The Muhimbili hospital experience part 1

The Hospital Experience at Muhimbili Hospital

The Entrance to Muhimbili Hospital

Sorry this blog has been updated much later and behind schedule than anticipated, to suggest the internet has been only a little unreliable would be like suggesting the Pope is only a little catholic!  Nevertheless, I’ve managed to try and amalgamate my hospital experiences at Muhimbili hospital into one blog…one very loonngg rambling blog that may be best read over a couple of sittings (if you’re not bored to tears after a few minutes!!).  Before I start this segment, I should put a small disclaimer in here to state that having only spent 6 weeks in Tanzania, there is no way I could fully comprehend the complexities and challenges faced by the medical system there so this blog should in no way be interpreted as a perfect representation of how things are, it is merely my opinions and some anecdotal experiences I had there and I can only hope those reading this will take it as just that.

I tried to come to Tanzania with an open mind and few expectations as to what I would see or experience. It is fair to say however that no matter how prepared I thought I may be for what I would see or do, I couldn’t have imagined what awaited me at the Muhimbili Emergency Department, the only one of its kind in Tanzania and a tertiary referral hospital.  Tertiary referral in Tanzania quite basically means that injured patients must first attend their local practice or a local hospital (sometimes 1, 2 or more) before being referred onto Muhimbili to be treated, usually because the local hospital is not equipped to handle the degree of injury or illness the patient is experiencing.  In concept, it’s not an entirely bad idea as it means more basic injuries can be treated without the need for travelling upwards of 6-8hrs at times to reach this hospital, however in practicality, it equally means that someone who’s been scooped up off the road with massive head or other injuries from an accident, even if they were only blocks away from Muhimbili, must first go to a local hospital which is not likely equipped to deal with them to get a bit of a ‘patch up’ job (which, in some cases, means getting something like a head wound sutured with pig’s skin) before putting them back in an ambulance/taxi and send them to Muhimbili.  By this point when they arrive, they have sometimes lost a lot of blood, have diminishing obs, have had no pain relief, and in some cases, are too far gone by the time they reach Muhimbili for successful resuscitation. Obviously this is not true for all patients I saw however it was not uncommon to see that scenario quite regularly.

Some of the Hospital Grounds - The E.D. is in front

Medical School campus

Walking into the entrance to Muhimbili hospital the first day, I was first struck by how spread out the hospital was, in fact, it was not so much of a single hospital, but a large variety of buildings of different sizes, shapes and colours over a large expanse of land housing the various medical specialities along with a dental school, medical school and allied health (ie nursing, physio etc) school.  The buildings were joined in some cases by open aired walkways made of concrete where patients often lined the sides of the walkway, either sitting out from the various wards for some ‘fresh’ air or awaiting some form of treatment.  The road walking to the Emergency department (A&E) was a large dusty unpaved road filled with people, medical or otherwise walking to and fro amongst the numerous taxis, cars and bjaj’s which didn’t seem to have a discernible ‘right of way’ system so crossing the dust road at times, could in itself, result in a visit to the emergency room if your timing was off lol.  It took around 10-15 minutes to walk to the Emergency Department by which time I often arrived looking far more tanned than when I’d left the house, purely as a result of the amount of red/brown dust which stuck to our skin in the heat.  We were advised to wear ‘street clothes’ to the hospital and change there, which, in retrospect I was so glad to have done as it would take at least a few minutes to dust myself off, wash my arms/face and feet in the bathroom before changing into my scrubs to begin the day (or night as the case may be). 

What struck me as I first walked up to the A&E, was that it didn’t seem much different to any UK A&E entrance (well, with the exception of the dust roads); the front entrance also served as the ambulance bay with a covered concrete paved driveway where ambulances could pull up to drop off patients who could then be taken directly into the A&E (AKA Emergency medicine department – sorry I’m using these interchangeably although it could be argued successfully that there are some distinct differences between Emergency Medicine and A&E.  For the purpose of this blog however, I’m not going to go into the differences as it would take a while, be a little too in depth & quite frankly, probably a little boring for those non-medics reading this).

Entrance to the Emergency Department

One of many wards/departments

 I was first taken to be introduced to the head of the department, a lovely older professor whose role was to oversee the activities of the department.  I’d tried to learn as much medical Swahili as possible before coming intertwined with some pleasantries such as ‘nice to meet you’, ‘lovely weather’ and  ‘excuse me sir, your arm seems to have fallen off’ to better converse with  patients & staff. I think, however, I ended up being more of a source of amusement for the professor with my poor accent and limited vocabulary (not to mention making a faux-pas on my first day of mis-pronouncing the number 10 (phonetically pronounced Koo-mee) with (Koo-ri) which apparently is a colloquial term for a ladies private bits!  At least he was able to see the light side of this and I like to think he appreciated my attempt to at least try speaking the language.  Following introductions and getting my temporary badge, I was then taken to the Emergency department to meet the team and get a tour of the department.

I’m not sure what I expected of the emergency department in Tanzania, but I must admit, I had some preconceptions of seeing a less sterile ward type environment with 3-4 people per bed, overcrowded waiting rooms, minimal staff with only ceiling fans, if anything, to cool poorly equipped treatment rooms (a stereotype, I know, but in fairness is what I was to see in the rural village hospital and some wards at the hospital outside the A&E).  I was very pleasantly surprised to find the emergency department to resemble a very modern, clean and heavily air conditioned area complete with 4 large, separate treatment bays, each which could take 3-4 beds comfortably, possibly 5 beds at a push before becoming a little overcrowded. Each room/bay had an 1 observation monitor (to watch blood pressure, O2 sats and pulse etc), an oxygen providing unit on the wall and several trolleys and desks, equipped with similar equipment you would find in the UK like syringes, cannulas, intubation equipment, fluid giving kits, blood taking equipment and several different types of fluids for infusions.  Several bays housed movable defibrillators and there were a few portable ultrasound machines in a couple of the bays (little did I know what an essential piece of kit that was at the time, which I’ll come onto later).  All in all, first impressions were quite good, particularly the centre area with multiple computers for staff and a big wall board, not dissimilar to those seen in the UK, which listed the doctors on duty, cases being considered and other ‘normal’ protocol details.  There were a number of doctors and nurses about, all very welcoming and dressed in various coloured scrubs, depending on their roles within the department.  Many spoke excellent English, particularly the doctors, with most nurses speaking proficiently to the point that between my broken Swahili and their English, we could converse pretty well (although it has to be said that their English was far better than my Swahili).

One of the Emergency rooms

Everything seemed well organised in the department with the only thing noticeably lacking at this point being patients!  There was one patient in a far bay being attended to by the nurses however the rest of the rooms were empty.  I was to find that due to the nature of this being a referral hospital (and being quite early in the morning), patients would often not arrive in greater numbers until later in the morning when they were transferred from elsewhere by ambulance & then numbers would again dwindle in late evening with the exception of some of the most serious cases which could arrive throughout the night. During the day however, numbers of patients varied quite a bit and the department was generally fairly busy.  Around the corner from the Emergency bays, were a further 6 treatment rooms, again, quite similar to those found in most developed countries where day cases of ‘walking wounded’ were treated, freeing up the emergency bays for the more serious conditions. Beyond a security locked door after the treatment rooms (also the main entrance into the department), were 2 triage rooms for initial consultations and the payment booth, where families or friends could pay for the patient’s treatment within the department. 

From my understanding, at Muhimbili and the majority of hospitals, care is not free with the exception of several groups of people including those who are pregnant, children under 5, and for those with HIV/AIDs, TB and diabetes.  For all other patients, starting fees just for being assessed are 10,000 shillings (the equivalent of around £4UK), which for some, can be more than they can afford.  I have been told however that if an emergency case comes in and they are unable to pay or no family is around, they will be treated first, regardless if they are able to pay or not and the finances would be sorted out later, a policy I quite agree with rather than having patients turned away.  Generally, patients must also pay for any investigations, treatment and medication they subsequently receive, with a simple CT scan alone costing upwards of  $200-300 USD.  Considering that a ‘high’ income here is around 600-700USD per month (which, from what I understand is what many doctors are on), a single investigation could cost a low income family a half a year’s salary, and that’s before any treatment costs. It didn’t surprise me therefore, that many patients seemed to wait quite a long time until things were pretty serious or advanced to actually attend a hospital, perhaps in the hopes that their problem would clear up without any need for treatment.  I think it is safe to say that people in Tanzania don’t attend hospital unless they really really need to, I don’t recall seeing patient with a cold or flu, or even worse, man flu which we all know is worse than childbirth…

 One of the first cases I followed a doctor to visit once I’d been shown the department was a middle aged gentleman who was brought in following a run in with a motorcycle.  I was told he’d suffered a fracture to his lower leg (at this point, those with sensitive stomachs may wish to stop reading until the following paragraph!). Entering the room, the first thing I noticed was a couple pieces of what was likely his tibia laying on the floor beside him, with his foot somewhat dangling precariously close to the edge of the bed, remaining attached by only a single tendon at the back of the foot.  What got me was the chap was lying there calmly, fully awake and alert, having not yet received any pain relief, and even managed a small smile as the doctor began talking to him.  Besides the blatently obvious problem, he was pretty badly bruised and scraped elsewhere with a further possible fracture to one of his arms and a bit of a gash on his head.  It was decided that the immediate action needed was to have his leg splinted and the bleeding from his leg and foot stopped and stabilised, prior to moving him across to the Orthopaedic institute, in another building, where they could  continue his treatment.  One of the nurses went to get a splint so the fracture could be stabilised and whilst the doctor went to check on another incoming patient, I decided to pick up the pieces of shattered bone on the floor and place them beside his leg…not that I figured I was being much use or that anything could be done with the pieces but it seemed a better choice than just standing there waiting and staring at what had to be the worst injury I’d seen in my medical training to that date. 

Reading an I-stat machine - a fast blood analysis machine

The nurse returned carrying a large cardboard box so went over to look to see what kind of splints he had brought for this man’s leg& foot.  Looking inside the box, it was totally empty, prompting my next question of ‘where is this splint you plan to use? Are you out of splints?’ which the nurse found quite amusing.  Smiling, he took a pair of scissors from the table and began cutting the cardboard box at which point it dawned on me that this cardboard box was to become the splint for the leg.  Apparently another department had taken all the ‘proper’ splints some time ago so the Emergency Department relied upon cardboard, fashioned into the necessary shape to become a leg, or arm ‘cast’ tied on with strips of wrapped gauze.  At this point it has to be said, one thing I came to appreciate about the doctors/nurses here is what they lack in resources, they certainly make up for in creativity and ingenuity!   Once the cardboard had been cut into an L shape to support the leg and foot, we were ready to try and reduce this poor guys fracture and fashion his foot into the cardboard splint. 

One thing I realised very quickly is that painkillers (amongst many other ‘common’ UK/US/Canadian medicines) in Tanzania are in short supply in the hospitals.  For a bad injury such as the open fracture (ie foot falling off) we were treating, a patient would get 5mg of Morphine.  To put this in prospective, this is what some patients in the UK may get if they went to the hospital with a very bad toothache or some bad stomach pains!  If the pain was totally unbearable, then they may get 1mg of Ketamine or 5mg of Diazepam and possibly a further top of a further 5mg of Morphine at some point later but it was really a case of trying to treat with the lowest possible pain relief due to the limited availability wherever possible.  After this chap was given his 5mg of Morphine, myself and 2 others began the task of attempting to hold the food in place whilst applying the makeshift splint to the leg.  I couldn’t believe how stoical this gentleman was, it was clear he was still in agony however he hardly made a noise, only letting out small whimpers occasionally as his foot was rotated around a hundred degrees, manoeuvred, then wrapped with gauge around the cardboard, with further gauze used to pack the massive hole between his foot, the visible fractured bones/ muscles, & the rest of his leg.  The pain he was experiencing almost brought tears to my eyes as I’m pretty confident that had I been in his position, I would have passed out long before we’d finished.  We took turns talking to him as we wrapped saying ‘Pole Sana KaKa’ (meaning I’m very sorry brother) which was all that could be said but seemed far too little given the situation, not to mention the pain he must have been feeling from his other injuries which still needed tending to.

After we’d finished splinting the leg, a cannula was placed to provide some fluids and he was left to rest whilst plans were made to have him transferred out of the department.  I’ll never forget this man because after all the pain that we must have caused him manipulating his leg and ‘reducing’ the fracture while he was wide awake, having to watch the whole process and on so little pain control, the first thing he said was a very sincere ‘Thank you’ in Swahili.  That was the first of many ‘Thank you’s’ I was to receive from people that I should have been thanking for being so brave and strong in the face of horrific injuries and pain, who never uttered a single complaint about anything and were grateful for even the most basic treatment received.

The matron, Megan, Abi and I on the general med ward

That was one of the first of a number of patients I saw and helped with that day, each patient with illness or injury almost as severe or as bad as that first gentleman.  The only thought I had when leaving the hospital that day was that I was definitely not in Kansas anymore.

Washing hands - note the sink is not connected and there is no basin! (on a general ward)

Part 2 to be continued….

Settling Into Life in Dar Es Salaam

Well it’s hard to believe a week has already passed here in Dar Es Salaam although I imagine by the time the internet allows me to post this, this post may be a couple weeks delayed! I’ve been surprised by the temperatures here in the city which is in the southern coastal part of Tanzania, I half expected to be sweltering in heat and dripping in sweat much of the day however I’ve been surprised by the pleasantly warm but not ridiculously hot temperatures. 

CoCo beach - 2 mins walk down the road but we get too hassled to go there to swim or relax

During the peak of the day, from around 11am-1pm, the temps hit around 28-32 degrees max but then cool slightly to a balmy 25-27 degrees for the remainder of the day, normally with a nice breeze which makes it quite nice to walk around in a t-shirt and shorts without melting J. 

Neville, our house pet

Where I’m staying in Dar is considered to be the ‘nice’ area of town, Oyster bay, as it’s called, hosts most of the embassy and UN houses along with many of the top government officials homes and is a popular area for higher budget hotel chains.  

Each house is lined by high walls and guard posts at the front doors to ensure that visibility of the property is not particularly easy from the street.  

A local outdoor shop in Oyster Bay - note the difference from the city

Gardeners are seen outside each house constantly planting new ‘african grass’, a much thicker version of grass to what we’re used to, in an attempt to keep the front lawns looking ‘green’ and there is much distance separating each house with a wide road which runs down the middle which seems surprisingly quiet, except for around 6pm when there is a mass of people who make the journey back from the local beach through towards one of the main roads past our house which has Dahla Dahla’s (minivan type buses which seat 20 but take around 40-50 people!) and Bjaj’s (3 wheeled half covered motored transport used as a form of taxi for short distances) to take them back towards the main city. 

Oyster bay seems to be like a little ‘bubble’ of wealth which seems oddly out of place from the rest of the city.  If you walk around 5-10 minutes in any direction from the house I’m staying at, you enter what could be considered the more ‘usual’ scenery of Dar Es Salaam.  The ‘main streets’ have an interesting combination of ramshackled buildings made varying lengths of wood slats where local tradesmen sell various furnishings, locally grown produce and sometimes eat-in or take away meals cooked in large metal pots on open fires to be given to customers in black plastic bags to take away or metal trays if eating in.  Small old concrete buildings of various colours are interspersed amongst the wooden ‘shacks’ containing various small businesses or ‘corner shop’ type stores and every once in a while, a new, shiny tall building, not dissimilar to any found in the UK/Canada etc is seen which seems oddly out of place amongst the rest of the landscape, usually a hotel or large corporate building catering to international individuals. 

The Dalla Dalla

The Dalla Dallas

The streets themselves never seem to sleep, with men often rushing from person to person, offering ‘great deals’ on souvenirs or furnishings, often African style paintings from the numerous local artists or wooden carvings, necklaces and beaded or massai type sandals on display every 100 meters or so.  Women sit on the sides of the roads offering fresh vegetables and often have corn for sale which they cook on open flames as a ‘take-away’ snack.  The bjaj drivers often follow people who are on foot vying for business along the dusty old tarmacked roads with cars and dahla dahlas speeding by honking at anything that moves with no discernible distinction between which side of the road should be driven on thus making driving a bit of a ‘free for all’ event. Unless you are on one of the main ‘highways’, where the road is divided by a meridian, I get the feeling that the driving rules are rather loosely applied to bigger vehicles getting right of way over anything smaller which is likely to be crushed in the event of a collision (a common occurrence here, particularly for the numerous motorcylists where helmets are rarely, if ever used).

The Night Bjaj with Lizzie and Megan

A normal downtown street in Dar

During the first week here, it became quickly apparent that we should never leave the house carrying anything more than a small amount of money hidden in a bra or a closely attached bum bag (fanny pack for my Canadian friends J ), particularly if you are a ‘mzungo’ (Swahili for a ‘white person’). In my week, 2 of the girls staying at the house had their purses brazenly taken from them in broad daylight by passing vehicles where the men hang outside the window and grab anything they can reach before speeding off and one girl was unfortunately dragged around 200 meters as a thief tried to pull her purse from over her neck but was unable to free it easily.  Just prior to my arrival, a newly hired night security guard at the house waited for all the students to go out then broke many of the room’s lock boxes with an accomplice and made off with hundreds of pounds and valuables.  Surprisingly, or rather stupidly, he remained at the house after his accomplice left, presumably as he thought the goods taken would not be immediately noticed so he could claim ignorance, but was quickly apprehended and taken away by police.

Central Dar

  

Despite the high level of street crime in the form of thieving, the majority of Tanzanians take thieving very seriously and often take punishment into their own hands, observed first hand on our first trip to a local restaurant.  A young thief attempted to pickpocket money at the outdoor restaurant where we were eating and was quickly set upon by restaurant staff, as many as 10 staff members beating the thief as they dragged him off the premises, presumably to continue punishment away from view of the customers.  I’ve been told that this type of crime has become more and more common in the area where I’m staying as criminals have cottoned on to the fact that Oyster Bay houses mainly affluent ‘Mzungo’s’ where they are more likely to get more money from a robbery then elsewhere in the city.  As much as this type of crime is upsetting, I can’t help but feel some sadness for those committing the crimes as they are often young, poor unemployed men with little or no means of supporting themselves or their families.  I find myself wondering if I were in their position, starving and having to watch my children go hungry & crying from starvation, what extent I would go to in order to put food on the table.

The largest Orphanage in Dar (To be discussed more in another post

My first trip into town, 3 days after I arrived to reach the hospital where I would be spending the coming 5 weeks, was quite an experience in itself.  From the house I am staying in, there is a 15-20 minute walk along dusty roads to a ‘main’ road which travels towards the centre of town.  Myself, plus 4 other medics and nursing students waited for our ‘dahla dahla’ to pull up at the bus stop whilst being approached by various ‘punters’ begging us to buy trinkets for sale and bjaj drivers offering ‘good price’ fares to the city (which we were told to avoid as they are known to use both the roads, sidewalks/pavements and grassy verges to reach their destination as quickly as possible).  As our dahla dahla pulled up, it resembled something you would expect of a clown car, with several men hanging out the door and 40 people crammed into what should fit maybe 20 people at a normal ‘push’.  Given that the dahla dahla stopped in front of us, we assumed that people must be getting off to have space to fit us in, however this quickly proved not to be the case.  The ‘money man’ who takes payment for the driver and gets you onto the bus, quickly ushered us to get on the bus, pushing people as fast as he could to the back of the bus to the point where sardines would have had more room than we did!  The ride couldn’t pass fast enough with my face was firmly planted in the armpit of a local man who clearly didn’t believe in deodorant  as we were jostled back and forth by the dahla dahla, honking it’s way through the traffic towards town.  As we disembarked at the entrance to the hospital, I tried to manage a smile at the man who’s armpit had been my headrest for the past 40 minutes whilst subtly reaching for the alcohol gel in my bum bag.  I have a feeling the buckets of alcohol gel I brought with me to Tanzania will be well used!

6 is a normal number for a taxi right? (With Megan, Lizzie, Me and Abbie - Simon +1 in the front)

KARIBOO (WELCOME) Day 1

KARIBOO! (Welcome in Swahili!)

Day 1

Waiting in Heathrow at 3am waiting to check in almost 80Kg's of baggage, vacuum packed into 2 large suitcases + 3 smaller carry-on style suitcases, I came to the conclusion that if I EVER travel to Africa in the future bearing medical supplies, I will send them ahead of me in the mail!! My arm muscles (or lack thereof) were throbbing as I lifted, and tried to pretend as though my 2 heavily overstuffed carry-on bags were light as feathers in a pathetic attempt to avoid having them weighed by the kind desk agent who looked decidedly concerned as I heaved and pulled my way to his desk with all my luggage.  Luckily, once I showed him a letter from his airline which had kindly waived my excess luggage as much of it was medical supplies to be given to the hospital I’m volunteering at, he was bending over backwards to help me check in all the luggage.

After a stop-over in Zurich, I slept much of the way through to Nairobi where we made a quick pit stop to drop off a majority of the passengers before the flight moved on to Dar Es Salaam.  The mood on the plane after leaving Nairobi seemed somewhat like a social gathering, I’ve never seen anything like it on a flight, everyone was out of their seats standing in the isles talking to other passengers and the stewardesses, who had by this time changed into more ‘casual’ clothing, came down the isles bearing alcoholic beverages and pop on trays which were handed out to all the passengers and the stewardesses then joined in with the conversations as we continued on our 1.5hr journey to Dar.  The relaxed, friendly and casual atmosphere was probably a good indication of what was to come upon arrival in Dar Es Salaam!

After landing in Dar, we were shuffled into a ‘holding’ area where we had our pictures taken and went through the process of obtaining our visitor’s visas which was quite an amusing process. Two passengers ahead of me spoke only French and were struggling with authorities to understand their questions (which, in fairness, was difficult even for English speakers due to questions being posed in thick Swahili/broken English) so I offered to interpret which was ended up being a comical mix of French/English and a multitude of hand gestures to get some points across as some of the French sayings just don’t translate very well!  After they had finished their process, I was about to proceed with my visa when I was tapped on the shoulder by the same security chap I had just tried to help who said ‘you don’t happen to speak Italian??’…. After managing to fumble through broken Italian to translate for the gentleman who didn’t speak a word of English besides ‘hello’, he was granted his visa, which was a slight relief as I’m sure at one point I confused the word for girlfriend with the Italian for prostitute…luckily I was corrected by the Italian chap before I really put my foot in it for him! By the time I finally got to complete my visa, I think the security man was happy enough for the previous help that he didn’t even bother asking any questions and simply approved the visa.  With that, I entered into Dar Es Salaam to begin my new adventure J!

My lovely contact from ‘Work the World’ (the organisation who helped organise my elective) met me as I came out of the gate with a big smile, and introduced himself as Mark, although it has to be said, he’s the spitting image of Will.I.Am so I still half expected him to break out into song at any minute.  He accompanied me by taxi through the bustling streets of Dar which seemed so calm and picturesque by nightfall albeit there was not much, other than palm trees and some tall buildings that I could make out in the dark.  We passed a large billboard which was lit up advertising the tv show Glee, which made me do a double take, it wasn’t the first thing I imagined seeing on a giant billboard on the side of a road filled with small bjaj’s (3 wheeled covered motor type vehicles which can take up to 3 people comfortably, however normally filled with 4-6, reminding me of circus clown cars!!) and Dala Dala’s (small 10 seater van/buses which normally cram in 30-40 people or more like sardines – and you may end up with a random Tanzanian using your lap as a seat!!).  The taxi scurried through the streets towards Oyster bay, the ‘wealthy suburb’ area I where I would be living for the coming 6 weeks and after a 40 minute journey, we turned into what looked to be a very ‘posh’ road with houses which could easily cost upwards of £5-10 million in the UK.  We pulled up to a front gate, where we were greeted by one of the night security guards who opened the gate, allowing us entry into the organisation named  ‘Dar House’. 

Front of the Dar House the night I arrived

My first impressions of the house were of surprise, I guess I had prepared myself to be living ‘rough’ for the 6 weeks here, however from the outside, with manicured lawns and palm trees lining the walk ways up to the ‘main house’ which was a large, extended bungalow with a big covered outside sitting area with several sofas looking out at the front garden, I realised I had possibly underestimated my accommodation.  Marc took me on a brief tour of the large kitchen with several fridges filled with some ‘left over’ food cooked by our chef Raheema, who apparently has a reputation for cooking amazing Tanzanian/Arabic style cuisine for dinners during the weekdays, a big dining room area at the front of the house with 4 large wide wooden tables which could accommodate up to 45 people (which reminded me of a relatively small pseudo-cafeteria), and a larder filled with various dried goods including UHD milk and a strangely large number of boxes of Coco pops, apparently a popular breakfast choice here.  He then took me around the 4 bedrooms attached to the main house, all of which had 6 bunk-beds with a shared on-suite bathroom for 6 including a small shower and toilet.  Following Marc out the back of the house, another smaller ‘bungalow-style’ building was a 30 second walk away which had 5 further rooms, 4 of which again had 6 bunk-beds and then I was shown to my room.  

My Room (Bottom Bunk)

I was relieved to see that although it was only a quarter the size of the other rooms,  it was the only room with only 3 beds, two of which are bunk-beds, and seemed much more ‘homey’ than the other rooms. 

The Bathroom - Pretty basic - things grow in here :o

Just outside ‘my’ bedroom through a little path to the left, was a lovely large swimming pool with a small pool bar off the side and a mass of sun loungers dotted around the pool. 

The Dar House Pool at Night

I have a feeling the pool and I are going to become good friends!

I was greeted upon my way back through the house by a group of around 15 young girls, who introduced themselves as 2^nd year nursing students from Manchester, all of whom seemed very friendly and welcoming, which is always a lovely way to arrive at a new accommodation.  Marc, our bubbly 20 something host who’d accompanied me from the airport and chatting away in excellent English, proceeded to show me every security feature of the houses, which included panic alarms in every room, the security office at the front gate where our security guards stayed and all the fire alarms and fire extinguishers dotted around the place plus electronic door locking systems on the main house.  I kind of got the impression that security was a pressing issue by this point…it wasn’t for a few days later that I realised why (to be added in a later post).  Following a quick debriefing, I was left to explore the property and go to my room to unpack.  

Ned, my room-mate

Given that it was around 11:30pm by this time, and I’d been travelling for over 22hrs from the time I left Norwich, I was ready to crawl under my mosquito net and hit the hay! 

The temperature in the evening was lovely, around 22-24 degrees with a warm gentle wind meaning that I was still comfortable in the sweater I’d worn across but could equally have been wearing a t-shirt and still felt quite warm.  I was half expecting to be hit by a sticky hot heat getting off the plane, despite the sun having set at 6:00pm, so was pleasantly surprised that the temperatures were more than bearable!  There are high ceiling fans in every room which run 24hrs a day which doesn’t really affect the temperature but allows for fresh circulating air and is quite a calming sound at night when trying to lull off to sleep. 

The Front 'veranda'

I nearly suffocated as I applied a heavy spray of 50% deet on every exposed part of my body, then crawled under my mosquito net into my ‘camp style’ bottom bunk, ensuring that I tucked the mosquito net thoroughly around the bed, and began fell asleep with a big smile on my face as I listened to crickets chirping away outside, having finally arrived in a country I’d dreamed about coming to for many years.  As I started to doze off, I heard a distinct buzzing and a sharp pinch on my shoulder. I slapping my shoulder, killing what was likely to be the first of many mosquitoes but couldn’t help grinning, I felt as though I’d just had my first initiation into Tanzania.

Front Side view of Main house (right), front gardens (left) and Security Gate (Left)