6 down & 2 to go

6 weeks ago I had squeezed the final items I had on my detailed packing-list (that I started in November) into a big backpack and was more then ready to head of to Tanzania.

Overwhelmed by the new impressions, strange distractions and the adaptation to having no personal space what so ever, the first period at Kolandoto made me so exhausted that my bedtime became the minute after I finally shut down my computer.

But it is supersizing how quickly you adapt to a complete change of lifestyle, find solutions to problems you have never came across before and how fast you establish new routines while the oddest things become ordinary.

It might not always seem like it but times really flies here and even though it does not always feel like it, effort does pay off. I have, since day one, struggled a bit with the feeling of always being just a small step behind, putting down fires as we go. This without really having the impression of a clear advancement of the project. For me, this changed today


WORKSHOP DISCUSSING THE FLOWS OF THE RECONSTRUCTION

When summarizing the work of the previous days I realized that there might actually be a good solution to the puzzle of the maternity ward that seemed completely impossible to solve a few weeks ago. And on the way back from a successful workshops for the new private ward we passed the site of the new emergency department and saw that they had now started the construction work.
DAY ONE AT THE CONSTRUCTION OF THE EMERGENCY DEPARTMENT 

With two weeks left, it now feels like we are back on track and in a good phase. The hospital will most likely have an emergency department before the fall starts and feasible solutions for a future development of the hospital by this summer.

Just another day in Kolandoto

We are now finishing our fifth week here in Kolandoto, and as Emelie talked about the other day, time really flies by. We are starting to get some routines, and therefore, I would like to invite you to follow us around for one day here in Kolandoto. This is what our Wednesday looked like this week.

The morning started as usual, with breakfast on the porch. Today I ate banana pancake with fresh mango and of course, coffee. 

Emma and I walked up to the hospital area, passing the church which was extra pretty today.

We were going to meet up with N'kaka, one of the hopital staff who were going to take us to see the water pump. While we waited for him, we walked past the area where the Emergency Department is to be built, to see the absent electricity pole.

The whole were it used to stand was covered and neat. 

 

The pole now has a new spot outside the administration building.

After looking at the electricity pole, we found N'kaka and walked to the location of the water pump. The chloride system connected to the pump is currently in need of some maintenance but will hopefully work smoothly soon.  

After the visit at the pump station, we went back to do write on our thesis. When in need of a change of scenery, we use the hospitals meeting room for studying. Very nice of them to lend it to us.

Later in the afternoon, we walked down to the village to get some tomatoes and bananas. On our way there, we met up with a bunch of bees, it was not a pleasant meeting so to say...

To sooth ourselves, we decided to get some mango juice, it made it feel a little bit better at least. 

After treating our stings with some hydro-cortisone, we did some more writing. Unfortunately in the dark since there was a power shortage. We are used to them now, so we make sure to charge our computers when there is power, so we can work on battery power during the shortages. 

To have a gas powered stove is a good thing during power outages. This very nice meal with pasta, aubergine and tomatoes was prepared in the light of a flash light so we could have some dinner despite the lack of electricity.


After dinner it was almost bedtime, so this picture will conclude the day. Thank you for following us around!

Sketching

The last days we have spent all time on sketching and designing the new private ward and the extension of maternity ward, which is very fun!

Another good thing is that next week they will start the construction of the emergency department. Already now they have cut down the tree and moved the electric pole that were in the way. We are very excited for next week :)

Reconstruction of maternity ward and a new building for private ward

This week after we have both submitted applications for a building permit and finished the drawings for the construction document and the contract was signed for the construction of the emergency department, we Sandra and Emelie, have been able to spend all our time with the main topic of our master thesis - a design of an extension and reconstruction of the maternity ward and a design for a new building for the private ward at Kolandoto Hospital.

Entrance to maternity ward

Currently the private ward and the maternity ward are in the same building and our intension is to move out the private ward to a new building. Today the private ward provides income to the hospital, since patients who are able to stay here, pay a higher fee than other patients to get higher standard – staying in single patient rooms or sharing ward room with a maximum of 4 patients instead of 20 - as it is in the other open inpatient wards at the hospital. With a new building with even higher standard in terms of sanitary facilities and indoor environment, the hospital can charge more per bed – and in turn it can provide a higher level of income for the hospital, which can be used to finance future investments in the development of the hospital.

The building today

The other big motivation to move out the private ward and extend and reorganize the maternity ward, is the current overcrowded situation at the maternity ward, partly due to the reason that this service of care, is now provided for free at the hospital. So at the moment there is not enough beds and space and no flows are separated, they lack proper waiting room and nursing station. Women are almost sharing beds sometimes, and the doctor told us that they sometimes have up to five births at the same time but only two delivery beds – which put them in situations where they need to be “creative” he told us – meaning they give birth a little here and there if it's urgent. Also the 7 pre-delivery beds and the 9 post-delivery beds where the mothers keeping their newborn babies, almost shares the same room today, which poses a high risk of transmission of diseases and infections between patients and to the newborns.

This is the pediatric ward - but it was the only empty ward suitable for a photo

 

Examination room/ observation room sometimes a delivery room

So there is a lot of things to work with here. We have used participatory design with a lot of workshops with the staff to get a good picture of what is needed and to understand the work flows etc. Very interesting!

 

Coming from Sweden with our background, you sometimes get a bit uncomfortable of what you see - even if everyone seems happy and everyone is really doing their best. The biggest difference we think is the integrity and privacy. Everything is done open here and sometimes when you're on guided tour at the hospital, they try to pull you into the delivery room just in the middle of a childbirth - and inside, already 10 people are watching a mother giving birth – many is of course students from the college but it still feels very strange for us. Or when people want to take photos with us and them - posing in the front of patients. Similar situations also happened at the study trip to Mkula Hospital 3 hours north of Kolandoto, where they guided us through the surgery theatre in the middle of a surgery. But even if you see a bit uncomfortable things here, everything is super interesting and very exciting. You get another perspective on things and this work feels very rewarding and meaningful for us.

Fantastic outdoor waiting room at Mkula hospital

How odd things have become normal

 

We have almost spent 4 weeks in Kolandoto and time has really passed by quickly. You realize now how fast you got used to things and got an everyday life with routines here that are actually very different from home. Suddenly a lot of odd things feels totally natural. Therefore we are going to give you a glimpse about these things – before we forgot them J

Kolandoto village

 

The heat:

The main difference that is very evident all days is of course the heat and it’s very hard to cool down due to the lack of water. The heat makes you very slow between 11-17, so the best ideas and efficient work must be made during mornings or evenings. This, together with loads of work in front of the computer or sketching indoors, have contributed to the fact that we are still very pale. We totally understand that people screaming Mzungo (white man) after us as soon as they see us – we really light up with our white arms and legs. Sometimes, however, we try to get some tan - by sunbathing one part of the body at a time, usually the legs or a feet we manage to stick out of the shade from our veranda.

 

If it’s not sunny it is the opposite - extreme rainstorms or big thunderstorms, since the rain season is here. Then you have to make sure not to have your computer plugged into the socket - already one computer has broken because of this, even though we use surge protectors.

 

Water and hygiene:

If you want to cool down or take a shower, you can do so by going to the toilet and pour water over yourself with a bucket. We usually have water about an hour in the morning, and then you have to hurry up to fill up our buckets with water - one for the shower/ hand washing, one for flushing the toilet and one in the kitchen. It's funny because now we have become used to not having water, so even when we have, you still pick up the scoop instead. But then you realize how wonderful it is to turn on the tap water and wash both hands with soap at the same time - and not one hand at a time with the bucket.

Our bathroom

 

The electricity:

As we mentioned before – we never take electricity for granted here. It comes and goes little as it wants to or sometimes you hear about planned power outages in the village. Therefore, we charge phones and computers as soon as we are able to sit nearby a socket.

The food:

In the village here in Kolandoto you have two dishes to choose between - eggs with potatoes or beans with rice. After eating this a number of times we cook most meals at home now - to get more variety. In the beginning though, it was still most rice with eggs or rice with beans we cooked.

The hardest part though is always to sort out all the stones from the rice and the beans, and still after 4 weeks, we haven’t found an easy way to do it.

The creativity has however been improved and we have become really good at varying us using the same groceries. This has also been easier after we discovered this Arabic shop in Shinyanga market - selling ketchup, Japanese soy, coconut milk powder, vegetable conserves, spices, peanut butter, oatmeal and pasta.

 

The best parts of the food here is all fruit - we live on mangoes, pineapple, watermelons and huge avocados.

 

Sometimes we eat dinner with our neighbors and they serve all kinds of traditional food – like ugali and some meet dishes which is fun to try - the dried fish we happily refrain though. Tomorrow we will invite them to taste our "Swedish" carrot soup and they will teach us to do "the best” chapati bread.

Dinner at our neighbors

Daily exercise:

To not completely get stucked in front of the computer we all try to do some exercise in some form. The best time to do this is in the morning before 8.30. For example, we have found a good running track around the village at around 7 km. The run is never the same and quite exotic actually - sometimes you have company of about 1 to 20 kids (or adults) running after you or waving and shouting at you - best encouragement! You also get to see the amazing landscape with cows and cattle, workers on the fields, houses made of adobe bricks and even round mud huts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Except the running we have to admit we are also quite inventive in training equipment – like watermelons or water bottles.

 

 

 

Wildlife or insect Life:

Last but not least, we meet a lot of animals and insects everyday - some more welcome than others. It is now standard that cows walk by two meters from our house or that a hen or rooster is trying to come into the house - like when we had a meeting on skype with our tutor and we were constantly interrupted by the cackling rooster right by our door – quite surrealistic for her we think.

Other common animals is bats or lizards along with several thousand mosquitoes. Around ten each night, all the giant mosquitoes wakes up (which we found out to be the malaria mosquito). They are really aggressive and if you sit up at night much of your legs are bitten. Or if you sadly fall asleep with your head or hand too close to the mosquito net in the bed, you have at least 20 mosquito bites when you wake up. Luckily we eat malaria prophylaxis and using mosquito repellent.

 

Insects have simply become a part of everyday life here and we have probably all became a little more "brave" – at least we don’t panic if a cockroach crawling up from the toilet anymore. However there have been two times when we got totally panic - first when we were invited to dinner to the two boys living next to us and a rat came running on the floor and they hardly reacted, and secondly one cozy movie night in the sofas and suddenly a 10 cm scorpion came crawling out under the sofa – I think we all died a bit then.

After Work on the rocks

Last Friday, we had an after work in the evening. Now, you might imagine us going to the local pub or bar, but no, we went to the local rocks instead. In this area, there are many rock formations that reminds you of a giant playing with her blocks and building all kinds of formations in the middle of acres and fields. Some of the formations are very steep, but there is one close to us that has a path so that you can climb it. Once you are on top, you get a really nice view of the area, and it is really pretty at sunset. So, this is where we spent our Friday AW, not so bad at all.

Umeme- electricity

Since our arrival almost three weeks ago, the power has been out three times, for at least 5-6 hours each time. This does not seem to be unusually many power shortages, since it is rather common that the power network suffers from electricity shortage every now and then. Therefore, there is a need for a backup electricity system, which the hospital has in the form of a generator. However, the generator does not turn on automatically when the power goes off, but takes about 15 minutes to start. This means that another solution is needed to give electricity in the meantime, so that the hospital is not left powerless in the middle of a surgery for example.

Due to this, one improvement that was made during Kolandoto Healthy Hospital part 2 last spring, was the installation of a UPS system (Uninterrupted Power Supply). It runs on solar cells that are installed on the roofs and that are connected to batteries in the buildings. More information about the installation of the system can be found here.

The batteries that holds the electricity from the solar cells are stored in a special room in each department or building that needs this system. However, as anyone who has been using their phone for a long time knows, batteries get quite hot when used. To avoid overheating of the batteries, air conditioning for these rooms is therefore necessary. It was a little bit uncertain if the reason for having air conditioning was clear when installing the system, and we were very anxious to see if the battery rooms were cold when we arrived.

Mikael and Maria went on an “umeme-tour” with Mkaka who is responsible for the electricity on our second day here. We went into two different rooms that were cold, but this could be staged by Mkaka because he knew that we wanted to see them and could have turned the AC on earlier. When Mikael asked to go into the third battery room, Mkaka looked a little confused but then said yes. And imagine our joy when we went in and felt that it was very cool in that room as well. 

Just look at Mikael’s smile here. It is really good to know that the implementations that were previously made are used in the correct way! 

Sign on the dotted line

(Mamma, det finns en sammanfattning på svenska längst ner)

Last Friday was a big day for us and the hospital. We finally signed the contract for the construction of the new Emergency Department!

During meetings on Thursday and Friday with our contractor, we finalized some details like how the windows should look and what type of drainage system should be used for the rainwater. By lunchtime on Friday, the hospital and the contractors were both ready to sign the contract. This agreement was certainly worth celebrating. Next thing we knew we were toasting with ice cold sodas in PET-bottles.

No deal is completed before picture time.

Parts of the hospital management with representatives from the contractor.

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I fredags skrevs äntligen kontraktet på för den nya akutavdelningen!

Under möten med vårt byggföretag på torsdag och fredag diskuterade vi detaljer som utformningen av fönstren och vilken slags dränering vi skall använda för att hantera regnet. Vid lunch på fredag var både sjukhuset och byggföretaget redo att skriva på kontraktet. Detta firades med iskall läsk i PET-flaskor.

Soko- the market

During our time here in Kolandoto, our main focus is of course on the project and our master theses, but we do have some free time as well. One of the things that we have put quite a lot or our time on so far is food, both buying it and cooking it.

At home in Sweden, one takes the grocery store for granted, and most things you want to eat can usually be found there. In Kolandoto, the grocery store is rather some stands where people sell vegetables, fruit and sometimes eggs. If you want to eat more than this, and we want to, one has to go to the bigger city Shinyanga about 20 minutes from here. In Shinyanga, there is a big market with many things, some familiar, and some previously unknown to us. Many market stands has small dried fishes, which we have not yet tried. We go for the fresh fruit and vegetables such as mango, avocado, pineapple, and watermelon instead. And of course, rice, eggs and beans.

To have so much fresh fruit for breakfast is really luxurious- just look at our fruit plates after we got back from the market last Saturday.  However, we are not yet completely familiar with the cooking habits here. So far, we have done some very nice dishes sush as pasta with tomato and eggplant sauce, and beefs from beans with ginger and rice. Some dishes were not as successful, like when trying to make the local bread chapatti, but ending up with lumps of dough that were slightly burnt on the edges. We are invited to a cooking class with our neighbors who maybe can show us how to make proper chapati so that they will be better next time!

Here is a short list in Swahili that might be good to know if you ever visit a market in eastern Africa:

Mayai- Eggs
Maembe- Mango
Maharage- Beans
Nanasi- Pineapple
Avocado-Avocado
Tangawisi- Ginger
Viazi- Potato
Maji- Water