Saturday - Wednesday

Sorry I couldn't think of a more creative title....

It's been a few days now since I have had the time to sit down in front of the computer and put up a blog. I will do my best to summarize what the last few days have been like:

Saturday: We went up to the beach to a little village called Kendwa. It is on the north part of the island. That part of Zanzibar is completely exploited for the sake of tourism. I have no idea how much the local people actually benefit, but the hotels on the beaches are very beautiful and exotic. The main tourist area is called Nungwi. I went to Kendwa because it is a little less developed and I had been there before and really liked it. The beach was beautiful. The weather here is still very hot and humid so it was nice to be by the ocean for a couple days.

The Indian ocean is magical. The colours, the winds, everything. The sand is snow white and soft and really makes you feel like you are in paradise. The hotels are filled with backpakers and traveller who come to Zanzibar for a break from their African explorations. I went up there with one of my flat mates (Brian - who is a 5th year Urology resident in Ottawa) and we paid about $15 for the room which was on the beach.

I turned myself into a big lobster by burning the crap out of my legs, but I was happy to have a couple days to sit and read and relax before the countdown began for my match results for residency.

Sunday: More of the same. We spent most of the day at the beach and then came back to Stone Town to have a quick dinner and get ready for the coming week's adventure.

We bumbped into some other medical students at the beach, which was nice. So we had some people to hang out with while we were relaxing for the weekend.

Monday: big day for me. I can't say I slept well the previous night. Today I had to think about getting the residency match results and hoping that I was accepted to UofT for Internal medicine. I went to the hospital in the morning, but I couldn't really concentrate too much because of the stress. I ended up coming back home a little bit early.

For the evening I went to the sea food market down by the ocean to get some fresh dinner and let the time pass before 8pm when I could login and check the results. The oscars had just been on and I kept thinking about an Oscar-type ceremony just for me... where some nice looking woman would walk out on stage in front of everyone, take out an envelope with my fate and say "the winner is..."

The results came out at 12noon in Toronto, which was 8pm Zanzibar time for me. I will set the scene for you:

I was sitting on the couch, watching the news and wondering why seconds hand on the clock looked like it was going counter-clockwise. One of the Germans living in the same apartment was jabbering away to her boyfriend oblivious of the thoughts going through my head and the amount of stress I was feeling.

As I thought about the millions of little ulcers that were probably forming in my stomach from my own anxiety, the 8pm call to prayer sounded across Stone Town (and Zanzibar Island, which is 90% muslim). I thought to myself, I don't know if it is ironic in some way, but there is definitely something interesting about the experience of checking my fate to the sound of "Allahu Akbar" (allah is great) being sung in all directions. Also, the evening prayer call, for some reason, is accompanied by an air raid siren similar to what used to sound when rockets were falling in the vicinity of Be'er Sheva (I think it signifies that government employees are officially required to go home from work). All in all, it was a very sureal experience.

I didn't want to jump from my seat because I didn't want to seem anything less than cool as a cucumber. So I let the German girl keep talking. I pretended to watch the news but all I could think was "get the shit off the computer or I am going to throw you off the flippin balcony!"

After about 5 minutes of agony when the streets were quiet again, I said to her, calmly, "would you mind if I check the computer quickly". Brian, who was sitting to my right knowing how nervous I was feeling - he had endured the same agony 5 years previously and told me that he still remembers exactly where he was and how he felt...he had also been eagerly watching his watch all day and counting down the minutes with me - chuckled, knowing how much I was holding back. The German girl said ok and I hoped into the computer driver seat.

I figured the website would be backed up because of the volume of people checking all at the same time. I logged in with my name and password and in a FLASH it was there in front of me "You have matched at UofT in Internal Medicine". I jumped up, clapped my hands once and held my hands in the air like a catatonic. I am pretty sure I held them there for about 10 minutes straight (also, like a catatonic) before I called my folks to share the good news.

I first called my mum, who was probably more nervous that I was. I thought, I could tell her straight, or I can mess with her a little. Anyone reading this who knows me can figure for which I opted:

Mum: Hello 
Will:  Hi mum, it's Will
Mum: So? whats the word (sounding like she was going to vomit)
Will: I have good news and bad news.
Mum: OK.
Will:  The good news is, I matched in Canada.
Mum: OK
Will:  The bad news is, now you have to deal with me because I'M COMING HOME!!!
Mum: Where did you match?
Will:  Toronto (thinking, well that was a waste of time, she didn't even get it)
Mum: William.....William.....William....**sob sob**

So that was exciting.

Dad: Hello?
Will: Hi dad
Dad: So?
Will: I got Toronto!
Dad: Oh, we are so excited. I am going to give money to charity?
Will: What?
Dad: That is how I have to celebrate this. I'm going to give money to charity.

Then my Toronto cell phone battery starting beeping, about to die. So I had to get off the phone.

The rest of the evening was spent just thinking about moving back to Toronto, finally.

Tuesday: We lost power last night at around 2am and the fans stopped working in the apartment which was already about 35 degrees. Needless to say, that was the end of my sleeping for the night. I think I only slept about 2 hours the whole night and I was a wreck during the day. I ended up taking a short nap in the afternoon and then going to have a beer with some friends on a rooftop restaurant that over looks the town.

We all went to the night market to get some food for dinner and then call it a night.

Wednesday: Today I am tying up some loose ends and trying to meet with a few more people to discuss coming back here for a follow up similar to the one we just did in Ethiopia. I am trying to show my face enough times to people that they recognize me and know my name for when I email them down the road.

I also have a trick that I try to do now. I try to take pictures with people that I may need to contact down the road so that I can email them the photo as proof that we know each other. It made things really helpful, I found serendipitously when I sent the cardiologist in Ethiopia a picture of me and her in 2003 while we were both in Israel at SACH.

So otherwise, I am going to meet someone today at the ministry of health to talk about potential research projects that students from my school could be a part of if they came here for some elective time. He is no expecting me, so hopefully it works out.

all for now,

Will

things unfolding

Hello all,

Thursday: So I was excited to head back to the hospital and see some surgeries again today. The operations today were on children. One with a cyst that needed to be drained and one with undescended testes. Also there were a couple hernia repairs. All went smoothly and then they ran out of sterile gowns so they CANCELLED THE REST OF THE SURGERIES! Shocking. You would think that they would have had enough gowns prepared to do all the surgeries that were scheduled for the day. I mean, what if there was an emergency.

This brought about a new questions for me: How much of the medical conditions here can be blamed an sheer laziness? The more I talk to people here, the more I am learning that the problem is less with finances and more with what to do with that money and the willingness of the population to make changes happen. Guests are so common and they come here with so much money and supplies, but there is little motivation from the local community to fend for themselves. They are almost reliant on the missions that come through to do the work for them.

I also went by the pediatric department to stop in and say hello to the cardiologist (who works in the only air conditioned room in the hospital). When I was here last time, I spent some time with him doing ECHO examinations and he remembered me. He is important to me because if I am to come back here in 2013 to do another follow up project, I will need his help with the examinations. I'll be joining him on Monday to do echoes and I will speak to him about my plans then.

So I left the hospital, in shock, at around 2pm. The heat here really exhausts me. I can hardly drink enough water and I am drinking water all day. In the evening, I went to meet with a woman I had met last time I was here. We met on a bus going to the north of the Island. She is in her 60s or so and has been living on the Island for about 10 years (originally from the US). She has started a organization called Participate Now! and she does little projects around the island. She does not, however, play by the typical NGO rules and therefore does not raise money very well. But she works with the locals and facilitates their self empowerment (she made it clear to me when we first met that she does not believe that one can empower another, rather one must empower themselves). We stayed in touch a little bit since last time I was in Zanzibar and I got back in touch with her again before I came this time to see if there was any small projects that medical students could be a part of. She didn't know of anything personally, but she connected me with a whole bunch of people in the ministry of health and I will be meeting with them after the weekend.

We sat for about 4 hours on her rooftop apartment that has a 360 degree view of the city. It was an amazing little place and we talked about a million different things. She even offered to do my laundry for me if I needed it (which I do...badly).

Afterwards, I was pretty much down for the evening.

Friday: Today I went to a town on the other side of the island called Makunduchi. It is a tiny little town that really has nothing except for a little medical project called the Makunduchi project (you can google it if you are interested). It is a small 30 bed clinic/hospital and that operated within the community. I met a nice doctor from the UK who is there for 6 months doing a bit of everything. I was really interested in their facility because it is much more within the community than the hospital in Stone Town and I think it would be a great hands-on experience for medical students from my school. Plus, there could be some nice opportunity for some good community research projects there.

It was a hassle getting there and involved sitting next to many roads and flagging down many people hoping to get a ride across the island. The distance isn't very far, but getting there took forever. Then it started to rain again, hardcore! African rain. It comes almost without warning and then disappears as quickly. It's mother nature at her finest.

So that is basically what I have done for the last few days. This weekend, I am heading up to the north part of the Island to get some beach and relaxation. I am going with some of my flatmates here (germans). We are renting bungalows on the beach for about $15/night with breakfast included. It's a pretty special place. I will be taking pictures.

Next week will be my last week here. My plans are to spend some time in the maternity ward and hopefully deliver some babies and get some experience with that. I will try to watch some surgeries as well and I may go back to makunduchi later in the week and try to spend a day or two there before heading back to Israel.

I am energized and feeling really good about things here. Not sleep very well, because of the heat, but I feel generally well.

lots of love

Will

days 3&4

Hello to all,

Days 2 and 3 have been exciting.

Day 2: I woke up at 6am and headed to the hospital eager and ready to see whatever awaited me there. I was spending this first week in surgery and Tuesdays is a surgery day. The “surgeon” I was attached to was not actually a surgeon at all. He was the equivalent to a general who has had nearly the same training as me plus some clinical experience in the Zanzibar setting. He can basically function as a Obstetrician/gynecologist, general internist or surgeon (you are right to shudder, if it gave you that reaction). It’s not that he is incapable. On the contrary, he is actually quite gifted. He basically needs to be prepared to save a life no matter what the condition.

We had 3 surgeries. They were all done with spinal anasthesia which means that the patients were awake the entire time. Sounds intense, but they were all very comfortable and in no way distressed (which I could determine both by their facial expressions and their recorded blood pressure) during the operations. Because I was not scrubbed in an participating in the surgeries directly, I took on the role of getting supplies and doing my best to maintain sterility as well as giving the odd encouraging wink or nod to the patient who was lying there wondering what the hell was going on. The operations involved two prostate removals and one bladder stones removal. I won’t go into the details and I will save that for when I return for anyone interested. The procedures were all very interesting and I will be scrubbed in on Thursday to assist as well.

I was actually pleasantly surprised with the sterility measures. They are no where NEAR to Israeli standards, but they were nonetheless significantly better than I was expecting. Again, I won’t go into the details.

I also stopped by the pediatrics department to meet a boy who I had met in Israel when he came for surgery. I saw him last time I was in Zanzibar as well. He doesn’t speak any English but we were excited to see each other. Last time I saw him, he gave me some Zanzibari music on my cell phone and I played it for him again and he was pretty excited. Anyway, that was a nice meeting. He told me, through a translator (the nurse who was in Israel with me in 2003) that he would like for me to come to see his village on the east coast. I will try to make that happen at some point.

In the evening I just relaxed and ate a fresh pineapple and a couple mangos. The fruit on this island is exceptionally tasty. I have restricted myself to only the fruits that can be peeled (don’t worry mum). My stomach can handle the food here much better than it could in Ethiopia. There is a huge market about 2 minutes from my flat and I have gone there everyday. In the apartment, we are 7 people sharing a small fridge so I do my shopping for food on a daily basis because storage is limited. I am fine with that.

Day 3: Today consisted of ward rounds in the morning. I saw some of the patients that had been operated on yesterday. The wards was pretty run down. It was a big room with IV bags and mosquito nets handing from lines that were put up from wall to wall. We saw one case that made me think I was going to vomit. It was the health status mixed with the humidity in the room and the stench. Everything together was not a good mix.

After rounds we had a meeting with all the elective students and the hospital director and some of the staff. The hospital director was trying to improve the teaching quality of the hospital and wanted feedback from the elective students. To his fault, he hadn’t considered that all the students had come at different stages in their training. There are also students from Canada, the US, the UK, Germany and Australia so everyone is used to a different system. The meeting was useless but I didn’t really care because I am not here for very long.

After the meeting I spoke with the hospital director. I introduced myself and thanked him for having me at his hospital and told him what a great time I was having (a bit of politics to start on the right foot). I then told him all about my medical school and how I would like to see students from my school start to come to Zanzibar as one of their fourth year elective sites. I proposed to him a way that it could be done that would be mutually beneficial in the hopes of creating a sustainable relationship. I also spoke with him about Save a Child’s Heart and the recent project we did for them in Ethiopia and how I would like to repeat it in Zanzibar in 2 years when I can get some time for electives in residency. He was EXTREMELY receptive and asked to meet with me again tomorrow in a more formal setting. I am now typing everything out for him so that he can have it on paper. Hopefully something good can come of it and I will be able to do another follow up study on the children from Zanzibar that have come to Israel.

This evening I am going to head out once the heat if the day breaks a little. Zanzibar has a great market in the evenings where they cook food on the streets and it’s all very delicious. I will check that out with some of my new flat mates.

My plans for the rest of the week are to go to the hospital tomorrow, Thursday, and hopefully scrub into a couple surgeries and help out…should be a good experience. On Friday I may travel to the other side of the island to see another hospital called Makonduci. Apparently there is an American doctor there who has been there for a while and I would like to meet her. It’s probably about 1.5 hours by dalla dalla to get there. I may try to check out that boy’s village as well, if I am already going to the east coast of the island.

All for now.

Will

from Zanzibar

Well I have arrived in Zanzibar. Great to back here.


The contrast with Ethiopia is stark. People here are also poor, but they are much less destitute. In Ethiopia, we saw many disfigured people and people often begged with a particular amount of aggression. Children would block your path with their hand extended in our faces. One woman actually reached out and touched Liad's hair (which made every ounce of blood in my body boil). Zanzibar, however, is different. I still stand out (though now I am at least tanned). Everyone says hello (or Mambo/Jambo) to me. If I don't answer (Poa) they say it again and again. If you ask anyone a question (ex, where is the bus, or dalla-dalla, to a specific place) they will escort you all the way. They won't let you go anywhere else whether you want to or not. Then they will ask you for money for their effort. It gets annoying, but it is much more pleasant than in Ethiopia where we saw young children everywhere begging. All together, Zanzibar is a happier place, there is music in the streets everywhere and though it is poor, people seem to manage. At least in the main city, Stone Town (which has been likened before to Gaza....I wouldn't know).

My first day was eventful. I arrived at around 3am and went to the hotel to get some sleep. I got up at around 8am because there is a mosque near to by head and the call to prayer got me up early. Breakfast was at the hotel (included) and consisted of a scrambled egg, some fresh mango juice (yum) and some coffee (necessary).

I went to the hospital, though it was Sunday, and tried to track down someone I knew. there was a nurse there who I had met last time I was here who spotted me and said hello. She said that no one was around and I should come the next day.

I then hopped onto a dalla dalla and headed to a forest called Jozani. It was about 1.5 hours to get there. Dalla dallas are pickup trucks that have had a roof put over the flat-bed and a few benches put in. They drive at what feels like a million miles an hour and just when you think you are more crammed than you have ever been, they add another person. You have to duck to not bang your head so women usually give their infant to someone sitting near the back of the truck, they the climb on, then everyone passes their child from person to person. The babies don't seem to mind. Without fail, they always sit on the bus and stare at me (the hairy - I have a beard - funny looking Mzungu - white-guy). I usually make a few faces (Liad can attest to that...I have this thing where I like to make faces at babies... usually the people around find it funnier than the baby).

the forest was amazing. I got there and hopped off the bus and sat down under a little straw hut with a table and few chairs to write down some thoughts. About 5 minutes later, it started raining. Like Africa raining. It was POURING! I was stranded under this little dry oasis and was just in awe of the scene. I took some pictures but nothing can capture it.

Eventually it stopped raining and I headed into the jungle. It was hot and humid and I was completely alone on the trail. All I could hear were birds chirping and insects buzzing and monkeys from above jumping from tree to tree. I was scared shitless, but having a nice time and I enjoyed being alone with my thoughts in such a raw environment. I took a million pictures of monkeys. Up to this point, the only monkeys I had ever seen were either in the Toronto zoo, or stuffed and sitting on my bed. These were totally comfortable around people. They walked right next to me and pretty much smiled for pictures. I swear that one even said cheese.

After Jozani I waited by a speed bump for either a car or a dalla dalla going back to Zanzibar town. The nice thing about speed bumps is that everyone has to slow down so there is just enough time to ask the driver if he is going to stone town.

Back in the main city, I had a quick bite to eat and then headed to bed so I could start my next day.

Day 2: I woke up, had a quick breakfast and headed to the hospital. I was met by a man named Abdullah who showed me around the hospital. I asked him to start with surgery, that is where I will spend the rest of the week. I was very excited to be there and name dropped just about everyone that I knew. I went to check their library to see that the books had arrived from Israel (some had, not all).

They said I needed scrubs and Abdullah said he could get them for me (and made it sound like it was going to be a big task for him). I stepped out of the office to pay for the time here and when I came back the scrubs were on his desk (that was fast) and he asked me to give him $10 for the effort. I said no. I draw a distinction between being in need of money and taking advantage of people. He had the flippen scrubs in his desk drawer. Besides, I was in the process of sending 40 boxes of books to their hospital library AND I drove the hospital superintendent and 3 nurses to Jerusalem to Al Aqsa mosque while they were in Israel for Save a Child's Heart. I didn't think it was fair to ask for $10 for scrubs which I am going to return, so I refused.

I had to check out of the hotel and I was waiting to be shown to an apartment. I had my fingers crossed that it wasn't going to be horrible. A guy named Suleiman picked me up (originally from Oman) and took me to the apartment. His family owns a few properties on Zanzibar island and neighbouring Pemba island (which I will try to go to on the weekend). The apartment is fantastic. There are other medical students here (all German) but the space is big and everything locks so I feel like my things will be safe here. Best of all, there is a nice big kitchen and fridge and even a washing machine. He gave me a special price...whatever... but I am only paying $10/night so that was just fine by me. I will be very comfortable here. Best part is that they have a computer with free internet so I can do all the blogging I can handle (hence why this message is so bloody long).

My plans/intentions:

I would like to have some good experience here learning about medicine in this country. More importantly, I would like to repeat the project that we just did in Ethiopia in 2 years here in Zanzibar. I would still like to see this site become one of the sites for students at my school for their fourth year and eventually I would like to see a Tanzania stream at my school where students can start in their first year to learn about medicine in Tanzania in preparation for their fourth year elective, which I will hopefully facilitate in 2 years time.

I will meet with the hospital director in a couple days and submit to him a proposal and if he likes it, I will let me school know as well and we can take it from there.

The guy who showed me the apartment, Suleiman, has family on Pemba island and they have an organization called Zanzibar Childrens Fund for orphans on Pemba. I am going to try to head out there on the weekend and meet them and see what they are about...Maybe they can fit into my plans.

So that is all for now. I am going to go and explore the town a little bit more. It's boiling hot here. it's the end of summer in the Southern hemisphere (sorry Nat, I know how cold it is there). I am over dressed but I will be in scrubs for the next few weeks so that should give me some breathing room.

lots of love.

Will

Coming to you live from Addis Ababa Airport (Liad)

Hello everyone!

So here we are. This part of the project has come to an end. It's hard to believe I am on my way to the holy land :-)
Arriving at the airport we didn't realize that Will and I are flying out through different terminals. So after all was sorted out, Will went to check his bags at Terminal 1, we had a short goodbye and he is already on his way to Zanzibar. I was asked to wait in Terminal 2 with the people at customs until check in time. So after a 2 hour wait, I got the absolute Royal treatment. I was escorted to the business class check in counter, checked my huge bags, was shown through immigration and within minutes I was in the duty free. AMAZING! It's actually quite nice here, besides the fact that apparently you are allowed to smoke..Ug.

On the way to the airport, Will and I were talking and we both agreed that the time we spent here seemed much longer than 3 weeks. I think this feeling comes from different places. First of all, this experience was very unique and special! Being here under these circumstances - Ethiopia being the first connection to SACH, the country where the first patients came from, following up on these patients. Seeing for ourselves what an influence it made in these people's lives. I also believe that we each learned a lot about ourselves, as Doctors and otherwise. We got to see different aspects of medicine and how it is practiced here. What are some of the difficulties the medical staff encounter on a daily basis. In my eyes, it is both inspiring and unbelievable.

Coming here we had a goal in mind and we have really worked hard and did all we could in order to achieve it. Hopefully good will come out of it and this could be used as a template for further follow up studies in the future. After all SACH has brought children for surgery from about 35-40 countries worldwide. I for one would be happy to contribute my time and in the future (hopefully) my expertise for projects like this.

I am really tired, so I will say good night. I still have a couple of hours until my flight. I think I will find a nice spot to close my eyes for a bit (cuddled up with the echo machine - of course).
It's going to be a long way back home but worth every minute.

Signing out..
Love and Kisses to All!

Liad

final moments to reflect (Will)

So today we leave Ethiopia. Liora already left a couple days ago and Liad and I are flying out this evening (her to Israel, me to Tanzania).

Our last few days were filled with action. We were hoping to finish things up on Thuursday and have some time to just explore the region for a day or two and catch our breaths. It turns out that we ended up having some more patients towards the end of the week so we were actually at the hospital until Friday afternoon. Also, we have been trying to organize all the data for the office in Israel so that they can have a list of the every patient that has come from Ethiopia, their diagnosis, the correct spelling of their name, whether or not we had a chance to see them (and why) and contact details for those who we did not have a chance to see.

|We are going to finish that today and then head to the airport. The hospital in Ethiopia has arranged all of our transportation to and from the airport because we have with us an ECHO machine that is fragile and very expensive. They have actually been fantastic about that and they have gone to great lengths to make sure we have been able to look after the machine - On that note, no one in israel has offered to collect Liad from the airport when she arrives in Tel Aviv, so she will have to take a taxi first to the hospital to drop off the echo machine, and then to her home....all this after two flights and a full night of flying.

We had a chance to say our goodbye from here and see everyone one last time. We got some nice gifts from some of the doctors (in addition to be taken out for dinner earlier in the week). I also had a chance to sit with the hospital director and just say thank you. he was the original collaborator with SACH when everything began in the late 1990's.

Needless to say, we have learned a lot over these past few weeks. We have learned about Ethiopia and Ethiopians as well as their culture and their behaviour. Importantly, I think we have learned a lot about ourselves and the type of medicine we would like to practice.

We all feel accomplished with our task and we believe we have seen as many patients as we possibly could have. The majority of the patients are fine and well and only come for periodic follow up, if at all. Some, however, are going to need to be re-operated and we are glad to have brought that to the attnetion of the physicians both here and in Israel. hopefully if some of them come to Israel in the coming months, we will have a chance to see them again.

So that is all for now. Looking forward to going through our pictures with anyone who is interested upon our return.

all the best,

Will (and Liad)

winding down (will)

Hey folks,

So things are still winding down here. We are mostly done seeing patients, though we are going to try to squeeze a few more in, possibly on Friday. Liora is heading back to Israel tonight :( so we are really faced with the end of our trip.

Our final number of patients ended up being 130, plus another 27 patients were are deceased (157 total)

We were really pleased to have seen more than 100 and I think we will be able to draw some interesting conclusions both from the medical and social follow up questionnaire from this project. We are now trying to figure out where the remaining 200 or so patients are and why we could not reach them. So far, we have learned that either people have moved, left the country, died or simply prefer not to be in contact. We have had some patients just refuse to come in.

There is also a group of rheumatic patients (women) that are boycotting us because we have not met their demands to find a solution to the fact that they need to be taking warfarin and therefore cannot get pregnant. On the one hand, we have all be sympathetic to them, especially in a country where getting married is such a big part of a woman's security. On the other hand, each of the women would not be alive if not having been treated in Israel (for free, might I add) and we are very frustrated that they refuse to come in for follow up to "teach us a lesson"

We are compiling a list of the deceased patients (Liora has been working on that) to figure out the reasons.

One other difficulty was timing. We came on very short notice to Addis Ababa and it required a lot of good fortune that the cardiologist we are working with happened to be free at this time. We saw as many patients as well could in a day (sometimes close to 20 in a single day). We are now going to discuss and figure out if we can get more patients in to follow up with a bit more notice, and perhaps I (Will) may return during pesach break (the girls will not have the time off.... an advantage to still being a medical student) and finish up whatever we can... We will be exploring that today.

In other news, we had a great dinner last night. We were treated by the doctors and went to a great restaurant with live music and dance. The food was excellent and we should be fine to not eat again for 2 or 3 days.

Today we are coming to the hospital with gifts for everyone...

more on that later.

best from us

Will (Liora and Liad)