All Packed.. Am I Ready To Go..?!

It's been a pretty busy week for me really and I'm very glad that I managed to get it off placement as there has been lots to sort!!

Monday was spent sorting out all my many documents.. And there are a lot! I've got flight tickets, safari tickets, hotel tickets, insurance documents, professional indemnity insurance documents, my yellow fever vaccination certificate - very important else I won't be allowed in the country!

Tuesday I started sorting out what clothes, etc. I needed to take. So my bedroom looked like a bomb site! I had piles everywhere, of everything I thought I may possibly need, these had to be sorted out and minimised, as I had way too many items to squeeze into my 23kg, let alone my backpack! Also ordered my US dollars for my safari, visa and CTA permit whilst I'm out there.

Last minute shopping was done in Exeter on Wednesday with my brother and boyfriend.. All important jami's were purchased, along with batteries for my torch (for when there's no electricity in the house!), and a journal to help me remember everything I need to. And I also enjoyed my last subway for at least six weeks!

Yesterday I had to go to London for the day, which was lovely! I went to be videoed for a 'YouTube' blog by 'YourWorld Healthcare'. This was more than scary, but once I'd done it I felt much better. I've also got to do a couple of blog posts for this company about the comparisons between here and there. Once I've been sent a link for the video, I'll pop it up here so if you fancy a look you are more than welcome!!

And today has been very, very stressful sorting everything out.. But I think I'm finally there now! Anti-Malaria tablets started, hand luggage packed, lunch sorted and backpack packed, although I needed a lot of help packing it and trying to squeeze everything in. It's only 16kg of stuff, but that's all my backpack will take (leaving a little bit of space for anything I want to bring back - although I have been told that I will not be allowed to take a giraffe through customs sadly!)

I'm a little nervous about getting the plane now, as I've never caught one alone before. But I'm so very excited to get out there and enjoy everything the country has to offer me! I was however very annoyed to hear that the weather was showering over there today as apose to the glorious sunshine over here (it was still 30 degrees though!)

Now it's time to relax and get a good nights sleeo before a long day of travelling tomorrow!

Next time I get a chance to update you guys, I will be in a very different country experiencing very different things.. So Watch this space to see what happens and what I get up to in Dar Es Salaam!

Hospital Swahili..

So, A week and more has passed since I was last here and my Swahili knowledge has not improved drastically.. But I have picked a few more useful phrases that I can use in the hospital and with patients.

When asking about symptoms and side effects, useful phrases could include:

Umetapika? Have you vomitted?
Umetapika damu? Have you vomitted blood?

Unakohoa? Do you have a cough?

Una homa? Do you have a fever?

Unaumwa? Do you have pain?
Unaumwa wapi? Where do you hurt?

Umeharisha? Have you had diarrhoea?
Mara ngapi? How many times?

Instructions to patients that may be needed are:

Fanya hivi. Do this.
Tulia. Relax.
Usisogee. Don't move.
Subiri. Wait.
Kaa. Sit.
Inuka. Sit Up.
Lala kwa mgongo/ubavu/tumbo. Lie on your back/side/stomach.

However, although these words may be needed if techniques and practice were the same as in the UK, I'm unsure of just how necessary they will be whilst I'm in Tanzania. I will have to wait and see in just a few days..!

Learning The Basics of Kiswahili..

Swahili comes from the plural sawahili, a derivative from the Arabic Sahil, which means boundaries or coast. With the ki- in front, kiswahili literally means coastal language.

Swahili (or Kiswahili) is a bantu language that is the national language of Tanzania, Kenya, Uganda and the Democratic Republic of Congo, (Coastal Countries) along with being a means of communication through much of East Africa. Some of the language is derived from Arabic due to the years of Arabic-inhabitants, but there is also some incoorporation of Portugese, German, French, Persian and English due to contact with traders and slavers over the years. 
So, I'll start somewhere simple that everyone loves.. The Lion King! As it uses a few Swahili words that I've picked up on:

Hakuna Matata - No Worries!
Simba - Lion
Sarabi - Mirage
Pumba - Careless; to be a fool; to be bewildered!
Rafiki - Friend
Banzai - Skulk/Lurk
Upendo - Love
Shenzi - uncouth, savege, demon, barbarous

Some Swahili words are incorporated into English:
Safari - Journey/Travel
Jenga - From 'Kujenga',which means to build
Tote - Possibly derived from 'Tuta', meaning to haul

There are also some English words that have been incorporated into Swahili Too!!:
Polisi - Police
Boksi - Box
Hoteli - Hotel
Televisheni - TV
Baiskeli - Bicycle
Hospitali - Hospital
Soksi - Socks
Picha - Picture
Muziki - Music
Redio - Radio

Here are some general, basic phrases that I've picked up:
Jambo - Hello (Mambo is the more informal version of this)
Shikamoo - Greeting to an elder, which originally meant literally 'I touch your feet', as a sign of respect
Kwaheri - Goodbye

Habari? - How are you? Or literally, 'news?'

Variations on this include:

Habari yako? - What's your news?

Habari za leo? - How are you today?
Habari za kazi? - How's work?
Habari za nyumbani? - How's home?
Habari za asubuhi? - How are you this morning?
Habari za usiku? - How are you tonight?
Habari za mchana? - How are you this afternoon?
Habari za jioni? How are you this evening?

(I am yet to fully master all of these variations - and am still working out the correct pronouciation!)

An informal version is, 'Mambo Vipi' - How's it going?

Responses to these can be:
Nzuri - Good
Njema/Mzema - Fine
Poa/Shwari/Bomba/Mzuka - All meaning 'cool', which can can be doubled up, ie. poa poa

To ask in response you would say, 'Za Kwako?'

Asante - Thank you
Asante Sana - Thank you Very Much
Tafadhali - Please

Karibu - Welcome/You're Welcome

Samahani - Sorry (Forgive me)

Apparently, this is a word that I will hear a lot, not in an offensive way, but just as a statement - 'Mzungu' meaning foreigner!

Jina langu Ni.. - My name Is..
Ninaitwa.. - I am called..
Jina lako Nani..? - Your name is..?
Unaitwa..? - You are called..?

Ndiyo - Yes (Or just raising both eyebrows!)
Hapana - No

There's a lot to learn and I am trying my very hardest! I'm working on body parts and phrases I will use more in the hospital at the moment, so when I've got a better grasp of those, I will let you know and post some of them up here too!

Safari..

I looked at so many different safari's when I was browsing.. Ranging from a weekend to three weeks.. All going on different routes to different national parks. Whatever one I chose I was intent on going to the Serengeti and Ngorongoro crater! When I found this one with STA travel it sounded perfect and means that I can travel around to a few parks and have a nice relaxing few days to finish it all off..

I finish my placement on the 28th of June, so on the 29th I'm meeting my boyfriend and then we're flying upto Nairobi, Kenya early in the morning where our safari starts the following day. When there for the day, we intend to do a bit of exploring and there's a giraffe centre, run by a charity, that I would love to visit where you can feed the giraffes.

On Sunday morning we have a pretty early start at 8am where we head off through the Great Rift Valley to the Masai Mara, where we camp on the reserve edge for two nights and explore the park during the day looking for the big five and other wildlife! With the possibility of encountering some of the great migration of wildebeest, zebras and other grazing animals. Also, we are likely to encounter the red robed Masai warriers (who can be very scary on there approach)!

Great Rift Valley

On our third evening we head back to Nairobi to stay, before heading out on Wednesday to cross the border back into Tanzania. We go to Arusha - known as the safari capital - and explore here for the afternoon, with the possibility to visit the Meserani Snake Park and maybe Mt. Meru.

We will then have a two night/three day excersion to the Serengeti and Ngorongoro crater. On the first night we camp on the Serengeti planes after having game driven all day; the name Serengeti is derived from the Masai word siringitu meaning 'the land moves on forever' as the planes are endless! After our second day we will camp around the rim of the crater at 2400m above sea level, where we will be surrounded by wildlife for a second night, before descending down into the 326 square metre World heritage site on our last day here; where the only animals that can't get down here are giraffes due to the steep descent. After this we will drive back to Arusha to stay the evening.

Ngorongoro Crater









On day eight, we visit a local Masai village to get an insight into everyday life and the culture there. Then heading south via Moshi, we will pass Kilimanjaro and camp on the banks of the Pangani river, below the Usambara and Pare mountains in the Eastern Arc Range of mountains.

Day nine involves the journey back down to Dar es Salaam, where we camp on the beach before our trip to Zanzibar!

From day 10 we spend our time on Zanzibar, where we have no specific plans, but lots that you can do! It's known as the spice islands so you can tour around to see the exotic spices being grown, in Stone town the markets are bustling where you can explore and see what's on offer, white sand beaches encase the island for a relaxing day, there are snorkelling and scuba diving opportunities, along with the chance to swim alongside dolphins! So with all that choice, I'm sure there will be something that we can agree on to do!

It's an overland safari, in two-man domed tents, which means that everyone has to pitch in when it comes to setting up camp, cooking (although we have a cook who comes along with us) and shopping, so it can be a great experience if you have a good bunch of people!

It's all very exciting and I can't wait to get over there and see all the beautiful landscapes and wildlife! It really will be an amazing experience, with an amazing man!

My Preparations..

Getting ready for this trip has been a massive whirlwind, what with having revision, exams and placement to do too! But I think I've finally got there.. I hope I have, because if I've forgotten anything, it's getting a bit late now!

It started back in March when I had to arrange everything with Work the World, which was no problem at all! It was so easy, I basically just had to tell them where I wanted to go and when and then they accomodated me as best as they could. I recently found out that I will be definitely staying in Oyster Bay House, with lots of medics, nurses, physios, a couple of midwifes and a few diagnostics.

Work the World also offer a travel insurance package especially designed for their placments through Endsleigh, so I decided to use this for the entire 6 weeks as it seemed to be the best thing. I also had to ask SCoR for proof of my professional imdemnity insurance so that if anything were to go wrong then I would be ok and covered.

Once my dates had been confirmed, I started thinking and looking into what I could do post placement to make the most of my Summer and time out there.. After searching everywhere and asking many questions to lots of people and companies, I decided to book a 2 week safari with Acacia Africa, through STA! I also booked my flights with them as It was easy. I'm flying with Quatar airlines, with a stop-over in Doha, before landing in Dar es Salaam - the journey time overall is about 15hrs; so I will be bored.

To make sure that It was safe for me to travel out there I had to have quite a few injections, much to my dismay as I am really not a fan.. Hep A, typhoid, meningitus ACWY and yellow fever. A couple of these were quite expensive, but had to be done because you're not allowed entry to Tanzania unless you have a special certificate to say that you've had yellow fever! Anti-Malaria tablets were also a must and buying 6 weeks of Malarone is not a cheap purchase.

Due to the strong Muslim culture in Tanzania and therefore, having to keep my shoulders and chest covered and have shorts that come down my thigh, as mentioned before, I've also had to do some shopping for new summer clothes that fitted these criteria and were also lightweight and preferably cotton (but lets face it, not many girls would be disappointed with having to go clothes shopping - and I wasn't either!) I also needed to buy clothes that weren't too bright (blue, yellow, etc.) for safari, as these colours attract insects which can give you dengue fever - not very nice as it can make you very delusional, sadly there isn't anything you can take to protect you from this. Another item the safari compant recommend, although I thought this very strange it does kind of make sense (if you need it), is a sports bra?! Apparently because the roads are very bumpy, the truck ride can be very uncomfortable!

I didn't really know what to do about my phone because I didn't want a massive bill when I come back, but I did want to be able to send the odd text home. I got recommended to suspend my contract and get a pay as you go sim card instead, so that's what I did. It's not too expensive, 50p to send a text and free to recieve and it's £1 a minute to recieve a call and £1.75 a minute to make.

There's also been all the general holiday stuff to buy too and it's been quite hard to figure out what I'm going to need for 6 weeks, as I've never been out of the UK for more than 2 weeks at a time before! Sunblock was a definite need of course - both factor 30 and 50 (if I burn with this still, my skin must be paler than I thought!), along with new sunglasses and of course insect repellant, which had to have 50% DEET in (not really sure what makes DEET so good, but it was recommended, so thought it best to have!) and then all the shampoo, shower gel, moisturiser etc. etc.!

One thing that I've been trying to do since Work the World confirmed my placement, is learn Swahili. It's very interesting, but when It's a language that you've never really heard before, it is hard to know whether you are pronouncing the words correctly at all. I'm still trying my hardest so I know at least the basics when I get out ther, but am not really a language person, so it is very trying at times!

I think that I've now got everything in place that needs to be sorted, I've just got money to get and then the packing to do.. And at the moment I'm feeling that 20kg is not a lot for 6 weeks, but I'm sure it's probably more than I think.

Radiotherapy In the UK.. VS.. Radiotherapy In ORCI..

Radiotherapy in the UK is all about accuracy. Without this who would know where we are treating?! To achieve this there are many different procedures put in place for each and every patient.

Patients will have CT scans done, in a CT Simulator, prior to treatment in order to plan there treatment so that we're in exactly the right spot and the cancer is getting the exact dose needed. For the CT scan a patient has to be comfortable and immobilisation equipment is used in order to keep them still and in the same position - this sounds like an awful term, but basically all it is is something like a head rest and something to support under their knees, for head and neck patients they will also have a shell made to keep them in the exact position.

 A CT Scan and Breast immobilisation

Example of A Head and Neck shell

The plans created using the information provided from this scan can range from two different beams of radiation treating the patient.. To five or six (Intensity Modulated Radiotherapy - IMRT) creating a very precise dose distribution around the cancer target.

A Two Field Plan

 

An IMRT Head and Neck Plan

The patients have to be in the same position as they are for this scan when they come for treatment. To make sure this happens, the same immobilisation equipment is used, and permanent marks (aka tattoos, but no I'm afraid we can't give pretty butterflies as many patients ask!) are given to the patient during their CT. These marks then have to be aligned using lasers in the treatment room.

X-Ray images are also  incooporated into the treatment machines - linac's - that we use, and are taken when the patient has been positioned on the bed correctly, another method to ensure that the patient is in the correct place. If not initially then alterations to the patients position will be made to make sure that they are.

In Tanzania however, the situation is very different - with little accuracy compared to practice over here!

The department was donated two Colbalt-60 machines (the older version of a linac, which uses a live radioactive source - and can be dangerous if this source gets stuck in an active position and will not return to the safe) and a simulator (the older version of a CT simulator, still used in some centres in the UK, but not as much as they once were). This was great.. However, the last that I heard one of these Colbalt-60 machines has broken down, along with the simulator and one of the lasers used to align patients in the working Colbalt-60 machine is broken too! So equipment wise the insitute is in a very poor state sadly. 

 Example of A Simulator

With no simulator, this means no initial immobilisation (head and neck shells are reserved for the 'VIP' patients) to get patients in exact positions and no images to plan the treatment with. Therefore, there is a lack of accuracy before the treatment set up even begins! No tattoo marks are given to patients, and reference points are often just plasters stuck onto patients skin, which could easily come off - leaving the radiographers with no idea about where they are treating!

As they have nothing to plan with, basic techniques are used - those seen for palliative treatments in the UK - Single direct fields or parallel opposed paired fields, all of which are very large, leading to bad side effects; which are poorly managed.

Infection control is poor in ORCI, with there often being no running water let alone soap! As this is the case touching patients is a no go, so even if reference plasters are on the patient, they are unlikely to move the patient anyway!

The fact that the centre is working with only one Colbat-60 machine influences the throughput of patients too. As the pace in the country is slow, even in the working environment, days become very long for staff, often treating patients from 8 in the morning until 10 at night!

As you can see, the situation in Tanzania is very far from perfect and for a country with such a huge population is no-where near what is needed. I'm looking forward to going out there and experiencing all of this with my own eyes.. And seeing if there is any little thing that I could do to help!

The Hospital..

The other day I got a call from Work the World to finalise more of my trip and the hospital I'll be working in,Ocean Road Cancer Institute (ORCI). So I thought I'd do some more research into this hospital and find out more of what I'm in for..

ORCI is the only specialised cancer institute in Tanzania, along with one of the oldest institutes in the country, located along the Indian ocean about 200m from the beach. It works under the ministry of health, so is funded by the government, but works along side the Tanzanian community to offer the services they are in need of most.

The hospital is a referral insitute for about 3,500 patients a year and follows about 10,000 patients through in a year. The services it offers includes:

• General laboratory services

• Diagnostic imaging including X-Rays, Ultrasound, Mammography and Nucleur Medicine

• Chemotherapy delivery

• Radiotherapy treatment - Treating 150-200 patients a day, over 24 hours

• Outpatient cancer patient clinics

• Inpatient services

• Palliative care services - The delivery of oral morphine, counsilling and spiritual services

• Cervical and breast cancer screening outreach programme and screening itself - ORCI is the only hospital that offers this service in Tanzania, they use exsisting family planning clinics and reproductive health services to integrate this into practice

• HIV/AIDS care and clinic

• Offers teaching programmes for undergraduates and post graduates in medicine and other healthcare courses

Hopefully whilst I'm out there I'll have the opportunity to experience all that this hospital has to offer so that I will get a full picture of the management of cancer in Tanzania.

THE BIG 'C WORD'!!

The Big C Word (cancer) is a bit of a taboo subject in the UK, with people avoiding the subject totally in a lot of cases. But in Tanzania the situation is worse still as it is under recognised and over shadowed by HIV and AIDS. Although cancer can have a good prognosis, local doctors missing early signs and giving incorrect diagnosis' due to their limited knowledge of cancer and the public not being aware of what they should be looking out for, leads to cancer being picked up at a late stage and sadly with a much poorer end outcome to cancers in the UK; with the majority of patients dying withing a year of diagnosis.

In the UK the most commonly diagnosed cancer in females is Breast, followed by lung and bowel. In males, prostate is most common followed too by lung and bowel.. In Tanzania the common cancers are very different..

Whereas cervical cancer is the 19th most common cancer (Cancer Research, 2010), it is the most prevelant cancer amongst women; especially common in areas of non-circumsised men - a causal factor of the disease, along with the HPV virus. It accounts for between 35-40% of all cancers in Tanzania.

With men, the most commonly diagnosed cancer is Kaposi's sarcoma (a skin cancer) something relatively rare in the UK. It is caused by the Herpes virus and there are two types that affect the African population - AIDS related and African endemic, which are much more aggressive than the type that affects the UK. Numbers of this disease are so high due to the incidence of AIDS in Africa and it is considered to one of the AIDS defining diseases.

Other common cancers include skin cancer, primary liver cancer and Burkitt's lymphoma.

Although skin cancer is easily treatable, it is much more noticable in caucasian people due to the colour of skin. In coloured people it is often assumed that they are immune to the disease, therefore diagnosis is late when disease is advanced and potentially fatal.

Primary liver cancer is a disease rarely seen in the UK, whereas in Africa it is common due to Hepatitis B and C which are causal factors.

Burkitts lymphoma is a disease which was discovered in equatorial Africa and is divided into three categories. One category is classed as non-African, the other two are very commonly seen late stage amongst African children. It is related to the Ebstein-Barr Virus (EBV) and also HIV/AIDS (leading to it's high incidence).

Although the cancers prevelant is Tanzania can be life-threatening their lack of knowledge, late presentation and lack of money in the country mean that education, control and treatment of the disease is hard. And means that the majority of cases I will be seeing will be palliative to improve quality of life rather than obtain cure.

As you can see the cancers I will be experiencing will be very different to anything I have ever seen in the UK and at times I imagine it will be very trying and I will experience some very tough and sad situations.. it will definitely be an eye-opener in more than one way!!

The Country..

When in Tanzania, located on the East coast of Africa, I will be staying in Dar es Salaam which is the largest city and political capital. It has a hot and humid climate and when there in June it is considered the coolest and driest month, just after the rainy season, with average temperatures of between 25-30°C! (I don't class this as cool! And having very pale skin this will probably not mix very well - so I can imagine some sunburn!)

English is quite widely spoken, but the main language in Tanzania is Swahili or Kiswahili; which is part of the Bantu group of African languages. As most of the patients I will encounter will know little English, I've got to get my head down and learn some general words and phrases before I go - But more on that later!  

The general religions are Muslim and Christian, so although having four weeks of sun will be nice, covering up will be a must to avoid unwanted attention from the local men and unwanted looks and remarks from the local women. 

To travel to the Radiotherapy department; Ocean Road Cancer Institute, I will have to use the local form of travel - the 'daladala', there version of a mini-bus, which can get very crowded and with maniac drivers and no air conditioning I've heard that the experience is definitely something very different!

As well as work, I also intend to experience as much culture and do and see as many different things as I can!

I've heard very good reports of the variety of foods in Dar and the prices for food and drink are very, very cheap! The local dish of Ugali (a dish of maize flour served with a meat or vegetable stew) is just £1, a beer is 75p and a soft drink just 25p. Konyagi is there local spirit which is 35% and this is cheaper still!

Kariakoo is a district in Dar es Salaam that is most famous for it's extensive market which offers a thrilling, authentic shopping experience! It offers cheap souvenirs including jewlery and African drums. However, being a muzungu (foreigner) means that traders try to charge way over the actual price, so haggling is a must and it's recommended to take someone who knows the market and how it runs if you're a bit unsure.

Kilamanjaro National Park is located in the North of Tanzania, but I'm afraid I do not have the stamina to climb Kilamanjaro - as much as I would love to! As well as this park, there are also a lot of others - some of which I will be visiting. They include:

• Mikumi National Park; which is famous for it's tree climbing lions!
• Ngorongoro Conservation Area; a large volcanic crater, which is a UNESCO world heritage site
• Lake Victoria
• Selous Game Reserve; one of the largest faunal reserves in the world
• Serengeti; extends into Kenya and is well renowned for hosting the worlds largest terrestrial animal migration in the world - one of the 7 natural wonders of Africa.

The Big Migration!








Zanzibar is another must, just a two hour boat ride away! t's a semi-autonomous part of Tanzania which consists of numerous small islands and two larger one; known as the 'spice islands'. It's capital, 'Zanzibar city' is located on Unguja island and is known as the 'Stone town', a UNESCO world heritage site. It is one of the only places where saffron is grown, along with many other Middle Eastern spices. There are beautiful beaches to explore, the possibility to swim with doplphins, open air markets in the Stone town and a seaweed centre; where soaps, etc are all made using seaweed an natural products.

Another beautiful area, just a boat ride away from Dar, is the Bongoyo Marine Reserve, a secluded area where you can picnic, swim or snorkel amongst the diverse marine life amid the coral!

This touches on only a few of the many opportunities available whilst in Dar es Salaam, so as you can see I will definitely not be getting bored on my weekends off and intend to take full advantage of the beautiful country whilst out there. This includes a cheeky 12 day overland safari post placement, for which my boyfriend is flying over to meet me.. Details of this will follow shortly!

Diagnostic In Tanzania..

For the Diagnostics amongst you (the majority I imagine!) thought I'd link this up for you..

My fellow winner +Richard Betteridge is also blogging about his journey to Tanzania to work in a diagnostic department, if you're interested in hearing about his preparations etc. here's his blog - A Student Radiographer goes abroad!

Thanks guys!

Hello..

So, being a bit of an internet novice and having never written a blog or anything similar I'm very unsure of how this whole thing works - Apoloigies for any clumsiness and such, but here goes!

Firstly, my name is Kimberley Balsdon (Kim please!) and I'm currently a second year student at Cardiff University studying Radiotherapy and Oncology. And the reason I've decided to start this blog is due to my recent success in winning the Society of Radiographers (SCoR) International Elective Competition!

Being a student member of SCoR means that I have the opportunity to tap into loads of different resources, including journals, conferences and weekly newsletters to keep me up to date with the world of radiography. When I saw this competition in StudentTalk advertising a prize of a 4 week elective placement in a third world country it sounded like an amazing experience! I've always been interested in travelling the world, experiencing new cultures and having lots of amazing adventures, so being able to combine this love with my love of radiotherapy seemed to be perfect! To enter I had to write an 800 word personal statement about where I wanted to travel to and how I would benefit from the experience.

Having not heard anything by the end of Decemeber (when I thought winners would be announced) I assumed I had not won; I was disappointed, but I had expected not to. So I forgot about it really..

Then at the end of January, I had just finished Uni and got a phone call from SCoR saying that I'd won!! I was in complete shock and amazement and was sooo excited!It then became official.. And me and +Richard Betteridge could begin our journeys across the world :)

The society work with Work the World to offer this opportunity and since I won I have been working along side them to plan my trip. Originally, I had written in my statement about how I wanted to go to Ghana for my four weeks. However, the links that Work the World have in Ghana for radiography are diagnostic, but not radiotherapy. Therefore, I had to change my plans and am now off to Tanzania for four weeks! I wasn't disappointed about the change as both offer amazing opportunities!

I'm flying off to Tanzania on the 1st of June - less than a month away?! - and leading up to this date I will be regularly posting and keeping you guys up to date about the country, the healthcare, the hospital I'm going to, the culture, the language, my preparations and then my experiences whilst I'm out there (although internet connection can be very dodgey I hope to be able to keep in contact as much as I can!).