Flying Home

There really are no words to describe the last thirteen days…hopeful, heartfelt, challenging, surprising, awe inspiring, tearful,joyous. We’re heading home (currently somewhere over Greenland) after a sometimes frenetic but very fruitful time in Arusha. This has been a trip of hope. The antiretrovirals (ARVs) have finally reached sub Saharan Africa and our now being used; saving lives, restoring futures and families. It seems a time of cautious optimism. But there is still so much to do.

We all have a much better overview of the healthcare system in Arusha and Northern Tanzania-thanks in large part to the many meetings and visits with the main testing and treatment centers in the region. Volunteer testing and counseling is well established but had not been much utilized because of the stigma of HIV/AIDS. The presence of the antiretrovirals, though still not widely distributed, seem to be changing that. Eight to ten percent of the population of Arusha-some 20,000 people, are thought to be infected with HIV/AIDS. Treatment centers such as Mount Meru Regional Hospital, St. Elizabeth Hospital and Selian Hospital in Arusha and Kilimanjaro Christian Medical College (the primary referral center for Northern Tanzania, also known as “KCMC”) in Moshi are providing antiretroviral therapy for some 2,000 individuals-perhaps a drop in the bucket, but a drop all the same. Tanzania has a limited arsenal of ARVs-primarily four drugs compared to the twenty two available in the U.S. But it is making a difference. We learned that Peter-one of the HIV infected individuals who welcomed us into his modest hut in a local squatter’s village last year, who was at that time barely skin and bones is now on the medications and back to supporting his family. Several of the members of Ann Kleeger’s and Jody Casserly’s HIV women’s group at Upone Clinic are also enrolled in HIV treatment programs and doing well.

With a small number of available drugs, there is some concern about the development of resistant virus-a subject much discussed at our second annual HIV/AIDS symposium held at the end of the week. Learning from the mistakes of the developed world, the Tanzanian government has taken simple, yet effective steps to discourage improper use of the HIV medications. Taking the profit out of the drugs, distributing them without charge only through designated treatment centers and closely following clinic visits and compliance at home have seemingly produced a very high adherence rate. More individuals are testing and HIV prevention is being discussed freely now in many support centers around town. Mount Meru Hospital and Upone Clinic are interested in an oral fluid testing project sponsored through The Phil Simon Clinic. Team member and laboratory clinician, Cheryl Arteaga has trained several members of Mount Meru’s staff on oral fluid testing techniques and we hope a larger project will be launched soon. One of the shining moments was when Cheryl’s oral testing program discovered a patient who had been misdiagnosed and was really HIV negative. Certainly an enormous relief for the patient and another example of how even small projects can really make a difference. Cheryl has been offered many jobs at the various medical centers-so if she ever wants to move to Tanzania…

This trip, like much of Africa is a marvelous mixture of technology and tradition.
Team member and pharmacist, Jim Avedekian organized medications and helped with patient care at Upone Clinic, met with the CEO and scientists of an Arusha based pharmaceutical company that makes ARVs and spent an inspirational afternoon with a traditional healer in Moivaro Village. Raffee Reyes, director of food services at Huntington Hospital, toured the efficient, if not somewhat eye opening food facilities at Kilimanjaro Medical Center. “Ugali” or “stiff porridge” seems a staple for many of the inpatients (and medical students), but probably won’t be appearing on the Huntington menu soon. I still see Raffee gleefully exchanging information and probably war stories with the KCMC food director. Wood fire stoves are the back up plan for the frequent electrical outages of Tanzania and the meat cleavers of Tanzania are not to be believed!

It seems that each of the past trips have built upon themselves. Ann Kleeger’s HIV positive support group is still meeting and was awaiting her when she returned to Upone Clinic-a testament to Ann’s perseverance and compassion. Jody Casserly’s camera project and the return of her Tumaini women’s group shows the depth of her bond and commitment to the people of Arusha. Jody had the opportunity to show previous camera project photos to the group members-the cackles and chirps of joy are not to be forgotten. We have had just a glimpse of this year’s Children’s Camera Project and, suffice it to say, they are amazing photos. Tom Warren, our veteran nurse, triaged the Upone patients with aplomb and had several opportunities to exchange stories and expertise with fellow Tanzanian nurses. Tom’s clinical expertise continues to impress all who work with him and his obvious love for the people of Arusha really represents what this project is all about.

Suzie Icaza and Gyongver Sovago had their first taste of Tanzania as well. Suzie spent several hours reviewing patient care and interviewing HIV positive individuals at Upone Clinic. Her expertise in sand tray therapy may play a role in future projects and it was a delight to see Suzie carefully and compassionately explore the mental health aspects of HIV in Africa. Gyongver, our videographer did a marvelous job recording the entire trip and clearly was moved by the emotion and beauty of Tanzania. A real moment occurred when she met a fellow Romanian physician in the female ward of Mount Meru Hospital. The world is indeed a very small place. We are all anxiously awaiting the images she has captured so thoughtfully.

Finally, Lyn Smillie has once again gotten everyone and everything to Africa and back again. No small task given the thirty hour plane flights, one thousand pounds of luggage, dietary dilemmas and ten different personalities. And that doesn’t even count the bumps in Moivaro Road, enormous African spiders, Serengeti dust, cranky lions, slippery showers and of course, the occasional bouts of Tanzanian Two Step. Thank you, Lyn.

As we fly across the Atlantic, so many images and sounds and smells come to mind…the phenol odor of almost all the Tanzanian medical facilities, the soft fragrance of honeysuckle in the morning, the sweet voices of the children of the orphanage and their cheers to their colleagues at Holy Family School, the loud “twats” of the resident hornbills of Moivaro Lodge, the bustling and dusty streets of Arusha, but most of all, the grace of the African people who have so willingly and warmly welcomed us into their lives. We are honored to be part of their community and we say, Asante sana Arusha.

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