Another marathon day here on the Health Sector Development Study front. We laugh at weekends here. Ha ha, we say.
Victor, Halimu (the Chamwino region's Reproductive and Child Heath director), and I launched out for the mountainous region of Chamwino today. About 15 minutes into the drive, we careened off the single paved road that connects Dodoma to Dar and spent the next 45 minutes navigating completely unpaved dirt/sand/dust paths. This is what SUVs were actually made for, kids. Huge, knock-the-wind-out-of-you potholes the whole time, taken at approximately 50 mph. It was like riding one of those rickety wooden rollercoasters they have in the "Wid West" section at amusement parks, except more painful. Kind of hoping I'll bruise along the seatbelt line and thus prove to you, Gentle Reader, what a crazy ride it was.
The view bouncing by the windows was great, though. Big craggy mountains in the background (Victor suggested they looked like Arizona, but as neither of us has been there, we couldn't say for sure) above wide, rocky plain. And the baobab trees! I love them! They look like the tree where the evil sludge lived in "Ferngully", if any of you remember that. Enormous trunks, wide as redwoods, that immediately erupt into scraggly little branches only 40 feet up or so. Great body type.
Arriving in the village of Mkang'wa (I can't really hear the apostrophe, but I saw it written so I know it's there), we were greeted by bright sun, sandy soil, and a constant moderate wind bringing the scent of woodfire. It actually tricked my brain for a minute into thinking we were near the ocean; the dryness gave it away. The local dispensary's Chief Medical Officer, clad like most men here in a loud shirt, trousers, and plastic flip flops, proudly gave us a tour of his buildings. It's actually a pretty smooth operation he's got there, taking full advantage of the local climate: the clinic gets electrical power from solar panels on its roof and collects rainwater off the same roof to fill a huge collecting tank. Very clever and effective. Near the tank, I spied a row of malaria bloodtest microscope slides along a wooden bench, drying in the sun. Whatever works, I say.
The clinic seems to be working well with limited resources; it has a solid record of no maternal deaths for the past four years, but has trouble keeping drugs in stock thanks to the bureaucratic machinations at the Ministry of Health. Not having their own ambulance, they borrow one from a local Anglican mission. Again, clever.
After interviewing the dispensary workers and a group of locals, we dropped by the nearby Mvumi Hospital, which has a Maternity Waiting Home. I've been curious about these Homes ever since hearing about them in the office in Dar; they're set up so that women in rural areas can show up a few weeks BEFORE they go into labor, hanging out near the hospital, gestating along, before safely delivering their babies and heading home. The Home at Mvumi is off to the side of the main hospital campus. Upon first sight, it appears just like the typical main square of any small Tanzanian village, just if everyone in that village were 7-9 months pregnant. People are cooking over small wood stoves, others are selling fruits and vegetables, chickens are wandering about, and the women often bring a family member or two along as well, so it's a good scene. The ward with beds was a little windowless for my tastes - but since there are only 18 beds and definitely at least 30 pregnant women milling about, most of them aren't affected by the official sleeping arrangements anyway.
Victor seemed very nervous to be surrounded by all these oddly shaped women. Halimu and I were amused.
On to Handali, where we went through two more interviews...probably overdid it. By the last interview, Halimu was yawning, I was tired, and Victor's questions seemed a little rushed. (He was even taking notes in Swahili - a true sign of exhaustion from a man who (rightly) takes pride in his simultaneous Engish-Swahili translation abilities.)
No journeys tomorrow, on the official Day of Rest. I'm not sure what I'll do, exactly, and am considering dropping in at the Anglican Church next door, simply in search of company and music. (I can hear their childrens' choir practicing through my windows and they are fabulous.)
Saturday, June 27, 2009
Friday, June 26, 2009
I've decided that listening in Kiswahili conversation is a bit like reading Joyce: if you sort of let it wash over you, not focusing directly, you can convince yourself that you're really getting the gist of it. Of course, like Joyce, there's no guarantee that you actually are understanding anything. (My brother tells me Ulysses is also more comprehensible three drinks in. Maybe I'll try a few bias (just say it aloud) here.)
Today, 10 days after arriving, was my first real day of work. We began with a few more government offices, seeking signatures. Tanzanian officials seem to have similar taste in office decor: long, imposing tables (which they can sit at the head of), sumptuous red carpet, and a TV that is not switched off with the presence of visitors. Despite the Chamwino director's chiding that we should've known better than to ask a busy district like his to lend us his only car, we somehow ended up in a somewhat dilapidated government SUV within the hour, heading to the sun-baked terrain of Chamwino, 30 km away.
It's so, so dry out there. Very few trees, all scraggly. The soil is basically sand. It's hard to imagine how anything edible/sellable could grow there in a good year, and this has been a famine year; crops are not coming through now, in the harvest time, and the heath workers told us of parents coming to ask for food at the health dispensaries. (The health dispensaries are armed with "Corn Soya Blend" flour from the World Food Bank - thanks, US corn subsidies! - but it's supposed to be only for pregnant women and kids under 5. This year, kids over 5 don't have enough food either.)
Our first visit was to the main Chamwino Health Center, right in the middle of the town's main (sand) road. I actually found it more welcoming and reassuring than Dodoma's hospital - at least the roof was open in the middle of the building to let in sunlight. Lining the sun-filled space, shoulder to shoulder, were dozens of quiet, very young-looking moms, each sporting a bundled infant. (Tanzanians here seem to be really convinced that it's cold, at maybe 70 F. Victor went out to buy a coat last night and wore it all today, and many of the moms had their babies thoroughly wrapped in socks, hats, and thick blankets. All relative, I guess.) We took a tour of the wards to start off with, appreciating the new lab that lets them test for malaria, HIV, syphillis - all services newly available in the past few years. The wards were very clean, everyone commented, and I appreciated the nets that hung over every bed. We actually only saw two inpatients - a hilariously cute sleeping baby in the pediatric ward, and a alarmingly tiny female figure in the maternity ward, buried motionless under her kanga.
Our research "focus group" was conducted in the corner of the waiting area, with whatever 12 moms happened to be closest - I think subject selection is going to be a little more lax in our study. Probably other research aspects as well; sorry, stats professor Dr. Smith. Victor held court, trying to coax answers out of the women, but they weren't particularly forthcoming. (I think part of it must be attributed to the fact that Victor is 1) male, and 2) older than all of them, in a culture where both those qualities bestow power. But there's no fixing that, really.) I did my best to follow the conversation by reading Victor's English notes and occasionally adding a small side question for him to throw out to the group in Swahili. I think of myself as the Teller to his Penn...although that would imply I had skills of my own. That remains to be seen. Though I think I did add some good questions today (Why don't men accompany their wives to antenatal clinic? Time issues? Cultural? One woman suggested a fear of HIV testing, which I thought interesting). Over the course of our visit, I saw a total of 3 men in a clinic meant for general healthcare and with about 60+ patients waiting. Health care doesn't seem to be appealing to the male sector so well.
Upon exiting the clinic, our driver told us right away that Michael Jackson had died. Poor fellow. But still, for one's death to be mourned by the variety of people in our group today - that's true fame.
We continued with interviews at the local village government building and at a local dispensary, the latter of which occupies the lowest, most basic unit of the Tanzanian health system. (The dispensary interview became particularly noteworthy when a posse of drumming, whistling, ululating women went trotting by the office window - the nurses told us they were celebrating the circumcision of the new village baby boys. Looked exciting.)
My main tasks, besides shaking a lot of hands and apologizing for my bad Swahili, seem to be manning the computer aspect of data keeping (Victor can't open his own email) and surveying the clinics and dispensaries to see whether they have certain essental medical tools and drugs. I did my best to scan the WHO website and then narrow our list down to about 30 basic things; hopefully Geneva won't get too mad about my cuts. It's interesting to see what different sites have and don't have; the dispensary today, for example, had deprovera shots available, but didn't own a speculum.
I've eaten more bananas in the past 48 hours than I have in the previous whole of 2009. My potassium levels must be fabulous.
Today, 10 days after arriving, was my first real day of work. We began with a few more government offices, seeking signatures. Tanzanian officials seem to have similar taste in office decor: long, imposing tables (which they can sit at the head of), sumptuous red carpet, and a TV that is not switched off with the presence of visitors. Despite the Chamwino director's chiding that we should've known better than to ask a busy district like his to lend us his only car, we somehow ended up in a somewhat dilapidated government SUV within the hour, heading to the sun-baked terrain of Chamwino, 30 km away.
It's so, so dry out there. Very few trees, all scraggly. The soil is basically sand. It's hard to imagine how anything edible/sellable could grow there in a good year, and this has been a famine year; crops are not coming through now, in the harvest time, and the heath workers told us of parents coming to ask for food at the health dispensaries. (The health dispensaries are armed with "Corn Soya Blend" flour from the World Food Bank - thanks, US corn subsidies! - but it's supposed to be only for pregnant women and kids under 5. This year, kids over 5 don't have enough food either.)
Our first visit was to the main Chamwino Health Center, right in the middle of the town's main (sand) road. I actually found it more welcoming and reassuring than Dodoma's hospital - at least the roof was open in the middle of the building to let in sunlight. Lining the sun-filled space, shoulder to shoulder, were dozens of quiet, very young-looking moms, each sporting a bundled infant. (Tanzanians here seem to be really convinced that it's cold, at maybe 70 F. Victor went out to buy a coat last night and wore it all today, and many of the moms had their babies thoroughly wrapped in socks, hats, and thick blankets. All relative, I guess.) We took a tour of the wards to start off with, appreciating the new lab that lets them test for malaria, HIV, syphillis - all services newly available in the past few years. The wards were very clean, everyone commented, and I appreciated the nets that hung over every bed. We actually only saw two inpatients - a hilariously cute sleeping baby in the pediatric ward, and a alarmingly tiny female figure in the maternity ward, buried motionless under her kanga.
Our research "focus group" was conducted in the corner of the waiting area, with whatever 12 moms happened to be closest - I think subject selection is going to be a little more lax in our study. Probably other research aspects as well; sorry, stats professor Dr. Smith. Victor held court, trying to coax answers out of the women, but they weren't particularly forthcoming. (I think part of it must be attributed to the fact that Victor is 1) male, and 2) older than all of them, in a culture where both those qualities bestow power. But there's no fixing that, really.) I did my best to follow the conversation by reading Victor's English notes and occasionally adding a small side question for him to throw out to the group in Swahili. I think of myself as the Teller to his Penn...although that would imply I had skills of my own. That remains to be seen. Though I think I did add some good questions today (Why don't men accompany their wives to antenatal clinic? Time issues? Cultural? One woman suggested a fear of HIV testing, which I thought interesting). Over the course of our visit, I saw a total of 3 men in a clinic meant for general healthcare and with about 60+ patients waiting. Health care doesn't seem to be appealing to the male sector so well.
Upon exiting the clinic, our driver told us right away that Michael Jackson had died. Poor fellow. But still, for one's death to be mourned by the variety of people in our group today - that's true fame.
We continued with interviews at the local village government building and at a local dispensary, the latter of which occupies the lowest, most basic unit of the Tanzanian health system. (The dispensary interview became particularly noteworthy when a posse of drumming, whistling, ululating women went trotting by the office window - the nurses told us they were celebrating the circumcision of the new village baby boys. Looked exciting.)
My main tasks, besides shaking a lot of hands and apologizing for my bad Swahili, seem to be manning the computer aspect of data keeping (Victor can't open his own email) and surveying the clinics and dispensaries to see whether they have certain essental medical tools and drugs. I did my best to scan the WHO website and then narrow our list down to about 30 basic things; hopefully Geneva won't get too mad about my cuts. It's interesting to see what different sites have and don't have; the dispensary today, for example, had deprovera shots available, but didn't own a speculum.
I've eaten more bananas in the past 48 hours than I have in the previous whole of 2009. My potassium levels must be fabulous.
Thursday, June 25, 2009
Ha! Yes! I officially have one follower! Nothing like an ego stroke for all to see. Thanks, Mer.
Yesterday was mostly consumed with the journey from Dar, the capital-in-everything-but-name, to Dodoma, the capital. Victor and I opted to travel by bus, heading out on the Scandanavian Express (which has some truly weird decorations on its vehicles; I think I saw a cartoon version of Christopher Columbus at one point). I'd heard and read rather scary stories about bus transport in Tanzania, a sometimes deadly combination of horrible roads and a national tendency towards completely fearless driving, but our six hour trip was actually very pleasant. Like an American chump, I arrived on time, thereby having to wait an hour and change for departure, but once we set off, the light breeze flapping through all the bright orange curtains was quite soothing. The scenery was mesmerizing. Guava juice and coconut crackers were served. What's not to like?
Victor graciously gave me the window seat (partially probably to enable his own napping, but I'll take it), so I spent almost the full trip gazing happily out the window. After the vestiges of urban life disappear about 30 minutes outside of Dar, the view mainly consists of vast picturesque vistas, spotted with feral dark green mango trees, spiky sisal plants, worn footpaths along the road, and the enormous Uluguru Mountains visible towards the middle of our trip. Gawgeous. And so many little villages just in site of the road. I watched a lot of people watching the bus - moms with ever-calm babies in slings, solitary teenagers sitting in the shade of low mudbrick buildings, young men fixing bikes. (I love bikes in rural areas. Watching a single cyclist wind around a sunflower crop with enormous mountains miles away in the background - awesome.)
But I think my favorite people to watch are the Maasai. I always noticed them in Dar. They're very noticeable, really, always dressed in long draped red and purple robes, the men tall and thin and never carrying anything more than a walking stick. They're from the northern part of Tanzania historically, but they've made their way south now. And in the country, you can see them with their cattle, calmly countrolling dozens of animals around with a rather small-seeming stick. I definitely saw a herd of about 10 cows at one point being led by two six-year old boys. (Cows. Not the sharpest tools in the evolutionary box, really.) Victor tells me that the number of cattle owned by one Maasai man is a big status symbol; one fellow may own up to a thousand animals and be quite revered for it. Perhaps they should just sell a few of those animals, says Victor, buy clothes for their kids or a nice house rather than stubbornly holding on to them all. (Victor, in case you can't tell, is not Maasai.) I guess they've become the iconic East African tribe - apparently some men make a living simply charging for photographs in tourist areas. But I liked seeing them out with their animals.
So now, Dodoma. The revered ex-president Julius Nyerere optimistically decided in the 1970s to move his capital to the poorest part of the country, hoping to bring it business and industry. Since his death, however, it's a bit of a white elephant. "Perenially unfinished", my guidebook says. Apparently every new president promises to commit wholeheartedly to Dodoma...and 12 months later, all the ministries have somehow stealthily snuck back to Dar. It's sort of funny.
The city is small - Victor joked after an hour-long walk that we'd seen it all - and much less cosmopolitan. Maybe 1 in 200 people in Dar wasn't black African. Here....well, here I'm one of two that I've seen two days. The attention also feels a little more hostile than it did in Dar, but that may be because fewer people know the handful of English phrases that used to greet me on the coast. Or it may be that I'm walking with Victor - people might not know what to make of the 5'10" white chick and the 5'4", 60-some Tanzanian man with the smart-looking sideburns.
Today was spent gathering signatures at government buildings and the local hospital. The latter was a grim place, really: many people sitting, waiting, both inside and outside (one man with his rooster), and the only wall "decorations" were price lists for various medical equipment ("Stool container = 500 Shillings"). However, by an amazing stroke of luck, it turned out that a regional meeting of reproductive and child health district managers were meeting today in our very guest house. Amazing! We were invited to tea, then sat in to listen to various districts report (sometimes in English, sometimes Kiswahili) on their progress with reducing maternal and child deaths, increasing HIV and syphillis screening, etc. I'll write more later about some interesting things I learned, but for now I'll just leave you with this teaser: Bahi region is kicking ass.
Yesterday was mostly consumed with the journey from Dar, the capital-in-everything-but-name, to Dodoma, the capital. Victor and I opted to travel by bus, heading out on the Scandanavian Express (which has some truly weird decorations on its vehicles; I think I saw a cartoon version of Christopher Columbus at one point). I'd heard and read rather scary stories about bus transport in Tanzania, a sometimes deadly combination of horrible roads and a national tendency towards completely fearless driving, but our six hour trip was actually very pleasant. Like an American chump, I arrived on time, thereby having to wait an hour and change for departure, but once we set off, the light breeze flapping through all the bright orange curtains was quite soothing. The scenery was mesmerizing. Guava juice and coconut crackers were served. What's not to like?
Victor graciously gave me the window seat (partially probably to enable his own napping, but I'll take it), so I spent almost the full trip gazing happily out the window. After the vestiges of urban life disappear about 30 minutes outside of Dar, the view mainly consists of vast picturesque vistas, spotted with feral dark green mango trees, spiky sisal plants, worn footpaths along the road, and the enormous Uluguru Mountains visible towards the middle of our trip. Gawgeous. And so many little villages just in site of the road. I watched a lot of people watching the bus - moms with ever-calm babies in slings, solitary teenagers sitting in the shade of low mudbrick buildings, young men fixing bikes. (I love bikes in rural areas. Watching a single cyclist wind around a sunflower crop with enormous mountains miles away in the background - awesome.)
But I think my favorite people to watch are the Maasai. I always noticed them in Dar. They're very noticeable, really, always dressed in long draped red and purple robes, the men tall and thin and never carrying anything more than a walking stick. They're from the northern part of Tanzania historically, but they've made their way south now. And in the country, you can see them with their cattle, calmly countrolling dozens of animals around with a rather small-seeming stick. I definitely saw a herd of about 10 cows at one point being led by two six-year old boys. (Cows. Not the sharpest tools in the evolutionary box, really.) Victor tells me that the number of cattle owned by one Maasai man is a big status symbol; one fellow may own up to a thousand animals and be quite revered for it. Perhaps they should just sell a few of those animals, says Victor, buy clothes for their kids or a nice house rather than stubbornly holding on to them all. (Victor, in case you can't tell, is not Maasai.) I guess they've become the iconic East African tribe - apparently some men make a living simply charging for photographs in tourist areas. But I liked seeing them out with their animals.
So now, Dodoma. The revered ex-president Julius Nyerere optimistically decided in the 1970s to move his capital to the poorest part of the country, hoping to bring it business and industry. Since his death, however, it's a bit of a white elephant. "Perenially unfinished", my guidebook says. Apparently every new president promises to commit wholeheartedly to Dodoma...and 12 months later, all the ministries have somehow stealthily snuck back to Dar. It's sort of funny.
The city is small - Victor joked after an hour-long walk that we'd seen it all - and much less cosmopolitan. Maybe 1 in 200 people in Dar wasn't black African. Here....well, here I'm one of two that I've seen two days. The attention also feels a little more hostile than it did in Dar, but that may be because fewer people know the handful of English phrases that used to greet me on the coast. Or it may be that I'm walking with Victor - people might not know what to make of the 5'10" white chick and the 5'4", 60-some Tanzanian man with the smart-looking sideburns.
Today was spent gathering signatures at government buildings and the local hospital. The latter was a grim place, really: many people sitting, waiting, both inside and outside (one man with his rooster), and the only wall "decorations" were price lists for various medical equipment ("Stool container = 500 Shillings"). However, by an amazing stroke of luck, it turned out that a regional meeting of reproductive and child health district managers were meeting today in our very guest house. Amazing! We were invited to tea, then sat in to listen to various districts report (sometimes in English, sometimes Kiswahili) on their progress with reducing maternal and child deaths, increasing HIV and syphillis screening, etc. I'll write more later about some interesting things I learned, but for now I'll just leave you with this teaser: Bahi region is kicking ass.
Tuesday, June 23, 2009
A "Murder", indeed
So I have decided to tell the story of my morning on here, even though it led my mother to nervously suggest I might want to find somewhere else to live. Mom, avert your eyes. Nothing to see here.
The story involves two species of the local fauna. The first is the
Yesterday on my walk to the office, however, I made the mistake of bringing my breakfast toast to eat along the way. Decidedly unwise. Every crow on Kibasila Street knew that I had bread and that it was in my eminently peckable hands. Hungry circling began. A few of them were shuffling backwards on the ground about three feet in front of me, forcing me to make regular kicking motions like a crazy person. And THEN, I happened to look up to my right to see a particularly bold crow flying right next to me, hovering not two feet from my face. I minorly freaked out and ran the next half block, tucking my bread under my shirt and heading for the safety of the office. Yes, I ran from birds. My cowardice is no longer in question.
So that’s the crows. The other animals in our story are the rats that live in my guest house’s kitchen. My bedroom’s not anywhere near the kitchen (not even the same building), so this doesn’t particularly bother me. They mostly make their presence known at night, when a sort of wild rat rumpus can be heard emanating from the kitchen. Although I didn’t particularly like seeing one when I tried to throw something in the trashcan under the sink one night, I don’t really mind that they’re there. I like to think of them as the Tanzanian rats of NIMH.
This morning, I got up unusually early, before dawn, with plans to Skype with Mom. Through the windows in my room, I can always hear the matron, Mary, cleaning the house and sweeping the whole courtyard every morning, putting out breakfast and such. She's usually finished long before I get out of my bedroom, but not today. Today, I got showered, got dressed, then headed out through the courtyard to the main house to grab my toast (this time to transport in a crow-resistant opaque plastic bag). Right under to the big tree in the yard, however, I noticed an unfamiliar pile. Somehow suspicious already, I leaned in to discover it was, in fact, a pile of dead rats. Well done, Mary. She must’ve gotten at least a dozen. But why put them out in the yard, you ask?
Ah, the great circle of life. The crows were already descending on the pile. I looked away and walked quickly inside. In the time it took for me to toast three pieces of bread and return outside, every single rat body was gone. (Recycled, if you will.) I was already pretty creeped out by the abstract idea of their being carnivorous, but when a crow with an enormous dead rat in its mouth landed above the gate as I tried to walk out beneath it (true story), I allowed myself a big girly shudder. Ewwwwwwww. Grossgrossgrossgross.
Ok, out of my system. Will be on guard against evil crows from here on out.
Monday, June 22, 2009
Wikendi
Picasa and I have joined forces to conquer the interwebs, communicate across vast distances, take pollution down to zero! First, a link for the May Ball album. Hopefully the captions and Gillean's coming facebook photos (cough, cough) will be enough to narrate the whole evening.
And then, one short week later, a few pictures from recent Dar adventures. I tried to use this weekend to see some of the main city spots that appealed to me, since I'll be away from the coast for the next two weekends. (And I was just getting kind of comfortable here, too. Such a habit-forming creature I am.)
After the usual breakfast (three slices of toast with tea; bananas if the matrons are feeling generous. I've heard there are occasionally eggs but I suspect this to be an urban legend), I headed down to the "African" part of town. Kind of funny to have an African part of town in a city in Africa, but that's colonialism for you. I wandered through the Kitusu market first, a collection of closely packed stalls selling mostly food. A little claustrophobic, especially when I had to step over a posse of about 30 loose chickens in a small ditch. (I saw two of them being carried away, still alive, in a plastic bag that allowed their heads to stick out and enjoy the view. They looked pleased.) Next, to Ilala fabric market, where all the ladies of Dar get their kangas from an overwhelming selection. I'd like one but I think it'll have to wait until I learn my colors in Swahili. Then to Kariakoo, the huge market built in the buildings that used to house the British Carrier Corps (hear it? Carrier Corps? Kariakoo?). Cooler, thanks to the crazy roof (see pictures), but not as manic as the earlier markets of the day.
Then, in an act of bravery or possibly heatstroke, I leapt aboard a daladala headed for the Kivukoni seafood market, where all the ferries leave Dar. Riding a daladala is kind of awesome, and I will write about it more, in a future blog posting dedicated solely to transportation in the city. You smell the seafood market for several blocks before you arrive at Kivuknoi, and a truly fine array of scaled heads and tenacled legs awaits the shopper. The water right off the ferry dock is mostly filled with trash, but a walk up Ocean Drive, just to the east, has some very lovely views. The water is so very blue, and almost wave-free. Apparently the Indian Ocean is rather zen compared to the Atlantic.
Sunday, my fellow lodgers Happy (a Tanzanian studying German in Dar for the summer) and Dorothee (a German med student) and I headed even further south, to Kipepeo beach. Actually getting onto the beach was a little tricky - some resorts charge entry fees just to let you walk over their sand to the water - but we eventually made it to the ocean. A very relaxing afternoon, filled with sleeping and reading and bargained-for ice cream. One interesting thing: of all the people on the beach, I think that Dorothee and I were the only ones who could actually swim. The native Tanzanians and Indians stayed very close to the shore for the most part, unless armed with floats. Dorothee thought that swimming might be sort of a luxury for most people here, but I wondered about the practicalities of that - plenty of people make their living from the water in the city, and it wouldn't do to be drowning if your rinky-dink boat capsized. Perhaps most of the people at this beach had come from inland? (The situation did turn me into a sort of hero, however, when I rescued a little boy's inflatable toy that had blown out to sea. Good way to make an instant friend.)
Got a Tanzanian cell phone today. Pretty delighted with it. $35, works immediately and can be switched over to any other network with a mere snapping in of another SIM card. Get with it, America.
Friday, June 19, 2009
This post was almost worth more than a thousand words
Day two at work. Really settling into the swing of things now. You barely notice me. Except when they throw minor curve balls at me, such as today at lunch: the entree included a whole, fried fish, approximately 5 inches long, complete with head, scales, tail, etc. The only utensil offered was a spoon. I surreptitiously watched others neatly mince their way through before tackling it with my fingertips. Tasty, if a little crunchy...but that's probably my own inferior bone-removal skills. On the upside, I don't think I'll forget the word for fish ("semake").
Further planning for the Dodoma adventures, reading through various Minisitry of Health publications and working with Victor on his list of questions for the focus group sessions and interviews. Thanks to my time doing research interviewing at the NIH, this afternoon actually felt vaguely familiar. It was a comforting sensation and gave me the possibly correct, possibly erroneous notion that I'll be able to contribute something of use.
But enough of this chit chat. It's time for pictures! If I can figure them out!
(30 minutes later)
This computer is apparently having none of my upload attempts. Expect a Picasa link with the next post.
(30 minutes later)
This computer is apparently having none of my upload attempts. Expect a Picasa link with the next post.
Thursday, June 18, 2009
Another Day at the Kazini
Correctly assessing that I would be unable to find my way back from my hostel to the Women's Dignity offices (having ridden there in a sort of sleep-deprived haze yesterday), the WD folks kindly sent Rabojo to pick me up this morning and walk with me to work. His English is just slightly better than my Swahili (read: poor), so we spent the walk pointing a various things and saying them in our respective languages. Hopefully we were pointing at the same things. Hopefully I will also be able to remember the route: Kibasila road, then left at the painted advertisement for Kilimanjaro Beer, then right onto United Nations Road....see if you can follow me on Google Maps.
I have to say that my first day of work seemed to go rather well. The folks in the office are very welcoming and friendly, and incredibly receptive to my Swahili attempts. Elaborate greetings are very big here, so I've already learned my part in about five exchanges that in the US would simply be translated as "Hey, 'sup?". About half of the office speaks English; I'm going to work hard on my vocab in hopes of chatting up the others. Simon the administrator gave me a detailed orientation that hit all the highlights of the office: how to request a pen, where the coffee and tea is kept, what time lunch is served. Lunch is served communally here by the mama lishas - cooking ladies. They come to the office and bring traditional and plentiful Tanzanian food, eaten as a group at a table on the roof. Today involved rice, bananas, a bit of beef (or possibly goat), some leafy green mchicha, and oranges, which are currently in season and really tasty. A nice way of getting the office together and, for me, learning about food outside of the Indian restaurants all over my neighborhood. And the pen request form briefing actually came in handy; unlike US offices, there's not an overflowing cupboard of office supplies somewhere, so I had to make an official request of Patricia the receptionist in order to procure an underlining implement.
For I am reading documents! For an upcoming trip! They have been making plans for me. Big ones. I am going with Victor, a research consultant, on his trip next week to do health policy research in the Dodoma region in inland Tanzania. We'll be traveling from the 24th to July 9th. It's sort of shocking to me to be traveling so soon after arriving, but a good sort of shock. I'm excited to see the more rural parts of the country (Dar is the biggest city in Tanzania by far) and I'm especially excited to see the Reproductive and Child Health clinics outside the cities. This is basically what I was hoping for when I came, though I was trying to be more practical in my expectations. As Teddy my Tanzanian contact says, this seems pretty great for an NGO intern. Hope I don't slow Victor down too much. Maybe I can even be useful.
I have to say that my first day of work seemed to go rather well. The folks in the office are very welcoming and friendly, and incredibly receptive to my Swahili attempts. Elaborate greetings are very big here, so I've already learned my part in about five exchanges that in the US would simply be translated as "Hey, 'sup?". About half of the office speaks English; I'm going to work hard on my vocab in hopes of chatting up the others. Simon the administrator gave me a detailed orientation that hit all the highlights of the office: how to request a pen, where the coffee and tea is kept, what time lunch is served. Lunch is served communally here by the mama lishas - cooking ladies. They come to the office and bring traditional and plentiful Tanzanian food, eaten as a group at a table on the roof. Today involved rice, bananas, a bit of beef (or possibly goat), some leafy green mchicha, and oranges, which are currently in season and really tasty. A nice way of getting the office together and, for me, learning about food outside of the Indian restaurants all over my neighborhood. And the pen request form briefing actually came in handy; unlike US offices, there's not an overflowing cupboard of office supplies somewhere, so I had to make an official request of Patricia the receptionist in order to procure an underlining implement.
For I am reading documents! For an upcoming trip! They have been making plans for me. Big ones. I am going with Victor, a research consultant, on his trip next week to do health policy research in the Dodoma region in inland Tanzania. We'll be traveling from the 24th to July 9th. It's sort of shocking to me to be traveling so soon after arriving, but a good sort of shock. I'm excited to see the more rural parts of the country (Dar is the biggest city in Tanzania by far) and I'm especially excited to see the Reproductive and Child Health clinics outside the cities. This is basically what I was hoping for when I came, though I was trying to be more practical in my expectations. As Teddy my Tanzanian contact says, this seems pretty great for an NGO intern. Hope I don't slow Victor down too much. Maybe I can even be useful.
Wednesday, June 17, 2009
Touchdown
Made it! Hongera (Congrats) to me. Sitting now in the big Post Office a few blocks from my hostel, listening to the soft echoes of Tanzanians sending letters in the big open space behind me. Rather soothing. I went out in search of food and internet and am exceedingly pleased to have found at least one. After this, the quest for juice and bread continues.
I realize that if my trip were a movie, the arrival in Dar only 24 hours after the end of the Jesus College Cambridge May Ball would strike me as a bit cliche. The difference is so great as to be sort of ludicrous. Gillean, my cousin, worked her usual artistic genius and did a beautiful job with the "Oz" theme of the May Ball - guests walked in through the creepily destroyed door of Dorothy's tornado-ed house (complete with squashed wicked witch feet), strolled along yellow brick road carpet pinned down to the lawns, sat under trees with glowing apple lanterns, warmed themselves by the enormous fake fireplace in the Witch's Castle. (I helped with making the flying monkeys. They turned out good and menacing, I think.) The excess in every aspect is enough to make a slightly "crunchy" American girl (as Mer described me) just the tiniest bit uncomfortable: 20+ musical acts, carnival rides, piles and piles of free food and alcohol. Gillean's friend Ali mentioned that she'd seen people at previous Balls order a free hamburger just to take a single bite and throw it into the trash. That's of course sort of the whole idea of the Ball, if taken a bit to the extreme: a truly sumptuous celebration in the old world style, 800 years old.
So to arrive at 5 AM in Dar via Cairo (where a Avian flu "checkpoint" caused a delightfully chaotic mob) was such a huge juxtaposition as to be sort of silly. There is a distinct dearth of tuxedos and ball gowns here, I've noticed. I'm sharp. Though the kanga dresses that many of the women wear are rather fancy in their own right.
First adventure: though my usually trusty guide book told me I'd need US$50 to purchase myself a Tanzanian entrance visa, it turns out prices have doubled. It also turned out that I had only US$67. There would be no leaving the airport until I located another US$33, and there was no ATM behind customs. (I really should've been better prepared for that. Who relies on ATMs in foreign countries? Suckers, that's who.) I think I would have been much more alarmed by the situation had I not spent the last 10 hours wedged into a plane seat - blood moving through my limbs again was a nice endorphin. So I managed to agree to leave my passport behind in return for a trip to the two ATMs just outside of customs; luckily for our story, both were out of service. I noted a strident American accent nearby complaining about the same problem to her Tanzanian acquaintance, and sidled on over to make friends. In about 5 minutes we had charmed our way past security and I was in the backseat of a car with Happy, Diana, and Sarah, bags and passport still behind in the airport, zooming through the darkness in search of a working ATM. First ATM only took Mastercard; apparently Visa is NOT everywhere I want to be. Second ATM - success! Back to the airport, to fetch the bags, to buy the visa, to reclaim the passports, to wave goodbye to my new friends and hop into the van with Majid, the driver from Women's Dignity who had been waiting patiently.
First day of work tomorrow. Hungry now. Hoping to procure some of that guava juice they served on EgyptAir.
I realize that if my trip were a movie, the arrival in Dar only 24 hours after the end of the Jesus College Cambridge May Ball would strike me as a bit cliche. The difference is so great as to be sort of ludicrous. Gillean, my cousin, worked her usual artistic genius and did a beautiful job with the "Oz" theme of the May Ball - guests walked in through the creepily destroyed door of Dorothy's tornado-ed house (complete with squashed wicked witch feet), strolled along yellow brick road carpet pinned down to the lawns, sat under trees with glowing apple lanterns, warmed themselves by the enormous fake fireplace in the Witch's Castle. (I helped with making the flying monkeys. They turned out good and menacing, I think.) The excess in every aspect is enough to make a slightly "crunchy" American girl (as Mer described me) just the tiniest bit uncomfortable: 20+ musical acts, carnival rides, piles and piles of free food and alcohol. Gillean's friend Ali mentioned that she'd seen people at previous Balls order a free hamburger just to take a single bite and throw it into the trash. That's of course sort of the whole idea of the Ball, if taken a bit to the extreme: a truly sumptuous celebration in the old world style, 800 years old.
So to arrive at 5 AM in Dar via Cairo (where a Avian flu "checkpoint" caused a delightfully chaotic mob) was such a huge juxtaposition as to be sort of silly. There is a distinct dearth of tuxedos and ball gowns here, I've noticed. I'm sharp. Though the kanga dresses that many of the women wear are rather fancy in their own right.
First adventure: though my usually trusty guide book told me I'd need US$50 to purchase myself a Tanzanian entrance visa, it turns out prices have doubled. It also turned out that I had only US$67. There would be no leaving the airport until I located another US$33, and there was no ATM behind customs. (I really should've been better prepared for that. Who relies on ATMs in foreign countries? Suckers, that's who.) I think I would have been much more alarmed by the situation had I not spent the last 10 hours wedged into a plane seat - blood moving through my limbs again was a nice endorphin. So I managed to agree to leave my passport behind in return for a trip to the two ATMs just outside of customs; luckily for our story, both were out of service. I noted a strident American accent nearby complaining about the same problem to her Tanzanian acquaintance, and sidled on over to make friends. In about 5 minutes we had charmed our way past security and I was in the backseat of a car with Happy, Diana, and Sarah, bags and passport still behind in the airport, zooming through the darkness in search of a working ATM. First ATM only took Mastercard; apparently Visa is NOT everywhere I want to be. Second ATM - success! Back to the airport, to fetch the bags, to buy the visa, to reclaim the passports, to wave goodbye to my new friends and hop into the van with Majid, the driver from Women's Dignity who had been waiting patiently.
First day of work tomorrow. Hungry now. Hoping to procure some of that guava juice they served on EgyptAir.
Saturday, June 13, 2009
Leaving for O'Hare in a little less than four hours. The logistics of international travel always awe me:
Car from Hyde Park to O'Hare -> plane to Manchester, UK -> plane to Heathrow -> Tube to King's Cross -> train to Cambridge. Two days off. Train to King's Cross -> Tube to Heathrow -> plane to Cairo -> plane to Dar -> car driven by Majid to Upanga.
It makes me happy to write all that out, as if I can somehow control all the little vagaries that might prevent me from actually getting through that itinerary (what's this about a Tube strike, now?). Everyone must have their own little mental tricks for getting through situations that make them a little nervous; mine is apparently to indulge my barely suppressed OCD urges. There were lists everywhere in my apartment this week.
Car from Hyde Park to O'Hare -> plane to Manchester, UK -> plane to Heathrow -> Tube to King's Cross -> train to Cambridge. Two days off. Train to King's Cross -> Tube to Heathrow -> plane to Cairo -> plane to Dar -> car driven by Majid to Upanga.
It makes me happy to write all that out, as if I can somehow control all the little vagaries that might prevent me from actually getting through that itinerary (what's this about a Tube strike, now?). Everyone must have their own little mental tricks for getting through situations that make them a little nervous; mine is apparently to indulge my barely suppressed OCD urges. There were lists everywhere in my apartment this week.
Saturday, June 6, 2009
Low Hanging Fruit of the Womb
I was talking about my summer plans wit a pair of female friends yesterday, Meredith and Sayward, trying to explain:
1) where I was going (pretty sure about that, thanks to the magic that is GoogleEarth),
2) what fistulas even are (somewhat sure, if only in a textbook sense), and
3) what I'd be doing with the NGO (mostly unknown, truth be told).
Meredith wondered if it might be tough, seeing women with a devastating and completely unnecessary debilitation each day and not having any friends or family nearby to talk it over with. And I realized that strangely, I'm not worried about that at all. In a certain sense, I've chosen this group and this project because I don't think it'll drag me down emotionally. I actually have this idea that it'll boost me up, make me feel like progress is being made and that a lifetime in global health wouldn't be an uphill battle. Obstetric fistula has always appealed to me as such a low-hanging fruit of a problem: if we the healthcare professionals can get to the women (or they can get to us), chances are quite good that we can get them back to full health and functioning status. That's pretty rare with most of the things we worry about in global health. Further, it's less complicated to prevent it happening again - a woman is only at risk during labor, a rather recognizable state, so surgeons can legitimately ask women with repaired fistulas to try to give birth in a hospital the next time around. (Granted that costs get in the way, but compared to something like HIV, when you're at risk everytime you have sex/take care of an HIV-positive relative, or guinea worm, when you're at risk everytime you want a drink of water, the chances of avoiding fistulas by education and behavior change look pretty good.)
My spin on this is admittedly probably naive. But I'm not going to be working on HIV, or unwanted pregnancy, or gender-based violence, or any of those seemingly intractable problems in women's health where the public health workers seem to be constantly swimming hard against an overwhelming tide. Compared to those battles, the outlook for fistula patients is downright sunny. A good surgeon can completely turn a life around; the pull of instant gratification is very strong here.
So I know that I won't be tackling the hardest of the hard problems facing the international community. But I've always been a fan of tackling low hanging problems first anyway (see also: putting things on my to-do list that I've already done, just so I can cross them off); in fact, you might be able to help more people at an earlier point in time than if you tackle the hard problems first. And maybe this way I can get a little taste for what a successful health intervention campaign feels like - maybe the knowledge of that taste will keep me going if I move on to the more complex things.
1) where I was going (pretty sure about that, thanks to the magic that is GoogleEarth),
2) what fistulas even are (somewhat sure, if only in a textbook sense), and
3) what I'd be doing with the NGO (mostly unknown, truth be told).
Meredith wondered if it might be tough, seeing women with a devastating and completely unnecessary debilitation each day and not having any friends or family nearby to talk it over with. And I realized that strangely, I'm not worried about that at all. In a certain sense, I've chosen this group and this project because I don't think it'll drag me down emotionally. I actually have this idea that it'll boost me up, make me feel like progress is being made and that a lifetime in global health wouldn't be an uphill battle. Obstetric fistula has always appealed to me as such a low-hanging fruit of a problem: if we the healthcare professionals can get to the women (or they can get to us), chances are quite good that we can get them back to full health and functioning status. That's pretty rare with most of the things we worry about in global health. Further, it's less complicated to prevent it happening again - a woman is only at risk during labor, a rather recognizable state, so surgeons can legitimately ask women with repaired fistulas to try to give birth in a hospital the next time around. (Granted that costs get in the way, but compared to something like HIV, when you're at risk everytime you have sex/take care of an HIV-positive relative, or guinea worm, when you're at risk everytime you want a drink of water, the chances of avoiding fistulas by education and behavior change look pretty good.)
My spin on this is admittedly probably naive. But I'm not going to be working on HIV, or unwanted pregnancy, or gender-based violence, or any of those seemingly intractable problems in women's health where the public health workers seem to be constantly swimming hard against an overwhelming tide. Compared to those battles, the outlook for fistula patients is downright sunny. A good surgeon can completely turn a life around; the pull of instant gratification is very strong here.
So I know that I won't be tackling the hardest of the hard problems facing the international community. But I've always been a fan of tackling low hanging problems first anyway (see also: putting things on my to-do list that I've already done, just so I can cross them off); in fact, you might be able to help more people at an earlier point in time than if you tackle the hard problems first. And maybe this way I can get a little taste for what a successful health intervention campaign feels like - maybe the knowledge of that taste will keep me going if I move on to the more complex things.
Monday, June 1, 2009
Reinnervation
I've decided to revive (resuscitate, perhaps) this blog for the purposes of using it as a sort of public journal during my time in Tanzania this summer. I will do my best to be better about updating it. Hopefully there will be deep thoughts. And pictures. No promises.
Thanks to the generous Human Rights Program at the University of Chicago, I will be spending mid-June to late August working for Women's Dignity (Utu Mwanamke) in Dar Es Salaam. (Though apparently only outsiders use the city's full name. "Dar" it shall be from now on.) I'm really quite excited (and scared. Excitiscared) to work on many of the international women's health issues that drew me into medical school in the first place: family planning, abortion access, and particularly obstetric fistula. In a rather delightful coincidence, the NYTimes has decided to also get into Tanzanian women's health these days, running a series of articles. Today's was about the consequences of unsafe abortion; one last week was a more general article on threats to maternal health. Both were particularly helpful in adding specific detail to my blurry conception of the failings in the health care systems of East Africa.
Departing on June 13th. Much to do.
Thanks to the generous Human Rights Program at the University of Chicago, I will be spending mid-June to late August working for Women's Dignity (Utu Mwanamke) in Dar Es Salaam. (Though apparently only outsiders use the city's full name. "Dar" it shall be from now on.) I'm really quite excited (and scared. Excitiscared) to work on many of the international women's health issues that drew me into medical school in the first place: family planning, abortion access, and particularly obstetric fistula. In a rather delightful coincidence, the NYTimes has decided to also get into Tanzanian women's health these days, running a series of articles. Today's was about the consequences of unsafe abortion; one last week was a more general article on threats to maternal health. Both were particularly helpful in adding specific detail to my blurry conception of the failings in the health care systems of East Africa.
Departing on June 13th. Much to do.
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