Port and walked through the city. I went past the House of Wonders, the Palace, and Old Fort. Freddie Mercury’s childhood home was by my hostel. I went to the Slave Market Museum and learned about the slave trade in East Africa, all of which passed through Zanzibar. It was a pretty powerful and well thought out representation, and tied the past to modern day slavery.
For lunch I went to a rooftop restaurant and had a view over the city and a delicious vegetarian platter. I spent the rest of the day walking thought the narrow streets of Stonetown, coming across different sights, sounds, and smells.
I made some new friends at my hostel and together we went to a reggae festival inside the Old Fort.
On Sunday went to Mass at the Saint Joseph’s Cathedral. It and the Anglican Cathedral are the only two Christian churches Stonetown, as the population of Zanzibar is almost entirely Muslim. Saint Joseph’s is not open to tourists, so after the two and half hour Mass I spent a few more minutes looking at the building itself.
I spent the remainder of the day exploring and going to more of the popular restaurants and stores in Stonetown. At night I went to the Forodhani market, which opens at night and has a huge assortment of street food and shawarma stands.
This morning I am leaving Stonetown to catch up with my classmates in Paje on the East Coast.
The last week has been busy wrapping up my rotation at Muhimbili National Hospital. I spent most of that time in the operating room, and continued to learn more about the medical school training in Tanzania and the specific research and academic interests of the surgeons. The students with whom I have rotated had examinations on Wednesday and Friday, which resulted in me working more closely with the faculty.
Wednesday I was able to help one of the senior residents with three foreign body cases. The patient on whom I performed esophagoscopy had the ingested item (usually a coin but now this time we don’t know yet) pass to the stomach so I did not get to remove it.
Chest radiograph of ingested foreign body (this was a button battery
On Friday I said goodbye to as many people as I could. I saw many of the students before and after their last examination (now they get a small break before starting ophthalmology on Monday) Dr. Martin said I performed well and Dr. Aslam told me to come back sometime soon. Perhaps once I have acquired a more complete skill set.
I am not headed home quite yet. Taking the seven AM ferry to Stonetown, Zanzibar.
Looking out from a rooftop in the city center on my last night
Over the last few days I have made great strides in ordering food a local eateries. First, I received help about how to go through the food line at the medical university cafeteria. I can order a starch and a protein (chicken/fish) if I want, but everything comes with cooked cabbage and beans. On Friday, I ordered wali na mboga, and they also have me a big scoop of cooked okra, which I really enjoyed.
Lunch at the school Cafeteria
Yesterday, Saturday, I finally went to a local restaurant on Malik Road which I pass on my way to the hospital. I again ordered wali na mboga, and received the standard rice and vegetables with the bowls of sauce and beans. The restaurant, Tairo Bar, is probably going to be my favorite place I have been when I leave. There are not as many roadside bars with plastic chairs where I have been in Dar compared to other places I have been outside of Tanzania, so it is fortunate that I have a great one so close.
Tairo Bar
Today I went to Mass at St. Immaculate Parish which is only a five minute walk away. I went to the English Mass but got to enjoy part of the Swahili Mass which was finishing when I arrived.
St. Immaculate Parish Marian Garden
In the afternoon, I went to a place called Village Museum with two medical students from Oxford whom I met earlier in the week. It is a compound with replica dwellings made in the style of many of the different Tanzanian ethnic groups. It was totally catered to outside tourists but I ended up enjoying the time more than I expected. There were around twenty dwellings, and many of them were quite different from the others – but I forgot to take pictures to prove it.
I have begun to be more involved in the operating room and so have had longer days at the hospital. Assisting with functional endoscopic sinus surgery (FESS), gastric feeding tube placement, and tracheostomies. This participation has been to the level, or less than, I have on ENT services throughout my fourth year.
This past Monday I toured some parts of Dar with a classmate to see the small arts scene here. We went to the Alliance Francaise, which regularly has exhibits. This time, there was an showing of paintings by Amani Abeid that I really liked. We walked to the Botanical Gardens, which was a park where they also were growing seedling of many types of trees and plants. Shabani approached us and showed us the names of the trees and commented on potential medicinal properties. Finally we drove to Nafasi Art Space, which was a big compound with some galleries and many workshops. I have been told that artists are brought in and given support to develop their art.
Otherwise I’ve been eating a lot of good chicken (at Mamboz and Kwa Edo’s et al.)
Today, Thursday, rounds were cancelled again so I went to the operating room (NB: when I say that they are cancelled I mean that the formal 9 AM rounding does not happen and the attending physicians round on their own at an unknown time). I was not able to scrub in because there was a shortage of surgical gowns again (sterilization machine not working) but the surgeon walked me through his approach to an adenotonsillectomy. Later, we had a young patient with pediatric recurrent respiratory papillomatosis (RRP), a disease that I presented on during Otolaryngology Grand Rounds at Ohio State last May. It is not curable and would not be good to have as a child with limited surgical access like this patient. The surgeon let me place the laryngoscope and identify the anatomy of the larynx. My emotional response was magnified by the fact that I submitted my residency rank list yesterday. The circumstances of the patient’s condition made me feel sad and frustrated, but I also felt excited and motivated to be pursuing the training that will permit me to care for patients like him.
My first week at Muhimbili did not quite finish the way that I wanted, but was at least interesting. I went to the OR and asked if I could assist in the first case, an adenotonsillectomy. The surgeon told me that she would have let me, but that there were not enough gowns for me to have one. The second case was a wide local excision of a dermatofibrosarcoma protuberans. DFSP is a rare tumor and would usually be treated easily by a dermatologist after early detection in a place like the US. This patient had a significant tumor burden, however, and so I have had many questions as I investigate how his case will be managed following the surgery.
On Saturday, I walked to downtown Dar, and spent a few hours exploring. I saw a handful of the monuments and well known locations in town, and it was nice simply to familiarize myself with this area and to observe the general hustle and bustle of the people. I made a few friends as well – one showed me his artwork for sale, another showed me the ferries that take people to Zanzibar and gave me advice about going to National Parks (although I will not be).
Askari Monument – dedicated to Tanzanians who fought in World War IStephen’s art
In the evening I went with some of my new friends and ordered dinner while we were hosted at the home of the Danish Embassy interns. Then we went to meet my classmates at a restaurant called Samaki Samaki (Fish Fish) and enjoyed the great Afrobeat music played by the DJ.
Today I joined a large group and made a bit of an excursion to a hotel pool. It was on the coast in Masaki on the Msasani Peninsula, and so provided a great view of downtown in the distance.
I returned from Mafia Island two days ago. Before I left, I did another whale shark safari with the Big Blu dive shop. The boat trip started out cloudy, windy, and rocky, but the sun came out right as we found the first whale shark. We eventually found six sharks, and often I would be swimming after one only to find another beginning to cross my path.
I flew back to Dar and stayed at hotel in the City Center. It had a rooftop restaurant on the twelfth floor which provided my first view of the downtown area. Sunday morning I checked out and walked the twenty-five minutes backed toward my new residence. I checked in and prepared for my classmates to arrive. My friend Aaron is staying with me and there are six others staying in a nearby apartment. The bed and breakfast has ten rooms and I’ve met residents in six of the other rooms already. A bunch are from Sweden, some from Italy, and others from Tanzania.
In the biggest news so far this trip: I started my hospital rotation today. I am working with the otolaryngology department. There are two services, called Firms. I was assigned to Firm 2 and my classmate Phil is in Firm 1. There are about 15 Tanzanian fourth year students in each Firm. This means that, while the attendings teach a good amount during rounds, we probably will not have much opportunity to participate in the operating room. I will have to see as I meet more of the physicians and other trainees.
Yesterday I left the first place I stayed on Mafia Island and rode a boda-boda for the first time in a few years. It was a beautiful ride – the sun had just come out and it was amazing to see palms trees standing out with a blue backdrop above the rest of the green plant life. I arrived at the Marine Park, signed in, and continued to the Big Blu dive center, where I am staying in a little safari tent. I checked in, spent some time catching up on reading, and then had a nice meal with some of the other solo travelers who are doing dive holidays here.
Big Blu beach
This morning I left with a group to do two dives. The first site was named Coral Gardens and I am not sure about the second. Hassan was our dive master and Professor Man Gideon was another trained guide who assisted. Unfortunately, visibility was poor. We came across eels, shrimp, and some fish along the reefs. No sea turtles though, which I had been hoping to see. I have not been diving in a long time, so I was excited when I was able to better control my breathing and buoyancy on the second dive.
List of dive sites at Big Blu
In the evening, one of the expert divers who went out in a different group said that visibility was much better outside the bay, and that she had seen sea turtle on all her ‘out’ dives. I guess that means that I will have to come back.
This morning I woke up in my tent, which was my lodging for the first night since they had overbooked the bungalows that I had reserved. Breakfast was at 6:30, and at 7:00 we boarded a boat for a Whale Shark Safari. This is one of the primary reasons I came to Mafia Island, and people had seen groups of three and four whale sharks in the prior days so I was hopeful to see some as well
Juma came out on the boat with us, and went through their regular introduction about how Whale Sharks are wild and will not be seen if they swim too far out or too deep. We headed out on the water and started to look. About one hour in, we past an area and some fisherman called us back because they saw a whale shark. I got a glimpse of a fin, but, once we turned the boat around, we could not relocated it. We searched for another hour without luck, until one of the crewmen received a call from another tour boat. We turned around and went toward an area where six other boats were following a whale shark.
Guide Thomas watching the shark
Ultimately, I swam with this one shark. We made about a half dozen jumps into the water to see it. The shark is so large and moved so fast that I often found myself chasing the tail. The water visibility was not great, and when I was at the tail I could not see much of the body. Toward the end of the morning, half of us asked to do one more jump. I am glad we did, as it swam right under us. While I did not get to follow a large group with for distances with great visibility, it was certainly a successful trip.
The shark swam straight under me once……but usually I was giving chase
In the evening I walked the kilometer along the beach to make it back to the main town, Kilindoni. I bought avocado and mango at the market. I know there are makeshift restaurants that serve local fare, and, while I’ve really wanted to have a meal at one of these, I have not been able to locate one on my own.
I arrived in Dar es Salaam after roughly twenty-four hours of travel. my host for the first two nights was Parvez and he was a great person with whom to spend time in my first days in Dar es Salaam. He was incredibly welcoming and helped to show me around the neighborhood where I will spend a majority of my time in Tanzania. Importantly, he helped me to get a SIM card for my phone and showed me around Muhimbili, the hospital where I will be rotating. I visited some of the supermarkets as well as the bed and breakfast style residence where I will be staying starting next week. It is owned by one of the physicians who works at Muhimbili. There is a lot of common space and ten rooms, so I expect that I will build good relationships during my time staying there.
On my second full day I spent the morning doing some more errands and exploring more of the neighborhood. After dropping some extra items at the bed and breakfast I went back to the airport. This time I went to Terminal 1 which is the terminal for domestic flights on smaller planes. I had booked a flight to mafia Island which is a lesser known island off the coast of Tanzania. There’s an abundance of sea life and a marine preserve encompasses a large portion of the island. The primary reason why I left for my rotation in Tanzania early was to spend time off the beaten track and to do some activities there.
Plane to Mafia
The flight went smoothly and I was able to find the first place where I am staying, called Afro Beach Bungalows. There was a barbecue the first night that I arrived. I introduced myself to two Germans who recently climbed Mount Kilimanjaro and enjoyed fresh red snapper and octopus for dinner. They also shared their coconut beer with me.
Weston Sees the World 