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 29^th of August and departure 15^th of September.