These last two weeks (15th-29th of September 2013) I spent between here in Bagamoyo and Dar Es Salaam Muhimbili Hospital.
We got introduced to a newly diagnosed family, Hamisi finally had his operation at Muhimbili and a week was spent in a Bagamoyo Arts Festival testing and giving information of HIV to all people.
Wednesday 18.9 we left together with Hamisi and his sister to Muhimbili, once again. This time we were determined not to leave until the operation; double mastectomy was done. He has been suffering from gynaecomastia (enlarged male breasts) since 2008. He was operated Friday 20.9. I visited just after operation at the hospital and he was in a lot of pain. However, he was so happy and smiled through his pain and kept pointing his flat chest! He was discharged on Wednesday evening and Friday I and David (local volunteer) visited him in his sister’s house in Dar where he will be staying until he has recovered. The family in Bagamoyo has no money so they want to keep him in Dar where he can be looked after. On Friday he looked already much better and was eating and mobilising. We left them with all dressing supplies and Waterguard to make clean drinking water. His dressings appeared clean and dry and they were changed last Friday at the local health centre. I will be visiting him once a week in Mbagala. The only problem is it takes 6 hours to there and back in local bus ‘daladala’! His follow up appointment will be in two weeks time.
Patient S was discharged from Ocean Road Hospital Dar Es Salaam where he was treated few months with radiotherapy for his anal cancer. He is now back home in Bagamoyo and he was in a lot of pain and had forgotten his hospital card and medications in Dar Es Salaam. I went to pick them up from Dar but the nurses informed me that he was not due any medications, only pain relief. Luckily Mama Kizenga a nurse at the hospital here has a supply of Morphine for patients discharged from there and she paid a visit to him. Patient S has follow up appointment in Dar tomorrow (Tue) but he only just informed us today. I am trying to organize funds and the transport for Wednesday same day as I will visit Hamisi there. Charles informed me also that patient S wife is not well so we need to pay them a visit too.
For the past two weeks I have been visiting Patient MF several times. Her family has lost her hospital card so we do not know the date for the next appointment. Two weeks ago I discovered a pressure sore (grade 3) in her hip, which I have been redressing every few days but every time I arrive it has come off. I gave some dressings to the family too to make sure it will stay covered at all times. Her skin was also in a very bad condition. I went to the hospital to talk to the doctors at the clinic and mama Kizenga. They informed me that the family is her problem; they do not take care of her and do not give medications properly. They said there was no point to keep bringing her to the hospital because it is the family that is the problem and no one can go there every day to make sure she takes them. I organized a meeting with mama Kizenga and local volunteer to try to go to speak to the family together about her care. When the day came (last week) Mama Kizenga never called me like she had promised. She also promised to organize a new hospital card but that also still is not done. I went again to the hospital last Thursday to see the doctors about her. I told them I will just bring her here without the card as she is due CD4 test too. Today I was going to pick her up but the family (one daughter) refused to take her with me as there were no other sisters there to take care of the house. I felt so frustrated as I had informed them two days ago that I will be coming today. Where were the other 4 sisters?? You need two people to transfer her and the family should also be involved. I gave them another two days to get ready and I am taking her on Wednesday now. I gave them three different creams to use for Mariam’s skin and Floconazole tablets for a month (Mama Kizenga gave me) and it has little improved in two weeks time. Also patient MF has been smiling on my last two visits, which is great as facial impressions are her only communications tool. We just need to keep working together with the family and support them as much as I can so that we can take of little burden from the family. I feel that they are tired of looking after their mum. It is so sad.
Patient CP is doing well. He has had his two showers per week. His arm muscles are so big now and he looks bigger all over. Family must be giving more food too. His legs are still week and his family used his exercise pole to build another kitchen, typical! His appointment for CD4 is in 10 days time and I have a strong feeling it will be much improved. His family still never takes him out of his room that is why he loves us visiting so he can get some fresh air and to see life around him.
This lovely family comes from Morogoro and the father Gidioni & his wife Aloisia were diagnosed with HIV last July 2013.
They are in their mid 30s. They arrived to Bagamoyo less than week ago to stay with Mama Ponda (Gidioni’s sister) because they had 4 hours drive to the nearest clinic in Morogoro and no support.
Gidioni got sick already last January when it all began. He got fevers typhoid and malaria that made him really weak and reduced mobility. His CD4 was 50 in July and he was started on ARVs (combination therapy one tablet at night). He has had difficulties taking them because of nausea and malnutrition issues. His diarrhoea has resolved now. He can walk short distances but is very unsteady with feet and feels dizzy, however he is alert and orientated. He is also on Septrin (in the mornings). He appears severely malnourished. He also reported to have had low Hb in July.
His wife Aloisia had CD4 616 in July and was put on Septrin only. She appears well but complained to have had a cough for few months.
They have a son Michael 1,1 year old who has TB. It is not active anymore; he has been on medication for it since May 2013. His mother has been breastfeeding Michael until now but Charles told her to stop now. The baby appears well, but the mother complained the baby has a fever.
They have 2 other sons; 7 year old who is also in Bagamoyo and not been tested yet (he appears well) and older one in Morogoro 12 years of age who also has not been tested for HIV. Family reported that he is not sick. This family has no income now as the father was the main bread winner.
All family was taken to the hospital and registered with CTC. Father was checked for Malaria, which came back negative. Haemoglobin was within normal range. Two TB sputums were taken and we are now waiting for the results. We got him a walker to help with his mobility and supported the family financially to buy nutrition. He was given ARVs for another month.
Baby was checked for Malaria and unfortunately it came back positive and he was started on medication. Dry blood sample was taken from the baby Michael and sent to Muhimbili in Dar to test for HIV. We are waiting for the results. Mother was also screened for TB and we are now waiting for those results. Doctors informed that the source for baby’s Malaria must be somewhere and is suspecting the parents. Both young boys still need testing.
Charles did some counselling and explained the family everything of the process and living with HIV. He gave them real motivation end encouragement. He explained about nutrition and ARVs. The family has a great support around them from Mama Ponda and Pili and from each others. We will be visiting them regularly. I can only hope that the children will test negative. We will work on Gidioni to get his strength back and his CD4 up in the next few months so he can become the breadwinner for his family again.
TASUBA BAGAMOYO ART FESTIVAL:
Last week we were given a big room for testing and counselling at the Bagamoyo’s yearly music and arts festival. We had four local volunteers to do the testing and the first couple of days many people were tested; around 30 per day. We also gave information and free condoms. These kinds of events are a great opportunity to get people tested and it was a great fun too!
Next week I will visit Hamisi in Dar again and continue to see my patients here. We are really running out of sponsor money and medical stock so I will be concentrating on fundraising. David and Godfrey have come back to volunteer for a month at the office for testing and counselling and we have alocal girl there too. Next month we will have two volunteers coming; Debbie and Kirstine and will have a great team together for homecare and other new ideas!
After a month working in Zanzibar and a month in Europe visiting friends and family I was happy to get back to work in Bagamoyo. It was very stressful and busy week, which included sorting out accommodation for me and visiting patients between. This was also the last week for the two local volunteer Godfrey and David.
Updates of the patients I visited:
Patient CP appeared in good spirits when I visited him Wednesday evening. The two local volunteers Godfrey and David had continued to shower him and have done his laundry visiting once per week. Next week I will assess his muscle strength and nutritional needs and do a full physical assessment when I shower him. His family continues to use the kitchen we built and are very happy with it. Patient CP is also happy not getting any smoke into his room. He reported that the bag in his toilet chair had not been changed for two weeks. He also complained about large amounts of insects in his room.
Continue home visits 2-3 times per week: two showers per week, laundry, nutritional support, use of exercise bar to strengthen his limbs, transport to hospital appointments and medicine management. Give a good clean to his room with Dettol and clean the floor from rubbish. Do this every week. Change toilet bag as required and look into solution for his family to do it. Spray his room with insect spray. Possibly changing his toilet bag regularly will get rid of a lot of the insects. Do his laundry possible at home where I have a washing machine, especially his sheets!
Patient MF appears to have declined in her condition. She has been in the stage 4 of AIDS for a while now and needs continuous palliative care. There were only two of her daughters present when I visited (she has 5 daughters or more) and they did not seem to be interested on my concerns and questions about their mother. One kept texting on her mobile phone and the other stayed in the back room. They told me Mariam had not been to the hospital for a while (to appointments) but Charles from UKUN office had visited one week ago. I gave them the usual stuff; gloves and disinfectant as they said they had run out. MT’s skin appeared worse than ever; some lesions, cuts, fungal arms/hands and some very dry areas especially the ears and back. I gave them antifungal cream, which I had with me and advised to use on MT’s hands and arms. I am unsure which treatment is the best for the rest of the skin as it has different conditions. I was not able to do a blood pressure as we do not have a machine that works at the moment. Her pulse and temperature were fine and she was responding to speak with facial expressions and had some grip in her hands. I did not see any pressure sores. She did not smile like she usually does when we visit. She was also covered in urine. Charles told me the family has lost Mariam’s hospital card so no one knows when her next appointment is. Family reported that MT is still drinking and eating. She appears very thin as usual.
Visit hospital asap to get her a new card (on Monday). Ask doctors advice for skin problem; possible needs antibiotics, which ones? and which creams? Take MT to the hospital.
Have an informal meeting with MF’s daughters next week about her care. Talk about palliative care to keep her comfortable; pain free, clean, warm and dignified. Make more frequent visits; minimum two per week and get involved in MF’s care e.g. feeding or showering. Show support for the family to motivate them. Give the family emotional support; talk about death, worries and fears. Possible get pampers for MF to wear if family agrees as she is now constantly incontinent, which makes her skin worse. We hope to make the end of life journey for Mariam as peaceful and dignified as possible.
*Need someone to translate as Godfrey and David are gone.
Patient AM / HT:
AM was in very good spirits and they were having a family meal. She did not show me her walk with the zimmer frame but she said she is doing it every day and doing fine. She had got married two weeks ago and the wedding was at their house. I cannot believe I missed it!
HT appeared a little weak; tired to walk and a bit unsteady on his feet. He did not complain pain to his enlarged breasts. He had not had his operation (double mastectomy) like it had been planned. The date for the operation in Muhimbili Hospital should have been 6th August but that date had been a public holiday. Charles had taken Hamisi to Muhimbili few days after that but the doctors just did more blood tests and sent him home for two nights. Hamisi slept those nights in Dar Es Salaam with some family. After he went back to Muhimbili and was given another date for the operation for later that month (August) but when this date came he was informed that the list was full due to more priority patients who had cancer. Charles informed that after that HT was referred to specialist plastic surgeons who after some more blood tests (CD4 again!) then said Hamisi did not need their specialist care and needed to be referred back to the normal surgeons. He was then given a date 12.9 to go to Muhimbili, once again. So last Thursday 12.9 I and Charles went together with Hamisi. He was seen by a new doctor/surgeon. They refused to give us one of HT’s old doctors that would know his case. This new doctor told us to come back next week to get a new operation date without even assessing his case. This seemed too easy. He said HT would possibly be operated next week Friday if we came to get the date on Tuesday. We took the doctors number and Charles said he will come and call him. We were also told that HT did not have to come until he got the operation date. Before midday we were already on our way back to Bagamoyo with new hope.
Patient AB has grown to be even more handsome and a happy young man. He appears in good spirits and physically in good health. He still spends his days at the office and enjoys playing board games with locals nearby but at night he sleeps at his home now (auntie and uncle). He said he was too scared of robberies when he sleeps at the office. I have not had a good chance to talk with him about home but he did not report any problems. He had sold his mobile phone that we helped him to buy and bought a cheaper one, making 10,000TSH profit for himself! What a business man. He still likes to draw and I got some more colouring pens and paper for him. He is still on the TB medication (tablets) and has also been on ARVs for a while now. He takes them independently without prompting. He has some friends; most of them go to school. He does not go to the HIV children’s group anymore as he never liked it. We still pay for his food weekly for a local restaurant nearby the office. He has been happy with them.
We need to talk to patient AB about education; what he would like to do. Maybe he could study some practical skills with hands as he seems to like drawing and handicrafts. Or maybe he wants to study writing and reading Kiswahili or English. Also soon we should help him to find a job that pays a little as he needs his own money now. He spends his days playing board games and sometimes apparently goes to the fishermen to try to find some work for few shillings. The unfortunate chronic illness (HIV) he has does not seem to bother him much. He really is a great young man with a lot of positive energy.
Sulemani is still treated for his anal cancer in Ocean Road Hospital in Dar Es Salaam. He reported to have had radiotherapy over 20 times now. He will have it again tomorrow and after that doctors will reassess his cancer. He could be discharged home. Chanzi visited him today (Sunday) and took him water, food and credit for his phone. He said could be too sick to travel to Bagamoyo by bus if he is discharged and asked money for a taxi. This might not be possible with the funds we have as we need to fund Hamisi’s trips. The least we could do is to escort him to his bus in Dar with a TucTuc/Taxi and meet him at Bagamoyo station. Sulemani’s wife in Bagamoyo is also reported to be sick and is now staying with her mother. I have never met her but I guess she must be HIV positive too. We should pay her a visit next week.
This week was really hectic as it was my final week before departing Bagamoyo for two months. I said goodbyes to all clients and passed on my duties to volunteers; old and new. Cindy, Stefanie and William started this week and for Sarelle and me it was the final week. Charles also went on a leave for two weeks. Abdullah had a bad week with his health and Captain’s family got a new kitchen built.
On Monday I visited Mr Captain with Sarelle. He reported that his son had showered him the day before as he is on his school holidays and paid a visit to him. This was great news knowing that someone from his family had got involved in his care. I asked if he was coming again this week but Mr Captain said: ‘probably not’. We cleaned his room and took him outside for a while. Afternoon was spent in CCS (Cross Cultural Solutions) meeting where we received a new volunteer Cindy from the US. She is an experienced nurse and will make a great difference to people lives here in Bagamoyo even if it will be only two weeks stay.
On Tuesday Cindy joined our team and CCS provided us a minivan with a driver to visit patients so we can orientate all our volunteers to the clients efficiently. It was great to have a big team of volunteer together; me, Cindy, Sarelle, David and Charles. We visited Mariam, Captain, Amina and Hamisi. Patients were happy to see so many volunteers! Mariam’s physiological observations were within the normal range and her skin looked fine. Volunteers were taught about her weekly visits and to purchase her mango juice weekly. William arrived Tuesday afternoon and was introduced to the program. He will be taking over a lot of my duties after this week. Charles went on his leave Tuesday afternoon and we were left to our own devices but with instructions of each of our roles for the next two weeks. David our local volunteer took over testing and counselling at the office and Godfrey will be helping with home care and assisting at the office. Me, Cindy and Sarelle will be doing home visits and orientation to William as well as getting things ready for next week when I won’t be here.
On Wednesday Cindy was orientated to take over Mr Captain’s shower. He was happy about Cindy; he does not let many people to see his privates! We also visited Hamisi and bought him a nice red jacket that covers his enlarged male breast so that he will not feel embarrassed to walk in public places. He was so greatful and loved the coat! We also paid visit to Hadija and her family to introduce Cindy and William. They were OK themselves as usual and happy to see more volunteers joining us.
David took Abdullah to the hospital Wednesday morning as he had a toothache. They ended up removing the tooth completely and he came back with lots of antibiotics and pain relief. They also told Davis that Abdullah needed his Hb (Hemoglobalin) checked but this could not be done at the hospital as they were missing some important equipment in the laboratory! He should go back on ARVs (Antiretrovirals) as his TB treatment is finishing soon.
On Thursday morning we took Abdullah back to the hospital again and did an orientation to Cindy and William. Abdullah forgot to take his hospital card so they could not do his CD4 or check his TB medications. We had to take him to the private hospital St. Elizabeth to have his Hb ckecked. It was only 5.3, which is very low. I asked to have it done again but they refused. All of us were very surprised as he does not appear to be that weak or tired to have that low reading. We took Abdullah back to the doctors in Bagamoyo Hospital to tell them the results. It was frustrating as the nurses were telling us to come back tomorrow as he did not have his card. I told them we did not care about the card and he needed to be seen right away because he was very sick. After a while doctor came to see him. He was told to have iron deficiency anaemia. His diet has been really good for the past few months so the doctors are suspecting it could be worms. Hookworm can cause iron deficiency. He was put on worm medication and folic acid with iron syrup and iron rich diet. Cindy said he will need a lot of Vitamin C in addition to this for the iron to absorb. We should recheck his Hb next week again. We took him back to the office to rest and explained all his new medications to him and bought a bag of oranges for C vitamin. Doctors informed us that he cannot be started on ARVs until his Hb will come up to 7 or 8. Later that day I took William to Mariam’s house to introduce him to the family
Next morning (Friday) we; I, Cindy and a new volunteer Stefanie took him back there to have his CD4 checked. Stefanie joined us from CCS and she is also an experienced nurse from the US and will be a great asset to our team! After couple of hours of waiting it was done and we will get the results sometime next week. After this we joined the other volunteers at Mr Captain’s house. Abdullah wanted to join us too. They had been building a kitchen that Chanzi had designed to family since the morning. Unfortunate thing had also happened. I had given money to one of his family members to buy materials for the kitchen and Charles said he will be joining us to build it. He never came and obviously took our money so everything had to be purchased again! However the smile in Mr Captain’s face made me to forget all of that. There were all of us there; Sarelle (saying goodbyes), David, Godfrey, Cindy, Stefanie, William, Chanzi and our local friend Omari. It had been an on-going problem to our patient to have the kitchen outside his room. All the smoke had been going inside and him being vulnerable for chest infections. He often suffers from a bad chest. The family had not shifted the kitchen elsewhere even after several discussions with them so we thought the only way was to just come and build one ourselves. Sarelle wanted this to be done before she left so she got things moving. The kitchen was ready before midday and looks amazing! After that we built an exercise pole on his yard and stood Mr Captain against it. His limbs are very weak but volunteers will come few days a week to do physiotherapy so he can build his strength. We are not sure if he will ever walk again but at least we are hoping that he will build up enough strength to transfer independently from bed to chair. At last I washed his mosquito net and sheet and also said goodbyes, which was so sad. I will be returning after two months. The kitchen was a great finishing to the week and everyone left exhausted but happy.
I did some last orientation and job lists for William. Sarelle had organised medications and other things at the office so it will be easier to access things now. Her leaving will be big loss to us but she had a great impact here on her short visit. This week I and Chanzi also made a fundraising project for ‘Every Little Helps’ by selling his handmade shoes for friends and family. This turned out to be great success. Chanzi makes beautiful shoes from leather including nice decorations from colourful beads. £5 for each pair purchased will go to our home care clients. I will be taking these pairs to Europe next month. Some of our volunteers also ordered few pairs! We received 10 orders already this week and hope we will get some more.
Next week William will take charge on the ‘Every Little Helps’ sponsor money and report writing. They will still have great team of volunteers and the week after Charles will be returning. I will be in regular contact with all the team and come for a short visit in few weeks time. I will miss my clients and work so much, it has been my life for 16 weeks. I cannot wait to return!
This week was busy with home visits together with our new volunteer Sarelle.
On Tuesday Charles and Sarelle did visits to Semeni, Mariam and Amina to introduce them to Sarelle. Semeni who has been a client for many years was doing really well with her family. We used to visit her for physiotherapy when she got really weak. Now she is still doing fine and is able to walk independently. She also has a good support from her family. There were no changes with Mariam and we provided her mango juice and more gloves. Amina continued her walk with the zimmer frame and it appears that soon she will be strong enough to change the frame to a walking stick.
Mr Captain had two showers Wednesday and Friday. The same problems occurred again; no-one had been there to help him to the toilet so he was covered in faeces again. Friday I took him to his hospital appointment after giving him a full change and shower first. Doctors assessed his strength on his limbs and suggested to build a pole in his garden to do some physiothrerapy. They think he could be able to walk again and build more muscle to his legs if we did regular physiotherapy. We decided to make this plan for next week. We will be also building a new kitchen outside for his family to shift it away from outside of his room. His family was happy with this idea and Chanzi made a design for the new kitchen. With all the volunteers arriving next week also we made the plan to build it Thursday and Friday next week. His CD4 had dropped from 506 (last year May) to 384 so this was alarming and we need to build him up fast. Doctors also mentioned that he is lacking many vitamins and that is why his hands are week. The family do not cook many vegetables and he does not like the fruit I bring him. I took some multivitamins for him and he was also started on neuropathic medicine for a month to get more strength on his limbs. I hope these medicines together with better nutrition will help to increase his CD4 count. His new appointment was made to the end of the month to reassess. I hope something more can be done for his nutritional support but it is a complicated situation with the big stigma that exists in the family. His uncle sho lives next door is the traditional healer and has a lot of money and wives I have been told. I wish they would help Mr Captain more. It makes me so sad.
I, Sarelle and Chanzi took Abdullah to the beach on Wednesday but he was too afraid to swim. We found a volunteer who is a swimming teacher and she agreed to teach him next week! Abdullah was happy to hear that. Next week will be his last few injections and he will finish all his TB treatment. We need to look into getting him back to education. He is eating really well and acts like the boss at our office now. He has been sleeping in the office for a while now and his family has not been asking after him, which is really sad. He is continuing with his English lessons and likes to greet us now in English and telling us in English all the things he has eaten!
Chanzi visited Sulemani in Ocean Road Hospital in dar Es Salaam and took him water, juice and bread. He was doing fine and was still waiting to start his radiotherapy treatment.
Charles wanted to involve one of Captain’s family members to help to shower him while I will be gone (July & August) but the person had gone away. Once Charles come back from his holidays beginning of August I hope he will find the person to assist Mr Captain. For now it will be our American volunteers together with our local volunteers.
Next week there are two new volunteers joining our team; Cindy for two weeks who is a registered nurse in USA and William for six weeks who is a medical student and from USA too. It will be nice to have a big team. Our local volunteers Davis and Godfrey continued to practice on HIV testing and counselling. They are also willing to help with home visits and will be translating when the American volunteers arrive.
Charles will go to visit his mum and on holiday next week Tuesday for two weeks and it will be my last week with UKUN also. We will have a lot of orientation and organizing to do for the new volunteers!
This week was a sad and busy week for me, the girls and our patients. We visited all clients and girls said goodbyes. We also did another trip to Muhimbili Hospital.
Monday and Thursday was spent with Mr Captain with showers and laundry. He also got a new mattress; bigger one and better quality. On Thursday we went to visit Amina and Hamisi Tanga first and girls said goodbyes. After that it was Mr Captain’s turn. After showering him we took him for a walk in his wheelchair. We went with him to visit Hadija and her family who live nearby and girls said goodbyes there. Mr Captain was happy to see Hadija. Then we took him for a goodbye lunch in a local restaurant. He was very happy but had no appetite to eat much. Girls found it hard to say goodbyes and promised to come back before the end of the year.
Girls spent a lot of time this week with Abdullah. They have created such a special friendship with him now and I am sure Abdullah will also miss them so much. On Wednesday we went to join Abdullah to a HIV children’s group BaoBao, which is run by great local volunteers George and Bernard and they often get other foreign volunteers to work with them. Most of the children were much younger than Abdullah who is 17 years of age and he was not joining in fully. This could have just been due to nerves as the both leaders said. We played ball games and had snacks with them after. This group meets every Wednesday afternoon for few hours and Saturdays for the full day 9am till 5pm. They have activities like games, exercises, life skills, counselling and days at the beach or swimming pool. On Saturday we went with him and the group to swimming pool in a nice hotel and spent the whole day there. Abdullah does not know how to swim and he had so many teachers there. He really enjoyed this day and all the children got ‘chips mayai’ (chips- omelette) to eat and were so happy!
On Wednesday there was a meeting here at UKUN with local home- care volunteers, which Charles attended. We had organized them to come here with their supervisor. They are not active anymore and most are lacking motivation and supplies. I wanted to take some of the burden away and work together with them. Charles asked for their ‘bed-ridden’ patients but they said all the patients need to be reassessed for their needs before they can give us information. They promised to come back on Friday for another meeting having to have reassessed the patients, however they cancelled it. I will go next week to the hospital to find the supervisor again, mama Kizunga.
On Friday I and Sophie took Sulemani back to Muhimbili Hospital in Dar Es Salaam to get his biopsy results. Last week they told us they were not ready and asked to come on this day. We left again early at 6.30am with the same driver Ally as last time. Unfortunately we received the same news again that the results were still not ready! I got little angry with the doctors as we had come from really far twice and spent a lot of time and money for the car. One of the doctors then organized to get the results that had to come from a different hospital in Dar. We waited about an hour and then they told me Sulemani has carcinoma (cancer) in situ in his bottom. I was told not to tell the patient yet but come back next week to admit him to the hospital. He will need a surgery or maybe radiotherapy. This was really sad news but at least it was now found and we could start treating it. Doctors think it can be detected early and he will be fine. I have to call back on Monday to get the date to go there.
On Sunday we had a leaving meal with Charles and Abdullah and the girls in town. We followed this with ice cream bar for deserts! I hope Mathilde and Sophie will be back soon, it will be extremely difficult to find as wonderful hard- working volunteers as they are!
Next week I will have things to sort out in home visits and I won’t have volunteers with me. There is also another trip to Muhimbili and meetings with Hannah to look at UKUN’s future plans, structure and funding options.
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