Tim en Marije in Tanzania

Pumbu ward

Oops, it looks like we are not doing any work here. We haven\'t mentioned the hospital on our blog for quite a few months.

For Tim\'s non-medical friends, you may consider to continue reading on the following blog post of our babu Robert with who spent a nice Easter weekend on Mafia Island (drinking ‘bears\' (as stated on the bill) and snorkling) and Kilwa (Arab ruins). http://www.travelblog.org/Africa/Tanzania/blog-779342.html

Since we arrived eighteen months ago, I (Marije) have been working mostly in the male surgical ward. Jocular named Pumbu ward, which means scrotum ward in Kiswahili. Most common complaint is either swelling or pain ‘down there\'. We see giant hydroceles (scrotal cyst with fluid), which can reach to the knees, a condition that might be related to disturbed lymph fluid circulation due to the worm infection Filariasis. Sometimes they become infected, which even led to Fournier\'s gangrene in some unfortunate cases. My motto and one of the most prevalent indications for operation: ubi pus, ibi evacua! Same counts for necrotic tissue (dood weefsel). Yummy. Another cause of impressive enlargement of patient\'s privates is scrotal hernia. Where in the Netherlands we sometimes need ultrasonography to look for the hernia, here it is easily seen by physical examination. It is my pleasure to teach my new colleagues and students inguinal anatomy, the differences between hernia and hydrocele, between reducible and irreducible hernia, and the danger signs of intestinal obstruction and strangulated hernia. Even more pleasure to demonstrate it during an operation :)

The past months however, we have had such bad supply of materials, that we don\'t do elective surgery. It bothers me big time, because I see obstructed hernias that could have been prevented. The materials (like gauze, sutures and iodine) are available in town, but it is forbidden by the higher authorities to have the patients buy it themselves as that would interfere with the public health care system. Very political. Sometimes a colleague is able to operate a patient from my ward during the weekend; I never understand why some patients get priority and why things that can\'t happen during the week happen during the weekend. My favourite colleague and I tried to introduce a waiting/planning list for operations, but it failed. Although people accepted the concept, it was too difficult to effectuate, due to unforeseen obstacles and because people communicate little and travel without notice.

Bad luck for me, my colleague was ‘transferred\' to maternity. The doctor who was working there was appointed to work as medical officer in charge of the hospital. He is the third doctor in this management position since our arrival. The high turnover of staff is not supportive for the common development objectives to bring ‘sustainable changes\'. Luckily, VSO has also a very sincere and humble objective: share skills, change lives. Even on an individual basis. Although many days are frustrating and we are certainly not saving the world, I feel useful being here when I actually get the chance to teach an operation to another doctor, or daily when I discuss all my patients with my colleague or a nurse.

We have achieved a few successes. In January we started with a New Year\'s resolution: to revive the quarterly scientific meeting for doctors. I wrote a proposal for funding from VSO which we got, one million shillings (€500), probably enough for two meetings. I spent hours and hours texting almost all doctors in the two regions Mtwara and Lindi; luckily after each 100 texts the Airtel provider gave me 100 texts for free :) It took me some effort to inform and update everybody, and to find speakers, and to persuade participants to subscribe to a meeting for which they wouldn\'t receive any allowances but only lunch (and knowledge). The topic was ‘Trauma\', who could not be interested! It was a great day with 40 attendees. Nice to have enthusiastic speakers, amongst whom my adored doctor Jankiewicz; very good to fresh up our minds and motivating to meet doctors from different hospitals. Next meeting is already planned.

Also this year we\'ve got some donations from the Netherlands. We bought very useful equipment for theatre and the surgical wards, amongst which a pulsoxymeter (which measures heart beat and the level of oxygen in the patient\'s blood via a finger sensor). Safe surgery! The nurses in the operating theatre were very happy and use it now during every operation. When the alarm sounds, everybody starts searching for their phones to check if they received a text message. I was not sure if they were fooling me, so I gave a presentation about the fact that people die from lack of oxygen and how the machine works. Another item I really needed was X-ray viewing panels for our wards, which we bought, but the electricians who are supposed to create a socket for it point to each other to fix it for four months now and are rotationally on holiday, very annoying. A good purchase was the small steriliser for the ward; my nurses are not depending any longer on the small oven in maternity ward, or the always broken steriliser in operating theatre. They take their responsibility for wound dressing very seriously and we all find the hissing sound of our steriliser very comforting.

When we arrived, I refused to be the walking ATM, the mzungu with money, but after all this time in the hospital I see that there are severe shortages and with many small and big donations from friends and local companies we find solutions, even though they are sometimes temporary. But to buy food for a young boy with pyomyositis and his father, so that they stay in hospital for treatment and the boy will cure without disability, is not temporary, it is life changing. Thanks all!!

Riots & Lions

Some months have passed by, and it\'s time for an update in pictures:

  • Mid-December we went to the Annual Conference by VSO, this year in Dodoma- the official capital of Tanzania. A good opportunity to catch up with our fellow VSO\'ers who are spread out over the country.
  • For Christmas, Marije\'s mother and Tim\'s father accompanied us for two weeks. During that time also Tim\'s sister Maaike and her boyfriend Dennis joined us for a good New Year\'s celebration!
  • Last month, Tim\'s former rowing team from University visited us. We showed them around in Mtwara and went for an exciting and adventurous car safari through the wilderness of Selous Game Reserve, and a hike in the scenic Uluguru Mountains- it\'s so great to track and spot all the wildlife, driving through vast array of landscapes passing local villages.

This post is not only about beautiful photos. 2013 started with some Mtwara survival tests for us. Firstly, the rainy season started quite heavily, with our house almost flooded, but luckily all our furniture is hard wood, so no damage. Some people were more unfortunate, like our cleaning lady Agnes. She had the water in her house up to her waist for two days... movie The same month people started rioting against the government gas policies (remember the huge gas discoveries offshore Mtwara), even burning down some buildings. Another town in the region (Masasi) burned heavily. Although officially protesting against government gas policies, many sensation seekers are attracted as well. On Friday evening, coming back from Mikindani on our way to Mtwara, we were stopped by road blocks and angry mob, throwing stones at our car (window broken). Luckily we could escape, turning back to Mikindani, returning to Mtwara on Sat morning. After a few hot days everything went back to normal pretty quickly, especially after some Presidential promises to give everyone a better life.

See it all here.

Road trip to northern Mozambique

The last week of November we drove into Cabo Delgado, the most Northern province of Mozambique, for an adventurous one-week holiday. Cabo Delgado looks similar to Mtwara region: highland plateaus, impressive inselbergs, and valleys with beautiful baobabs and large mango trees. For the tribes living here (mainly the Makonde), the whole of the Mtwara region and Northern Mozambique has always been their homeland, despite the Europeans dividing the area by a (natural) border, the Ruvuma river. However Portuguese legacy has left a much better cuisine in Mozambique than the Brits in Tanzania. Cabo Delgado is as remote and underdeveloped as the Mtwara region; North Mozambique has always been left behind due to the capital Maputo being 3000kms away and focussing on South Africa. They even choose to have the same time zone as South Africa, which lead to strange hours for sunrise and sunset: around 4am and 5pm. The independence war against the Portuguese started in 1960 from Cabo Delgado with support from Tanzania, leading to independency only in 1974, and the subsequent long-lasting civil war (until 1992) also didn\'t bring the North closer to Maputo.

For us, this all meant that most of our trip was on rough roads through vast forests with only small mud house villages and monkeys on the road. As said, much of Northern Mozambique is very remote, the road network virtually nonexistent or under construction, only driveable by 4x4, and we were prepared for anything from potholed gravel to thick high sand, encroached by dense bush.

Until recently, the Ruvuma River splitting the two countries was almost impassable by car, but in 2009 a bridge was constructed 200km inland from the river mouth, a 333 km drive from Mtwara (5 hours including changing a flat tyre). This new bridge is quite surreal: coming from the dirt road, suddenly a brand new tarmac road starts, leading you to the bridge that could have been designed by a European architect (maybe they even shipped it straight from Europe), then a few kilometres tarmac road before the dirt road starts again. No visa available at the border, but we had them in our passports already.

After the bridge, a tropical storm turned the dirt road into a mud river. Sliding slowly forward, we stopped in a village, asked permission to park our car, and slept in the car. A very hospitable couple who spoke Kiswahili gave us ugali with mutton, delicious! The next day we continued to the coast, which is endowed with about a dozen of mangrove islands which form together the beautiful Quirimba Archipelago. We left the car in a coastal village and with sunset we joined a small boat to Ibo Island, a lovely island with some historical touches left behind by Arab traders and Portuguese governors. On our return, when leaving the parking garage (4 parking lots with a roof made of bamboo and leaves), our wheel pulled one of the standing poles away, which made the whole ‘building\' collapse! Very embarrassing, we can\'t write who was driving. Luckily only the nose of our car had a scratch, but the poor owner had to build a new garage, which we compensated financially by adding $5 to the parking fee. After that we continued to Pemba, a port town similar to Mtwara, but 10 years ahead in development thanks to a gas boom. With the current gas boom in Mtwara in mind (http://www.lngworldnews.com/ophir-jodari-field-has-potential-to-anchor-tanzania-lng-development/), Pemba gave us good picture of Mtwara\'s future. A big contrast: large industrial yards next to mud huts. People speak Portuguese but also we got along with Kiswahili. Nice beef, hamburgers, Portuguese and Indian restaurants, bread, coffee 

Not to forget: also at Pemba very beautiful coral reefs!

To get back to Tanzania, we decided to follow the coast straight to Mtwara, rather than going inland again to the bridge. However, this would imply using canoes to get our car to the other side... From Pemba we drove north to Palma, a coconut groves village just an hour south from the border. Almost cut off from the world, it is Palma where they just started construction of a 18bnUSD LNG terminal (the biggest in the world as they say). However, the only sign of it now was a fenced off yard with containers and 4x4s in the middle of dense bush. The next early morning off to the river to be on time for high tide (the river is only passable at high tide). But then the Mozambican Immigration Office delayed us for so long (asking money for nothing) that the tide was going out already, leaving us nothing else then waiting for the next high tide 12 hours later! Poor network reception, books finished, swimming in the river but not for long because there are crocodiles, the other 11 hours we did literally nothing but waiting and watching the tide going out and coming back in. Not ideal, because if anything would go wrong not much sunlight left for any emergency action. Watch this youtube-movie to see our crossing of the river http://timmarijetanzania.reismee.nl/video/14462/crossing-the-ruvuma-river-bordering-mozambique-and-tanzania/ (and how the boatmen forgot to anchor the boats making our Pajero sliding onto the boat but luckily not into the water). The river crossing itself was in the dark, but here\'s a movie of two friends who did it at daylight: http://youtu.be/HZVS54pKQsA On the last part to Mtwara we got stuck with an overheated engine, but with some help of really wonderful people (no, there is no Tanzanian Wegenwacht) we got a bottle of water and we could charge our phone in a hair dressing salon so that we could call a friend (a hero) who came to tow us back to Mtwara around midnight.

Check out our photo page again: http://timmarijetanzania.reismee.nl/fotos/134380/road-trip-to-northern-mozambique/ Besides photos of our Mozambique trip we also upload photos of the traditional tribal dance festival that took place in Mtwara early November (see also this http://timmarijetanzania.reismee.nl/video/14463/makuya-traditional-dance-festival-mtwara-tanzania-by-adea/). The day was organised by ADEA (center for African Development through Economics and Arts): http://adeaafrica.org/Home.html


It has been a long time since we wrote on this blog. Partly due to the fact that we updated many of you during our holidays in The Netherlands, partly because we cope more and more with the Tanzanian way of life, finding our balance between our own personal and Dutch attitude and the local culture and behaviour. I guess this ‘integration-not-assimilation-process' makes ‘back home' more ‘back' and less ‘home' (Tanzania becoming more ‘home'), which makes us less ‘needing' to write on our blog? Also, little by little we start to understand Tanzanian culture, society and history - although every day here still brings many surprises. This makes us more reflective, and better able to adapt and put things into the right perspective. Actually, our (re)confrontation with The Netherlands certainly contributed to this.

Our confrontation with the Dutch started mid-August, when Marten & Lisa, and Eric & Elian visited us. It was really nice to show them our life in Mtwara: the challenges in the hospital, the good life in our house at the beach, and the transformation of Mtwara from a sleepy town to a port hub for the gas industry. After that, Tim took Marten and Jorrit on a car safari through Selous Game Reserve and Mikumi National Park, spotting a group of lions just starting their dinner (buffalo on their menu), hyenas, a jackal, and the rare African hunting dogs. After a hike in the Uluguru Mountains, and a short visit to the historical port town of Bagamoyo, the road trip ended with a crazy party night in Dar Es Salaam. In the meantime, Marije went to Ghana to visit her brother who's doing his internships in the same hospital where Marije was four years ago.

The following three weeks in The Netherlands (including two days Brussels) were unforgettable, thanks to all of you for your great hospitality! So many things that happened in your lives during the past year, and so many babies (12!) that were born! It was a blessing to talk with you people who actually want something, who are ambitious, who are actively looking for improvements, and who have plans for their lives, houses, work, studies, children, etcetera. In Dutch eyes maybe not big and impressive, but at least ideas that sound as forward thinking, compared to the rather ‘passive' unplanned attitude we are confronted with here. It makes us realise what a difference it makes to live in a society where personal development is possible and actually encouraged, or to be dependent on too many external societal factors that limit every step you want to take forward. For us, it was also a blessing to understand what people say and what moves you, and the underlying societal aspects, rather than having to guess why people behave as they behave and why they say what they say.

Back in Tanzania, our first visitor was Kristine, it was so much fun to have her here for a week. We went on a boat trip to nearby village Mikindani, and she spent some days in the hospital with Marije. That week a plastic surgeon from Flying Doctors was visiting which was wonderful; he operated children with hare lips and a boy with club foot, really interesting.

In October, Tim's mom and youngest sister Lisette came to visit us, another really great opportunity to show our life to our closest. They enjoyed experiencing our life here, being it only for a couple of days. Lisette become quickly very popular among all Tanzanians (men and women) and I'm still receiving daily wedding proposals. On Saturday, after some snorkelling at the corals behind our house, we went to the fish market where we managed to get on board of a traditional sailing dhow! The next day we drove to Rondo Plateau for a nice walk to a small remote village for a tasty chipsi-mayai (omelette with chips). After 5 days, they went for a spectacular safari in Selous Game Park.

Last week, my oldest sister Margriet arrived, and yes, the number of wedding proposals I get doubled! Last weekend, we did camping at the Marine Park Mnazi Bay, without doubt the most beautiful tropical bounty paradise around. Next weekend, we're expecting the Makuya traditional African dance festival in Mtwara (2 days), looking forward to that!

Between these family visits, Marije went also for ten days to Nyangao hospital to work together with the very experienced surgeon Dr. Jankiewizc. Marije has been there before, and it is so valuable for her to learn from him. To work in a mission hospital where planning is possible is such a relief. And it is so exiting to treat crocodile bites, multi trauma patients, rare cases like congenital bowel abnormalities. And to be honest it is a pleasure to have a supervisor who you can ask for advice and who is very inventive, a dream for tropical doctors, for example to use fish line for sutures :)

Tim continued to work together with Dr. Gwao, our new the medical officer in charge (the hospital director), trying to get some improvements implemented, such as working on a new pricelist. Dr. Gwao is making good efforts in leading the hospital. Since we got back in Mtwara, Tim shares his office with Kiiza, a bright student in Public Health Administration, who is doing his internships here, and a pleasure to work with! In October, Tim also joined a Trade Mission by the Dutch Embassy to Dar Es Salaam and Mtwara. And besides his job in the hospital, Tim also took up the role to manage a VSO project to increase the level of the vocational trainings school (soort ROC) to catch up with the gas sector here in town. Almost no time left to spend on the beach, or to write blogpost! :)

Don't forget to check out our latest photos >> http://timmarijetanzania.reismee.nl/fotos/133082/home/

Underwater & Up in the air

Last two weeks have been a time of goodbyes. Our friends Moss & Merrit (Peacecorps) are going back to the States, and Jana & Kerrigan (GIZ) to Berlin, diminishing the level of our volleyball team substantially. Before they left, we spent another wonderful weekend camping on the beach in the Marine Park Mnazi Bay, a bit south from Mtwara. The coral reefs are so beautiful there! An underwater camera was the best present I could get for my birthday, (see photos!) thanks family J We went to Dar Es Salaam to say goodbye to Claire, who's going back to UK. Together with Robert, Claire organised our VSO induction course in Dar in our first week in October last year (see '1st week in Tanzania'). Last week good old is gold Martin left Mtwara (who introduced us to Mtwara when we just arrived; see '1st week in Mtwara'); he got promoted to become a big white collar boy (General Manager) in Kenya. And last but not least, Jolanda and Kirsten, fellow Dutch VSO doctors in the region, left Tandahimba- they were so meaningful to us sharing local hospital experiences. We will miss you all!!

But this is not only about goodbyes :
We had visitors!! It's fantastic to have friends who take the effort to come all the way to Mtwara, it's so nice to share and show our daily life, which is not possible through emails/ weblog alone. First, Yvette visited Mtwara, which was awesome J She joined me to work, and we went out for dinner. Time was too short, because in the same week (the week before we climbed Kilimanjaro) we had travel to Holland for the funeral of Tim's grandfather. After Kili, Lotte and Irma drove with us to Mtwara. They also experienced a working day in the hospital, and we went to visit tribal dance performances in two villages in the region. It was a three hour drive, partly on some really rough roads, but definitely worth it to see this part of the traditional village life (which we don't see in -relatively- modern Mtwara). The day was organised by ADEA (center for African Development through Economics and Arts). And of course we spent some time on the beach and underwater.

On the remembrance day of Florence Nightingale, a sherehe (Tanzanian party) was organised for all nurses in the hospital. As on previous sherehes, being the only male mzungu (white person), Tim had to open the bottle of ‘champaign' and divide it to everyone by pouring some drops of it in everyone's drink. We enjoyed warm beer and cold food and danced on the same three songs which we hear every day on the radio. It was a great night out with our colleagues.

Three weeks ago, we attended the wedding party of Mweri, a colleague from the hospital administration, and his beloved Agnes. It was good fun, and we were delighted to be invited! The wedding was in Dar, and we used the opportunity to visit some other hospitals and medical shops, in preparation for a renovation proposal for our hospital.

See our photos on the ‘Foto'-page!

Work wise, the last two months have been a bit quiet for me (Tim). I was advising the medical officer in charge (the hospital director), but he suddenly left in April to go for further specialisation in Russia. After that, someone acted on an ad interim basis, but not many decisions were taken due to the somewhat unclear situation. It took some time before a successor was appointed (because we're the regional public hospital, it had to go through regional government bodies). This month, the new medical officer in charge has been appointed and that is good news. It is a young Tanzanian doctor who was already working here, who has studied in Turkey, and - most importantly - someone who is looking for improvements.

I also found some projects outside the hospital to keep me busy: the organisation of a traditional tribal dance festival, the planning of a cultural center / ethnological museum for Mtwara (both with ADEA), and a VSO project to increase the level of the vocational trainings school (soort ROC) to catch up with the gas sector here in town.

For Marije as well, work was at slow pace these two months. The national drug supplier closed for a month, which is a yearly event but still unexpected. And consequently and even worse: we ran out of ketamine. All procedures are performed under general anaesthesia with ketamine, although spinal anaesthesia is the preferred type of anaesthesia in almost all procedures we do (mainly herniorraphy, hydrocelectomy, caesarean section, hysterectomy). Why don't we use it as routine? Good question, with all kind of different approaches I still haven't found out why. I get different answers each day, that spinal anaesthesia cannot be done, even when doctors are around who are able to do/supervise it. Unwritten rules make it sometimes very difficult for me to understand these issues. Besides this, we face problems like power cuts, no running water, broken laryngoscope (which we never use, but for back up, broken may mean that there are no batteries), no sterile gloves, no needles, no nurse, broken steriliser, no ephedrine, no ketamine for back up, etcetera. When one problem is solved, you'll find next, it just never seem to happen that everything is working at the same time. Despite all challenges, during last week the nurses agreed to use spinal for a few cases, with success, and I really appreciate it. Hopefully this is encouraging for everybody, and I hope the material problems will diminish, because I'm really tired of telling my patients not to eat before operation, and in the afternoon to disappoint them day after day by saying ‘pole, kesho' (sorry... tomorrow..). It's horrible for the patients and shameful for me. Fortunately, fasting during the day is now less a problem because Ramadan has started and the majority of our patients are Muslim, nevertheless patients are supposed to eat to be in good nutritional condition.

What enlightened my work the last weeks was the fact that COTC students (3 year training to become clinician) had to do practicals in the wards. Some days I could hardly see my own patients because they were surrounded by so many students. Now I have about 8 students who join my ward round and are eager to learn, and are amazing at asking difficult questions (why is inguinal hernia more common on the right side, can you get appendicitis from eating sand, what must be given first: metronidazol or ampicilline, etc). It's fun and it's triggering me to do a lot of bed side teaching.

Last but not least: my birthday. Tim got me the best present ever ever ever: a helicopter flight over Mtwara (and no, he didn't fake-propose again, although it would be an ideal romantic situation). Flying was fantastic, I couldn't help the permanent grin on my face, the view was gorgeous and it was just so exciting!
In the evening, we had a potluck party at our house, where everybody brings some food or drinks. 40 people turned up and it was the best party ever, dancing, loads of food and if I remember well loads of drinks. A fabulous weekend.
Monday, my real birthday, I got to open another ‘present': my first appendicectomy in Tanzania J
Thanks everybody for lovely text messages and phone calls and mail.

We're looking forward to see you all in Holland in about a month, expected flying dates 29th of August and departure 15th of September.

Kili time!

We climbed Kilimanjaro, highest peak in Africa: 5800m! It was tough, and awesome! We (a group of 9) all came together in Arusha on the 4th of June; all ready but a bit nervous for the big challenge. Yvette, Irma and Lotte came over from The Netherlands; fellow VSO doctor Jolanda joined with her niece Maaike; and Ellen joined from South Africa with her trainer-coach Menko. We used Machame route: 6 days in tents. Marije had taken her pulsoximeter with her and we all became her daily victims for her research. On Monday we drove to the Machame Gate and started walking through rain forest. Thick clouds of fog made the weirdly bearded trees look like wizards. We arrived at the first camp just at sunset. According to the pulsoximeter, we were all still pretty normal. Second day was moorland, with the snow capped Kili visible in front of us. On day three the deserted rocky and windy moon landscape started. Doc started worrying whether her pulsoximeter was not working correctly or we were really not much alive anymore. Nights were cold. Despite being tired, the hard rocky floor made sleeping even more difficult. Respect for the whole crew that guided us up this mountain. They carried all our bags, tents, chairs, and food. Every morning after we left, they packed all the tents, cleaned up the area, ran to the next camp while passing us underway, put the tents again, and made sure warm water was boiled when we arrived for tea and to wash ourselves. And did we yet mention the delicious and plenty food? Wow! We set off for the top on the 5th day, on 5am in the morning. Some of us started suffering really badly from altitude sickness, nausea and headaches. They blamed lack of oxygen; Tim blamed Diamox, which we all took preventively except him and he didn’t suffer from anything. Doc measured blood saturations of 71-75 and resting heart rate of 120. Nevertheless, we were sitting on the top of the African world, happy we made it, and even happier to go back. We went down in one and a half day to be on time for another Kilimanjaro (beer) and to watch the first miserable match of the Dutch. Two remarks: The last part to the top is quite a garbage belt. What a shame that so many people leave their empty water bottles, tissues, candy packing, etc, behind. Having difficulties on the last part is never an excuse not to behave! Second, the snow cap starts a few hundred meters below the peak. However, only twenty years ago, the snow cap was more than one kilometre below the peak. There, we could still see the worn paths of former glaciers, now all melted away. Expectations have it that in ten years, the whole snow cap will be gone.

Our house, Easter weekend, and life in Mtwara

After having lived in guest houses for 5 months, mid-March we finally moved into our house: a one floor block with 6 bedrooms and 4 bathrooms. Our garden is the size of half a football pitch, with our own roundabout, parking lots, vegetable garden, banda (African-style shelter), rain harvesting system (how green are we!). It has very colourful flowers and exotic trees (including just another lemon tree), and is home to beautiful butterflies and singing birds. All maintained by Fredy, our day guard and gardener. And o yes, a 100m walk leads from our backyard to the beach and Indian Ocean. See photos.

Last weekend we wanted to finalise our house by raising the Dutch flag, just in time for Queen's Day. Attached to our house is a long pole, we think an unused TV channel receiver. Now Tim had asked his mother to send us the Dutch flag (thanks a lot for sending this over!!). Tim spent all day Saturday installing a good working hoisting system. Suddenly the District Police Commissioner himself came at our door saying that we cannot have that flag there because that would imply that The Netherlands claims or even conquers this place! Haha, yes, we're starting our small Dutch colony from here! Now we have to seek permission from our ambassador and the Regional Commissioner here. What a formal hassle! As the sun set down anyway, we took the flag down. This was another shock for our poor police officer as we didn't follow any procedure of saluting, singing the national anthem, folding it according to rules, and all kinds of other formalities. These uncivilized people in The Netherlands!

We have to say that we appreciate Mtwara more and more. It doesn't have all the inconveniences of cities- no traffic jam, no rush, no big buildings- and it feels like a stretched village, very relaxed, green and beautifully located at the ocean. It also doesn't have the disadvantages of a small village where there's nothing to do. Home to some 90,000 people, Mtwara has some more restaurants (4), some variety of goods in shops and even a lounge bar and two night clubs. Being the capital of the Southern Region, there are more wazungu (white people) around to share experiences with- most of them development workers or working in the gas sector (huge gas fields have been discovered off shore Mtwara). We play volleyball twice a week, there are barbecues and drinks organised, we do activities like snorkelling trips and visits to the local cashew nut factory, the port, other health facilities, a construction site, the helicopter base, and so on. And of course, daily activities, such as cooking, shopping at the market, doing the laundry (by hand), take a bit more time than back home.

We spent Easter weekend in the region with some other wazungu. On Good Friday, we went to the Rondo plateau for a good walk. The views here are panoramic, looking into some sort of green canyon, eroded over time. After that we set off to Ndanda for a good meal. Since some 100 years, Ndanda is home to a Benedictine complex housing a hospital, a big cathedral, several schools and workshops. Although the village is small, these (German) monks and sisters managed to bring life here up to a pretty convenient level. They installed their own hydropower system and water supply system, both much more reliable than the public systems we have in Mtwara. Next day we went to another village Nanchingwea, where we visited sesame fields (although even after several ‘Open Sesame's' there was no gold to be found until someone directed us to gold mines some 90km away- a bit too far for that day). On Sunday we climbed one of the rocks around Msasasi (we need to practice for the Kilimanjaro!). As there was no path the only way up was making our own way through the bush and hanging on the rocks. On the top we enjoyed Paasschuimpjes, sent by Marije's mother!

After this enjoyable weekend, Marije went to Tandahimba to join Jolanda and Kirsten, two Dutch doctors, to see how they survive in their hospital. At the end of that week, cashew nut farmers started protesting in and around Tandahimba. The vast majority of all people in the south is dependent on cashew nuts, and the government bought their stock but did not pay. We do not know all details, but the cashew nuts are sold to the government which subsequently sells on to private factories for further production. The farmers are paid in 3 instalments: 70% immediately, 30% later and possibly an after-sales bonus payment. In October, everything was sold and the second payment was not yet done. We heard from friends who work at a cashew nut factory that the government was not able to sell on because their price was way above world market price. These companies (big internationals) obviously went for cheaper cashew nuts from India and Brazil, but the Tanzanian government still didn't want to lower its price (probably because they promised these local farmers this higher price). Anyway, after an official demonstration, they started rioting. On all sides were roadblocks and there were demonstrations, police came from throughout the region for the revolt to crush. The whole evening and night there were explosions and gunshots (in the air, by the police). The whole village was deserted, all shops closed, a veritable ghost town. On Saturday, Tim drove down to Tandahimba to pick up Marije. After 50km, he noticed the first villages with removed road blocks, but he could pass without problems. But then, in one village, a big tree was cut to block the road. Tim had to stop, and he was immediately surrounded by hundred yelling cashew nut farmers. First, he was not allowed to pass at all, but after a while this was possible but only for some big amounts of money. Tim managed to get this down to 15 euros, 10% of our month salary!, and only under the condition that this would be a lump sum for going back and forth, passing all the next villages without having to pay again. To guarantee this, half of the amount would only be paid on the way back, and one of the villagers jumped in the car to guide him through the next villages. Luckily enough, it all went well as agreed. We only found out that one of these hundred villagers had stolen the wheel cover of our spare wheel at the back of our car. So when we got back in that village we refused to pay the second half until they brought back our wheel cover (which apparently was already on the local market).

In the hospital, last month was pretty quite. The Medical Officer in charge (MOi/c- the hospital's CEO) suddenly left to Russia for further specialisation. At the same time, the Regional Medical Officer (RMO- the governmental boss of the MOi/c) got promoted to become RMO in another region. Due to trainings, congresses and multiple-day-training sessions, quite some other decision makers in the hospital are away as well during the last weeks. In the meantime, NO decisions are taken as people are waiting for the new decision makers to be appointed. This week, the new RMO arrived and hopefully the new MOi/c will be appointed soon. So we hope that after that, things will start to move again.

Many new photos on the 'Foto'-page (as we have to make up for our silence during the last two months)!