Random musings of a bored mind

Nothing really happened during my second week here in Bagamoyo. I've more or less settled into a routine work, home to read or work out, bed at 9 or 10. A number of people have asked about food and stuff like that so I guess I'll mention it... Before Ramadan started breakfast was pretty good! Hole-y bread and and margarine but it usually came with an egg and coffee or tea. It took me a few days to figure out why my coffee tasted so funky. It was only in the mornings... turns out they put ginger in the water! Ginger + coffee = eww... I have switched to tea in the mornings... During Ramadan I try and scrounge up whatever I can for breakfast some times I find bread, some times a banana sometimes its just coffee until lunch. For lunch we pretty much have 2 options. There's the hospital cantina and a small hut just outside the hospital. The food at the cantina is horrible! Well, the beans and rice are ok (how can you screw that up?) but on days when they have "meat" I try and stay away. The first day I ate there everybody watched me take the first bite. As soon as I bit down I found bone, fat and tendon. I wanted to spit it out but so many people were watching! Apparently I don't have a good poker face because several of them started giggling and I eventually spit most of it out (after trying to chew it for quite some time). The other place is decent, they have chipsi and mishkaki, that's really greasy french fries and meat on a skewer. It's not bad but you really can't eat it 2 days in a row. Dinners during Ramadan are fantastic!  We sit outside on a mat on the balcony and eat yummy things like pasta in tomato sauce, mashed sweet potatoes, cassava (cooked every way imaginable), chicken (which some times is more than just skin and bones), some noodle and sugar dish and we eat it all with our fingers. I'm getting a little better at controlling the mess but mashed potatoes and pasta definitely require a skill I do not possess...

random musings compiled from the first couple of weeks: I think the first phrase children learn here is, "Muzungo, give me money" I am going to hate the summer! which starts in a month or so... My face is permanently stuck in a "squinty-eye" position. Nobody wears sunglasses here so I try not to either (I'm sure that helps me blend in...) Things I miss - hot showers, reliable internet, meat, real coffee The only word to describe the attitude of most doctors here is apathetic. In general (from what I've heard from multiple unrelated sources) is that doctors are completely disinterested in the outcome of their patients' health. Live or die, it doesn't matter. They are also alarmingly undereducated in many diseases outside of malaria, HIV, TB and sometimes diarrheal dz. There is a tendency to over treat giving broad antibiotic treatment in the hopes that one of them will work. This is probably due in part to the lack of appropriate diagnostic equipment and a general lack of knowledge regarding the dangers of overtreatment in the proliferation of more virulent strains of viruses and bacteria. In deed, this is seen far too often in the US as well although I believe the root cause of it is quite different. In the US I feel it is, at least initially, more patient-driven. Most patients aren't satisfied with the response of "wait it out and it will pass" so instead, Dr's prescribe abx tx that may or may not be necessary. In Africa this trend of over treatment leads to MANY complications. First of all, they prescribe costly drugs to patients that don't need them! There is a belief that IV or IM (intramuscular) treatment is superior to standard oral medications. There was a story about a child with superficial burns from water. The treatment probably should have been clean it and keep it dry...  However, the doctor here actually prescribed IV antibiotics! For a superficial burn. Talk about overkill. At the same time the over use of abx is creating drug-resistant diseases (see XDR-TB, p falciparum malaria is not responsive to many 1st line treatments and MRSA common in US hospitals). Another side of this issue is the general apathy experienced in hospitals results in many patients preferring to be in a trial of some sort because it essentially guarantees that they or their child (as is the case at IFAKARA) will receive adequate care. There was a story of a 9 year old girl at one hospital who suffered from Diabetes. She presented to the clinic in rough shape but all she needed was insulin (which was available). Instead she received food and sugar... the nurses couldn't be bothered to treat her (often the case unless one provides some sort of monetary compensation) and the doctors aren't around because they can "work" at the public hospitals and then skip out and work at the private ones in the afternoon where they earn more money. One doctor finally noticed the lack of insulin treatment (pointed out by a med student) after which the nurses started giving insulin but stopped administering food... I don't nee to mention how it ends. I plan on trying to observe a little bit of rounds and such here at Bagamoyo in the next couple months to get a better idea first hand. I also have a few contacts and am working on getting more at other clinics in Nairobi, rural Tanzania and hopefully some where in Uganda.