Roche Health Center

WHAT DOES HOPE LOOK LIKE?

2011-12-09T09:17:00.000-08:00

Post by Dr. Chris Lewis, Founder of Village Life Outreach Project-(Twitter @doclewis1)

In 2007, shortly after announcing his presidential campaign, Barack Obama visited Cincinnati. Village Life founder Dr. Chris Lewis (thanks to connections with Obama's law school classmate Jan Michelle Lemon Kearney and University of Cincinnati Board of Trustee member Robert Richardson), was able to meet briefly with Mr. Obama and share about Village Life's work with the Luo people in Tanzania, the same tribe as Obama's Kenyan father. Mr. Obama provided words of encouragement, a photo op, and was gracious enough to sign several books, one of which contained an inspiring message to Mr. Josiah and Dr. Esther Kawira, founders of Village Life's partner organization in Tanzania, the Shirati Health, Education, and Development Foundation (SHED).

The book has been described by the Kawiras as one of their most prized possessions, and the photograph of Dr. Lewis and Mr. Obama has been seen and shared throughout Kenya and Tanzania. Stop in a gas station along the Narok Road by the Great Rift Valley (the journey described by Obama in Dreams From My Father) and you might just find a copy of that photo hanging in the shop window. The shop owner will tell you that Dr. Lewis is his cousin and is friends with President Obama, and will encourage you to buy his copy of the "Jambo Bwana CD" while filling up. Take the story with a grain of salt, but get the CD, and the delicious samosas!

Shortly after that meeting with Obama, Village Life began discussing plans to build Roche Health Center. The photograph of Dr. Lewis with Mr. Obama helped inspire an entire village of 5,000 people to mobilize and partner with Village Life and SHED to build the first-ever health care facility in Roche Village. Knowing that Obama had discussed THEIR village with Dr. Lewis gave the people of Roche HOPE. Hope that their children would live. Hope that their women would have a safe place to deliver babies. Hope that their sick could be healed, that their children could be vaccinated, that their community would live and thrive.

The hope inspired by Obama helped the Roche people take the training provided by Village Life and build their health center. Roche Health Center opened 4/1/11 and now provides access to healthcare for over 20,000 people. That is what hope looks like.

Students and faculty from the University of Cincinnati, Xavier University, the Clinton School of Public Service, and other U.S. institutions of higher learning have been involved in transforming Roche Health Center from a set of drawings to a life-saving facility. Join the Village Life team. Support Roche Health Center, and keep turning hope into reality.
For more information about Village Life, please visit: www.villagelifeoutreach.org
or on twitter at @VillageLifeOP

"First, Do No Harm" from Dr. Kawira

2011-09-28T09:43:00.000-07:00

From Dr. Kawira, SHED Medical Director:

The first patient of the day was, according to the chart, a 3 year old
boy. As the father carried him into the exam room, I noted that the
child was well nourished, nicely dressed, and appeared well cared for
and contented. I noted further, as the father settled the child into
his lap, and I got a good look at his face, that the child undoubtedly
has Down Syndrome.

"He doesn't talk", the father said. "He should be talking by now".

"Does he hear" I asked.

"Yes, if you tell him to come, he comes, but he doesn't speak".

As I got further history from the father, I found out that this was
the ninth child, and youngest. He had not started walking until 18
months of age.

As I examined the child, happy to find normal heart sounds (some Down
Syndrome children have congenital heart disease), I was also
considering how I was going to explain a chromosome abnormality to a
parent with no knowledge of modern biology or genetics.

I also found out from the father the treatment suggested by friends
and neighbors. A common traditional practice, considered now to be
among those "harmful traditional practices" that should be abolished
(as opposed to those considered benign), is to cut off the uvula, the
"V" of skin hanging down from the back of the palate, as a treatment
for chronic cough. Some neighbors advised that this child should have
his uvula cut as a treatment for his mutism.

With the help of my nursing assistant (who had never heard of Down
Syndrome but did his best to translate my words into the local Luo
language), I explained to the father that this child had been born
with a condition that had caused the delayed walking and the delayed
speech.

"He will talk eventually", I assured the father. "We doctors know
about children with this condition, and they all are able to talk". I
also mentioned slow learning in school, so that a teacher would have
to give special help to this child. I assured the father that
children with this condition have happy natures, and if they are given
love and attention, they will respond with love and affection. I also
emphasized to the father that he should never allow the child to be
injured in any way, such as cutting the uvula.

Although the father would not understand chromosomes, I trust that I
was able to give him enough understanding so that he will educate the
older siblings to love and treasure this special younger brother
within the large family unit.

Life at the Roche Health Center

2011-06-15T18:39:00.000-07:00

When our group arrives, many friends come out to visit.

This is part of our construction crew.

Here is Jacob, one seriously dapper dresser.

This is a photo of 3 guys named Dan.

This is the construction crew for most of the work that we did while on-site in June. From left is Barack, Daniel, Jeanne, Sakkai and Johnny. Our contractor Julius isn't in this one.

Roche Health Center photovoltaic lights

2011-06-14T18:48:00.000-07:00

As a result of a University of Cincinnati DAAP Signage Grant, we received funding for photovoltaic signage that would illuminate the health center lobby at all times. Until it is installed, our on-site Nurse Assistant, Daniel will be using the lights to provide much needed light at night.

The Roche Health Center Committee

2011-06-12T18:46:00.000-07:00

Village Life has committees in the US and in Tanzania. This is the local RHC Committee - an inspiring and insightful group.

Roche Health Center design strategies

2011-06-12T18:33:00.000-07:00

It was thrilling to see how the "passive design" strategies for ventilation and shading had worked. The building was much more comfortable and better ventilated than other buildings around.

We also achieved our goal of building a "quiet" roof. Most metal roofs in the region are so loud during a rain that people have to leave the building. Our layered roof system was extremely quiet and comfortable in the strongest of downpours.

Seeing the Roche Health Center for the first time

2011-06-11T18:27:00.000-07:00

I began working on the Roche Health Center in June 2008 and have worked on it continuously since that time. It has been an incredible project that continues to inspire me. Until this past June, I had not seen the completed Health Clinic building. It was an amazing experience to finally see the project built and in use. Emily Roush, Richard Elliott and the whole construction crew in Roche did a phenomenal job creating this building using only local materials and no power.

Life at the SHED compound in Shirati, TZ

2011-06-10T18:19:00.000-07:00

While working in Tanzania, we are hosted by our partners, the Shirati Health, Education and Development (SHED) Foundation. We eat our fantastic meals in the banda (pergola) shown below.

University of Cincinnati School of Architecture and Interior Design faculty Tom Bible and Michael Zaretsky enjoying a sunset.
Michael Z, Dr. Esther Kawira and Josiah Kawira of SHED.

The Great Rift Valley

2011-06-09T06:15:00.000-07:00

The Great Rift Valley is an awe-inspiring site where we step out of the vans and stretch our legs. The Village Life June Brigade group included students and faculty from UC, Village Life leadership, members of Engineers Without Borders and an Architect from Portland, Oregon.

Travel from Nairobi, Kenya to Shirati, Tanzania

2011-06-09T06:11:00.000-07:00

The van ride from Nairobi to Shirati takes us through some fascinating places. Below are a couple of photos taken while driving through towns in southern Kenya.

Nairobi

2011-06-09T06:00:00.000-07:00

Arriving in Nairobi is always surreal. Extremely dense and congested city with some amazing pockets of beauty scattered throughout.

June Brigade in Paris Airport en route to Tanzania

2011-06-08T17:56:00.000-07:00

22 of us traveled to Africa together and a 23rd met us there. We had an amazing trip. It was a great group and everything went smoothly throughout the trip.

"Four Stories" Update

2011-06-04T09:28:00.000-07:00

From Dr. Esther Kawira, May 30th, 2011:

I have good followup from the story of the abdominal pregnancy.

The patient had surgery 24 hours ago in Mwanza. Mother and baby (girl, 1150grams) are doing well. The placenta was attached only to the left tube and ovary and therefore was able to be removed surgically. This is the very best outcome we could have hoped for.

Meanwhile Under the Same Sun, the NGO for albinism, responded to my email queries. There is much help and support for people with albinism in Tanzania, including a school in Tarime! We will be looking into it further. We're still counting on you bringing the protective clothing, plus sunscreen which I didn't mention before. My nurse Dorothy says the family live near the clinic in Roche.

I go again tomorrow to Roche....probably I'll have a dull routine day:)

Esther

"Four Stories from Tuesday at Roche" by Dr. Esther Kawira

2011-05-31T07:52:00.000-07:00

By Dr. Esther Kawira
25 May 2011

Abdominal Pain
“My abdomen hurts”.
This is a very common initial complaint. I responded by asking my
common first question to young women of child bearing age.
“Are you pregnant?”
“Yes”, she responded.
She was from Musoma, the district headquarters several hours away, but
had come to Roche to attend a funeral at her brother’s home. She had
taken the opportunity to be examined by me on my one day per week at
the Roche Health Center.
She had been troubled by abdominal pain for months during this, her
third pregnancy. By history she was now about six months along. She
had had an ultrasound a few weeks before, she said, at a private
clinic in Musoma. She said she had been told that the placenta was
high and the baby was low....but nothing that made sense to me. The
report, she said, was on her antenatal card that she left at home.
I examined her, and found that the swelling of pregnancy in the lower
abdomen was not as large as I had expected. I found good fetal heart
tones with the doptone. However, more worrying was a hard mass across
the upper abdomen. Could she be developing some kind of ugly tumor, I
wondered? It didn’t seem to be connected to either the liver or the
spleen. I advised her that we needed to do another ultrasound, to
determine the true age of the baby, and to see what that mass was.
At the end of clinic hours, I found her waiting, requesting a lift
with our vehicle to Shirati, my home base where I do ultrasound. I
agreed that if the power was on when we arrived, I would do the
ultrasound then, though I normally do non-urgent scans just in the
mornings.
When we arrived, we found that the power, after being off all day
(rationing), had just come on again.
I started the scan in the lower abdomen, and was surprised to see that
the uterus was only minimally enlarged, and did not contain a
pregnancy, only thickened endometrium. I could already see an ugly
looking tumor encroaching into the scanning field in the lower
abdomen. Where was the pregnancy? Had I really heard the fetal heart
tones earlier, I wondered, or was the patient’s own heart rate rapid?
I rechecked the patient’s pulse, and it was about 80. Perhaps my
memory was faulty.
I scanned upwards a bit, and the ugly tumor continued into the upper abdomen.
I looked again in the uterus. Still no baby, not even a tiny one!
With a sigh, I decided to look for familiar structures in the upper
abdomen, starting with the spleen and left kidney in the left upper
flank. Moving my probe, I saw clearly....a fetal head!!
I was dumbfounded. Yes, it was definitely a fetal head, it couldn’t
be anything else. It was big. I measured it, giving no visible
reaction to the patient. It was 26 week size.
I scanned across the upper abdomen and found the body, with a beating heart.
This was an advanced ectopic pregnancy, abdominal type, with the baby
still alive, and the ugly tumor was the placenta, plastered among the
intestines no doubt.
I turned off the machine. I was still almost speechless, though I let
out a big sigh, intentionally, to start gently cluing the patient in
that perhaps all was not right with her world.
“Do you have someone here with you?” I inquired.
“Yes, my brothers are outside”, she replied. Sure enough, not one but
two brothers had followed us by motorcycle and were waiting for my
report.
I sat us in a circle and began gently to explain the problem, the
potential disaster that was brewing in the abdomen of their sister.
They listened intently. “Risk to the baby, risk to the mother,
surgery will have to be done, placenta can’t be removed”...some of it
went over their heads, but they got the basic message. It was urgent
to transport their sister to the hands of a specialist surgeon in
Mwanza, five hours away.
As I write this report, they are en route by bus to Mwanza, with my
referral letter. Meanwhile, I have traced the name of an Ob/Gyn
doctor there to receive them, consulted with him by phone, and sent
his name to them by their cell phone, so there is no undue delay or
confusion when they arrive.
According to the Obstetric textbook, this situation of advanced
abdominal pregnancy occurs in about 1 in 10,000 pregnancies. The
baby, if not already dead when the situation is diagnosed, is often
born premature because of danger to the mother of expectant
management, and therefore the decision to operate immediately. The
mother is at risk of death from hemorrhage during the surgery, as the
placenta may separate spontaneously from its anchorage onto other
abdominal organs. Even when the placenta is left in place, its
resorbtion over time can be complicated by abscess or fistula
formation, sometimes with need for subsequent repeat surgery.
I am thankful for my stellar reputation, that led this patient to
seek me out during a funeral visit to our area. I am thankful that I
have a good ultrasound machine. I am thankful that the power was on.
I am thankful for cell phones, that have completely penetrated even
into rural areas of Africa. And I pray that the doctors at the zonal
referral hospital will have the means to save this patient’s life,
even though the risks are greater here than in the country where the
textbook was written and from which the statistics came.

Party Gone Wrong?
Our team was preparing to depart from my weekly visit to Roche Health
Center, when a man carrying a large child was ushered into my room.
He had been running, apparently a long way, to catch us before we
left.
His story came out in confused bursts, partly in Luo and partly in
Swahili. He had gotten a call, he said, that two of his children,
plus his brother’s child, had suddenly become ill and had been taken
to a dispensary near their home. When he arrived, he found his three
year old girl child, Schola, was the one most ill. The dispensary
advice had been that he should take the children to the traditional
healer, as the problem was that they had all begun to act strange
(maybe bewitched?). He decided to race with this child to my clinic.
Schola was indeed acting strange. She was not able to walk on her own
at first, but swayed and staggered when supported on her feet. She
looked around randomly, alternately smiling and appearing afraid. She
staggered erratically here and there, aimlessly. She picked imaginary
things off her clothes, or the floor, or out of the air, and pretended
to eat them. She occasionally talked nonsense to herself.
The only noteworthy thing on physical exam was that she had dilated
pupils that reacted minimally to light. Her heart and lungs sounded
normal.
A visiting student from the US, observing her, commented, “It looks
like a party gone wrong.”
“What happens then, do they all get taken to the emergency room?” I asked.
“Yeah, or if it’s not too serious, they eventually sleep it off and
wake up fine in the morning”, he assured me.
Party drugs not being available here, and certainly not to children
under five, I began to suspect that the children had gotten into some
poisonous substance. Further questioning of the father revealed that
he indeed had toxic chemicals stored at his home, for use in curing
tobacco, general category no doubt being “pesticides”.
About six hours had passed since the “illness” started, and we had no
way to do any toxicology screen. The general advice said that trying
to pump the stomach or induce vomiting often did more harm than good,
but in any case it was too late to consider. So, we all sat and
observed the child, and tried to keep her from injuring herself (and
tried to keep from laughing).
Over the next hour, she improved, was able to walk by herself, though
still unsteadily, and could sensibly answer questions, such as “What
is your name?”. She drank some water without much trouble. She
denied feeling any pain. Her pupils were not dilated very much any
more.
We allowed the father to carry her off again, with advice to lock up
the chemicals. It is amazing, what nasty tasting stuff children will
ingest. But when I think of it, adults also ingest stuff that to me
is like liquid fire!

Under the Same Sun
A young mother, looking anxious, entered my exam room. Tied on her
back was a large child, and an older boy walked after her. Both of
the children were albino.
Of her six children, these two, she said, were affected. She and her
husband were bewildered. They had never heard of albinism, or seen
any albino person. They wondered what kind of curse had appeared in
their family. The mother talked with my nurse, who had encouraged her
to bring the children to be seen by the doctor.
For my part, I had seen albino people in cities, but never in my rural
clinic before. However, a week before, I had seen an interview on
television with some staff of “Under the Same Sun”, an organization
promoting awareness and rights of albinos in Tanzania. It was
mentioned there that the incidence of albinism is higher in Tanzania
than in other countries.
The boy, age seven, had chronically burned skin in sun exposed areas,
especially bad on the face and forearms. The mother had no idea a
person can be burned by the sun, and didn’t know what was causing the
“rash”. The baby sister, due perhaps to being developmentally
delayed, could not yet walk, had been kept in the house, and still had
mostly pristine white skin. Both children had nystagmus, the dancing
eyes typical of the most common form of albinism.
I wondered what the boy thought of seeing, perhaps for the first time,
another “white” person. Many times albino children are teased by
others using the slang “mzungu” yelled at white visitors. I wondered
if he had been called “mzungu”, or if perhaps no other child in his
village had ever seen a white person and had occasion to learn the
word.
The “treatment” consists of sun avoidance, using brimmed hats to
protect face, ears, and neck, sunscreen, and long sleeves. Sunglasses
protect the eyes. To white North Americans, all of this sounds like
routine advice when we go to the tropics. But of course none of this
protective gear is available for children in villages here.
With a promise to ask upcoming visitors to supply clothes, hats, and
sunglasses for the children, I requested photo permission. When they
return in June for another visit, they will meet a very large group of
white people (hopefully none of them sunburned)!
Albinos in Tanzania have been in the international news lately, at
risk for being murdered for their body parts that some witch doctors
use to bring good fortune to their clients. Both children and adult
albinos have been murdered. I shudder to think of such a fate for
these children and their oblivious parents. We will have to gently
clue them in to be vigilant for their children’s safety, even as we
educate them about the condition and let them know their children are
not alone. We will get in touch with “Under the Same Sun”. Perhaps
they have literature in Swahili, or contact with support groups.

Moth Eaten
“My hair is falling out” said the patient.
She had unusually thick and luxuriant hair, I noted, and wore it
natural and loose, not braided down. But sure enough, around in the
back there were patches that looked thin, as if it had been eaten by
moths.
Why did that term come to my mind? I recalled that, under
descriptions of syphilis in the medical textbook, one was that the
hair could fall out, giving a “moth eaten” appearance.
The patient had no other history or symptoms to suggest syphilis. But
syphilis can be sneaky. I heard that it used to be called “the great
masquerader”. It can remain for years without symptoms. And while in
the US it has been reduced by years of screening and prenuptial and
antenatal testing, in Tanzania it is still prevalent, almost forgotten
in an age where HIV overshadows everything. I have had many occasions
to review medical textbook descriptions of syphilis. And recently, I
had come into posession of rapid testing, that can give an answer on a
fingerstick drop of blood in 10 minutes.
This patient agreed to be tested for syphilis, and her result was positive.
After I explained about the treatment, and the advisability for
testing her husband and her co-wife, she had one more question for me.
“After the treatment, will my hair grow in again?”
It doesn’t say in the books, but I recklessly assured her that it would.

Roche Health Center Update!

2011-05-06T13:52:00.000-07:00

Dr. Esther Kawira sent the news to Village Life yesterday that the first baby has been born at the Roche Health Center. The photos are of the new baby, named Daniel after our Nurse Assistant Daniel Paul who is staying there at the Roche Health Center and did the delivery.

Congratulations to the mother!

Thanks to everyone who has supported the Roche Health Center! We are able to see our hard work make a difference! Thanks to Dr. Kawira, Josiah, Dorothy, Daniel, Rose, SHED members, and everyone on the Tanzanian side of our work. Your efforts are truly saving lives! Thank You!

World Malaria Day Update!

2011-04-25T11:11:00.000-07:00

Monday, April 25th has been recognized as World Malaria Day!
Village Life Outreach Project continues the fight against malaria.
During the 2005 trip to Tanzania, Village Life's partner villages identified malaria as the number one health concern. Since this time, our donors have helped with funding to provide over 7000 mosquito bed nets for families in the villages of Roche, Nyambogo, & Burere.

A recent report from Dr. Esther Kawira concerning malaria cases at Roche Health Center and Sota Clinic:
"On the medical side, we continue to see hardly any malaria. I
have had ONE case so far in April, at my Sota Clinic, a 9 year old
child. Total of seven cases in March (the average before that was 30
per month, when I look back at my stats), and none of the seven was an
infant...the youngest was a two year old child. We have also not seen
any malaria at Roche on the last 2 visits (we have checked some people
with the rapid tests, and they are all negative). It looks like bed
nets with wall spraying is the magic combination!"

The efforts of many government and non-government organizations have helped to lessen the burden of malaria, but more can be done to eradicate malaria.

Please join Village Life Outreach Project in the fight against malaria by learning more about our efforts: http://bit.ly/Malaria_Prevention_Program
or you can provide 4 nets by donating $25 today: http://bit.ly/Mosquito_Bed_Net_Donation

Thanks to everyone who has helped in the fight against malaria!

Roche Health Center is Open to Patients!

2011-04-15T13:24:00.000-07:00

Patients relax in the Waiting Area, Roche Health Center, April, 2011, during Dr. Kawira's clinic.

Opening Day for Roche Health Center!

2011-04-04T10:02:00.000-07:00

April 1st will forever be so much more than April Fools day for everyone who has worked on the Roche Health Center. April 1st will now stand as the first day that the Roche Health Center offered medical assistance to the community of Roche. So many thanks go out to everyone who has contributed to this project! A special thank you to Dr. Esther Kawira and our Tanzanian partners, The Shirati Health, Education, and Development Foundation (SHED). Your continued support of the project has made the dream of providing health care to this region a reality. Read more about SHED's work @ www.shedfoundation.org/home . Dr. Kawira was so kind to send a report of the first day at Roche Health Center. Please enjoy:

April One was Day One for starting patient care at Roche Health Center!

Two days earlier we had moved a nursing assistant, Daniel Paul, plus
some furniture, to the site. On Friday, April 1, we loaded up another
large table, 15 plastic chairs, and two action packers of drugs and
supplies. Besides me, there were Nyamusi Magatti, SHED volunteer as
driver and receptionist, and Carla, nursing student from Goshen
College who also volunteered to help at reception. At the last minute
we added Adek, a driver and mechanic, who would know what to do in
case of bogging down in swampy ground (it had started raining heavily
here in mid March). In other words, he would know how to put the Hilux
into four wheel drive.

It was a cool cloudy morning, and there were puddles in the road along
the way. It turned out that we went through them all easily, and soon
arrived at the Roche Health Center. Patients were already waiting.

The building was large enough that, even without the internal walls,
we were able to spread out and create some privacy of the doctor
consultation area from the lab and drug dispensing areas and
reception.

The first patient was an 85 year old gentleman who had been suffering
for many years with symptoms of prostatism. Besides being given
treatment for infection, he needed referral to see the urologist at
Shirati Hospital. I got on my cell phone and was able to contact
Shirati Hospital for the date in May. I also started a list of
"things to bring along next time", the first item being a copy of the
schedule of the Flying Doctors!

At some point I also got messages on my cell phone, welcoming me to
Kenya! The Roche Health Center is within eyesight of the
international border, and the networks aren't quite precise.

During the day I also got several children who were ill with malaria.
I was able to confirm it on site using malaria rapid testing. The
Kenya residents had not just had indoor wall spraying like we have had
in our district, so I wonder if those with malaria were all from
Kenya. Maybe we could keep a record of which ones use nets and have
had their walls sprayed.

Another feature of being near the border is that more of the patients
did not know Swahili and I needed a translator from Luo to English,
easily provided by Daniel my assistant.

The two sickest patients were children. One was a five year old girl
who had been having fever on and off all week, and had started
vomiting that day. We confirmed malaria, and were able to get the
first doses of tylenol and malaria drug into her without it being
vomited. The other was an 8 year old girl who appeared chronically
ill and had skin infections and adenopathy. Her father said he had
been taking her to many places for treatment but without success. I
suggested she come back for HIV testing next time (next item for the
list, HIV test kits).

I saw one pregnant woman with a bladder infection, another woman who
had endometritis after a delivery the week before.

Another man, walking with a stick for assistance, brought a discharge
summary from the national hospital Muhimbili in Dar es Salaam from a
year ago. He is post stroke, and is supposed to be on diabetes and
blood pressure medicine, but has been out of and off of both for the
past five months. He lives near the Roche Clinic. His BP was high,
and he has glucosuria. We will get him started back on his drugs (add
Metformin, hydrochlorthiazide and Nifedipine to the list).

We have permission to give the traditional "RCH" (Reproductive and
Child Health) services at Roche as an outreach of the Sota Health
Clinic. At Sota, we have been given the vaccines and the refrigerator
literally within the past one week, so once we have this underway at
Sota, we will see how to extend those services to Roche also. This
includes antenatal checkups, child immunizations, and Family Planning,
in case anyone is interested.

I really enjoyed holding the first clinic in the Roche Health Center
building. There was plenty of natural light and air, not to mention
the wonderful view out over the valley when I opened the door. It was
a comfortable venue for patients. We seemed to have a big crowd in
the waiting area most of the time, no doubt some being onlookers who
were checking out how things were being done and will spread the
information.

Daniel Paul is occupying the two small end rooms at one end of the
building, and finds it to be elegant quarters. He has instructions as
to how to handle emergencies, and a small stock of drugs and supplies
for that purpose. We are not officially offering emergency services
there, but we want him to be able to help for first aid, and to know
what to do and when to refer. His presence most of the time also adds
to the care taking function of the watchmen. He has worked for me at
Sota for six months, and is reliable and trustworthy. We think he
will prove to be a good choice as the first health care worker for
Roche Health Center.

My nursing officer Dorothy will go to Roche twice during this coming
week in my absence (Tuesday and Friday), and after that I will
normally go on Tuesday and she will go on Friday. She is an excellent
HIV counsellor, and will go prepared to do testing and counseling.
Hopefully the ARV drug treatment that we hope to soon do at Sota can
also be started at Roche under Sota auspices at first, as for the RCH
services.

We'll give you updates as we work out the details of working at Roche.
Sincerely,
Esther

Please check the blog for updates and photos! For more information about Village Life Outreach Project, please visit our website @www.villagelifeoutreach.org, email to contact@villagelifeoutreach.org, or call 513-684-8614.

Final days for on-site director, Richard

2010-11-18T20:33:00.000-08:00

We have been incredibly lucky to have two of the greatest on-site directors conceivable. First Emily from March - September and then Richard taking over from her. This is a photo from his final day on-site. He did tremendous work, but also made great friends and inspired many to learn much more about construction. His impacts will go on indefinitely. Thank you Richard for all that you have done for Village Life, for SHED and for the Roche community.

Building exterior nearing completion

2010-11-17T20:55:00.000-08:00

Gutter under construction

2010-11-17T20:37:00.000-08:00

Though we are working in a region associated with having an extremely arid climate, we found that we could collect nearly half of the water needs for the health center with a 4000-liter cistern. We have built an over-sized gutter to address the occasional deluges. We don't yet have the cistern, but we are planning on having temporary water collection at the gravel circle until then.

Roche Health Center Committee meeting

2010-11-17T11:21:00.000-08:00

This meeting took place just before Richard left and included about 60 members of the community.

The braces within the waiting area are temporary.

View towards the valley

2010-11-16T21:20:00.000-08:00

These photos show the view from within the waiting area as well as from the veranda.

RHC Construction Team

2010-11-16T20:59:00.000-08:00

Our lead "fundi" (contractor) Julius - (on the right), one of our team leaders and translators Daniel (middle) and our site storekeeper Johnny (on the left).

The roof is getting installed!

2010-11-16T20:13:00.000-08:00

Community support

2010-11-15T20:56:00.000-08:00

The Roche community has becomingly increasingly involved in every aspect of the health center construction. In collaboration with the Roche Health Center Committee, these friends and others have been lending their hand to get things done in the final weeks of construction.

Interior plaster

2010-11-15T20:44:00.000-08:00

The intended goal of bringing daylight deeply into the building can be seen along the edge of this wall.

Plastering the ISSB

2010-11-15T20:43:00.000-08:00

Though everyone loves the look of the ISSB blocks, for long term protection, we need to plaster the blocks where they will be exposed to heavy rains. On the interior, we need a thin coat for protection as well as to increase the daylight that will reflect into the space through the louvered openings in the exterior walls.

preparing for the roof

2010-11-15T20:27:00.000-08:00

The construction crew has been working incredibly hard to get the roof completed before Richard leaves on November 18. Photos show the sheathing with integrated ventilation at the bottom and top of the roof. The sheathing was painted and topped with roofing felt and then purlins to support the metal roofing.

Coke break

2010-11-14T05:04:00.000-08:00

A well-deserved break for some folks who have been working long hours.

Roche Health Center taking shape

2010-11-03T03:24:00.000-07:00

Amazing crew working hard

2010-10-31T03:15:00.000-07:00

We have had such incredible collaboration with out local community throughout this project. But they have gone well beyond any reasonable expectations in the final weeks before our on-site director, Richard, returns to the US. Everyone has been working 7 days a week for 12 or more hours.

Roof progress continues

2010-10-29T03:20:00.000-07:00

Sheathing the roof

2010-10-28T03:05:00.000-07:00

After many design iterations, we chose to have continuous 1x8 sheathing for reasons of structure, environmental comfort, acoustics and daylight.

The trusses are up!!!

2010-10-25T07:21:00.000-07:00

Richard and the team have constructed an amazing set of trusses and they are all installed. It is all coming together....

The roof trusses have begun!!!

2010-10-19T18:21:00.000-07:00

Richard has been working diligently to get lumber, hardware and patterns set up for the trusses. They have begun getting installed and they look phenomenal.

Floor slabs look great!

2010-10-03T12:37:00.000-07:00

While Richard was back in the states, the local team in Roche poured the floor slabs. They look fantastic and we are thrilled to see what was done without any oversight from our directors. He is preparing to get the team started on the roof construction.

View to and through the Entry Lobby

2010-09-30T16:40:00.000-07:00

ISSB and Walls complete

2010-09-29T16:34:00.000-07:00

Richard has returned to the site in Shirati and has just sent some photos of the completed ISSB and concrete work. According to Richard, "The feeling on the site is one of joy and urgency. I feel this also and am trying to finish as much as possible in my time here."

A few quotes from RHC on-site director and our hero, Emily

2010-08-31T19:01:00.000-07:00

“Thursday we only worked a half day. The brother of one of the younger men we work with passed away and his burial was that afternoon. He was about thirty years old and had apparently been in good health. On Friday we gave another one of our workers and his family a ride to Shirati. They had a very fat lamb and seemed festive. They were coming to receive a family member of theirs who had been sent to Bugando hospital in Mwanza and had recovered well from some type of cancer. Both cases, the loss and the survival, were a reminder of how greatly needed this health center is, both in terms of quick responses to medical emergencies and treating longer term illnesses without having to separate a family for the duration.”

“After multiple weeks now of working with many of the same people, individuals have begun to settle into roles. Jennifer is devoted to curing the concrete at regular intervals during the day. She never misses a column, even if someone is standing on the other side getting a shower. Johnny, the storekeeper, is somehow always around though rarely visible, so when we need things from storage someone shouts, “Storekeeper! Storekeeper!” until he appears with his usual grin. And on Fridays the Seventh Day Adventists begin literally warming up for a day of worship on Saturday, regaling us with hymns, both solo and unison. It all makes for a really enjoyable work environment.”

“It will be so bittersweet to leave now. I have been here so long and so short; enough time to have built walls, columns, and so many relationships, but not enough time to have built the roof or to be ready to say good-bye to all these new and never expected friends. But it feels right to be passing the torch to Richard. They love to joke with him yet really respect him on the job-site, trying hard and looking for his approval before moving from one step to the next.”

Concrete crew celebrates completion of walls

2010-08-31T18:48:00.000-07:00

Under the direction of Emily, Richard and Julius, this team has done an unbelievable job. They have so much to be proud of. Emily is preparing to return to Cincinnati and Richard will continue on as on-site director. As this phase comes to an end, everyone in Shirati is excited to begin constructing the roof.

Ring beam unveiled!!!

2010-08-31T18:43:00.000-07:00

Floor slabs commence

2010-08-27T18:22:00.000-07:00

Quote from Elvis Osira

2010-08-25T18:25:00.000-07:00

“You know Emily, this was like a story. People thought it was just a story, but here it is. It is true. It is our kid and it is growing up. I don’t know yet if it is a girl or a boy, but I know it is a genius.”

- from Elvis Osira

Entry lobby emerging

2010-08-24T18:19:00.000-07:00

View of Roche Health Center from the road

2010-08-22T18:17:00.000-07:00

Forming the ring beam

2010-08-16T18:01:00.000-07:00

Creating formwork for concrete is a challenge when, in addition to having no power tools, there is no plywood or comparable sheet good available. As a result, formwork is created using 1x8 cypress lumber. This image shows the intensive formwork for the ring beam, the most challenging concrete element in the building.

Columns are up!!!

2010-08-13T19:46:00.000-07:00

These columns were created with no plywood formwork, no power tools, hand-crushed aggregate and all cement was mixed by hand. The concrete team has done a phenomenal job.

The columns are emerging

2010-08-02T21:08:00.000-07:00

Creating formwork for concrete columns with no power tools and no sheet good materials (such as plywood) as very challenging. Our team has just unveiled the first few columns and they look fantastic.

View east from the porch

2010-08-02T21:05:00.000-07:00

This is the side of the building that will eventually face the courtyard. We can see one of our colleagues testing out the structural capacity of the ring beam.

Forming the columns / capping the ISSB

2010-08-02T20:40:00.000-07:00

All openings (windows and doors) in our design are between columns for structural reasons as well as many others. The columns also wrap around the ends of the ISSB to lock them in place. In addition, steel is tied between all columns along every fifth course of the wall. These shots show the column steel and the formwork for the columns.

overview of ISSB walls

2010-08-02T20:36:00.000-07:00

Richard has been our documentary photographer and he has found a perch from which to capture the full health center walls. We can begin to get a sense of the rooms at this point....

Community-built construction fence

2010-07-27T20:02:00.000-07:00

There have been weekly meetings with the local Roche Health Center Committee since our June brigade. This committee includes members of the Roche community, the construction team, the Roche Village Council, SHED and VLOP. These meetings have been critical in keeping channels of communication flowing between everyone involved.

In the first meeting we asked what suggestions the local community had for creating a fence around the construction site (to keep out kids and animals for their safety) that wouldn't cut into the construction budget. They came up with a plan for the fence that you see here, completely built of volunteer labor.

Pit latrine underway

2010-07-27T19:27:00.000-07:00

UC Environmental engineering student Bryant just returned from a trip to the Roche site where he led the construction of our first on-site pit latrine. The bricks are curved ISSB. The top slab is now being formed and the shed will follow.

Quote from George, master of rebar

2010-07-22T18:38:00.000-07:00

“I understand Emily. This building is important and I need to be paid nothing. My mother died on the road from here going to Shirati hospital.”

- George

update of entry view

2010-07-18T13:10:00.000-07:00

more photos of ISSB construction....

2010-07-18T13:03:00.001-07:00

The ISSB team is improving every day.

The construction crew

2010-07-18T12:58:00.001-07:00

Axial view towards Acacia tree

2010-07-18T12:54:00.000-07:00

Walls are rising quickly

2010-07-18T12:50:00.000-07:00

Richard has sent some great photos of the construction. The ISSB walls are rising quickly and looking really good. There is a mortar joint with steel reinforcement every fifth course. The columns will be poured this week and will wrap around the ends of the brick.

Laying the ISSB on the plinth beam

2010-07-05T20:47:00.000-07:00

"...overall I am really pleased with the plinth beam...Everyone is raving about what a great foundation it is and how they have never seen anything like it but they will copy it if they can! That was exciting. Then we started laying the bricks! We worked with Julius (the concrete contractor) and he agreed that we should only employ a few people today and go slowly to make sure to get it right, so we did five courses on three of the interior walls and two courses on the other two interior walls and it was amazing. The bricks look beautiful and there was such a sense of excitement as people began to see what the building will be like."

Entry views

2010-07-04T20:37:00.000-07:00

This is a rendering of the view through the entry as well as the same view under construction.

RHC construction process - on-site training for the community

2010-07-04T20:15:00.000-07:00

Construction began in April 2010 and has been an amazing process. A University of Cincinnati Graduate Architecture Student has been the on-site project director in collaboration with our local partners from SHED Foundation. They have been working around the clock to develop a building that is constructable using no power tools, all local materials and skills and could be built by anyone in the community. Yet, this building will be resistant against earthquakes and other natural occurrences in the region. It will utilize natural ventilation and daylighting to create a comfortable interior and it will be the first building of a health center for a community that presently has no access to health care.

RHC Interlocking Stabilized Soil Blocks (ISSB)

2010-07-03T20:23:00.000-07:00

One of the most exciting innovations of this project is the use of ISSB - interlocking stabilized soil blocks - to replace the typical fired bricks used locally. These come from a hand press and are extremely consistent, durable and strong. They require no firing and have a much longer life span while using much less cement for the mortar. Though these are used in other parts of Africa, they are not commonly used in this region. It is our hope to introduce this technology locally through training and assist the development of local small businesses that would rent the press or produce bricks.

Meetings with Roche Village Council

2010-07-03T16:46:00.000-07:00

While in Roche in June, 2010, we had meetings with the Roche Village Council as well as with a newly-formed Roche Health Center Committee. We discussed many issues including the health center goals, progress on construction and the impacts on the community.

Groundbreaking

2010-05-30T18:57:00.000-07:00

The "literal groundbreaking" occurred today. This is always an exciting day on a job site, but especially so here. There are no power tools or heavy equipment - this is all being constructed by hand with small tools. The goal is that everything being done could be replicated by anyone in the community.

First major materials delivery

2010-05-14T11:26:00.000-07:00

From Emily, our on-site director - "On Wednesday, I had a shipment of 200 bags of cement arriving from Mwanza. It was a hectic morning arranging where the cement should be stored, purchasing a lock, and negotiating a watchman. The driver was never very clear about his arrival time, and with only about twenty minutes to spare, I called Owino and asked if he could find people to help us unload the truck. Because need is so great here, even the villagers most devoted to the health center would like to be paid something. We checked the price of unloading cement in Shirati, and found it was 300/bag. The total would then be 60,000 tsh for the truck! I hoped the Roche people wouldn’t propose such a price. When we finally arrived at the chairman’s office, our new storage location, Owino had a large group waiting. Our truck driver was in a hurry to get back to Mwanza and was pushing us to unload quickly. Owino reminded the villagers that this cement is really for them, not for me or for SHED, but for the benefit of their community. Eleven people then agreed to unload the cement as fast as they could for 2,000 tsh each (about $1.50 US). The scene that followed was inspiring. The men quickly divided themselves, and it looked as if a race had begun. Calling to one another and literally running, they were all determined to keep the cement moving into the storage building as quickly as possible. Though it needed no translation, Killian would sometimes say to me, “That man is saying, ‘We know this is for us. That is why we are willing to sacrifice ourselves.’” or “That one is saying, ‘We are so glad Owino called us so that we can help get this done.’” When the men inside the house started falling behind those unloading the truck and those running it from truck to storage building, I jumped in to help, fully expecting a “No, let me sista.” I believe it was a sign of how seriously they took the work of quickly moving the cement that they readily accepted my help. As we finished stacking, many of those we had hired came inside to count the bags for themselves, to be sure that Roche Health Center was not missing even one bag. The attitude of the villagers is not always easy to decipher as an outsider, but on this day, it couldn’t be mistaken that they view this health center as a great gift that they will gladly give of themselves to help realize. We have another shipment arriving tomorrow, and though it is a Saturday, I can’t wait to go to work."

First ISSB bricks

2010-04-21T19:21:00.000-07:00

After training from the manufacturers of the brick press, Makiga, Inc (from Nairobi), our brick team began making progress on the bricks for the health center.

Roche Health Center digital renderings

2010-04-15T20:08:00.000-07:00

These renderings were completed by University of Cincinnati Graduate Architecture students in studios taught by Assistant Professor Michael Zaretsky in Fall 2008 and Fall 2009. They are not completely accurate but provide a sense of the design proposal.

Water at Roche!

2010-03-24T15:43:00.000-07:00

After tremendous effort on our local team's part, we now have a submersible pump and a generator to pump water 350-meters to our 2500-liter water storage tank on-site. This will be tested and used for construction in the short-term. Because of the heavy rain season, the delivery truck bringing the tank couldn't get to the site. The first image shows villagers rolling the tank 4 meters to the site. The other images show the installation of the tank and the first showing of fresh water.

Getting water for the Roche Health Center

2010-02-08T15:29:00.000-08:00

Villagers in Roche have been getting most of their water for drinking and sanitation from a small pond that is shared by local livestock. When VLOP began working with the village, they soon learned that many of the diseases they were treating came from water-borne diseases that could be easily avoided with cleaner water. When we began the Roche Health Center project, it became clear that the first requirement was to provide a source of clean water in Roche. The first step occurred today when a borehole was dug by Majitech, Inc. This followed two water surveys and a choice location 350 meters from the health center site. The drillers hit water today at 90 meters below the surface!!!

brick training by Makiga

2009-10-20T19:27:00.000-07:00

Makiga, Inc (from Nairobi, Kenya) produce hand-powered brick presses for the Interlocking Stabilized Soil Blocks (ISSB). Village Life purchased a straight and curved press for use at the health center and for future use in the region. Below are pictures from the training taken by Emily Roush.

Studio presentation for SHED

2008-11-08T15:04:00.000-08:00

On November 8, 2008, representatives of our local partners, the Shirati Health, Education and Development Foundation (SHED) were in Cincinnati. We had the opportunity to present the progress of the design and get their feedback. This was completely invaluable for the progress of the project.

2008-10-20T15:10:00.000-07:00

The institutional and "higher income" buildings in Roche are built of a kiln-fired mud brick. This brick is fired in a kiln built of the same material and the results are that after 3 days of burning, about half of the bricks are usable at all. The usable bricks are brittle, inconsistent and weak. As a result, the wall construction includes a majority of mortar.

Why we need health care in Tanzania

2008-07-05T15:43:00.000-07:00

Tanzania is amongst the countries with the lowest ratio of population to doctors at 50,000:1

Image courtesy of doctorsoftheworld.nl