Deep in the Bush of Tanzania I just returned last week from Tanzania, where my family (husband, 21-year-old daughter, and myself) went deep into the bush of Africa to do some volunteer work. This experience has given me pause to really think about my own priorities. A number of my subscribers have asked me to share information about our work there.  I am still internalizing what I learned from this experience. Our trip to Tanzania was really intense. We feel fortunate to be back home safely. The trip itself was grueling and took two days each way. Once we landed at Kilimanjaro Airport, we had more travel by Land Rover. The three of us were advised to buy four seats on the Land Rover so we’d have extra space. We were really glad we did that. Otherwise, the Land Rover was packed with four people per seat. Fortunately they put the luggage on a rack on top and tied everything down with a tarp. We brought a lot of medical equipment (see duffle bags in photo below).  The equipment was given to us by a scrub nurse who said they were being thrown away by her employer. I still don’t understand why these perfectly-good supplies were being tossed, but we were happy to be able to take some of it with us, and our mission site was thrilled to receive these badly needed supplies. My seat was the one in the back left corner, which people had to crawl over to get to the forward seats in the Land Rover. In the photo to the right, you can see me at home with some of the donated medical supplies we packed in the duffles. The roads into the bush were very bumpy with lots of curves and steep drop-offs to negotiate.  We also crossed a river.  I later found out that several people have drowned in this river when the water level gets too high and the currents carry them away in their vehicle or on their bike.  The monsoon season began the end of March, and a great deal of rain fell during our stay.  We decided we’d arrange to go the long way back so we did not have to cross the river again. Bumpy windy roads were common. Fortunately, the river was not dangerously high when we crossed. All along the way we saw single homes, small clusters of homes, and small villages. We learned that the small clusters of homes (left photo) belong to a man and his wives. Each wife gets her own home. The man's home is usually in the middle of the other homes. The more homes you see in a cluster, the more wives a man has. On the right you can see a home on a hilltop, with crops growing all around. We saw quite a number of these plantations along the way.  Cows and goats are everywhere, usually herded by young boys. In the villages, animals mix easily with humans. They wander wherever they please when not being herded by a boy. Here a couple of donkeys had found some garbage to eat off the ground.

Our work site was Haydom Lutheran Hospital, which took about eight hours to drive to after taking several long flights from Seattle to Newark to Amsterdam to the Kilimanjaro airport in Tanzania.  Haydom Lutheran Hospital is a 550-bed hospital that was founded in 1953 by a Norwegian doctor.  The hospital has many ties to Norway and has a regular flow of Norwegian medical doctors and other professionals volunteering their time there.  Haydom attracts volunteers from other countries.  All are welcomed!  Although the Norwegian doctors were very good, they did not tend to teach.  My husband’s primary purpose for going was to teach.

This is the Haydom Lutheran Hospital main entrance. To the right is a photo of my husband, Dr. Doug Paauw, the son of the founder the hospital (and the current medical director), Dr. Oystein Olsen, and me (Kathy Paauw).

At Haydom, their permanent medical staff consisted of one MD and the rest were high school graduates with a couple years of medical training. In other words, the medical knowledge of many of the caregivers there is very limited.  They have a nursing school at Haydom Lutheran Hospital, so they have some trained nurses on staff. 

Common illnesses found among the patients included TB, Typhoid, Malaria, and HIV.  In the US, these diseases would be treatable and the survival rate would be high, with good diagnosis and treatment. At Haydom, treatments are available, but patients are often misdiagnosed so they don't get the right treatment.  One of the major challenges with attracting medical doctors to work in the bush is that the cost of medical school in Tanzania is much higher than it is in the US, and most doctors cannot afford to go work in the bush for such low pay when they must repay such enormous medical school loans. 

My husband, Doug Paauw, (a Professor of Medicine and a primary care internist at the University of Washington) did a lot of lecturing and bedside teaching with the medical officers.  One of Doug's gifts is his ability to diagnose. (In the States, many doctors refer their patients to Doug when they cannot figure out the diagnosis.)  Doug focused on teaching the medical officers how to take a good history and do a more thorough physical exam so they could expand the possible diagnoses to consider for each patient.  

During bedside teaching in the ICU, Doug found a number of undiagnosed diseases. The woman on the left had Typhoid and Tuberculosis.  The young woman on the right was diagnosed with Lupus.
This woman has rheumatoid arthritis. She had been treated for it but stopped taking her medication over a year ago. This 34-year-old woman now has contractures and will probably never walk again. It is common for patients to burn or cut themselves to mark where they feel pain, as demonstrated in the photo on the right.

The first time we walked into the hospital, the main entrance and hallways were lined with patients who were on cots or on the floor.  The big patient rooms had many beds.  In the pediatric wing it was commonplace to see more than one patient sharing the same bed.  The hospital has a policy that they do not turn anyone away, regardless of how many patients they already have. Patient care is free to all, although they must pay for whatever medicine is prescribed.  The hospital relies on donations to meet their budget.

During our first day there, I visited the neonatal ICU, where there were three very small babies.  One had been born three days before and only weighed 28 ounces.  His mother had died in childbirth.  His chances of survival were very slim.  If he lived, he would eventually move to the hospital orphanage.  Many of the babies in the orphanage have lost their parents to AIDS.

Family members were the primary caregivers and were required to provide the patients with basic care such as providing and preparing meals and feeding their ill family member.  On the long Land Rover drive to Haydom, we saw many people headed in the same direction, some on foot and some on bicycles.  We learned that some ill people travel for days to get to this hospital, which serves a very large geographic area of Tanzania. The next nearest hospital is a government district hospital in Mbulu -- a two-hour Land Rover drive away.  Mbulu often sends their patients to Haydom because it is a better hospital. 

Late March to June is monsoon season in Tanzania.  All but one of the days we were there, we experienced a huge downpour that lasted anywhere from several minutes to several hours.  These monsoons soak you to the bone if you are not under cover when they hit.  I felt so badly for the people we saw walking or riding their bike to the hospital in these amazing rainstorms.

We frequently got caught in a rain squall. When it rains at Haydom, the red dirt roads and paths turn into red rivers. These pictures are of the main entrance road to Haydom Lutheran Hospital. We had gone to the market outside the hospital grounds one afternoon. When we left the sun was shining. An hour later a rainstorm hit as we were walking back. We were able to duck for cover inside a small building once we reached the hospital grounds, but not before getting completely drenched. You can see how wet our daughter, Carly, got!
Homes varied considerably in their construction.  The home on the left was right in the middle of Haydom Village.  The one on the right was a short distance away.  We found the one with the thatched roof while we were on a hike just outside the village.
Our daughter, Carly, took this picture of a little girl and an emaciated dog that we came upon during our hike. Everywhere we went, there were lots of dogs running loose in search of any food they could find. Most of the people were very thin, but usually did not look as starving as the dogs. I wanted to take this little girl home with us. Her eyes said so much.
These pictures were taken in the Haydom village next door to the hospital grounds.  Cows and goats were seen just about everywhere we went. Transportation was usually a bike or a cart.  You can see an older boy pushing two smaller boys in a cart above, a short while after a heavy rain had fallen.  You can see several bikes in the photo on the right.
I had to laugh when I saw this shop.  Notice the sign:  “We are shaving/cutting hair here, even for white people.”  On the right you see several people in the village with their bean harvest.  They had dried the small red beans on the ground and were just in the process of gathering the beans into the bucket as we walked by.  Staple foods here are beans, rice, corn, bananas, beef, and goat.
We were housed in guest quarters on the hospital grounds. We each had a bed with a mosquito net. We also had a shower and toilet. The water did not always work, and sometimes the electricity cut out, but we were grateful to have a dry and secure place to stay. Although it was the wimpiest shower I’ve ever had, I was grateful to have one. This little girl seemed to pop up everywhere we went on the hospital grounds. I never saw her with an adult. Sometimes she was carrying a younger child on her back. Perhaps a parent was a patient in the hospital. This little girl craved attention and was also quite good at asking for what she wanted. Even though she asked in Swahili, we knew she wanted money.
Our first full day at Haydom was Easter Sunday. We went to the local church in the village. The service was in Swahili. Some members of the church were kind enough to sit with us and translate the entire service into English. One thing that was different about the service was that during the offering, everyone got out of their seats and walked to the front of the church and placed their offering in a large box. Everyone got up, and everyone put something in the offering. I was struck by how eager and enthusiastic people were to give … in a community where resources are so limited. (I also wondered how much our giving would go up in American churches if we did the same thing!) The music was beautiful. Click here and be sure your speakers are on so you can listen to a beautiful Swahili song sung by the church choir. (Ignore the video part.) After the service ended, everyone went outside for an auction. That’s right…an auction!
People who did not have money brought something else to give during the offering – eggs, mangos, bananas, beans, corn – whatever they had to give. The things in the plastic bags were auctioned off after the service, out on the church lawn. Our friends, Carin and Dilan, were very excited to see that they were auctioning off a watermelon – something that does not grow in Haydom and must be imported from Arusha. When they got it, they were slightly disappointed to discover it was actually a very large round zucchini (see photo on right)! While my husband was caring for patients, I worked with the Core Management Team of the hospital.  I was asked to do some workshops on planning, priorities, and time management.  It was interesting to hear the medical director introduce me in Swahili.  The only words I understood were “Kathy Paauw” and “time management and planning."  At that moment I realized that the Swahili language does not have words to translate these concepts.  I knew then that my work was cut out for me!  I learned that there are some cultural differences in how urgency and importance are viewed in this environment.  The concepts were very foreign to them at first, and I had to repeat some ideas multiple times before they started to grasp what I shared.  I spent quite a bit of time talking about Stephen Covey’s Time Management Matrix and sharing Covey’s six step weekly planning process. It seemed like at Haydom, everything was important and urgent, and at the same time nothing was important and urgent.  As I toured through the hospital wings and the lab, I noticed that whatever was in front of the medical caregivers was what got their attention.  The idea of prioritizing seemed like a foreign concept.  Chronic illness and death were all around and were commonplace.  Caring for people in the here-and-now, regardless of level of “urgency” was how things were done.  Doug found the same thing as he did his medical rounds in the hospital wards.  He’d find patients who were in critical situations who could be saved with surgery, or who needed tests to be run to confirm a diagnosis so they could be treated before they got sicker.  He’d check back a day later to find that nothing had been done.  A fellow medical volunteer who had been there for months, told us that sometimes tests would be ordered and would not be run for weeks, or sometimes were never run.  If the tests were run, the results often did not get entered into the patient’s chart.  In other words, even if a diagnosis was made through a lab test, the medical officer would not necessarily have this information as he determined the best treatment for the patient.  For example, many of the patients had a diagnosis of malaria.  As I reviewed the log book in the lab, I noted that only three out of 100 patients had positive smears for malaria. I was not sure if the staff members were calloused to the needs of the patients or if it was just the sheer overwhelm of too much work and too little help to get everything done. In my mind, these kinds of situations would make even more of a case for identifying what’s most important and urgent so at least those things could be tended to. It seemed that the opposite happened.  If the truth be told, it was hard for me NOT to judge the staff for making such “poor judgments” about what got done and what didn’t get done.  Then I stepped back and realized that I do the same thing all the time.  The difference is that the decisions I make are not life-or-death, so they are not as blatantly obvious to me or others when I ignore the tasks or activities in my life that are the most important.  Rather than sitting in judgment, I decided it was time to ask, “How often do I do something that is less important or less urgent because I am so stressed that I don’t want to deal with all of it and I just check out?” The Haydom staff are under tremendous and constant stress.  The human needs are overwhelming.  When I considered all of this and the limited knowledge and education that most of their medical officers are working with, I had a greater understanding and appreciation for why things run the way they do. The Medical Director, Dr. Oystein Olsen, is a very bright, capable and compassionate man. In spending time with the Core Management Team of the hospital, I came to understand how much they care.  They have a daunting task before them.  Our last day at Haydom was a very special day. Our friend who invited us to Haydom, Dr. Dilantha Ellegala, got married.  Dilan is a neurosurgeon who has been working at Haydom for many months.  He is a former medical student of my husband’s.  He met his wife, Carin (a pediatrician from Amsterdam), when she started working at Haydom last July.  Their wedding had thousands of guests, including many hospital employees and patients, and several tribes from neighboring villages.  Each did a wonderful tribal dance once the bridal couple was seated.  The wedding was a rich mix of cultures.  Dilan’s family is from Sri Lanka (although they have lived in the States for many years) and is Buddhist. Carin is from Amsterdam and is Christian.  Both cultures and traditions met together in the bush of Africa, where we shared yet more cultural differences.  Carin’s mother is a protestant minister and she officiated at the wedding.  The entire service was in English and Swahili. Click here to view some video footage of the wedding (be sure your speakers are turned on).
Dilan (the groom) is the tallest man in the photo. After the groom was escorted to his spot, Carin’s airplane landed on the airstrip at Haydom, where the wedding took place. Here you see her being escorted by her father as she walks toward Dilan. I think the women in the striped outfits were nurses in the pediatric ward of the hospital.
The tribal dances at Dilan and Carin’s wedding were very interesting. It was amazing how high they could jump!
How quickly the weather can change during the monsoon season! When the wedding began, it was a beautiful, bright and sunny day (see photos above). Soon after the wedding started, dark clouds rolled in. The rain became relentless soon after the bride and groom had taken their vows. On the left, you see the covered area (where the guests of honor had been seated) as the tarps collapse under the weight of the rain. The groom (white shirt) got drenched.

There’s No Place Like Home!

The trip home was very long. After nearly 48 hours of travel, it felt so good to be back home.  I missed the creature comforts I used to take for granted – a hot shower with good water pressure, a washing machine and dryer (my hand-washed clothes never dried in those monsoons!), a bed without a mosquito net, fresh vegetables in my diet, walking someplace in dry shoes. 

Since returning from Tanzania, I’ve reflected on the experiences I had and what I learned from it.  This reflection, combined with coming back to a backlog of emails, mail, phone calls, and other work, have caused me to think a lot about the word PRIORITIES.  Here are a few thoughts that I made note of, as they relate to priorities:   

• When I live my life like a runaway horse, I expend unnecessary energy without getting anywhere.  When I keep my focus and check in to make sure I am staying on course, or adjust the course as needed, I’m much more likely to get where I want to go.  When an airline pilot flies from one city to another, they may be slightly off course 99% of the time, but with many small course corrections, they arrive at their destination.  This is why I need to do weekly planning – to keep me on course with my values, purpose, and vision.
  
  
• Time management tools are only helpful when used in conjunction with clear values, purpose, and vision.  I must first be clear about what is most important to me now and over time, and choose actions that support both the short and the long-term goals. 

“If you don’t know where you’re going,
any road will take you there.”
-Anonymous

• When I’m in touch with my values, purpose, vision and goals, it’s easier to identify the actions I want to take to move forward in the direction I want to go.  When I feel the passion of doing something that has true meaning for me, it’s much easier to stick with it.   These are the four cornerstones of a strong foundation:
  
  VALUES:  The core elements that give the greatest meaning to my life. 
  
  PURPOSE:  What was I put here on Earth to do?
  
  VISION:  My values combined with my purpose will help me articulate my vision for what I want.  My vision includes the legacy that I want to leave.
  
  GOALS:
  • Specific – State exactly what I want.
  • Measurable – I must be able to measure if and by when I achieve my goal
  • Attainable – Although it may be a stretch, it needs to be achievable.
  • Relevant – It is aligned with my values, purpose and vision.
  • Time-based – I have set a specific time by which it will be achieved.

In closing, I just received a great tip from someone I deeply admire - Kendall Summerhawk.  Kendall was my marketing coach several years ago, and I learned so much from her.  She walks her talk and has created a high 6-figure business (she brought in over $500,000 last year alone) doing what she loves, while also taking plenty of free time to do other things she loves, like riding her horses.  Anyway ... here's a great tip she just shared with me.  Although this tip is specific to business endeavors, you can apply it to anything:

Ever noticed how much time it can take you to get things done in your business? Well, that time is also costing you BIG TIME by distracting you from working on creating profitable offers, relationships and opportunities. One quick trick that can make a real difference to your bottom line is to cut in half the amount of time you give yourself for a project.

I’ve found that using this technique has forced me to look at how I approach my work.  I was happy to get this reminder after returning from Tanzania, especially because I leave tomorrow for a short vacation in Cancun, and I have a lot of things on my plate.

I become much more productive when I have less time.  When I only have half the time to get something done, I know that I need to ask for support, identify new resources, not settle for delays, or allow perfectionism to take over.  Just imagine how much more you could accomplish if projects were done in half the time!

If you want more business-building tips like this one, I just learned that Kendall is offering a FREE teleseminar call THIS SATURDAY, April 12, where she'll share "My 6 BEST Marketing, Money and Soul Strategies I Used To Turn My Business Into a High 6-Figure Success (and How You Can Too So You're Making The Money You Rightfully Deserve, Helping The People You're Destined To Help)."  

I know that this free call will be packed with value, and I encourage you to register for it.  Space is limited so register now by clicking here to save your seat. 

I’d love to hear from you about what you learn as you consider your values, vision, purpose, goals, and priorities.  Drop me an email at kathy@orgcoach.net.

by Carly Paauw

The African rains are here. They’re surrounding me from every angle. The raindrops are not little anymore, like in the beginning, but strong and menacing. The tin roof above sounds like it’s quickly dying, pellets crashing down on it to the point of collapse. It reminds me of all of the times I used to press my face against the car windows, wide-eyed and absorbed by the high pressured waters of the drive-through car wash. Sometimes the rain is so loud that it makes me shiver, and I imagine that I am out amongst the drenching raindrops, but right now I don’t have to pretend; I am still damp and chilled to the bone. It started as a light sprinkle, not even a sample of what was to come. It is so innocent and deceiving; one second I am strolling in a casual mist, the next, I am sprinting towards the first shelter I can find, whether it is an awkward one or not. Yesterday, I was walking back from town when it happened and I was given the 30-second warning.