Life and Radiation

Domestic Life as a Machame Elective Student

Pole pole: slowly slowly

This second weekend in Africa has been easy-going, much like the Tanzanian lifestyle. We went to Moshi for dinner last night and this afternoon walked up the hill to Machame gate (1800m) – the starting point for one of the routes up Kilimanjaro. 90 minutes of uphill in the sticky heat provided me with good evidence that my no-protein, no-exercise lifestyle of late is not good for one’s physical fitness; the breathless few hundred metres were extremely difficult. I blame the altitude. I have new respect for my robust sister who made it up to the snow-capped summit (a fair bit higher at nearly 6000m) a few years ago.

Last night the clouds parted briefly and we caught our first glimpse of the summit, from plastic chairs on an extremely African rooftop bar in Moshi; sipping “Kilimanjaro” brand beer, taking lots of pictures of the tiny and barely visible segment of the mountain and generally behaving as foreign and touristy as possible, to the amusement of the locals. Our guest house allegedly boasts spectacular views of the hill but unfortunately in the past fortnight we have only seen spectacular views of clouds (and rain).

The clouds and the rain, and humidity, has made drying clothes nearly impossible. I had found the hours bent over a basin of suds scrubbing my sweaty and muddy clothes quite therapeutic, but ultimately futile since in the many days it takes clothes to dry they acquire a distinctive damp and mouldy fragrance. In a rare stroke of genius I took my wet towel with me on the most recent trip to Moshi (down the mountain where it is always hot and sunny) and it dried within a few hours on the back of my chair in the café’s garden.

Luckily the towel doesn’t need washing so very often since I shower less frequently in Tanzania; grime, dust and sweat all now feel normal, I’m reluctant to wash off my life-saving DEET, and the guest house shower is fairly primitive. The shower head provides a dribble of (beautifully warm) water and is precariously held up in a surgical mask sling by knotted surgical gloves. There is no shower curtain so the bathroom is effectively a wet-room, but this is not a problem since we’ve all flip flops. Often the power at the guest house goes out so showering (and everything else) is done by candlelight, which when coupled with the sound of thundering rain on the roof makes for a near-spiritual experience.

The guest house has a small kitchenette containing a propane fuelled 3-ring stove, oven, fridge, and an ant infestation requiring daily mass execution.  Planning and preparing meals is often the major event of the day. We have a frequently topped up kitty from which to buy groceries, and usually all cook and eat together. Mainly we buy from the local dukas (shops) up the road: potatoes, avocado, tomatoes, onions, carrots, bananas and oranges (inappropriately named as they are green on the outside and yellow inside), and so are living almost entirely vegetarian and keeping relatively healthy. So far we’ve made some fairly palatable and creative meals with these few (organic, locally sourced, earthy, pure etc.) ingredients – none of us are missing meat or western food yet. There is ample opportunity to buy chicken and beef, and sometimes goat, from the butchers, but since the animals themselves often look quite unwell and we’ve no idea how long the meat has been hanging up dripping in the heat none of us have been brave enough, yet.

The X ray department

When I become a proper doctor* I am likely to be, initially at least, the over-anxious sort; petrified of missing some terrible disease half-remembered from a footnote of a textbook or Wikipedia’s list of horrifying diseases and the junior doctors that overlooked them. The kind of F1 that is loathed by all radiology departments, requesting X ray scan after CT scan after MRI for any and all patients with the slightest whiff of an indication for them. Nervous doctors like this view X-ray images as detailed blueprints of the inner human body, capable of revealing any imagined problem but only when made intelligible via their expert translators, the frightening troglodyte consultant radiologists – such as my Dad, whom this post is for. In addition to silent greyscale diagnostic imaging, he also likes soundless black and white foreign films, I’m not sure if this association is cause or effect.

The X-ray department at Machame is similarly overwhelmed by requests, but probably nowhere near as many pointless resource-wasting ones. In a damp and darkened nook there exists a room with a single X-ray machine, controlled by an ancient and Frankenstein series of knobs and dials in the adjacent cranny. Along with a dusty ultrasound machine behind it, these make up the entirety of the X-ray department, guarded by a pleasant smiling and limping radiographer. Machame residents are not at risk of radiation exposure from the CT scanner, since it has been broken and unused for several years.

The X-ray images produced are real tangible physical items, not abstract ideas like in the UK. They require developing in a dark room (darkest room: all the rooms are dark) and dried outside, not merely loaded onto a-PACS system and viewed and manipulated via a computer screen. Mostly there are chest X-rays, often showing startling cardiomegaly (hypertrophy of the heart in heart failure) or TB, or films showing various smashed limbs following road traffic accidents. I’ve mentioned before about the fearlessness of local driving behaviours, extending to rapid, multiple-passenger, helmet- and sense-less motorbike driving through traffic. (Incidentally the local word for motorbike is bordaborda, since they’re used to travel from border to border.)

There have also been a few other notable cases whilst we’ve been here, including ionising, under cover of darkness to avoid the disapproval of some of the staff, both an eagle and a monkey from the farm at the bottom of the hill.

*When, not if, because confidence is a substitute for competence.