Obs & Gyn

… in Tanzania; Obs and Gyne (pronounced guy-knee) in the UK; and OB/GYN (oh-bee-guy-nn) back home in the US. No matter how you abbreviate it, obstetrics and gynecology is an interesting and interdisciplinary medical field.

Though obstetrics (the medicine of pregnancy and childbirth) and gynecology (the medicine of the female reproductive tract) are two separate fields, they intertwine very closely. Hence, most doctors specialize in both, which gives the OB/GYN field the multifaceted approach I especially enjoy.

In fact, at the age of 13, when I first considered medicine as a career, I wanted to be a gynecologist. I told everyone. The initial interest stemmed from my mother’s explicit descriptions of puberty, birth control, menstruation, childbirth, and pelvic exams; explanations that would have terrorized any pre-teen fascinated me. At 14, I built an anatomical model of the female human body, which still resides in my room back in New York. One could change the breastplate, intestines, and uterus to make the model 7 months pregnant.

The 9 years between those awkward adolescent moments and my first year of medical school have seen multiple changes in both career aspirations and academic interests – including serious time commitments to both HIV/AIDS issues and mental health issues. However, OB/GYN (and women’s health in general) has always held a special place in my heart.

In college, as I developed other medical interests, I’ve looked away from OB/GYN. Mental health is a heavily overlooked issue I desire to pursue, first of all. Also, the medical malpractice insurance for OB doctors is ridiculously expensive in the US (in the range of 150,000 to 300,000 a year), and not many doctors are compensated enough to cover such an egregious expense.

I decided to work in the Obs and Gyn department at KCMC this summer to acknowledge my initial interest – and because it is more difficult to shadow a psychiatrist in a country where everyone speaks Swahili.

Let’s see how it goes!

KCMC

Today (6/30/2010), we visited the Kilimanjaro Christian Medical Centre (KCMC) for the first time. I spent $385US dollars to pay for housing ($150 a month for 6 weeks) and $140US for a residence permit. The rent also covers the cost of having a house cleaner, who comes in and does yard work, washes the dishes, makes the bed, etc. For an extra 5000 T/= (or T shillings) per week, she can wash and iron your clothes.

KCMC is a major teaching hospital with a medical school (one of three in Tanzania) and a nursing school. Many patients travel a great distance to receive care. Because Tanzania is a developing country, disparities are apparent. For example, because the surgery department has limited supplies, we were instructed to bring our own scrubs, masks, and caps if we intended to observe a surgery. Blood supplies are drastically low – I plan to donate blood soon. Furthermore, the internal medicine department lacks a working EKG machine, and because there is no full-time pathologist, pap smears aren’t given to test for cervical cancer (I will discuss this topic later).

Despite the disparities, the hospital is full of talented and caring people who truly work hard for the benefit of the patient. Unlike any other hospital I’ve seen, the campus has many open spaces and courtyards. In the middle of the main building, a grassy courtyard beautifies a hallway for doctors, nurses, assistants, and patients. Plus, you can see Mt. Kilimanjaro from the campus.

The next day, I start work in the obstetrics and gynecology (OB/GYN) department. The schedule varies. Some days I start at 7:30am with the morning reports; other days, I don’t need to arrive until 9am.

I can’t wait to start!

"Vacation" Turns Into "Trip"

(06/29/10) Rested, relaxed, ready – our third and final day on Zanzibar marked the end of our vacation. We had to start our trek to Moshi, Tanzania to work at the medical center.

We left Zanzibar at 8:30pm and boarded an overnight ferry back to Dar Es Salaam on the mainland. Usually, ferries between Zanzibar island and Dar take up to 3 hours. However, to save hotel money, we took a ferry that would drop us off at Dar at 6am the following morning. As we boarded, veiled women, anxious children, and working men watched us climb the stairs into the VIP section, where the other Mzungus stayed. The conditions were detestable – cramped spaces, constant rocking, unusable bathrooms. I just wanted to get to Moshi.

When the boat docked, we were greeted by a sleepy town and Alpha, a taxi driver. I called him to pick us up from the ferry and shuttle us to Ubungo, Dar’s bus depot. It’s a crazy environment filled with bus workers, passengers, and pickpockets.

A classmate managed to have us pay 28,000 T shillings for a “luxury-class” bus that would arrive in Moshi at 1:30pm. Ha. The bus was cramped, and we arrived in Moshi at 7pm in the evening (total travel time of 22.5 hours). We saw many cool things on the way, including a crashed plane on the side of the road, which caused the traffic to back up for about half an hour. These are pictures we took from the bus:

Now we have arrived at our house, which I will talk about later. Now, I need a shower.

Zanzibar Spice Tour

Waking up in Zanzibar without having to pack up and travel to another continent meant paradise. I could leave my arduously heavy luggage in the room and move up to the roof for breakfast and view the city.

We soon left for a spice tour that morning – one of the highlights of any Zanzibar visit. A van took us north to a rural part of the island, where a tour guide showed us the numerous spices, herbs, and fruits that grew in this tropical land. We saw vanilla beans, nutmeg, cacao, lemongrass, peppercorn, etc. – with samples to taste of our own. I really enjoyed the aromas!

After the tour, we were taken to a compound, where lunch was served: rice with curry and nan (an Indian form of flat bread). In lieu of the food, I especially enjoyed seeing rural Zanzibar – my first time in a truly tropical environment since I lived in Hawaii as a young child. Many scenes reminded me of Hawaii.

We were soon escorted to a beach, where we got to swim in the Indian Ocean! The water was very salty! It reminded me of those glasses of salt water that my mom made me gargle as a kid. The bottom of beach mostly consisted of prickly coral remnants, which succeeded at scraping one of my toes.

When we returned, we caught another glimpse of the sunset at Forodhani Gardens.

Like I said, paradise.

Zanzibar Papasis

The fourth day of our “vacation” started with a ferry to Zanzibar Island, off the coast of Tanzania. Though an official part of the country, it has its own government – including its own president.

The Lonely Planet Guide to East Africa says this place never fails to retain an exotic edge, and I can see what it means. With its mix of African, Indian, Arabic, and Western cultures, there’s always an element of the exotic and unfamiliar.

The island has been flourishing since the beginning of the first millennium as a trade post for Arab and Persian merchants. However, with the advent of the Omani Arabs, Portuguese, and the English, the island has experience several cultural and economic transformations.

One interesting unfamiliar part of Zanzibar is the street touts, known in Swahili as papasi (literally means “ticks”). From the moment we stepped foot on the island, they bombarded us with offers to sell paintings, shirts, goods. Some became our unofficial tour guides without permission, only to ask for a hefty tip in the end. It can be very frustrating, especially when we desired to just walk around and enjoy the city in peace. Even if you say, “no, I’m not interested.” It’s just an invitation for these men to work even harder for the sale – at as high a price as possible.

Fortunately, it gave me a chance to practice my remedial Swahili. I learned how to say, “Hapana, bwana” (No, sir); “Hapana, lakini asante” (No, but thank you); and “Niache tafadali!” (Leave me alone, please!).

Dispite the pushy papasi, I really enjoyed our hotel, looking around Stone Town, and enjoying a cup a Chai at the Stone Town Café. We even watched the US v. Ghana soccer game at a local sports bar, but not before enjoying the sunset at Forodhani Gardens.

I can get used to this place.

A whole new world

After shorter, five-hour flight, we’ve arrived in Dar Es Salaam, the largest city in Tanzania. The airport was filled with people, chaos, confusion, and worry. The entire airport only had two luggage carrousels, of which only one was used, which meant tons of luggage in a little space and tons of anxious time that passed before our luggage finally appeared. Luggage theft occurs very often in airports like these. It’s a very scary thought. Make sure you keep your eyes on everything.

After we finally left the airport, scores of men in white shirts approached us with candid greetings of hello and aggressive offers for cab services. After bargaining our price for two cabs to the downtown region for twenty thousand Tanzanian shillings per car, we were off to the Jambo Inn, a cheap hostel frequented by Cornell students.

After checking in, collapsing, unpacking, resting, and reminiscing, we found the energy to explore the town as night approached. No sidewalks, street signs, or traffic lights existed. To cross the street, all you needed was aggression, awareness, and a little stupidity. Since Tanzania is just south of the equator, the sun had set much sooner than we initially expected—around 6pm.

“Nice to see you again! How are you?” we had heard from two Tanzanian men who had caught the attention of one of the female travelers. “You’re Canadian, right?”

“No.”

“ahh, you look just like someone we met earlier.” I grew suspicious.

After some conversation, the two men, George and Lucas, guided the six of us to a bar where dancing took place. We got some Tanzanian beer. A waitress recommended Ndovu beer. I really enjoyed the flavor and the relaxation that accompanies drinking a beer on a different continent.

George and Lucas were nice guys who talked to us about everything, from what to do in the city to the falling approval rating of the Tanzanian president. However, I wasn’t born yesterday. Two strangers from the street don’t just drop everything to hang out with seven obnoxious Americans just for the fun of it. They wanted to make a quick buck or two.

I decided to buy a painting from them, and we planned to tip the guys tomorrow when they help us get ferry tickets to Zanzibar.

Fun!

Consumerism with an Arabic Twist

After at 13.5 hour-long flight, we arrived in the city of Dubai. 20 years ago, it was the desert-equivalent of a hole in the ground, yet the city has been spiraling upward like the Tower of Babel. As we rode through the city, we observed scores of skyscrapers under construction. In the looming distance, the Burj Khalifa, the world’s tallest building (that just opened this January) graced us with its presence.

We managed to get a pleasant looking apartment-style room with 7 beds (for seven travelers). It looked amazing for only $33 dollars per person per night.

After our arrival, we dropped our luggage off and set off on a self-guided tour, which revealed two sides of the city. First, we visited the Golden Sok, or gold market, in the older part of town. The streets were full of small shops filled with crafts, jewelry, tea, and men who were eager to make a sale—at whatever price necessary. I regret not buying a silk shawl, which would have cost around 30-35 Durbon (so about 10 bucks).

After a long cab ride, we decided to return the Burj Khalifa’s initial greeting with a visit of our own to it's mall right below. The city’s aurora changed completely. Small independent shops were replaced with Bloomingdales, Prada, Starbucks, California Pizza Kitchen, etc. The prices were the same as in a New York or Las Vegas mall, except for the electronics, which was much more expensive.

Some friends of mine traveled to the to the top of the tower. Here's part of the view:

I was especially intrigued by the advertisements. Everything was in English and Arabic, including this Bulgari ad that was all over New York, now with Arabic writing.

With the financial crisis of 2007-2010, Dubai was in danger. As companies failed and people lost their jobs, construction projects have been suspended and foreigners have been fleeing the country to escape debtor’s prison. (http://www.nytimes.com/2009/02/12/world/middleeast/12dubai.html)

Who knows if Dubai will continue to boom economically again—now, I just want to be in Africa.

More articles:

(http://www.nytimes.com/2009/11/28/business/global/28dubai.html?_r=1)

(http://www.nytimes.com/2009/11/28/business/28markets.html)