Monday... Monday. Back to work today. Very sleepy because I have to get up at 6 to make the hour commute to get there on time. Today was pretty slow. Only two deliveries, sadly I didn't get to do either of them. No one really warns me when a mom is about to deliver so inevitable it seems like I'm running over after the baby has already popped out. I did repair a perineal laceration though, quite interesting. I did it with a visiting midwife from Germany who is volunteering there a few days a week. In general it was really nice to have her there because she speaks English infinitely better than the local nurses/midwives and she has been there for about 6 months so she can explain to me how things work and answered a lot of my questions. Thank goodness the laceration wasn't bad or through the sphincter (sorry non-medical folks... ) because I had NO idea what I was doing. The midwife asked if I wanted to do it and I said sure, as long as she could show me where and how to put the stiches. She said she didn't really know herself and had never even been taught to suture, so figured I was a better bet since at least I had been taught that much. I did the best I could from what I've seen back home, with a less than ideal set-up (sitting on the side of a bed in a dark corner wearing a very dim headlight and extremely questionable sterile technique) and it didn't end up looking half bad. The only other laceration repair I've seen done by a local nurse was at least at haphazard, if not more so. Also, apparently they do have lidocaine for local anesthesia, which we did use this time, thank goodness. I'm not sure I could have done it without. I asked the midwife about that and she said the local nurses just don't use it, it's available and they just don't, she doesn't know why. It's awful, she said she's heard a lot of the mothers are more afraid of that part than the actual birth (which doesn't surprise me based on how much pain the lady last week seemed to be in).

It's a little frustating to watch them practice medicine here. Last week I saw a completely botched neonatal resuscitation (the baby finally started breathing on it's own, but wasn't breathing for WAY too long without appropriate ventilation), the C/S I saw didn't exactly obey evidence based medicine (among other things, they close the rectus muscles which has clearly to have no benefit and cause lots more post-op pain), and I've seen some instances of quite excessive use of oxytocin (a drug to speed along labor, but can be dangerous if not used correctly). I know they are doing the best they can, but it is hard to watch sometimes.

Now I will stop boring most of you with medical details, as Mom wants me to talk more about Tanzania itself. So here goes, Mom, in answer to your questions:

- Is it pretty, bleak, flat, mountainous?
It is very pretty and mountaious in Arusha.

Is Arusha a city like we think of a city, or very different?
- Like a city kind of... except for the guy next to me in the internet cafe dressed in traditional Masaii clothing (they are the tribe that stretched out their ears and everything)

- What are the people like?
Very friendly

- How is the food?
Delicious

- Have you had a chance to take any pictures?
Yes
- Do you have weekends off?
Yes


Hehe... ok, just kidding Mom, I'll write more later but I'm running out of time as usual. Hope everything is going well at home (if a bit colder than here... :-) )