So my placement is now over, the last four weeks have flown past and I have no idea where! It's been amazing working there and hasn't felt like work at all!
The staff have all been lovely, there was only one woman in the department and she only works with the caesium machine really. There attitude is so laid back and there is no rush about anything. It's nice in a way, but can sometimes be annoying when patients are waiting around and left on the bed or waiting for their treatment for ages.
They have a poor opinion of UK radiotherapy and the staff. It's been said to me that we don't talk to patients at all, whereas we talk to patients a lot more than they do and have much more of a caring nature. Most of the time all they ask them is for their name and to go into the room and to leave the room. So I'm not sure why they think that their much more patient orientated!
Another statement has been made that we don't talk to each other at work or use our phones. I tried to explain that we do talk to each other and they said no you don't talk about things outside of work, they didn't understand that we did. And the fact that we don't use our phones was a professionalism thing, they didn't grasp that concept either.
They've made a big effort with me though asking lots of questions about the UK and how we do things. Most of them know how we do things though, as the sad thing is that their education at university is the same as ours, but everything is theory as that just don't have the equipment to practice how we do. One man told me how they got told they would get a chance to go to another country to practice, but they never heard anything else about it sadly.
They would all love to see how we did it and come over, but they can't get anywhere as its just too expensive and they have commitments here.
This week a lot of the staff have been off, due to the red they received at the end of last week. There were 7 interns working and 4 jobs were on offer to start when they are qualified at the end of the year. However, none of them were offered the jobs as they decided to offer them to diagnostic technicians and then train them up as this way is cheaper. This means that they know have nowhere to go as there are no other centres in the whole of Tanzania, so the last 4 years of their lives have been with no reward. It's very sad and they were very demoralised, so have not been in to work.
It will be sad to leave them, but I've got their emails and intend to keep in touch and see what's happening our there in the future and if things are changing like they all want it to!
Friday 28 June 2013
Tuesday 25 June 2013
Set Up..
Patient set-ups are all pretty similar out here and easily picked up.
So, the staff will tell the patient to enter the room and then give them a few minutes before entering again. ive been told two reasons for this, one because of the radiation protection and the other because of patient dignity. The patient will get on the bed by themselves, sometimes struggling and I've seen blind people with little assistance trying to get on. They all have to lay their individual kanga's on the bed for their treatments before getting on.
Sometimes they are moved to make sure that they are straight but they are mostly just given directions as to what to do to get themselves in the right position. Sometimes I disagree with what they are doing because they can move their ankles and legs after the field has been positioned, altering the position of the field possibly.
For cervix patient anatomical surface markers are used for the set up on every patient; as I blogged in my last post.
For other patients most of them have plaster markings around the edges of the field so that their is some guidance as to where to go. Although this is a good idea, the plasters are often put on by nurses outside of the treatment room. This means that the field light is not on the area and the patient is in a different position, therefore it can be non-representative of the actual treatment field. Another issue is that they do not stay on very well after washing etc. so if they fall off and patients re-position them (like they often do) it is hard to know where the exact place is. For patients having lateral fields treated the field is only marked on one side so this too can make the positioning hard as the bed can be unreliable with the measurements and movements. Obviously no movements are made from these plasters as they represent the actual field that needs to be treated.
The accuracy is better than what I thought it would be, even if it is a bit dubious sometimes! Most of the time I feel comfortable to set up and switch on with the set-up they have done as it is all that can be achieved with their equipment. To start using tattoos would require a large change in the department and a lot of time and money; but hopefully in the future.
So, the staff will tell the patient to enter the room and then give them a few minutes before entering again. ive been told two reasons for this, one because of the radiation protection and the other because of patient dignity. The patient will get on the bed by themselves, sometimes struggling and I've seen blind people with little assistance trying to get on. They all have to lay their individual kanga's on the bed for their treatments before getting on.
Sometimes they are moved to make sure that they are straight but they are mostly just given directions as to what to do to get themselves in the right position. Sometimes I disagree with what they are doing because they can move their ankles and legs after the field has been positioned, altering the position of the field possibly.
For cervix patient anatomical surface markers are used for the set up on every patient; as I blogged in my last post.
For other patients most of them have plaster markings around the edges of the field so that their is some guidance as to where to go. Although this is a good idea, the plasters are often put on by nurses outside of the treatment room. This means that the field light is not on the area and the patient is in a different position, therefore it can be non-representative of the actual treatment field. Another issue is that they do not stay on very well after washing etc. so if they fall off and patients re-position them (like they often do) it is hard to know where the exact place is. For patients having lateral fields treated the field is only marked on one side so this too can make the positioning hard as the bed can be unreliable with the measurements and movements. Obviously no movements are made from these plasters as they represent the actual field that needs to be treated.
The accuracy is better than what I thought it would be, even if it is a bit dubious sometimes! Most of the time I feel comfortable to set up and switch on with the set-up they have done as it is all that can be achieved with their equipment. To start using tattoos would require a large change in the department and a lot of time and money; but hopefully in the future.
Monday 24 June 2013
Techniques..
Explaining the techniques used in ORCI will not take me long as they are very basic and all very much the same. Not because they know no different, because they all get taught the same things as us (but their knowledge is just all theoretical rather than practical), but their techniques are the way they are because of the equipment that they have sadly.
As there sinulator is a bit tempormental and most techniques are just done by the book and with surface markings, after a few days picking the set-up was easy.
For cervical cancer - most of what I see - they are mostly late stage and the technique used is SSD100 (or SSD80 if you're on the other machine) and a field arrangement of anterior and posterior parallel opposed pair. Field sizes have to be large to encompass the large extent of disease (which you can often see bulging and can smell from a distance sadly for these women). The general field size is 15 x 15cm, which is sometimes coned down to 10 x 10cm or 12 x 12cm after their initial 25 fractions and review by their doctor. As these patients don't have marks on their skin, surface anatomy is used to position the field. The lower border is the anterior commissure and the upper is just below the umbilicus, to position the lateral borders the Sagittal laser is positioned running through the middle of the vulva.
For almost every head and neck cancer right and left parallel opposed fields are used. The field size for these is not as predictable and will vary depending on the extent of the disease and where exactly it is obviously. Some may be 8 x 5cm for example, while others 12 x 10cm. The decision on field size is made by the radiographer a treating the patient on the first day and their knowledge on the cancer and patient; so this can be very subjective. But their textbook knowledge is very good so they know how it should be.
Some lymphomas of the head and neck and other more superficial cancers are treated with direct single anterior or posterior fields - also varying in size depending on the tumour.
As you can see, the techniques are very much palliative in their style and although the majority of patients are very late stage it is not ideal. But Asides from these three techniques anything else is very much impossible due to their lack of equipment and money and the fragility of the equipment; I have been told by one that they don't like moving the jaws of the machine too much as it makes it very tempormental, like i wrote in my last post. They would all love to be able to move on to greatest things, but right now they are doing the best they can for their patients.
Their technique for breast is however nearly identical to our technical, the only difference being that they used an SSD of 100 as they don't have the facilities for planning obviously. So the standard treatment is medial and lateral tangentials; they were surprised when I said we were doing the same in the UK! They even use half beam blocking for the medial border, but not for the superior border of the field where it mets the supraclavicular field. There is a difference with the patients too. Because the majority are caught late stage this means they have all had mastectomies, I don't think I have seen one patient without one. As this is the case, it also means that they all have supraclavicular fields too - with the exception of one patient I have seen.
As there sinulator is a bit tempormental and most techniques are just done by the book and with surface markings, after a few days picking the set-up was easy.
For cervical cancer - most of what I see - they are mostly late stage and the technique used is SSD100 (or SSD80 if you're on the other machine) and a field arrangement of anterior and posterior parallel opposed pair. Field sizes have to be large to encompass the large extent of disease (which you can often see bulging and can smell from a distance sadly for these women). The general field size is 15 x 15cm, which is sometimes coned down to 10 x 10cm or 12 x 12cm after their initial 25 fractions and review by their doctor. As these patients don't have marks on their skin, surface anatomy is used to position the field. The lower border is the anterior commissure and the upper is just below the umbilicus, to position the lateral borders the Sagittal laser is positioned running through the middle of the vulva.
For almost every head and neck cancer right and left parallel opposed fields are used. The field size for these is not as predictable and will vary depending on the extent of the disease and where exactly it is obviously. Some may be 8 x 5cm for example, while others 12 x 10cm. The decision on field size is made by the radiographer a treating the patient on the first day and their knowledge on the cancer and patient; so this can be very subjective. But their textbook knowledge is very good so they know how it should be.
Some lymphomas of the head and neck and other more superficial cancers are treated with direct single anterior or posterior fields - also varying in size depending on the tumour.
As you can see, the techniques are very much palliative in their style and although the majority of patients are very late stage it is not ideal. But Asides from these three techniques anything else is very much impossible due to their lack of equipment and money and the fragility of the equipment; I have been told by one that they don't like moving the jaws of the machine too much as it makes it very tempormental, like i wrote in my last post. They would all love to be able to move on to greatest things, but right now they are doing the best they can for their patients.
Their technique for breast is however nearly identical to our technical, the only difference being that they used an SSD of 100 as they don't have the facilities for planning obviously. So the standard treatment is medial and lateral tangentials; they were surprised when I said we were doing the same in the UK! They even use half beam blocking for the medial border, but not for the superior border of the field where it mets the supraclavicular field. There is a difference with the patients too. Because the majority are caught late stage this means they have all had mastectomies, I don't think I have seen one patient without one. As this is the case, it also means that they all have supraclavicular fields too - with the exception of one patient I have seen.
Apologies..
Sorry I haven't been here in a while my last couple of weeks have been so busy exploring I've ran out of time to get down to updating you all on what is going on in the hospital! I think this week may be my last post/s while I'm out here too, as I'm off on safari on Saturday - no idea where the last four weeks have gone its very scary!
Hopefully I'll be able to catch you up on everything within the next few days though and if not then will do when I get back.
Hopefully I'll be able to catch you up on everything within the next few days though and if not then will do when I get back.
Monday 10 June 2013
The Hospital..
The hospital isn't very big as its purely specialised for cancer and it's treatment, so my orientation around didn't take very long at all. It's different from what I thought it would be like! It's all on a campus with different buildings that are all white and look very modern, but aren't! One of the building contains all the wards and clinics, which is really new but the others containing a canteen, church, mosque, chemo day unit, diagnostic imaging and radiotherapy is not as new.
There are lots of wards which are all full as most of their patients are admitted. This can be due to their poor health, late stage of disease, the poor healthcare system that they have near their homes or the distance that they have to travel from home for their treatment. For patients that are Tanzanian this is free as the hospital is government run, but for those who do not originate from this country only abide here, they have to pay a fee to use the ward. I'm hoping to spend a day there during the next three weeks, but have been warned that I will probably cry!
The clinics there are all very over-run and very non-confidential! There are many people spilling out into the corridors waiting to be seen by doctors, some very ill! It is very strange because when I was being shown around, the doctor I was with would just walk into clinic rooms without knocking and with no regard for the patient in there. The staff and doctors would then all ignore their patients and just talk to each other and me then, I felt very awkward about it and very sorry for the patient, but this is just how their country is - there is no privacy or dignity for anyone!
The diagnostic facilities are better than I imagined and the equipment looks surprisingly like that I have seen in the UK! They are equipped with 3 X-ray units, 2 ultrasound units and 2 gamma cameras - no CR or MRI. The gamma cameras are very new, but the rooms are very dusty and still remain looking a bit like a construction site. Privacy in this department is like the clinics too and I ended up walking in on a lady with her skirt around her ankles, they all acted as though it was just the norm though!
In chemotherapy I didn't get to see much, but I'm hoping to go back again! There was a fume hood being used by nurses with masks on and aprons, but no gloves?, to prepare and mix chemotherapy agents under. All the needles with the drugs in were being re-sheathed after being prepped, so it wasn't actually very safe anyway! In the corner next to this there was a nurse sat in the corner and then two lines of plastic chairs where people were queuing to be cannulated before being hooked up to there drugs. There were a few beds and a line of chairs across the wall, which were all being shared by numerous people. The queue outside was very big, with the courtyard outside the door full of people waiting for their treatment! I don't think that their organisation provides that best efficiency and time management.
The radiotherapy department isn't very big, but does provide a massive service to the population, treating upto 150 patients a day with hours between 7 until they finish, which can be at 2 the following morning! (Which makes our country seem very lazy, as we complain about 1 hour over time, whereas these guys don't complain about 5 hours overtime they just want to help all their patients!) So they have two machines like a knew, along with a simulator and brachytherapy equipment.
Both machines were in use when I first arrived last week, but one had a very broken table that they were trying to utilise to cope with the amount of patients. It has now been completely taken out of use, so all the patients have to treated on the one working machine. Although I had been told one of the lasers on the working machine was broken, it is actually working so this is functioning the majority of the time. Although the bed cannot be lowered completely, so a wooden step has to be used to get on and off the bed and the X2 jaw has been very tempormental over the last few days, with the engineers having to be called a couple of times. The machine also completely broke down on Thursday, so not all the patients could be treated! The source got stuck in the open position and the jaws got stuck again too.
Going into the room there is a 'maze' so to speak, but it is more just a straight corridor down to the room. The door in is very heavy and very big with a red and yellow light outside the room, the red is on when the radiation is on - like in the UK. In the room, the cobalt-60 machines are huge! So much bigger than linacs, there is a tennis racket section of the bed and the handset is hung on a metal pole over the head of the gantry. Along one wall are two very dirty and dusty tables which have all their immobilisation equipment on. There is no organisation though and barely any equipment. They have headrest A to F, a plastic plate with two Velcro straps across and a very old breast board! Most patients have a headrest, with the straps being used for whole brain treatments. The breast boards is positioned on a plastic slant which isn't indexed and then one arm is elevated, which ever side is being treated as the arm cup moves from both sides. I have seen a leg support being used just once, for a very very ill young man in a lot of pain!
The computer system outside the room is very very simple! There are three monitors in total - one general computer used most of the time for watching films, safari documentaries and a but of Kenan and Kell! Another monitor is not used because the camera inside the room is broken so there is no need for it. The third controls the linac! So there is a section where the parameters for the individual treatments are entered and that is all! No patient information is stored on there and the only record of the patients treated that they have is a notebook with all the patients names from that day written in. On the control panel there are auto-set buttons which I was surprised about, but they no longer use them as one time when no-one as paying attention (which happens 97% of the time!) the gantry head crashed into the wooden steps used to get on the bad and there is now a big hole in the top of it!!
I'm yet to take my camera in, but will be a few times over the next three weeks, so either when I get back or whilst I'm out here if the Internet allows it I will upload them all so that you guys have a better picture of what it's actually like, as I don't think my descriptions are very good and pictures will be much easier to understand!
There are lots of wards which are all full as most of their patients are admitted. This can be due to their poor health, late stage of disease, the poor healthcare system that they have near their homes or the distance that they have to travel from home for their treatment. For patients that are Tanzanian this is free as the hospital is government run, but for those who do not originate from this country only abide here, they have to pay a fee to use the ward. I'm hoping to spend a day there during the next three weeks, but have been warned that I will probably cry!
The clinics there are all very over-run and very non-confidential! There are many people spilling out into the corridors waiting to be seen by doctors, some very ill! It is very strange because when I was being shown around, the doctor I was with would just walk into clinic rooms without knocking and with no regard for the patient in there. The staff and doctors would then all ignore their patients and just talk to each other and me then, I felt very awkward about it and very sorry for the patient, but this is just how their country is - there is no privacy or dignity for anyone!
The diagnostic facilities are better than I imagined and the equipment looks surprisingly like that I have seen in the UK! They are equipped with 3 X-ray units, 2 ultrasound units and 2 gamma cameras - no CR or MRI. The gamma cameras are very new, but the rooms are very dusty and still remain looking a bit like a construction site. Privacy in this department is like the clinics too and I ended up walking in on a lady with her skirt around her ankles, they all acted as though it was just the norm though!
In chemotherapy I didn't get to see much, but I'm hoping to go back again! There was a fume hood being used by nurses with masks on and aprons, but no gloves?, to prepare and mix chemotherapy agents under. All the needles with the drugs in were being re-sheathed after being prepped, so it wasn't actually very safe anyway! In the corner next to this there was a nurse sat in the corner and then two lines of plastic chairs where people were queuing to be cannulated before being hooked up to there drugs. There were a few beds and a line of chairs across the wall, which were all being shared by numerous people. The queue outside was very big, with the courtyard outside the door full of people waiting for their treatment! I don't think that their organisation provides that best efficiency and time management.
The radiotherapy department isn't very big, but does provide a massive service to the population, treating upto 150 patients a day with hours between 7 until they finish, which can be at 2 the following morning! (Which makes our country seem very lazy, as we complain about 1 hour over time, whereas these guys don't complain about 5 hours overtime they just want to help all their patients!) So they have two machines like a knew, along with a simulator and brachytherapy equipment.
Both machines were in use when I first arrived last week, but one had a very broken table that they were trying to utilise to cope with the amount of patients. It has now been completely taken out of use, so all the patients have to treated on the one working machine. Although I had been told one of the lasers on the working machine was broken, it is actually working so this is functioning the majority of the time. Although the bed cannot be lowered completely, so a wooden step has to be used to get on and off the bed and the X2 jaw has been very tempormental over the last few days, with the engineers having to be called a couple of times. The machine also completely broke down on Thursday, so not all the patients could be treated! The source got stuck in the open position and the jaws got stuck again too.
Going into the room there is a 'maze' so to speak, but it is more just a straight corridor down to the room. The door in is very heavy and very big with a red and yellow light outside the room, the red is on when the radiation is on - like in the UK. In the room, the cobalt-60 machines are huge! So much bigger than linacs, there is a tennis racket section of the bed and the handset is hung on a metal pole over the head of the gantry. Along one wall are two very dirty and dusty tables which have all their immobilisation equipment on. There is no organisation though and barely any equipment. They have headrest A to F, a plastic plate with two Velcro straps across and a very old breast board! Most patients have a headrest, with the straps being used for whole brain treatments. The breast boards is positioned on a plastic slant which isn't indexed and then one arm is elevated, which ever side is being treated as the arm cup moves from both sides. I have seen a leg support being used just once, for a very very ill young man in a lot of pain!
The computer system outside the room is very very simple! There are three monitors in total - one general computer used most of the time for watching films, safari documentaries and a but of Kenan and Kell! Another monitor is not used because the camera inside the room is broken so there is no need for it. The third controls the linac! So there is a section where the parameters for the individual treatments are entered and that is all! No patient information is stored on there and the only record of the patients treated that they have is a notebook with all the patients names from that day written in. On the control panel there are auto-set buttons which I was surprised about, but they no longer use them as one time when no-one as paying attention (which happens 97% of the time!) the gantry head crashed into the wooden steps used to get on the bad and there is now a big hole in the top of it!!
I'm yet to take my camera in, but will be a few times over the next three weeks, so either when I get back or whilst I'm out here if the Internet allows it I will upload them all so that you guys have a better picture of what it's actually like, as I don't think my descriptions are very good and pictures will be much easier to understand!
Thursday 6 June 2013
Jambo!!
Jambo everyone at home! So I've been here for nearly a week now and lots has happened and is going on!
My flights were very good although long! The airline Qatar is lovely and they treat you really well and feed you lots of lovely food, I was surprised how good is was for airplane food. When I arrived in Dar es Salaam it was already in the high 20's at 8 and I was boiling! Work the world picked me up and I went back to the house to be shown around and meet everyone.
The house is very nice. There's a living room, dining room, kitchen, garden, swimming pool and then bedrooms coming off of these as well as a couple of chalet type outbuilding rooms. I share my bedroom and bathroom with three others - two medics and a physio! I get given breakfast and tea and can help myself to food from the kitchen during the rest of the day. So far, I've had pancakes, eggs, sausages and home made doughnuts for breakfast along with a lot of fresh fruit, like mangoes, bananas and pineapple. For tea I've learnt that they love their carbs! For example one night we had rice and mash in the same meal! There's a lot of chicken and beef dishes and also a lot of bean curry, but always a lovely lovely selection and it all tastes lovely! Tried banana stew last night and as horrible as it sounds it was actually very very nice! However, the one thing I do miss I sweet things as there are not many of these. It's a good job I brought gingerbread men and sweets with me!!
I've explored the local area and it's very nice. I'm staying in the posh part of town, where all the government members and the prime minister lives (obviously it is not like in England, but the houses are very big and very lovely!) the shop opposite where I am sells everything English which is nice, but I haven't yet brought anything as I'm loving everything African at the moment. It is all so cheap too! For example, I've just had a chocolate ice cream milkshake which cost 5,500 Tanzanian shillings, which equates to about £2?! There's a local post office, market which sells local crafts and paintings that are painted outside our house, a liquor store, ATM and air conditioned shopping centre where we can get wifi (where I am right now!).
The transport is very interesting! I have only got a daladala once, not because I haven't wanted to but because they are very rare in our part of town due to the caliber of people that live here which means the majority of them have their own cars to use. The one I got was fine and I even got a seat! However, most of the ones I see on my way home from work have people hanging out of the windows and doors and people say on eat other an pushing each other to get on and off, it is very chaotic! Taxis are common, but with no AC they can be very uncomfortable if there are too many of you in them - but they can work out cheap, as the drivers are not fussy about how many people are in their cars. An alternative to taxis seems to be hitching lifts which is very common too and I have participated in. Cars pull over at bus stops all the time offering lifts and they will squeeze as many people in as possible too as it means more money for them. They were only four in the back of the one I was in, but I have seen more squeezing in! The most common method that I have used is a bajaj. This sounds and has the front steering of a quad biker has a cover on the back - it's very cool. They are really small so can squeeze in between little gaps and are breezy too which is good in this heat! You have to haggle over the price as they see a Mzungu and immediately put the prize up loads! But I've pretty much sorted out how much most journeys should cost (and if you walk off they normally call you back saying you can have it for the price you asked!)
I'm loving the laid back attitude of everyone out here, the culture and everything new and all the locals are so friendly! They also say hi and are very impressed when you reply in Swahili. I think mine is getting a bit better and we have casual lessons at the house in the week too which is very helpful just to help with the basics. I'm hoping that in a few weeks I'll have picked up a lot more.
I think that's about it for now, but I will be back on at the beginning of next week to tell you all about what the hospital is actually like!
Kwaheri!
My flights were very good although long! The airline Qatar is lovely and they treat you really well and feed you lots of lovely food, I was surprised how good is was for airplane food. When I arrived in Dar es Salaam it was already in the high 20's at 8 and I was boiling! Work the world picked me up and I went back to the house to be shown around and meet everyone.
The house is very nice. There's a living room, dining room, kitchen, garden, swimming pool and then bedrooms coming off of these as well as a couple of chalet type outbuilding rooms. I share my bedroom and bathroom with three others - two medics and a physio! I get given breakfast and tea and can help myself to food from the kitchen during the rest of the day. So far, I've had pancakes, eggs, sausages and home made doughnuts for breakfast along with a lot of fresh fruit, like mangoes, bananas and pineapple. For tea I've learnt that they love their carbs! For example one night we had rice and mash in the same meal! There's a lot of chicken and beef dishes and also a lot of bean curry, but always a lovely lovely selection and it all tastes lovely! Tried banana stew last night and as horrible as it sounds it was actually very very nice! However, the one thing I do miss I sweet things as there are not many of these. It's a good job I brought gingerbread men and sweets with me!!
I've explored the local area and it's very nice. I'm staying in the posh part of town, where all the government members and the prime minister lives (obviously it is not like in England, but the houses are very big and very lovely!) the shop opposite where I am sells everything English which is nice, but I haven't yet brought anything as I'm loving everything African at the moment. It is all so cheap too! For example, I've just had a chocolate ice cream milkshake which cost 5,500 Tanzanian shillings, which equates to about £2?! There's a local post office, market which sells local crafts and paintings that are painted outside our house, a liquor store, ATM and air conditioned shopping centre where we can get wifi (where I am right now!).
The transport is very interesting! I have only got a daladala once, not because I haven't wanted to but because they are very rare in our part of town due to the caliber of people that live here which means the majority of them have their own cars to use. The one I got was fine and I even got a seat! However, most of the ones I see on my way home from work have people hanging out of the windows and doors and people say on eat other an pushing each other to get on and off, it is very chaotic! Taxis are common, but with no AC they can be very uncomfortable if there are too many of you in them - but they can work out cheap, as the drivers are not fussy about how many people are in their cars. An alternative to taxis seems to be hitching lifts which is very common too and I have participated in. Cars pull over at bus stops all the time offering lifts and they will squeeze as many people in as possible too as it means more money for them. They were only four in the back of the one I was in, but I have seen more squeezing in! The most common method that I have used is a bajaj. This sounds and has the front steering of a quad biker has a cover on the back - it's very cool. They are really small so can squeeze in between little gaps and are breezy too which is good in this heat! You have to haggle over the price as they see a Mzungu and immediately put the prize up loads! But I've pretty much sorted out how much most journeys should cost (and if you walk off they normally call you back saying you can have it for the price you asked!)
I'm loving the laid back attitude of everyone out here, the culture and everything new and all the locals are so friendly! They also say hi and are very impressed when you reply in Swahili. I think mine is getting a bit better and we have casual lessons at the house in the week too which is very helpful just to help with the basics. I'm hoping that in a few weeks I'll have picked up a lot more.
I think that's about it for now, but I will be back on at the beginning of next week to tell you all about what the hospital is actually like!
Kwaheri!
Subscribe to:
Posts (Atom)