Jack, get back, come on before we crack. Lose your boots, everybody cut footloose.

Monday means a new week and a new ward for me, the Dealer, the Bodyguard and Lillspättan. This time is also means the very last week. The last week at Mumhimbili Hospital and the last week in Dar Es Salaam. This last days will be spent at the Emergency for me and Frida, while Jenny and Anton will follow our footsteps in Main Theatre and ICU. And I know for a 100 procent that at least two of us are happy about the switch.
Anton and Jenny had a though week at the Emergency Department. (I feel really stupid writing about it since I wasn't there, but I tried to make them guest-blog here without success...) For the really first time they felt neglected as soon as they said they were nursing students, not doctors. Which sucks. And they also experienced their first death. A death that in a Swedish hospital could have been avoided. It had been wrong from beginning until end. They also got to go home earlier one day cause one of the patients in a room had active TBC. Which was information that they got after they had already been inside the room. A room that the patient also shared with three burn victims, that had burns on 60% of their body surface. Upset at the whole organisation is one word describing their feelings.
I and Frida on the other hand quite enjoyed Main Theatre. It was the first place where one didn't get any supervisor at all. We were out on our own. And it actually worked out really well. We could walk around a little bit of everywhere and see the operations we found interesting. There was also no need to stay for a full operation but could come in after they started and go before they had closed up. We could do a little as we pleased. And we took our chances to observe as many operations as possible.
It was mostly tumour extractions of different kinds. One on the esophagus, one on the lower jaw bone (mandibular), one gastric or intestines, one lung cancer on a 1 year old child and, the one that was most disturbing to watch, a malignt melanoma.
A lady came in and sat on the operationtable. We thought that meant that they would remove a birth mark from her back or so. Not really anything superinteresting to watch, and we were about to head out, when we realised that they gave her spinal anaesthesia. So it wasn´t a birth mark. It was actually on her right heel. And it was a biggie. Underneath the whole heel was just a cancer wound. Covering the sole of her heel. And to take it away they basically peeled the heel off. All of it. Deep. Into the heel bone. That they after had to file down so it wasn't all pointy under there. And once the whole heel was off, they just put bandages on. Done. I dont understand how that will be able to heal ever again.

The lions gone and come, the birds have just begun.

One week ago we just got back from a three day safari tour in Mikumi nationalpark where we enojoyed but animals and the instant coffee. 

Burn baby, burn.

Last week we finished our placements at the Pediatrics and Maternity wards. On our last day we gave the teddybears, that Jenny brought, away to the children at the oncology ward and burn unit (and to two of the staff... It was all kind of strange). That it the first time I ever experienced a smile that gave me goosebumps. And we all felt the same.
Okey, so we saw some terrifying stuff the last day at the burn unit. Burn injuries on babies is quite common here since the kids have no place to play except from where the family cook dinner. Where it often is a fire on the ground. According to Swedish guidlines a burn injury that is over 10% of the total body surface need to be taken care of at a hospital, a burn on more than 20% of the body is severe. In all of Sweden it is about 250 people (in all ages) that have burn injuries that counts as severe and need to be sent to a specialisation unit, that we only have in Linköping and Uppsala. Here there were at least 30 kids on the ward and the most of them hade over 30% of the body surface sculled. And there were new patients coming everyday to this ward that was a burn unit, though other than the name, nothing was specialised for the patients.
We went with the doctors on the rounds and got to here some incredibly sad stories. All of them started with children playing and having fun and ended with severe burns, pain, in some cases, even amputation. We were also allowed inside the dressing room where they dressed the wounds. Some got new dressing daily and some every third day or so. But all of them were screaming and crying loud. No wonders. We only saw one of the patients getting analgesia. And that was orally, right before the dressing started, meaning that there is no way that it would have kicked in. In Sweden they sometime even anaesthetize the patients before dressing cause no painkiller is enough. None of us could stay in the room for long.
But now it is a new week, with new possibilites and new experiences to take in on Emergency and Main Theatre Departments.

Sugar man, wont you hurry, cause I'm tired of these scenes.

Monday. New week, new opportunities and, here in Dar Es Salaam, it means a new ward on our internships. This week we have switched. Frida and Anton will enjoy a week at Kangaroo Mother Care while me and Jenny will try our wings in Pediatrics.
We started at the intensive care ward where we arrived at 08:40. At 08 the doctors were supposed to be there, but when we came they still hadn't showed up. And until the doctors had visited and checked the children none of the nurses could do anything. So for about two hours we sat there, looking through journals and waiting. What's interesting is that even though people are not fluent in English, the work-language is English. Everything is written in English. Everything has to be documented in English. All their education is also in English. Our English skills, that we Swedes usually are so proud of, is hardly enough when it comes to all this medical language. But still we are the only ones really speaking.
After two hours of not really doing anything at all we went for walk in the building. Greeting everyone we met with a Mambo or Jambo. There was not really anything at all going on. It looked like the whole 2nd floor was only waiting for the doctors to arrive. The biggest happening was when a cleaning lady opened the door on me while peeing on the squatting toilets. When the door flung wide open all I cried out was "Nooo" while my desperate eyes met with a mother to a patient 10 metres away. She probably saw everything. Everything of me. At least the incident made it possible for me to use the one swahilian phrase I feel comfortable with but never get to use. When the cleaning lady met me outside later she said "sorry, sorry", and I: "Hakuna matata".
After two hours of flipping through papers a nurse took us to the basement and practially threw us in in a renal ward, where there were rows of patients recieving heamodialysis. Not Jenny nor I had seen this treatment before which made the time until lunch truly fly. (And for once we timed our lunch with the others!) When we got back from lunch one of the doctors was there, but when we left he still hadn't written the plan for the day.

Dont you worry, it's gonna be alright. Cause I'm always ready, I wont let you out of my sight.

Tell me baby, what´s your story?

It's hard to remember that we are not here on holiday. We didn't travel to Tanzania for it's wide beaches and blue sea and staying under an umbrella all day. Nope.
We are here on our internships. We go to the hospital, we go to our different wards and we see what we can see and maybe do what we are asked to do. It can be when a nurse-in-training (here they apparently study nursing for 4 years and then have like 1 year working/doing internship-ish) just hands you the gear and says "I want to see if you can do this". And you prove him that you actually do know how to administer intravenous drip. Or it can be a nurse who worked with premature babies for three years, who puts peripheral venous catheter in their hardly visible veins like nothing, and asks "You want to try?". And you look at the baby next to her, with a weight on barely 1090 grams, and you feel just, naaaaaaah. Maybe not. 
It's been a week now. A internship-week at the hospital and seven days in Tanzania. And it's our first weekend off. And it's been a Saturday well spent.
I repeat my mantra. I'm not here on holiday. We didn't travel to Tanzania for it's wide beaches and blue sea and staying under an umbrella all day. Nope.