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!!