WE MADE IT!!!! and more...

Wow, what a time we are having. It is tough to begin this blog because so much has happened since the last. First- we climbed Kili and made it to the top. This was probably the hardest thing I have ever done but also one of the best. We did a 6 day hike up the Machame route- the whole hike was breathtaking. First day, you hike through rainforest and camp at 10000 feet, this was really amazing and we had an amazing sunset over Mt. Meru. Starting the first few hours of hiking I thought it was tougher than I expected. I had decided to carry all of our gear on my back, so this made it a little tougher but still quite challenging. The next day we hiked through the Moorlands, which we were in and out of for the next 2 days. The third night we had this amazing view that we looked straight up at the summit- it was probably the coolest view we had besides the summit. The fourth day we hiked for 7.5 hours in the cold, hiking in clouds pretty much the whole day, very exhausting. We finally got to our camp- the base camp for the summit- around 5:30pm, had some tea and then dinner. By the time we were able to fall asleep it was 8:30pm but I was so excited I could barely sleep. I woke up at 10:30pm, they got Audra up at 11:30 PM!!! That is right, you summit the mountain in the freezing cold dark so you can see the sunrise on the summit.
I hike to the summit was nuts. The guides told me to leave my pack for the porters, but they tell me this everyday and I say no b/c you never see them when you are hiking and you never know when you are going to need your stuff. So, up we hiked with are headlamps on underneath the most beautiful starry night I have ever seen. I preface this by saying Audra was not feeling well going into this hike (because of altitude sickness). The hike went from 15000 feet to 19300 something feet. The first few hours we were fine off of adrenaline alone. Then you start to feel like crap and you watch lots of people turn around. Audra was starting to feel really crappy at this time and it did not help as we saw all these people turn around. Half way through the hike we were really struggling, the problem is you cannot take more than a 1 or 2 minute break because you will freeze. Anyway, the guys were saying they did not think Audra would make it she had been so sick (no one can control or predict altitude sickness). Long story shorter- 7.5hours later we made it to the top, just on time for sunset and it was amazing. One of the most gratifying experiences of our life. I am so proud of making it to the top, she really was not feeling well but kept pushing. The guides said that people as sick as her don't make it, but she did. Problem was we felt really crappy and they then told us we had 4-5 hours to our camp and then 3 hours of hiking after a 1 hour nap. No one prepares you for how hard it is on the way down. On the way down Audra threw up 5 times! After forever long me made it to our camp. This is when I got pissed- you go up Machame route and down Mweka route. My understanding was we would be coming down a different way- makes sense, right? Well, apparently you hike back to where you camped before, then you go a different way. If I would have known this I would never have carried my pack to the top. Afterwards, they told me they had never seen a person carry their pack to the top (b/c you come right back to it). B/c of this I was granted the title of Stupid Muzungo- dumb white person, deservedly so. Anyway, we made it down and the rest is history. It was absolutely amazing and we both highly recommend it to everyone. It was just such an amazing journey. There are many more stories from this trip, but they will have to be saved for another day.

The next day (though we were exhausted), we went to see my Masaii friend. We had gotten back that day from hiking and we met one of my students who was coming with us to translate. I met up with him Friday night to confirm we were going and we called our friend together. It turns out our friend was already waiting for us a a bus stop 2 hours away (he knew we were not coming that day but this is just how people are here). The next morning we began our journey- a 2 hour ride to Arusha, then a 30 minute Dala Dala ride to the middle of nowhere. Here, there are no other tourist, just local. We ended up waiting for a the patients brother to show up here so we could catch a ride to village (at this point we had no idea how far this would be because they had always walked it). After several hours the brother showed up with a driver- apparently he just got his license and is not comfortable driving yet. So, they show up with the tiniest 2 door suzuki 4wd you have ever seen- it is not comfortable to seat 4 and we had 6. We went and ate some meat at the local store and then got ready for our voyage. When we were about to leave, they decided I would be driving since there really wasnt enought room for 6 (let alone 5). So we ditched the driver and I drove a manual suzuki 4wd from the right side for the first time (It really is different shifting gears with left hand). This drive was the craziest drive I have ever been on- all dirt road for THREE AND A HALF HOURS. It was crazy- We had to switch into 4wd multiple times and trails were just crazy. I did not know what to expect when we arrived.

THEN WE ARRIVED!!! National Geographic had nothing on this place. It was a tribe of 70 Masai. Their leader was the father of my patient, a 65 year-old with 3 wives. He was the baddest dude I ever met. We got out and they live in a circle about 100 meters in diameter made of sticks. Inside there, there are 8 huts made of cow dung and some other things (all I could smell was cow dung) and in the middle of the circle they kept their cows, goats, donkeys, lamb and some other animals in the middle. They greeted us very formally then the elder set we must sit down to explain our reason for coming. We sat down and I explained how I became good friends with the patient and he invited me here. Long story short- he welcomed us with open-arms. He then gave us a tour while the sun was setting. At the end of it all this noise started to break out in the back and they starting singing and dancing. It was unbelievable, they would run around, then jump in the air making noises we had never heard before. We were the first white people to ever come there so apparently they were excited. He then had us come in to eat- my biggest fear. They had slaughtered a goat to honor us and now we had to eat it with them. To understand this goat meat- no seasoning and almost cooked rare- it was AWFUL. They gathered us in a circle of six and pulled out their machete and started cutting off pieces of meat and passing it to each of us in the circle. We had to eat close to 30 pieces of it. Some of it was really bloody so when they were not looking I would tuck it in the pocket in my shirt then go out to go to the bathroom and chunked it over the fence. Luckily we survived it.
It was then time to go to bed. We brought our tent- hoping we could use it, but they would not allow it. They insisted we sleep in their cowdung room on a bed made of cow skin. When we got in it there were bugs and spiders all over it. Though it was very hot we zipped to our heads in our sleeping bags and slept off the goat. We knew that my student was made to sleep in the hut with the chief. What we did not know was that he would have to share a bed with the chief- and worse than that, apparently the chief stripped naked to get in the bed and they had to share a sheet while the chief talked his ear off all night (this is just something cultural to them we clearly don't understand). The next morning they got us up and we walked around. I then saw about 15 patients that had come from around with varying ailments. After that we thought we had survived and were about to say our goodbyes when the chief insisted we have breakfast with him- guess what that was- GOAT!!! After that we made our way back to Moshi, which took 7 hours. It was a crazy experience.
Wow, that was a lot of typing. Most of the great stories were left out, I cannot type that much, but it was a great experience. I am now settled back into my life as a doctor on the wards here and that has been quite adventurous as well. I really enjoy being at the hospital though there are clearly many challenges here we don't face in the U.S. Last week I started rounding on the "ICU" as well. I will save those stories for another time. Audra is doing well, still working at and raising money for the orphanage. 4 weeks from today I will be starting work at Duke again. It is a sad thought, I am really going to miss this place. Anyway, enough of me. I hope you are all doing well and we love to here comments from you, don't shy from them. I promise to update again soon. I apologize for the horrible grammar, my Mom would be disappointed. Till the next time.

Cheers,
Chris and Audra

Oh yeah, enjoy the picks. The one with me shaking hands is the chief of the village. The other is Audra dancing

Thoughts from Moshi

I hope this update finds all of you doing well. We are continuing to have a great time and have an exciting 10 days ahead. Since my last update, not much new going on- still working hard at the hospital and having a really good time. I continue to be amazed at how sick the patients are. Last Friday I went up into the mountains with a local NGO and hiked from hut to hut for 10 hours seeing patients they identified need to be seen by a doctor prior to me coming. In total I saw 30 patients and it was probably some of the coolest moments I have ever had as a doctor.

Audra has been volunteering at two different orphanages and is really enjoying it. In exciting news, she sent our an email to friends and family updating people about the orphanage and children. In that email she asked if anyone would be interested in donating money to sponsor an orphan here. It cost 130 dollars a year for these children to be educated, clothed and fed (think about the things we waste 130 dollars on). Amazingly, she has recieved over 1500 dollars in donations already- pretty fantastic. She is continuing to raise funds and if anyone is interested, please email her at audrameduri@gmail.com and she will tell you how this can be done. The nice thing is we know exactly where the money is going to because she is working there.

This week is going to be quite exciting. Saturday we are going on another exciting hash, then at night we are going to a dinner to celebrate the finishing residency for three people in the internal medicine department. Sunday I will be up at 4:30am to participate in my Fantasy Football Draft online with a bunch of guys from Memphis. After that is over we will be picked up at our home because we are STARTING ARE ASCENT OF MOUNT KILIMANJARO!!!! (Note, if any of you read Bill Simmons, don't you think he would give me some props for waking up on the other side of the world at 4:30 am to participate in a FF Draft then climb Kilimanjaro).

Anyway, yes, we are climbing Kili. We are climbing the Machame route and will leave Sunday morning. We will be climbing for 6 days, summitting on Thursday morning here. FYI, Kili is about 19500 feet, which I have been to twice before, but never have I started at 3000 feet, which is where we will be starting. Believe or not- on summit day you have to wake up at 11 PM, that is right PM, and start for the summit with headlamps- after 8 hours of hiking you make it to the top for sunset. You then have to hike down another 6 hours that day. Anyway, please keep us in your prayers during this time, we will definetly need it. We are still discussing what we will do when we get to the top- maybe a sign, maybe a pose, I dont know, but most people have a special picture up there- I guess you will all see in 10 days.

Another exciting adventure will be happening the day after we get back from Kili! On Saturday we will be going riding a bus to Arusha, which is 1 hour away. We will then ride it another 1 hour north of there to a small town, where we will hike for 2 hours to get to are destination (sorry, I want to build it up b/c I am pretty excited). Let me take you back a bit. Some of the patients I have had on my service in the hospital have been there since day one for me and we have been very good friends. One of these patients is a 29 year old Masai warrior. We became close and I helped him a pretty good amount while he was in. He is doing very well now and prior to him being discharged he challenged me to try to help herd his cow (masai's livelihood is based upon their cattle, if you dont know what a Masai is, google it, then you will say, oh yeah). Obviously, being who I am, I had to take the challenge. We then got in a lengthy discussion and he invited me to come to his Masai village to visit (you know I am really excited at this point). Making this long story short, the only weekend that would work is the day after we get back from Kili. So, it will be quite the adventure and we are really excited (I am bringing Audra and one of my local colleagues). They have many ceremonies and traditions and he said he wants us to be honored guest. As you can imagine, I will have a lot of interesting stories when I get back.

A few fun tidbits to end with (or you could call it Only in Africa):
- At least 2-3 times a week a patient tells me they have to go sell a cow so they can pay for a procedure or medicine
- Two times alone this week the hospital has completly run out of glucose testing strips (not good when you have multiple patients w/ DKA- severe diabetes complication)
- Do meetings in the US feel short- things are so incredibly formal here that meeting take 3 hours or more at times
- That a stamp is the most important thing in the world. Really, someone can have anything you want written on a sheet of paper and as long as it is stamped by someone, it is gold.
- That you can fit 27 people in a 12 passenger van
- That I am the best smelling person in the room, without cologne on (so Audra says)

Sorry, there is probably a million more but I am running short on time. Please keep me posted on any exciting news (i.e. vice-presidential choices) and we love reading your post- really.

Cheers,

Chris and Audra

Audra's Birthday Extravaganza Continued

Sorry, for some reason it did not publish the text to go with the picture, here we go again

Sorry for the long delay between blogs, we have had quite the adventurous time. Last time we spoke we were preparing to leave for Zanzibar for Audra’s birthday extravaganza. Zanzibar was absolutely amazing and exceeded all are expectations. Our first day we spent in Zanibar City (most call it Stone Town). It was very interesting and we have quite a few stories from just one day there. A few of the fun ones:
-We were eating a gelato (yes, they have it here, but only in Zanzibar) when a local squats over the water about 30 yards in front of us. To get the proper mental image it is really only us three in the picture. All the sudden he drops his drawers over the water and lets out a load right in front of us, looks at us and then walks away. I assure you we did not swim in any water along that whole side of the island.
- That night we spent eating amazing local food in their famous market at night where all the street vendors gather. We ate so much amazing food including tons of fresh seafood, a Zanzibar pizza and many other delicious items. My personal favorite was the sugar cane juice. They actually let me help them make it- I got behind the stand and put sticks of sugar cane into this machine that I then twisted while adding a little lime and ginger to it. All the juice came out of the stick and dripped into a bucket where I got my drink from. It was so good!!!
Day 2 we arose from out hostel quite sore (my bed made a Duke call bed feel like a King size pillow top). This is primarily b/c I am usually quite cheap but also because I wanted to set Audra up for her big surprise. We rented a car and drove up to the north of Zanzibar. If any of you ever come here, I highly recommended driving a car because it is essentially non-stop, hard core off-roading. We made our first stop at one of the spice farms and did the typical spice tour. It really was fascinating and very entertaining. After one of the natives climbed a coconut tree at least a 100 feet high with ease, I decided I would give it a try and as you can all imagine, I made it about 5 feet before falling on my face. I think Audra laughed at me for about an hour. We finished driving up north and began our search for a HOSTEL- or so I told Audra. As you can imagine, she wasn’t thrilled w/ the prospect of staying at a hostel and after looking at a few she refused to stay at (and rightlyfully so), I surprised her w/ the plushest place in the area, right on the water with a deck built over the water w/ giant swings you could swing out over the water on when the tide was high and giant hammocks lining the beach. It was so amazing and she loved it.
This lead us up to out third day, where we woke up to an American breakfast. We then enjoyed a long walk on the beach (and jog) where we negotiated our favorite part of the trip. For 16 dollars each, we had a private sailboat that took us snorkeling in a beautiful coral reef for an hour then took us to an island. After that we set sail and for 2 hours we sailed back. I brought a bottle of wine and we sat on an upper deck of the boat, by ourselves, marveling at one of the most amazing sunsets I will ever see. When we returned that night, to surprise Audra for her b-day, we were moved to the honeymoon suite where we were able to sit on a private deck w/ personal hammock and relax the rest of the night. It was an amazing day.
The next morning was Audra’s birthday, though we refered to the weekend as Audra’s birthday weekend extravaganza. We had a magnificent breakfast and then rode down to a beautiful strip of beach that was essentially our own for the afternoon. After a few more great little stops we made our way back to our sweet home in Moshi. It was an absolutely amazing trip.
On a more day-to-day level, I am really enjoying working in the hospital. I have never seen so many of the diseases I treat each day. When I say every day is a surprise, it is quite the understatement. In my 4 weeks on the wards I have done over 20 lumbar punctures, 8 bone marrow biopsies, 7 paracentesis, 5 thoracentesis, and 2 pericardiocentesis. They asked me to try to biopsy a giant mass today sitting over a patients right kidney but I was even scared to take it out and sent him to the OR. I used to think that people at VA hospitals showed up at the hospital very late in the course of a disease, but they have nothing on Tanzanians. Because of this there is a huge need for hospice like care but there is absolutely nothing like that at all. When a patient is in pain here the only thing we can offer very little pain killers. There are not true narcotics to my understanding. The nice thing is no one ask me for narcotics.
Through this, I have gained a new appreciation for how America runs. Nothing ever, and I mean ever happens here when you want it. Often I have a routine test I will wait for over a week to get the results. The surgeons are still surgeons here and never want to see a consult. As many of you know, I did not have an intern for 3 weeks, I just got one 2 days ago.
Everyday starts with morning report, which I think I have mentioned before. It is quite odd because I get so nervous every morning because they announce each death to us each morning and review their chart. It hurts so bad to lose so many young people and even older people to things you know you could easily fix state side. There is only one hospital in the whole country the has any real cancer treatment and if you want it, you have to get yourself a ride to the capital and show up with a sheet of paper from the hospital you were sent from requesting treatment. There are 2 ventilators in the hospital, almost never are they used on medical patients- trying treating ARDS or tetanus without a ventilator.
I hope by no means is this making you think I have any ill feelings toward the system here. It is what it is. I absolutely love the people I am working with and even more, I love the patient population- they are so incredibly grateful. I have a couple of Masai warriors (one that is in prison for 10 years for stealing cows)that have been on my service since my first day here and we have become pretty close. They laugh at me almost every day as I come into their room and attempt to speak Swahili with them- after using the 10 words I know we both start laughing.
Anyway- enough of my life. Audra is having a really good time as well. She is setting up working with the occupational therapist here at the hospital when she is not at the orphangage. I have never met anybody that reads as much as she does, she is plowing through some pretty big books here- she is about to finish Out of Eden in under a week. We are having a blast together and believe it or not- we have been married 1year and 1month and she is still not sick of me (at least not that she has told me).
We are having so much fun hanging out with friends here, we have made some really good ones. There is a couple from Austria here that we spend a lot of time with and we have made many other good friends as well. We continue to enjoy going to all the hashes and riding around on the Dala-Dala, which is always an adventure.
I would like to give a shout to my buddy Andrew Rassi who is currently in Beijing with Duke (and has tickets to the 100m finals). We were talking the other day on the internet and saying how we could not believe we are getting paid for this or that it is part of our residency. We don’t say that because we aren’t working hard- believe me, I am. We say it because we are having so much fun. This is a life changing, eye-opening experience I will never forget. I have been touched by the people here so much. Every corner I turn, someone wants to say hi or have a conversation, not because they want something from me, though some do, but because they are just wonderful people.
Lastly, we have tried to keep up with the Olympics, but it is quite difficult when you or none of your friends has a TV. Still, we managed to go to a hotel the other night to watch some events- it was all on an Indian sports channel. It was quite funny because they kept talking about the Indian competitors in each sport and mentioning their competition for medals. Some of you know I have been to India twice and love the place, but Olympic athletes are not their best export and cricket is not an Olympic sport. They have won one gold medal each of the last few olympics and all of them were in some shooting event. Found it quite comical. Anyway, we have not gotten to experience the images I used to see on TV of everyone in a small village gathered around a TV trying to see a local win a gold.
I apologize for the lack of pictures, I am having an extremely hard time uploading them because we have had a very slow internet connection lately. I am probably going to try to upload some more soon but the picture above is from our time on the spice farms in Zanzibar.
Very lastly, if you learn anything from this blog, it is probably that I was not an English major, apologize to all of you that are grammatically inclined.
We love your comments, keeping writing them and I promise we will update the blog soon.
Cheers,
Chris and Audra

Audra's Birthday Extravaganza and More...

Week 2

We are still having a great time here. Will just add a few quick highlights/random comments:

- Audra went to a village up in mountains on Monday where she is helping w/ an group that finds specific needs (medical, educational, etc) and essentially helps to meet them. She said it was an amazing experience, the people had never seen a Muzungu (sp?), which means white person, in their little villages. She plans on frequenting many villages like this to provide assistance

- I acutally had an attending on my rounds twice this week and it was great. I am really learning so much it blows me away. Unfortunately, someone screwed up the intern's schedules so there is only one intern covering all of medicine (normally 4 for 4 services). B/c of this I am without an intern so it leads to an increased number of challenges. Still, I really enjoy it. One of these days I will post a blog just of great cases though this will likely bore most of you. When you come here you are supposed to meet with the head of the hospital before you start working but b/c he wasn't here they let me start anyway. Thursday after rounds I was doing a procedure on a patient and he, for some unclear reason, came on the wards and walked into the procedure room. It was quite funny b/c the next day I was in a meeting with a lot of people to meet him and he was so excited about me doing a silly procedure he made everyone clap for me. Then, I asked to be excused from the meeting (b/c it took 2.5 hours and I had not rounded yet) and in front of everyone talked about how there were a lot of liver abscesses here and the residents don't know how to drain them. He asked me to teach them. I then informed him I did not know how to do this (medicine residents do not do this in the states) but would read how to, do it, and then teach it. He was really excited. It was quite entertaining. 

- As many of you know, we love to host parties so we had about 25-30 people over and had a cookout. We played bocci w/ coconuts and a lemon but a dog came and bit one of the coconuts in half thus ending the game. It was so much fun and the most beautiful view of Kili to date (it is often cloudy, see below). Afterwards we projected a movie (Brewster's Millions) on a wall in our house. 

- Many of you probably think we are living in this very hot and sunny enviroment here, could not be farther from the truth. We have had light rain about 7 of our 19 days so far and most of them are cloudy. We are several months out of the rain season and this is quite unusual. It is also not that warm, it is the middle of winter here. That being said, it is the perfect temperature, highs in the upper 70s and lows in the upper 50s. It is slowly warming up by the day. 

- Because of our location in the world our days our quite short. Sun comes up b/n 6:30-7am and it is pitch-black by 7pm. B/c of this we are usually in bed by 9pm at the latest. 

- We have no TV. As hard as it is for many of us to imagine living life without one, it is so nice. Every night Audra and I spend time talking to each other, friends, or reading a book. We also play a lot of cards. If there is anything I have learned from this trip so far it is how important and great it is to live like this. 

- Audra's birthday is August 4th and I am taking her to Zanzibar for the weekend, we will be spending 4 days there. 

- We absolutely love the people here, they are so amazing. The woman are so hard-working, the carry everything on their head. Everyone is so friendly and they really love Americans (I was a bit suprised-most countries I have been to recently don't like us that much). I think a lot of this stems from the US giving a lot of money for HIV. 

- We eat really well here. There are a few places in town that make great pizza. Audra, as always, finds a way to make a great meal out of anything. Everywhere we turn there is fresh produce for dirt-cheap prices. There is a bread shop 10 minutes from where we live and every time I walk in there I get the biggest smile on my face because it smells so good. They have some of the best bread and pastries I have had anywhere in the world. 

- We attend this fantastic little chapel on the hospital campus here. The services are great and their worship music is amazing, anyone would enjoy it. Audra and I were trying to dance with some of them and I think we almost made them fall over laughing. Unfortunately, my dancing skills have not improved by changing continents. 

- Audra is getting some clothes made today. She bought 3 huge pieces of fabric for 10 dollars and there is a tailor coming to one of our friends houses to make all the girls dresses. My sister Michelle and Paul, her husband, are having a baby in a few months so we are going to see if they can make her some baby outfits from the material. 

Sorry for all the tangential thoughts. We will keep you posted. We are running our second Hash this afternoon. We miss you all and love most of you (sorry don't know who all is reading this blog). 

Cheers, 

Chris and Audra

Week 1

We have been here a little over a week and our really enjoying ourselves. Audra is currently spending most of her day at an orphanage named Upendo and helps teach there. She says it is amazing and really moving how the nuns devote their whole life to helping these children. She is also getting involved with a group that does some social work in rural villages. They will primarily be using her with children that have special needs. She will trying to leave a long-term impact by teaching the children's families how to teach them life skills and educate them. 

I have been working pretty hard in the hospital. For any of you who have been to Africa, you can imagine how things run. I am the most senior person that ever sees any of my patients from what I can tell. We typically meet in morning, take a tea break, then start rounding around 9:30. I typically have 30-35 patients on my service that I round on every day.  It is unique because you may order medicines for a patient, but when you see them the next day you will find out they never got the medicine b/c if the medicine is not in the hospital they must send a family member to another place in town to pick up the medicine and often the family member does not do it. You must really change the way you practice medicine. The other unique thing is that you must do most of your own procedures.  Sorry for the medical lingo but I have already done a bone marrow biopsy on my own, countless lumbar punctures and thoracentesis, and will being doing pleural biopsies, liver biopsies, and pericardiocentesis in the future. I am quite excited. Typically I am doing bedside rounds 5 hours a day. I will save some of my very intersting cases for another blog. 

Last night, Audra and I were walking in the city and we saw one of the patients I had discharged that day. He was so grateful for all of my help and insisted that we come with him for a drink. I agreed and followed him to his sister's shop. There he proceeded to buy me several beers and we talked about the history of Tanzanian politics for an hour, it was fantastic. 

Last Sunday was our coolest day to this point. I am not sure how many of you have heard of a Hash, but they are so much fun. These are done throughout the world and are essentially a grown up "scavenger hunt"- kind of. Some makes up a course that is anywhere from 6-10 miles marked by flour. Everyone starts together and functions as a team to find the finish. Throughout the course you will find an X and that means everyone must break up in different directions to find where the trail starts again. When someone finds it they yell on-on and then everyone starts following them again. It last around 2 hours and is so much fun. At the end you arrive to a finish line where burgers, hot dogs and beer await you. Ours was so much fun, it was set in field right at the bottom of Kili and we ran through corn, coffee, sunflower, st. John's wart and flower fields as well as many little villages. I had to also cross a river twice where I was waist high in water. It was so much fun. I acutally saw a baboon when I was running around. 

The people at the hash were so cool. It is really amazing to here the stories of the many people that live here. There is a guy named Simon who is an ultra-runner and owns a trekking business here. He is a native Tanzanian. He holds the record for going up and down Kili- HE RAN THE MOUNTAIN UP AND DOWN IN 8:30 HOURS. Unbelievable. Apparently if his climbers need something he just runs up the mountain and gives it to them. There are many other incredible people here as well. Most night we end up getting together with some and playing cards. 

It is great to here from everyone and we enjoy your comments. We will keep you posted on all our new events and I promise to provide more entertaining stories in future. 

Cheers, 

Chris and Audra

Hallo

This is a quick update with a pic or two (we tried to add more but it took way too long, we will do more later). Sorry I picked our worst picture of Kili by accident, we will put better ones later. Audra met with a Catholic orphanage this week and is going there on Monday to look at working there. She is very excited but was amazed at how humbling the circumstances were. She might also do some research with a Duke OBGYN on effectively educating Tanzanian women on healthy pregnancy practices (Mom and Dad don't get your hopes up). 

I had a crazy day on Friday- just me and an intern. We saw 35 patients (it is really not that much worse than Duke Gen Med- kidding) and had some fascinating cases that I have no clue what is wrong with. I have been thumbing the tropical medicine textbook quite a lot. I did diagnose a kid (Internal Medicine takes care of everyone over the age of 13 in Africa) with nephrotic syndrome yesterday after one year without a diagnosis, that was fun. You would be amazed at some of the things they can do in this hospital including almost everyone with edema or ascites or dyspnea getting an ECHO, I think they are second only in Duke to this, though here it cost 4 dollars and at Duke 1500. I also was helping my intern when he got a crosscover call on a patient on the women's ward (I only care for men).  She had come in with stroke and now was completely unresponsive. Unfortunatley, I got to teach him what fixed and dilated pupils looked like as she likely had a haemorragic (british spelling) stroke and herniated. I tried mannitol and steroids knowing it would not help, but there is no neurosurgery or even intubation with hyperventilation here, I am sure she has passed. The strange thing is you do it all by exam, no CT. Anyway, I will fill more details in later. 

I went on an amazing 10K run yesterday that started at our house and ran through all these little villages where kids in "huts" come out and give you five and say "Hallo" when you run by and locals run for 3-4 minutes with you for fun at times. The whole way at you are looking directly at the peak of Kili, it is beautiful. It was so much fun. 

Audra, as always, has proved herself to be the amazing cook that she is, cooking here fabulous pasta with home made tomato sauce though it looked quite challenging- there is no tomato sauce, just tomatoes. It was very good. We are taking good care of each other and will keep you posted on all the latest events. I also think I am going to add some medical post for the doctors out there. I could use some help trying to make some diagnosis and treatment decisions and think it would be fun for all.  I hope you enjoy the pictures.

Cheers, 

Chris and Audra