Lay Down Your Heart

Denny's Theory of Blogging posits that for a blog to be readable, there must be a relatively even balance between sobering, depressing entries and happy-go-lucky ones. I think the scale has been tipped a little too far towards the sobering lately, so perhaps now is the time to backtrack to my activities last Saturday. I give you: Adventures in Bagamoyo!

Bagamoyo is about 70 kms (that's right, I'm all metric now) north of Dar es Salaam, right up along the ocean. Once, long ago, it was actually the capital of German East Africa. Almost all European missionaries began and ended their journeys there (sometimes for good - the body of Dr. David Livingstone, of "I presume" fame, rested in Bagamoyo before his final trip back to Westminster Abbey). It was also a huge center of the East African slave trade, where newly captured slaves were held before their transport to Zanzibar and further places. The whole city reached its peak around the 1890s - whereupon the Germans made the crucial decision to relocate their capital to a little harbor called Dar es Salaam. It was all downhill from there for Bagamoyo, I'm afraid. Nowadays, it's an example of my favorite type of city: once grand and important, now delapidated and mostly abandoned, with grand buildings in thorough states of disrepair and little hints everywhere of its former glory.

Fellow travelers Nina and Magdalina and I took a series of daladalas up the coast from Dar, navigating like pros. The one minor snag was that the final daladala terminal turned out to be quite a bit inland of historic Bagamoyo - we didn't quite know which way to walk, and the taxi drivers descended like jackals. Luckily Nina and Magdalina deal with these guys in the same way I do: walk confidently in one direction, even if you have no idea where you're going, until the touts/drivers finally give up and you can consult your guidebook in peace.

Having finally determined which way was east ("I see ocean over there!"), we popped out onto a long, neatly bricked pathway running right along the coast and through the center of town. Immediately to our right were the old German BOMA, a fancy-pants administrative building left roofless since El Nino, and the simply-named Fort. Both had that solid, this-building-will-be-here-for-generations look common among old European structures in this country. If there was any residual hope among the Bagamoyans that these Westerners might just go home after a few years, I think the Fort may have persuaded them otherwise.

We ambled north along the pathway, politely refusing a constant stream of offers ("Baisikeli [Bicycles]! Ice creami! Wood carvings!", etc.). The main buildings in town, near the ocean-side fish market, all have this great rundown appeal - very shabby chic, if you will. The outer walls are chipped and crumbling and clearly haven't been patched up in years, but the doors - oh, I took a lot of pictures of the doors. They're done in the Zanzibar, Omani-influenced style: really thick hardwood, with beautiful carvings bisecting the door and running around the edges. Apparently each tiny carving design has its own symbolism: a chain for protection, a lotus flower for prosperity, a wave to indicate a fisherman's home. Of course, no one has done any conservation for the doors any more than the rest of the town, but luckily they're so solidly made that they're survived fairly well.

After appreciating the hilariously low tide characteristic of midday Bagamoyo, we set out on unexpectedly long hunt for lunch, finally ending up with plates of rice, beans and veggies in a oceanfront field of picnicking locals. We all agreed that food tasted much better when you'd had to wander around seeking it for a few hours. Sour grapes, perhaps, but those beans were totally awesome.

A quick ice cream cone apiece, then off to St. Joseph's mission, a large chunk of land just off the coast. The Holy Ghost Fathers, among the first Christian missionaries to plant themselves in East Africa, established what became a rather sprawling complex over the years: church, bell tower, farms, living quarters, school, and a tiny but surprisingly good museum, with more information about Bagamoyo than seems even to be available on the internet. (I know, hard to believe.) We spent a good hour in the three-room museum, checking out items from the whole history of the town: pre-European tribal masks, Omani ash trays, slave chains, deeds of freedom for slaves ransomed by the priests, WWI-era German newspapers, 1920s handrawn British maps. Ran the whole gamut, really. We emerged, pleased and vaguely self-satisfied with our new knowledge. (Once a med student, always a med student.)

With the light waning, we strolled back towards the bus station, stopping to visit the huge fish market on the way out. Somehow during our walk back, our stabs at asking for directions in Swahili acquired us a series of friendly escorts: an older man walked us to the fish market, a younger man took us to a place to buy water, a middle-aged woman walked with us to the daladalas. Capped the day off nicely, really, and sort of gels with what I've generally found in Tanzania - a genunine attempt at Swahili, even a bad one, earns you a lot of good will. It's encouraging.

A bumpy trip home in the gathering darkness, notable only towards the end when our daladala went zooming right through a police checkpoint. Good times. So the first day trip was a success, I think; planning a second one this weekend to the Pugu Hills, where I shall seek the elusive giant elephant shrew.

EDIT: Almost forgot: "Bagamoyo" means "Lay down your heart" in Swahili, although it's not quite settled how it got that name. Some sources say that it was because Bagamoyo was the big city, fun times, lay down your cares and worries and all that. Other, more plentiful sources say that it was named during the slave trade: if they captured you and you found yourself taken to Bagamoyo, give up hope. Sort of fits nicely with with my aforementioned theory of blogging, I thought.

Return to CCBRT

A worthwhile day, yesterday. I felt content with the day's business when I crashed into bed last night, and marinating on it for another 24 hours has only made me more pleased that I went back to the CCBRT hospital. It wasn't particularly a happy day (though I suppose the women on the operating table will be pretty happy in two weeks, if everything heals properly). But I saw a lot, learned a lot, built up some relationships. And that's the point of this summer, right?

It occurred to me during a chat with David "The Yellow Dart" Foster that maybe I should explain what obstetric fistulas actually are, though again hopefully in blog-appropriate terms. You don't really hear about them in the US and Europe because...well, they don't really happen there. An obstetric fistula is basically a really bad complication of childbirth. As Dr. Masemga told me, every patient story he hears is essentially the same: The mother is stuck in labor at home for 3, 4 days, pushing hard, before someone finally takes her to the hospital. There, via C-section, the doctors deliver the baby - usually stillborn. But the pressure of the baby's head pushing for so long actually destroys the tissue between the birth canal and the bladder, rendering the woman incontinent. So then your child has died, you can't control your urination, and your husband/partner often leaves because you smell bad all the time. (The CCBRT fistula intake form actually has the question "Did husband leave because of fistula: YES/NO". Most of the ones I've seen circled yes.) Women do go on, of course, and show amazing resilience, but it's essentially life-shattering.

So that condition, then, is what the VVF operating theater sets out to remedy. CCBRT actually has a special theater set aside for fistula repair surgeries, with a special table that can be rearranged as different stages of the surgery require. Part of what made my second day in surgery more rewarding, I think, was that I had an idea of what was supposed to be going on and how I could help - adjusting the overhead lights for the surgeon, hoisting patients onto stretchers, fetching suture material, etc. Small things, but made me feel useful and more involved.

The other improvement for me was my chance to actually talk with the visiting surgeon, Dr. Masemga. He's actually based near Kilimanjaro, but as one of the premier fistula surgeons in the country, he agreed to do a week with CCBRT while their usual fistula surgeon was on leave. We started the day in the same silence as Monday, but towards the end of the first procedure a friendly Indian surgeon dropped in and made a point of asking a few fistula-related questions in English, assuredly for my benefit. Dr. Masemga was happy to respond, and then happy to recieve a few follow up questions from me as well. Ice = broken. It later turned out that out of Dr. Masemga's three trips to the US, one was to Duke University (where I went to college) and another was to the National Institutes of Health (where I worked for three years). The fates wanted us to bond. I wondered later if my perception of the surgeons' indifference wasn't mostly due to Dr. Robert, the vaguely grumpy assisting surgeon playing second fiddle to this hotshot visiting young guy. (Dr. Masemga's maybe in his mid-30s.) Who's to know.

So the team made its way through four repair surgeries yesterday. All were pretty fascinating to me, but two of the cases really stood out. One was an older woman whose fistula had actually come from radation treatment for her cervical cancer. Rates of cervical cancer are much higher here in the developing world, and the few women who actually do get treatment and manage to survive sometimes have tissue destruction that's functionally the same as childbirth-based fistulas. Luckily hers was a very small tear, easily shut.

The other case was the last woman of the day. So many things about her just made my chest tighten. For one, she was 17. For two, she was so delicate, really willowy and beautiful and not at all built for childbearing. Her fistula had developed from her first child (stillborn), and her husband had left soon after the fistula became apparent. Then, during the course of the surgery, the doctors actually determined that she had not one but two fistulas, the expected one connecting her bladder and vagina, but also a second one tearing from her vagina into her rectum. So the surgery ended up being twice as long and complex. But the final sadness was that she'd been circumcised some years ago. (FGM, many call it.) The resultant tightening and scarring made the surgery very difficult, just as it had made her first childbirth experience very difficult.

I was grateful that she was the last case of the day, I think. The more I thought about all the things conspiring aginst her, all the cultural and institutional forces that control her life and limit her choices in fundamental ways, the more overwhelmed I felt. But as I write this today, I'm sort of heartened by the key fact that she wasn't passive in the face of all this - she did get to a surgeon, and a very good one at that. The odds are good that she'll heal well, and that she'll march out of CCBRT in two weeks with her congratulatory kanga and go on with her life, with a chance for a partner and children (via C-section) and normal social life again. Those things shouldn't be underestimated, even if the greater problems that brought her to CCBRT in the first place still remain.

In which medical terms are used

I opt to go a bit out of order today, skipping over my exotic weekend day trip in favor of writing about my day yesterday while it's still fresh in my mind. (Random tangent: "Fresh" is a very hip slang word here. Someone asks you how you are and you reply not with "mzuri" (good) or even "poa" (cool), but "fresh", in English --> instant street cred.)

Although last week's attempt to observe a fistula repair surgery was thwarted by an untimely onset of patient malaria, I had learned at that time that a noted fistula surgeon would be visiting the CCBRT Hospital this week, with approximately five surgeries scheduled every day. So yesterday morning I hightailed it north on the Posta-Masaki daladala and made my way down the newly paved road to the hospital. (True, the paving actually only goes as far as the bar that shares the street with the CCBRT. But then, halfway's better than none, right?)

The CCBRT specializes in disability repair - they fix orthopedic problems like club feet and polio, eye problems, fistulas, and a few other specialized treatments. I threaded my way through the very crowded waiting room and returned to the fistula ward, a shabby but clean room with lots of light and beds for perhaps 25 women. Dr. Robert, who I'd met before, has his little office off to the side of the ward, assisted by an quiet but efficiently friendly nurse. Waiting for the cheif surgeon to arrive, the nurse decided that I was a worthy visitor (I think sometimes the sheer asking of questions earns one brownie points) and began showing me patient files and surgery logs, all of which helped me immensely to figure out what was going to be happening that day. She also introduced me to a fistula patient being successfully discharged that day - the patient had received a congratulatory kanga from the hospital and was happily trying to see how the color suited her.

So by the time we were called to the operating theater, I felt a bit more confident. I'd felt rather unprepared going in that morning, honestly. Fistula surgeries are simply never done in the States, or taught in med school, because they don't happen to US patients. I didn't know the theory of the surgery, or how long one repair took, or what made a surgery more or less difficult, or any of that stuff. Maybe it's because I'm a slacker and any good surgeon wannabe would have somehow figured it out, but some of it must also be due to the absence of the surgery in the West. Why learn or teach what you'll never use?

This post now becomes a little tricky, because I want to talk about the surgery but I also don't want some of my more squeamish readers to get queasy. (I see you, Matt Rocklin.) Even in sterile medical terms, it seems a little indelicate to describe in great detail on blogspot. Plus it's a tough surgery in terms of dignity - these women are already dealing with strange men (because all the doctors were men) in delicate areas. They don't need me further chipping at their privacy via the interwebs.

So I'll try to describe things a bit more experientially. The surgeon, in the traditional Tanzanian style, was very late - 3 hours late, to be exact, meaning that we didn't get to half of the scheduled women. Such is the country. I spent the extra time looking on during club foot repair surgeries (8 month old with two full-leg casts = sad panda) and drinking tea with the nurses. As a peace corps volunteer here told me, Africa is all about waiting, waiting and chaos.

Once the surgeon did arrive, he made his way quickly into the theater, where his first patient had been waiting for him ever since her scheduled surgery time 3 hours before, reclining peacefully. I introduced myself and he nodded courteously, but that was essentially the end of our conversation for the day - neither surgeon made another effort to talk to me for the rest of the surgeries. I really haven't done much surgery shadowing in the US, but I gather that it's not atypical for surgeons in any country just to leave onlookers to their own devices, so I was fine to just observe over their shoulders as they worked. It's not a particularly tricky surgery, though it certainly requires a lot of attention to detail, and luckily it's not a tiny orthoscopic thing or anything like that. So one can learn a lot via silent shoulder-spying.

Academically, it's actually a rather clever surgery, I think. It essentially involves making a new wall for the vagina out of tissue that's already there. At the end, the surgeons even check their work, filling the woman's bladder with blue dye to check for even the smallest of leaks. Very thorough.

But I felt a little bad for the woman - she's awake the whole time, with just an epidural for waist-down anesthesia, and the surgeons/nurses never tell her what they're doing or try to reassure her. They didn't even introduce themselves to her at any point. And there are little things the surgeons do for their own convenience that seemed undignified to me, like temporarily sewing the woman's body in certain ways so as to be able to see better. I know she can't feel or see it, but...I'm not sure. It's hard to know what I should be offended by here, whether it's different than surgery back home. Not that surgery back home is always inoffensive either, of course. It's confusing.

But despite mixed feelings, I'm planning to go back tomorrow. I'll never get a chance to see these surgeries for the rest of my medical training, most likely, and I actually like the environment at CCBRT a lot. It's a hopeful place. Also hoping to continue my record of not passing out (yesssssss).

Parasite Unseen

One of my favorite classes in the Spring quarter was an elective course that my friend Katie G. convinced me to join. (Thanks Katie G!) I forget the actual name of the course, but it should've been called "Wow, Problems in Global Health are Really Super Hard". Or something along those lines. I loved that class, and not only because we managed to turn it into a weekly potluck. The prof did a great job of steering us away from the typical introductory global health discussions; instead of a class about how sad it was that all these developing nations suffered curable epidemics, for example, we'd talk about how epidemics actually happened - what made them grow, what made them self-limiting, and what that meant for the proper timing for any sort of intervention.

One of our best class discussions was about malaria - again, not the usual "Malaria is Bad" lecture, but a long conversation about whether certain malaria interventions were all that useful, or whether a hypothetical vaccine would ever even be able to wipe out malaria, given what we know about the disease. Really interesting stuff.

And I think about that discussion fairly often here. A significant part of my life in Tanzania is dedicated to the noble goal of Not Getting Malaria. 1) I spray myself in a vaguely bubble-gum-scented mosquito repellent around 7 PM each night, just as the little suckers start to appear. 2) I sleep under the bed net, every night, and am getting better at not thrashing around while I sleep and undoing my careful tucking of net under mattress. 3) And, of course, I take a big, electric-blue antibiotic pill every day in the hopes of protecting my liver from parasites. Because despite the first two measures, I definitely still get bitten - little pink spots all over, especially my ankles.

Taking prophylactic antibiotics every day does make me a little uneasy, but then, the prospect of malaria seems a lot worse. My American friend Teddy, who's been here for about a year, told me that he spent his first few months in Tanzania being sure he had malaria every time he felt the least bit queasy. "And every time, it turned out I didn't have it at all. So when I finally did get malaria, I initially thought to myself, 'Ok, well, I know it's not malaria. Made that mistake before.' And then they took me to the doctor. And then there are two days of my life that I can't remember at all."

So that's the aim, avoid having my own story like that. But the interesting thing is that native Tanzanian adults are pretty blase about it. When I recently visited my housemate Happy and asked whether she always folded her room's bed net so neatly, she confessed that she'd actually never used it since she moved into the room. "Eh." She's had malaria before. Yes, she gets it every few years or so. It's not that bad. And then I learned today that not one but two women at the office today currently have malaria, including our executive director. But, you know, they have things to do, they're not taking the day off for a little thing like that.

It sort of makes me feel like a wimp, really, all my drugs and nets and nervousness and they're shrugging it off like it's a headcold. Even if I know it'd be a lot worse for me, since I never had it as a child, I still feel like I ought to toughen up a bit. You can't even see this parasite, you know? How bad could it be? Suck it up, mzungu.

It's a savannah out there

I have a rather deep and abiding love for transportation systems, particularly trains (this earned me serious points on the Autism Quotient test!). While it's a bit of a stretch to call transportation in Dar a "system", I've realized slowly that there is a sort of fundamental code governing the daily chaos amidst which I walk home.

Also, in preparation for my father and brother's visit to Tanzania in mid-August, I have been reading a LOT of safari manuals, learning about the shyness of elephant shrews and antelope migration patterns and watering hole congregating during the dry season. There's a characteristic pattern to those books that I thought might fit my transportation post nicely. Thus, I give you:

A Field Guide to Transport in Dar es Salaam:

The Pedestrian (Impala) : So clearly the lowest rung in the hierarchy. Traveling around on foot in Dar is a constant excercise in not getting smeared by the next passing vehicle; it doesn't help in my case that I'm constantly confused about which way the traffic is coming (stupid British driving system). There are crosswalks, in the sense that sometimes white lines are painted across small sections of road, but these are actually death traps for unsuspecting wazungu who foolishly assume cars will slow for them. Pedestrians even move like impala - we congregate nervously in the medians of the big roads, hovering on the curb as traffic whizzes by, then leap gracefully en masse onto the asphalt when traffic slows, darting between vehicles. (There actually are traffic lights in Dar, which change color and everything, but relying upon them to actually stop traffic will only lead to sorrow. And smushed toes.)

The Bicycle (Honey Badger): Slow, strong, and tenacious. I love the way bikes fit into the culture here. There's no road or mountain bikes, of course - everyone's got a low-riding one-speed with big curved handlebars and a once-cushy seat. And, of course, the essential bike rack. My friends, it turns out that what we can carry on a bike rack is only limited by the scope of our imaginations. A bike is not a one person vehicle. No no, dear reader. A bike can carry at least three. It seems like every other cyclist here has a friend or family member casually riding along on the back, sometimes side-saddle but usually astride. Sometimes it's an older female relative, often it's a pair of 10-year old male friends, and I even saw a dad riding along yesterday with his little girl who could not have been more than a year old. She was completely cool. The diaper cushioned her ride.

And even if you lack a bike buddy, you can carry SO MUCH STUFF back there. Jugs of petrol. A five-foot pile of laundry. Two enormous baskets full of live chickens. A bundle of sticks that must weigh at least 60 pounds. And despite the crazy car drivers, the bikers seem so serene. They ride along steadily, in no hurry, wearing their typical collared shirts, trousers, and flip flops. (Most riders are men, though I did see a skirt flapping around a bike seat today.)

I've only seen this Biker Serenity break down once, which also happened to be the only traffic crash I've seen since my arrival. Many men use their bikes as mobile fruit stands, usually with two enormous baskets full of produce counterbalanced on either side. One of the other bike variations is the hand-powered bike, where riders with disabled legs/feet are able to sit in a low chair while pushing a chest-level set of pedals in a circle - very clever design, really. In any case, I witnessed a very slow crash between a fruit stand bike and a hand-powered bike. No one was hurt, but oranges were rolling all over the road and everyone was seriously grumpy.

The Bajaji (Hyena): This is by far my favorite way to travel in the city. You know that game Mario Kart? Bajajis are Mario Karts come to life and zooming around the streets of Dar. There's a 3-person bench in the back, a little canvas over your head, a total of three wheels approximately 18 inches tall, and no doors. I find it absolutely impossible not to make "vrrrrroooom" noises under my breath the whole time I'm riding in one, and I often end up giggling uncontrollably as we bump up and down over potholes. It's just hilarious.

The bajajis ("tuk tuks" in Kenya) generally like to lurk in packs near big intersections, hoping to pick up some fares from folks that would otherwise go to taxis (bajaji fares tend to be cheaper). They're scavengers, really. And their owners tend to deck them out in bright solid colors and soccer team emblems. Very festive.

The Car (Wildebeest): Big, ubiquitous, but kind of boring, in my opinion, though occasionally necessary when trying to get somewhere far away after dark. Cars get right of way over bikes and pedestrians easily, but often end up thwarted by daladalas. Lots of folks drive SUVs in this city, which I've decided is actually more of a necessity than a luxury; trying to navigate unpaved potholed streets in a sedan makes you just cringe for the undercarriage.

One funny thing: there are certain corners in town that have been designated official kituo cha taxi (taxi centers), and every time you walk by all the drivers will call to you, hoping you need a ride. What I didn't understand, however, was why some drivers offered me a "taks" when gesturing to their vehicles, rather than a "taxi". Linda the Kenyan finally explained it. In Swahili, every word ends in a vowel, and English words are often made Swahili by adding an "i" at the end - doctor becomes daktari, for example. So Swahili speakers often assume the English version of a word is just the Swahili version minus the "i" - hence, "taks". Apparently some people will also try to sell a soft drink called a "Peps."

The Daladala (Lion): Ah, king of the road! The daladala knows no natural enemy. I've written a bit about them before, but the basic idea is that daladalas form a semi-regulated, semi-private bus system for the citizens of Dar. Most are these beat up, 15-seat Toyota Hiace vans. They have both their terminal destinations painted clearly on the front, with the sides and back painted with whatever strikes the driver's fancy(I've seen everything from "Praise Allah" to a very detailed drawing of Spiderman). And then, shuttling back and forth between those destinations, they haphazardly pick up and drop off passengers along the way. It's a two-man operation: one man drives while the other man collects fares and leans out the open door of the moving vehicle, eyes peeled for potential riders. Two open-palm slams on the side of the van signals the driver to stop; another two slams and they take off again.

They also tend to be ludicrously crowded. It is often flat out impossible to scratch your nose in a daladala because your arms are truly pinned to your sides. It's really shocking just how many people can fit inside (or if not inside, at least on board - sometimes the door has to stay open to accomodate). Luckily these close quarters make it less likely that you'll fall down when the bus screeches to a halt. Usually you can't actually see where you are in the route, so you have to wait until the fare collector announces an upcoming stop and yell "Shusha!" if you want to alight there.

But hey, for 20 cents a ride, can't be beat. And there's nothing for that "among the people" feeling like a daladala, particularly in rush hour.

The Coach Bus (Elephant): The real buses (ie, not daladalas) tend to do their own thing. Rarely do you see them among the inner city traffic, but they're everywhere outside, migrating in long lines all over the country. Trains in this country are hilarious slow (if they were in this guide they'd probably be porcupines), so buses are really the only way for the non-flying traveler to go long distances. Most, though not all, entertain their passengers with a constant stream of loud rap music for the duration of the trip. Perhaps the thinking is that this distracts them from the lack of toilet.

And that is how I've been getting around. I do miss the El, but in the meantime this is pretty fun.

Guacamole. American as apple pie.

One month in and one full bottle of malaria pills consumed, I think I'm getting a better grip on my preferred lifestyle as an expat. On one hand, I know I'm too old to ever really identify as a native Tanzanian, let alone over the course of 10 weeks. There are certain things I'll always do a little awkwardly, certain absent foods I'll always crave (god I miss you cheese). On the other hand, I'm very wary of becoming one of those expats here who constantly swims against the tide to live a completely American/European lifestyle, complete with overweight pet dog, a high pointy fence surrounding the yard, and a total refusal to eat unfamiliar fruits. (How the last item is even possible is unclear. Guavas are like 20 cents a pop here.)

So this weekend was a bit about balancing these two aspects, the when-in-Rome instinct versus the born-in-the-USA! one. Saturday morning I putzed around the Indian quarter of town, window-shopping past the confectionaries on my way to the National Museum of Tanzania down by the docks. The museum is a rather odd little complex of buildings with a rather odd collection of items, ranging from bits of Tanzanian history (German tax collectors' strong boxes), a special exhibition on Tanzanian soccer (lots of shiny headshot photos), a biology hall (stuffed dugong in the corner - ugliest "mermaid" EVER), and a big collection of items from Tanzania's 100+ tribes. Last one was probably the best. Still, for the equivalent of $2, I'm glad I went.

And then Saturday night was probably my most Western night since I've come here: the Harry Potter movie and pizza afterwards with two of my German housemates, Nina and Magdalina. They're two of my favorite people at the house, really friendly and kind, who shame me with their perfect English and seem to be striking a similar expat balance to my own.

On Sunday I spent the earlier hours gathering food from street vendors (parachichi, nyanya, pasheni na mkate - avocados, tomato, passionfruit and bread). Something vaguely satisfying about buying your comestibles directly from a blanket spread over the sidewalk. After an afternoon beach trip with a few other housemates and their friends, the Germans and I attempted some dinner with my earlier purchases. No stove in the house, but we made some pretty good guacamole and then toasted bread to smear it on. Passionfruits for dessert. Not bad. I thought it was a nice, edible combination of the familiar and the new. Went to bed feeling all warm and fuzzy, my chi aligned with Dar es Salaam, and wasn't even that annoyed when the crazy rooster next door started his usual crowing at 4:30 AM.

Though there are, of course, some balancing aspects over which I have absolutely no control. For instance, the complete absence of running water in my neighborhood for the last 48 hours. Buckets are all well and good, but unlike my Kongwa hotel, our house is not equipped to function without taps. Really hoping that starts working again. Or, another example, my first attempt to see a fistula repair surgery this morning. Made it all the way out to CCBRT hospital only to discover that the surgery had been postponed due to the patient's contraction of malaria. Which had happened while she was in the hospital. Oof. We'll try again in a few days.

No way! Women doctors?!?!

So this is interesting. A whole blog entry on my feet and I completely forgot to mention the event that rates highest on the MAI (Mom Alarm Index). Not sure if my brain's blocked it out or gone into denial or what. But back in Kongwa, I spent several hours one afternoon walking on tilted, uneven concrete along the side of the highway, wearing a pair of very cheap flats that I pulled out to try to look presentable for government officials. Half an hour in I was experiencing these weird, twinging pains in the inner balls of my feet, but I just sort of adjusted my stride and powered through. That night, however, I realized that my both my big toes, down to the main inner joint, were completely numb. Aaaaaaand....that hasn't exactly resolved, three weeks later. The left is a little better - I think - but the skin over both big toes still feels like it belongs to someone else. I ran it by Dorothee, who's (almost) a German doctor, and she told me not to worry. So I shan't! I have become comfortably numb, as they say. Don't worry, Mom. They're just toes. I have LOTS of toes.

After a pretty slow week at work, I opted to spend Thursday at the Medical Women's International Association conference, hosted this year in Dar es Salaam by MEWATA, the Medical Women's Association of Tanzania. I'm glad I went, and not only for its hilarious motto ("It's Women Doctors!"). There were some really interesting presentations, for one: a lot of discussion about cervical cancer, which is significantly more of a serious problem here than in the States. Quite a bit as well about how to fight brain drain. And then a bunch of smaller studies that I probably wouldn't see at home - "At What Age Do Mothers Plan to Reveal Their Children's HIV+ Status to Them?", for example. (Answer: age 15-18. From the standpoint of preventing the spread of disease, probably too late. Interestingly, moms are also much less likely to ever even tell their female children.) Also managed to meet a very interesting woman working on microbicides; hoping to meet with her again. Good, interesting stuff, right up my alley.

And of course the other intriguing part is getting to see how a big, academic conference goes down in Tanzania. I feel like I've been to more than enough American conferences (my collection of monogrammed canvas bags is nonpareil) so I was comparison hunting. At first glance, you might see the individual water bottles at each seat, the dishes of mints spread along tables, and think the Westernization was complete.

But that would be mistaken. The rather casual approach to scheduling was a key divergence - by the end of the day we were running approximately 2.5 hours behind schedule (a significant improvement over the day before, apparently). There were also quite a few scheduled presenters who simply never showed up, leaving me to wonder sadly about whether flash heating breast milk really DID improve child health outcomes. A "comedic" presentation near the end of the day was definitely the weirdest powerpoint I've ever seen, and reminded me forcefully that I do not understand Tanzanian humor at all. I'll post it if they make it available, but suffice it to say that it featured photographs of a child licking a pig, Robert Downey Jr. flexing, Obama punching someone in the face, and topless women (not in a medical or anthropologic sense). And then, of course, I've found that most American conferences are tragically lacking in group singing and ululating. Tanzanian women have resolved this.

One interesting discussion I had with other medical students there involved the conference's seemingly heavy focus on breast cancer. On one hand, I don't like the idea of dismissing the toll of disease that kills a lot of women, or insisting that we shouldn't discuss one health problem until another one that I or someone else deems more important has been solved. One of my weirder social moments over this past month occurred during a conversation with a friend of a friend. About five minutes after our introduction, he asked what I'd been working on that day and I mentioned some of the statistics I'd been organizing for the Maternal Mortality and Morbidity conference. He actually cut me off, saying "Oh man, that's nothing. Do you know how many women are raped in South Africa each year?" and rattling off numbers. I was sort of trying to get my bearings, which I guess he took as awe, so he announced "I work in HIV/AIDS, you see." It was such an unsettling interaction. The sort of single-minded focus on one particular disease or condition, and the competition among different global health fields to establish their particular issue as THE important issue, can't really be good for any of us.

At the same time, four presentations about breast cancer just struck me as a little...premature, I guess. The average female life expectancy for Nigeria, one of the countries heavily represented at the conference, is only 47, and the rest of East Africa isn't much higher. About half Nigerian women won't ever get the chance to die of breast cancer, honestly. But I suppose US donations to build mammography and other screening infrastructure can't hurt, really. And maybe it'll just lead to everyone's ship rising. Not sure.

Agony of De Feet

If my feet survive their time in Tanzania unscathed it will be miraculous. Just thought I'd let everyone know. I am looking at them now, and though they don't complain much, I can tell they are pining for their former days of luxury treatment like socks. Tanzanian feet live rough-and-tumble little lives down there.

Naturally, of course, there's no reason to wear anything but sandals here - even at work, all the ladies just switch into fancy sandals. So the feet see it all, tripping over enormous rocks in the uneven street, getting stomped in daladalas, and generally ending each day in a not-so-thin layer of grime. It's the dry season here, so those roads that are unpaved (read: 90% of roads) are essentially just packed down dust. A couple times I've looked down and thought, "Geez, my sandal tan is getting out of control", only to discover that a significant part of that "tan" could be scrubbed off. Ew. (In Kongwa, where all the dirt/dust is a pretty red-orange color, I was sure every evening that my feet had gotten terribly sunburned.) Probably doesn't help that I'm traveling around in rather shoddy sandals, either. I already ripped the between-the-toes piece out of the left shoe once on Sunday and had to shuffle around for a few hours, a rubber band holding it all together, before I found a fundi ya viatu (shoe repairman) open on the Sabbath. (But it's ok, because the shoes are purty.) Maybe my callouses will eventually let me wander around barefoot. Something to shoot for.

The frisbee excursion was a bust - turns out there IS a Tuesday frisbee league, but only when school is in session. Bummer. I'll bide my time until August 10th.

I do my best thinking when completely deprived of personal space

Last night, in a rather masochistic decision given Dar's rush hour traffic patterns, I accepted an inviation to "Mexican food" at Sarah's home out in Mwenge. (I have to say, she did a pretty decent job. If you overlooked the fact that the chips were made of cassava rather than tortilla, you'd judge the meal almost perfectly TexMex.) The ride out took more time than I'd care to say. But at least as I stood crammed against the door of the outward-bound daladala, dripping sweat and watching us creep forward about a half mile every 20 minutes, I had lots of time to think.

First, I grumped to myself about Dar's terrible, awful roads. Putting aside the question of enormous potholes and paving and such, there's simply not enough road space for the traffic in this city. I'm sure the streets were laid out perfectly well when the town was thousands of cars (and millions of people) smaller. But the city quickly built itself right up to (and over) the curbs, and denizens nowadays are faced with a crazy situation where the main highway - the only route out of town, really - is a two-lane road. Traffic between 4 PM and 8 PM is both completely jammed and completely unavoidable; there's no other way to get home. There's a certain novelty to the ride for me - I'm still dazzled by the candle-lit road stalls selling bits of fruit and ugali and octopus - but if I had to make the commute every day I'd go nuts.

And it's hard to imagine how they'll fix it, really. I'm not an engineer, but I can't see how you'd turn the Morogoro Highway into the modern thoroughfare Dar needs without enormous upheaval. There are sprawling markets for miles right along the side of the street, with permanent stores and homes (when daladalas go off-roading, as is their wont, they often have to honk their way through throngs of shoppers buying that evening's dinner). I have a tough time imagining the Tanzanian government mustering the willpower to shut down and raze thousands of small businesses. And can you really ever close down your only highway, even for badly needed renovations? How will people get into/out of the city?

And then I thought about Tanzania's transportation problems in relation to its health sector problems. In the former case, there's clearly massively insufficient infrastructure. Not only do adequate roads not exist, but it's hard to see a clear plan for ever creating them. With the health sector, however, I realized I'm a lot more optimistic.

Perhaps naively, no doubt. I've actually been reading rather gutwrenching health statistics all day in preparation for WD's upcoming Maternal Mortality and Morbidity conference. Tanzania's one of the top ten countries in the world in maternal deaths - 1 in 24 Tanzanian women will die from complications of pregnancy or childbirth. (Compare this with the US's 1 in 4,800 or Ireland's 1 in 48,000.) More than half of women never make it to any sort of health facility when giving birth. And the birth-giving starts early and goes long: more than 50% of 19 year olds are either pregnant or mothers already, and the average number of children in some regions of the country is 7.4 per woman. (Fifth page.) And this doesn't even consider all the women who are injured or permanently disabled during childbearing. Oof.

BUT. While the health system is clearly not serving its women (or anyone, really) all that well, it doesn't seem to be at the same sort of complete cluster...fudge....as the transportation system. For one, the physical health facility infrastructure is actually pretty decent. The government is doing a fairly good job of peppering the country with basic health facilities, and in fact more than 80% of Tanzanians live within 5 km of such a site. The problem is not the facilities - the problem is the lack of resources, particularly human. The sorts of things I saw out in Kongwa and Chamwino - a lack of staff, or consistent electricity, or antibiotics - those struck me obviously dire but not insurmountable. I/Tanzanians/the global health community can think of lots of different ways to try to fix those resource gaps, even if we all know its easier said than done. Furthermore, unlike the roads, you can keep the health system going while you attempt to fix it, training staff on new procedures or buying new supplies or increasing starting salaries for nurses. Seems like a key feature.

So I guess my final conclusion, as I rolled off the daladala into a sea of bodies and food stalls and sidewalks bedecked with cheap plastic goods, was that the Tanzanian healthcare system seemed....not a lost cause. I realize that's not the strongest of praise. But the current system is a bit like those little divot-covered platforms they have at the Lego stores - not much to look at now, but with clear building potential. (My analogies are AWESOME.)

Might, just might, have discovered a Dar-based Tuesday frisbee league. Checking it out this evening. Fingers crossed.

I've got a fever, and the only prescription is MORE ULULATING

My fellow housemate Linda informs me that when you reach the latitude of the equator in Kenya, everyone likes to show visitors this neat trick where you put a leaf in a bucket on the northern side, watch it drain in one direction, then move 10 feet south over the equator and do the same thing, watching it spin the other way. Science! It works!

But I've decided that perhaps this hemisphere reversal accounts for my exceedingly poor sense of direction here. I spent significant chunks of Friday evening and Saturday day totally lost, wandering for hours on what should've been a leisurely stroll to my destination. Friday was particularly bad: I was minding my own business, out to do a nice loop past the Muslim cemetery and along Bibi Titi Mohammed Road before heading home, when suddenly I was magically trasported blocks away to the corner of Mnazi Nmoja park. Or that's how I account for it, anyway. Still no idea how it happened. I kept walking, trying to look like I was just where I meant to be, thinking I was heading home but probably going completely in the wrong direction. Eventually it got dark enough to make me nervous, so I executed the equivalent of a reboot, hopping onto a daladala terminating in Posta, the station just down the street from our house (though not at all on my original route). When faced with a new problem, reduce it to a problem you've already solved, right?

I tried to brush Friday's unintentional adventure off, but the fact that I found myself lost again on Saturday seems to indicate a more systemic problem. I've decided to attribute it to a combination of a bad sense of direction, the complete lack of street signs in most parts of Dar (not so important when there's no home mail delivery in the country), and a rather liberal sense of scale in my guidebook maps. And, of course, magic.

Sundays are strange days in Dar, when the throngs of working folks that stuff the downtown "sidewalks" (the dirt between the pavement and wide gutter) simply disappear back to their families around the outskirts of the city. It's like a 24-hour ghost town. So I decided to follow everybody else's lead and head out of the city. One of my hostelmates, Happy, invited me and two of the lovely German girls here along on her typical Sunday routine: Catholic mass in Swahili at the simple cathedral by the harbor, then out to her sister's for lunch. I honestly think I got a lot more out of the Swahili mass than the usual American English version; true, the sermon didn't sink in much (I got "baba yetu" - "our father"), but the music is just wonderful. We sat in the pews right behind the choir and got to fully appreciate the clapping and fish-shaped tambourines and swaying and non-Western harmonies and the truly unearthly sound of women ululating. (I desperately want to figure out how to ululate, but it seems rather rude to practice in a house with 12 other people trying to sleep. Maybe in Chicago. Won't my new neighbors be surprised.) It felt so much more like a celebration than American mass and I got a little dizzy and tingly after some of the songs, possibly because I stopped breathing.

Then into a daladala, truly the most crowded and most awesome way to travel in Tanzania. We drove 30 minutes out of town, all the way past the big crazy bus station, then leapt out of the van on sort of lonely stretch of highway. Happy's sister Grace and her two daughters live up an uneven rocky path from the road, left past the hairbraiding stall, under the power lines and over two small hills. We were greeted by Irene the 5-year old (running super fast!) and then Grace herself, beaming and carrying 6-month old Agnes. (Agnes is adorable, with these enormous eyes that sucker mammals everywhere into having offspring.) Lots of asantes and shikamoos and introductions, then into Grace's home, a pair of small but neatly kept rooms rented at very high city prices. She had already purchased enough Cokes and Fantas for everyone to have exactly two, and had cooked us all lunch on the little bit of sheltered concrete just outside her front door. We feasted on rice with meat and potatoes, topped with slices of huge, shockingly yellow bananas and avocados as big as grapefruits. Food was repeatedly foisted on us (Grace pulling sad faces and insisting "I cooked all of this for you!") so we ate like champions, settling happily afterwards onto the big red couch on one side of the room or Grace's bed on the other. We talked about Grace's work as an assistant nurse, pondered the differences between Iringa and Dar, teased Happy about her inferior cooking skills, all the while everyone in the room trying to be as polite and gracious and thankful as possible - the wazungu ladies trying to avoid any faux pas, the Tanzanian women trying not to make the wazungu ladies feel bad about their many, many faux pas.

As I sat, I thought a lot about what sort of gift or offer we could make in return; we'd brought cookies for the two daughters, but this seemed so insufficient for a woman who had made a bevy of complete strangers a huge, wonderful, homecooked meal and was working 80 hour weeks to pay her $50/month rent. It sometimes seems like such an overly fine line between expressing gratitude and unwittingly giving offense, between giving gifts and giving charity. There are so many lines I haven't yet learned to walk here, and this is one of the harder ones.

Happy belated birthday to my brother David! Hurray for palindromic years!

Lucky Numbers

There’s a certain place, deep in our brains, that I think exists solely to make us terrified of situations in which we will unexpectedly look like idiots in front of other people. (This is the selfsame lobe that produces all those “I’m at school/work and forgot to put on clothes” dreams.) You will all be pleased to know that this lobe is alive and well with me here in the WD offices, where I arrived on Monday morning to discover that not only was there a 9 AM office meeting, but that I was expected to speak first, discussing my recent trip. I did my best to sound analytic and coherent, trying to remember all the things I’d thought were important and noteworthy over the past 10 days; hopefully I didn’t come off too badly. There was some thoughtful nodding around the table, but as Christine the Executive Director had proclaimed at lunch one day, “if East Africans don’t agree with you, they will just cross their arms and keep quiet”. So who’s to know.

So Monday was spent with putting data into the computer and preparing for Wednesday’s board meeting. What I didn’t realize until Monday evening, however, was that Tuesday is actually a national holiday in Tanzania – good thing I don’t live alone or I would’ve shown up to an empty office the next morning. The day is just called “Saba Saba”, Seven Seven, for July 7^th, and seems to be some sort of celebration of the peasant (or possibly the farmer – even Tanzanians are a little hazy on this one). What it really represents is a day off for everyone in Dar to visit the Saba Saba fairgrounds, a huge expanse just out of town with all sorts of exhibits and markets and trade shows. Several people enthusiastically told me they buy all their buckets there every year. I’m not sure why plastic buckets are such a hot commodity, but there you are.

I had met a Kenyan-recently-living-in-Houston named Linda at my house the previous evening. She was in town for a few weeks on a public health project, and she and her professor had plans of heading to the fair the next morning. Certainly, I could tag along. So could the two Swedish med students who’d recently arrived. It’d be a party. And so that is how the next morning, 20 minutes after meeting Professor Sheryl, I was riding out in the back of her pickup truck on the way to the fairgrounds, mzungu hat firmly in place.

The Saba Saba fair was a hot, interesting, and very crowded place. There were hundreds of hastily constructed buildings and thousands of people, and the whole thing had was slightly jarring mix of the modern and traditional aspects of Tanzania. All the big cell phone companies had their own halls, naturally, and at one point we walked by a breakdancing exhibition, but we also made our way through a large warehouse space displaying crafts from each region of Tanzania: hand-woven Iringa baskets, dried Zanzibari spices, Maasai beaded jewelry.

The Maasai stand actually caught my eye, not because of the jewelry so much as something that the storeowner selling me my Zanzibar sandals had said. When I had tried to get a lower price, pointing to some missing beads on one side, he had countered that that was nothing; I could take that to any Maasai and get it fixed right up. I thought it was haggling bravado at the time, but I worked my way over to the Maasai lady running the stall and took off my shoe, pointing to the missing beads and trying to ask via gestures if they could fix it. She gave me a confident-seeming nod, grabbed the shoe and passed it to an older woman sitting behind her, gesturing for me to take a seat. The second woman quickly attacked the leather of my shoe with an awl and got down to work. Within 15 minutes, she handed me back the shoe – completely perfect. Every tiny little bead was in place, precisely color-matched. Most amazing fix job I’ve ever seen. And the whole thing costs me 1000 Tsh (~80 cents). I was delighted.

Since we were traveling with two little kids (the children of Professor Sheryl’s research associate), we also decided dropped by the zoo on the side of the fair. Ah, mistake. Everyone else in the whole of Dar had the exact same idea. I usually feel bad at zoos, worrying that the animals don’t have enough space, but as the size of the crowd surging by the pens made it entirely impossible to control one’s own speed, I felt reassured that the hyena and giraffe at least had way more living space than we currently did. Bit of a mob scene. (Linda and I eventually decided to flee the whole situation by climbing through a nearby fence.) Everyone seemed pretty exhausted after this point, so we headed back to the car, passing by quite a few people carrying stacks of enormous, brand-new buckets. Apparently they really are the thing to get.

There was one other incident, towards the end of the zoo visit, that allowed me to see firsthand something I’ve only heard about here. Being a thief in Tanzanian culture is a significantly more abhorrent crime than it is in the US; you certainly wouldn’t use the term lightly (for example, in haggling), and thieves caught redhanded face some pretty harsh mob justice – or so I’d heard. I’d never seen. But as Linda and I made our way towards the gate, we noticed an angry-looking security guard dragging a small, ashen-looking man by his collar in the opposite direction of foot traffic. Just past us, the guard punched the man hard enough to knock him to the ground, clearing the surrounding crowd, and proceeded to land ferocious kicks in the man’s side as he lay curled on the ground. People initially looked confused, though not outraged, and when an older woman next to me muttered “mwizi” (“thief”), the crowd simply murmured understanding and flowed around the two men. Sort of shocking. Going to stick with my plan of not stealing while I'm here.

Apparently Nane Nane ("Eight Eight", August 8th) is a holiday here as well. Expect future postings.

Consider me thoroughly unwound

What will I do when I can no longer buy a mango the size of my face on my walk home? The thought plagues me. A few more backlogged entries:

So when we last saw our heroine, she was heading north in the back of a hired Hiace Toyota minivan, wind blowing in her hair. It’s a long, winding road up to Kendwa beach along the coastline, with spectacularly blue water to your left and very jungley-looking foliage to your right, interspersed with the usual little shops and shacks and mobile fruit stands that line tourist-traveled streets all over Tanzania. Quite a dramatic change from the dry Dodoma interior. (If dust were valuable, Dodomans would live like kings.)

Travel was a little slow, partly due to the road conditions, but more due to the series of “roadblocks” set up along our drive. About half a dozen times over the course of our 40-minute drive we were waved to a stop by uniformed polisi, who sauntered over to casually chat with our driver in Swahili, suggesting that perhaps he’d like to donate a few dollars to the officer in order to guarantee our approved passage into the northern part of the island. One guy was particularly blunt about his bribe demands, beginning the conversation with an overt “Nipe changu” – “Give me what’s mine.” Apparently this is par for the course in a lot of parts of Tanzania: policemen place barriers in the middle of the big roads to slow traffic and indirectly demand money from any vehicle that looks like it might have shillings to spare. Drivers can either pay or agree to pay on the return trip; outright refusal eventually leads to license revocations or traffic citations for one of the many road violations Tanzanian drivers are always committing. I wondered if we should pay our driver extra in order to cover his “tolls” for getting out to Kendwa, but it occurred to me that this is not an unexpected phenomenon for him – bribes were already figured into his asking price. I’m pretty sure the whole “tip” system would make me crazy if I drove a car here (that is, if my decision to drive a car in Tanzania weren’t already casting aspersions on my sanity).

If my and Victor’s action-packed days in the interior were episodes of “24”, our time at Kendwa was straight out of “Teletubbies”. Laziness abounded. We napped in the shade of huts, pretended to read Important Non-Fiction Books before falling asleep again, played Frisbee, swam, and generally frolicked around the gorgeous beach. The biggest setback of the day involved our unsuccessful search for ice cream bars. (The humanity.) Everything comes at American prices on Tanzania, which is a bit shocking, but the whole place is so goshdarn pretty you’re willing to forgive it. Oh, you cheeky Zanzibar, you say, forking over the price equivalent of four Dar es Salaam meals for one small bowl of coconut pumpkin soup.

Because the scenery itself on the northern Zanzibari beaches is almost a cliché. The sand is perfectly white and very fine, making your feet look as if you’ve been dancing in flour when you finally return indoors. The water matches that “cerulean” Crayola crayon exactly (a favorite of mine as a kid), and as deep as we swam out, we were always able to see clearly to the bottom. The only thing assuring me that I wasn’t in a Corona advertisement was the presence of a) amazing foot-long sea urchins that washed ashore and b) an energetic pack of Maasai teenagers strolling up and down the beach in full traditional clothing (except, of course, for the ultrahip pairs of sunglasses they were all sporting). Every so often they’d break into jumping contests; apparently Maasai men like to compete by see how high they can bounce into the air, no running start, legs perfectly straight. It looked like fun.

In a foolish move Sunday morning, I left my trusty, ever-so-vulnerable flipflops alone on the sand while I wandered up the shoreline, trying out the various “Scene” features on my camera. By the time I returned they were long gone. So that was dumb. Pole sana. But perhaps I was just subconsciously looking for an excuse to buy a pair of the pretty beaded sandals all the women here seem to have. Back in Stone Town, before my return ferry, I managed to find the single pair in town that fit my big feet. (I’m a size 43 here, it turns out. Seems enormous.) The beading is a little wonky on one shoe, but I figured that was just a bonus point for haggling. My feet haven’t felt this pretty in quite a while.

My ferry back had billed itself as the “Sea Express” and apparently took its 6 PM arrival time very seriously – we were flying. Big, choppy waves did not deter our captain in the slightest. By about 30 minutes into our journey, the whole economy passenger class was doing that half-gasp, half-laugh, half-scream thing usually reserved for rollercoasters. (Quiet, you. I can have as many halves as I want.) I had a great time.

So Zanzibar totals: + 1 bathing suit, -1 pair of sandals, +1 pair of sandals, + 1 very relaxing weekend. A lovely way to spend July 4^th. I shall return to the office rested and ready to get cracking on my interview data.

To meet the Zanzibarbarians!

July 4th weekend!:

Feeling thoroughly ridiculous due to the amount of luggage I was carrying - overly stuffed suitcase, enormous bag of semsem, purse full of borrowed books, mzungu sun hat - I boarded the 6 AM bus out of Dodoma on Friday morning, choosing the illustrious Mohammed bus line entirely due to the fact that it was the first one leaving the city. But I was also feeling a little smug: I had correctly guessed which side of the bus would be getting the brunt of the sunlight and had accordingly found a seat on the other side, thus at least sparing myself the humiliation of having to wear my mzungu hat indoors.

Riding a Tanzanian bus alone is a much trickier proposition than riding in a pair. Sure, you have to take your luggage with you whenever you leave your seat, but the bigger problem is trying to figure out when you can leave your seat. The average Tanzanian bus stops approximately once every 25 minutes, sometimes for 5 seconds and sometimes for 15 minutes, and I never had any idea what kind of stop we were involved in. Thus, after an alarming incident early on when I ventured off the bus in search of a bathroom and then had to immediately leap back through the door as the driver began to pull away, I decided it would be best to stay glued to my seat for the six-hour duration of the trip. Not the most comfortable, but at least me and my luggage arrived together.

For I was going to Zanzibar! In a classic example of the open-arms welcome I've received from most expats here, my brother's friend Teddy had invited me on a group trip to the "-Zan-" part of Tanzania, where we could celebrate July 4th with a traditional American meal of cinnamon tea and coconut-infused octopus. I dropped the main bulk of my luggage in Dar and headed down to the ferry docks, armed with only a svelte little backpack and a vacation mindset.

I've decided that I love Zanzibari ferries. Both my rides to and from the island were really fun (foreshadowing!), and the ride out was particularly delightful because they showed "Congo" during the trip. I don't know about your family, but I'm pretty sure my brothers and I watched this B-/C+ movie about 80 gazillion times when we were little. I'm not exactly sure why we loved it so much, but we did. It was great to see it again, marveling at Tim Curry's ludicrous "Romanian" accent and trying to figure out what Laura Linney is doing in the cast. Vacation had truly begun.

Teddy met me at the docks ("You'll recognize me - I'll be the white guy") and introduced me to Gene, Kai, Mark, and Sarah, our fellow vacationers. They were very welcoming and friendly, even when I managed to clumsily fall backwards out of my chair into the sand within about 20 minutes of meeting them all...just the smooth entrance I was hoping to make, really.

We sat on the sandy wharf sipping "dawas" (the Swahili word for "medicine", a lime-vodka-honey combination that supposedly cures all your ills), then moved on to an in-home restaurant called "Two Tables", where a little woman serves guests in her small dining room, with just enough space for - you guessed it - two tables. Delicious food, making full use of the nearby Zanzibar spice plantations. We had some tea while overlooking the harbor, then returned to the beach and sat around a sand pit fire until the wee hours, figuring out how to translate classic rap lyrics into Swahili. (Kai's literal translation of one of Teddy's attempts: "I have 99 challenges but my woman, she is not.")

Most of our group had already visited Stone Town, Zanzibar's main city, on previous trips, so we were bound for the northern beach of Kendwa the following morning. I'd left my bathing suit in the portion of my luggage locked away in WD's offices, so I spent early Saturday perusing the Zanzibari options. Probably to the future dismay of all Kendwa beachgoers, I ended up with a cheap but rather skimpy black bikini; apparently the Muslim influence on the island doesn't extend to swimwear. I headed back to the hotel, wondering if I could somehow just dip my whole, pasty body into a vat of sunscreen, Achilles-style.

(I put up some new pictures, by the way - now that I've finally reached posting about Zanzibar I figure I can reveal the corresponding photo album. There's one for Dodoma region, too.)

Open, Semsem

Getting close now:

One last half day out in Kongwa region. I've been very happy during the past two days in Kongwa, both in terms of the work we were doing and the people we were able to interact with. Today only drove that home a little more - I'm a little bummed to be back in Dodoma after what feels like a very short visit.

Armed with a sturdy vehicle packed to the brim with boxes of medical supplies, we headed out with Mama Elizabeth on a distribution run, trying to beef up the resources of some of the local sites. First, however, we made a special stop that I hadn't anticipated. Directing the driver to a roadside stand out on the edge of town, Mama Elizabeth had a quick chat with the stand's owner and then accepted a heavy plastic bag from him. As we drove off, she turned and plopped it into my lap. "Semsem! For your vegetables," she announced.

This was quite a surprise. The evening before, it had come up that I was allergic to both peanuts and cashews, both of which are used for cooking oils here. Both Victor and Mama Elizabeth had agreed that semsem oil, made of crushed sesame-like seeds, would be a good solution for me. But I'd completely forgotten about that covnversation until now, as I examined the 10-lb bag of seeds on my lap. "Asante sana!" I returned ("Thanks so much!"), not exactly sure where I'd be able to use this stash but touched that she'd worked out this delivery for me. It's a pretty great first Tanzanian gift, I think. Even if I'm not sure how I'm going to get it back to Dar.

Semsem safely stored, we stopped by two dispensaries to drop off drugs and supplies, sort of like Santa Claus if he operated out of a Toyota pickup truck. The second dispensary happened to be in the middle of a newborn weighing event, with many mothers and infants queueing around a scale dangling from a nearby tree branch. Babies were hoisted one by one into the sling to spin around sloooooowly, trying to figure out what was happening, before being recorded and reclaimed. Probably the cutest picture I've ever taken.

We moved on to one final health clinic, which was notable for the clinical officer's suggestion that her staff needed training to help treat complications of abortion. Abortion is mostly illegal in Tanzania, which of course means not that it doesn't happen but that we have very bad data on how often it happens. There is a girls' school near this particular clinic, so they are faced with the consequences of botched abortions perhaps more often than other clinics we'd seen. Victor noted this down, though it's unclear what WD can do on this front - hard to run a training session for something that isn't supposed to be happening.

Our last stop was a private health facility, of all things: the Catholic-run Center for Disabled Children, high atop a local mountain road. After all the public facilities we've seen, this one looked simply spectacular. They had plenty of staff. They had physical therapists. They had wheelchairs for all the kids. They had a beautiful, spotless operating theater. They had a wheelchair-accessible pool, for Pete's sake. (Not that it actually had water during the dry season, but still.) Music was playing, walls were painted cheerful colors....I think I'd gotten so used to certain facility standards during this trip that I was sort of shocked by what a clinic could be here, given sufficient money. There is wealth here, just not so much with the Ministry of Health (or at least, not doled out by the Ministry of Health.)

Our passage back to Dodoma involved with leaping aboard one of the coach buses that zoom through Kibaigwa. Most buses slow down for approximately 30 seconds, just enough time for passengers to buy water or cashews or giant bags of potatoes from their windows, then careen off down the road. On our third try, Victor and I managed to stop a bus long enough to stuff our bags underneath and leap aboard, just as it pulled away from the curb. Fun adrenaline rush.

I took Victor out for dinner for my last night as his tagalong research assistant; we feasted on ugali, vegetables, beans, rice, and Safari beer. (I tip my hat to Tanzanian food for being emminently edible. This sounds like a backhanded compliment, but is actually very reassuring in a country where you never known what the next restroom will bring.) It's been good tagging along with him and I'll look forward to seeing him again in Dar. Sort of sad - who will give me little lists of Swahili words to learn now?

All the single ladies! (All the single ladies)

Still backlogging. Have newly vowed to get my blog act together:

Really satisfying day today in Kongwa. Lots of sites, lots of interesting stuff, and really great interactions with folks, particularly womenfolk. Let us begin.

We started the day visiting the district hospital in Kongwa, a sort of sprawling compound in which wards and other buildings are separated by outdoor covered walkways, exposing you to fresh air and sunlight and road-crossing chickens on your tour. A very pleasant setup, really. It probably wouldn't work in a freezing place like Chicago, I know, but it's nice to at least know an alternative exists to our enormous monolithic American hospital buildings. Mama Elizabeth was completely in her element, zooming in and out of wards, chatting with everyone, showing off all the hospital features. It's inspiring to see the clever use of limited resources here - if your town doesn't always electricity during the day, by golly, you just do your surgeries at night. Or, instead of enlisting an expensive and unreliable electrical dryer for your surgical scrubs, you hang them outside the operating theater to dry in the breeze. I think my tendency is to assume that low income medical facilities simply can't provide many services that we richer countries can; that's true to some degree, but sometimes they just pull off the same feats in a much more efficient way.

A long ride later, we met with the all-female staff of the Pandambili dispensary, a little building on the side of a rocky outcrop near the Dar-Dodoma highway. I was doing my best to follow along during the interview, peeking over at Victor's notes, so it wasn't until I was working with the nurses and medical attendants on my supplies checklist that I realized how incredibly friendly they were. (I'm beginning to think that in many rural spots, the default assumption upon meeting a new person is that you will get along swell; if you don't do anything to disprove that, you have a quick bunch of new friends.) So despite my clumsy Swahili, all four women were extremely welcoming, asking about my life in the US, insisting that I stay in Pandambili longer, programming all their numbers into my cell phone. Victor thought the whole thing was very funny. I was rather charmed by the whole experience and vowed to send them all text messages as soon as I could think of something reasonable that I could send in Swahili.

Then on to a second dispensary for more interviewing. Waiting for the car to return afterwards, we were witness to a sort of tragic-comic vaccine assembly line. About 20 moms and their babies were in a single room, waiting for the nurse and her needle to swoop by. The little babies sat on laps, not a care in the world, thighs ready and exposed, until the nurse made her way over and gave them a quick and efficient shot. Like clockwork, each baby burst into indignant howls as his mom quickly bundled him up and headed out the door; the other babies watched with bemusement. "What's wrong with THAT guy?" they wondered, as the nurse made her way ever closer.

Waiting for Mama Elizabeth later, Victor and I wandered around through Kibaigwa, a little town based right on the edge of the Dar-Dodoma highway. We ended up in a dark little bar, watching the Bunge proceedings on TV, and were quickly greeted by the barmaid, who looked to be the sole woman in the whole place. After serving us, she plopped herself down at our table, looking delighted to have such exotic company - a refined-looking fellow like Victor plus a mzungu lady! She and I chatted with Victor's help for about half an hour, her helping me along by miming Swahili words (charades skills come in useful again!). Again, her attention seemed very genuine. She wasn't angling to get us to buy anything, or make connections, or figure out what we could do for her - just wholeheartedly curious about how we had wandered into her bar.

An almost identical thing happened with our waitress, Flora, that night. After bringing Victor and me food (there was only one menu option - made the choice easy), she decided to sit with us as well, chatting and making her way through bottles of Tusker beer. She had an easy, giggly laugh and seemed happy to have companions; the place was pretty slow. Conversation initially went entirely through Victor, but when I broke out my halting Swahili for "We went to the International Corn Market today" (it's true, we did), she exclaimed, "She can speak!", proceeding to direct very slow and easy questions my way. Good times. Everyone was a little sad at the end of the meal that it was our last night in town. We tried to buy her a Barack Obama kanga at the store across the street (she'd expressed envy of the one I'd gotten the evening before), but to no avail. We invited her to come visit in Dar.

Back to Dodoma tomorrow, that toddlin' town.

Adventures in Bathing, Sitting

Still backlogging:

A few months ago, back in Chicago, I made a list of simple, easily-learnable skills that I clearly should have but lacked. Driving a stick shift was on there. Also knitting, using a sewing machine, whistling really loud through my fingers, double-dutch jump rope, and a few others. I've been making slow progress down the list since then, trying to beef up my pitiable practical skill set.

It was revealed to me this morning that this skill set might be even more feeble than previously realized. I had noted yesterday upon checking in that my room's bathroom featured the dreaded squat toilet, which seems to me to require yoga master levels of balance. What I had not noted, however, was that the hotel lacked any sort of running water. This fact was cleverly concealed by the presence of three taps in the bathroom, which I will kindly assume were placed in anticipation of future running water rather than simply to mislead visitors.

So then, this morning, I was posed with the question of how, exactly, to get clean. (Or at least acceptably close.) I faced an array of three buckets of water. Buckets 1 and 3 had been sitting out since my arrival the previous day and contained chilly, early-morning temperature water. They were different sizes - 3 was bigger, with a wider brim - and seemed to have been carefully positioned. Clearly there was some obvious method implied here that was completely unknown to me. Bucket 2 had arrived this morning outside my door, full of recently boiled water and still steaming as it sat in front of me on the tiled floor. Also present was a mini bucket with a pour handle, about the size of a sandcastle mold that kids use on the beach.

Obviously the time for asking for some sort of guidance had long since passed. Not only was I not going to ask my 65-year old male coworker for advice, but the very need to ask for guidance was embarassing. People had done this for centuries. How could I not know? So consarnit, I would figure it out. I am 26 years old. This couldn't be that hard.

But I didn't even know where to start. Was either bucket 1 or 3 waste water? Was I supposed to actually stand in bucket 3, the wider one positioned almost exactly beneath the non-functional showerhead? Did my lack of washcloth hinder me, or was one not actually necessary? Did I really have to choose between chilly water or scalding water, or could I mix them? If so, how? I tried dipping a corner of my towel into bucket 2 and dabbing rather ineffectually at myself, but the water was still so hot that my body dried in the time it took the towel to cool between dabs.

I hadn't felt this incompetent in a long time, possibly since I had to ask my roommate Adrienne how to boil eggs when I first moved to DC. Between the toilet and the bathing, this bathroom was nothing but a series of blows to my ego (and hygiene). I eventually gave up on the hot water and turned to bucket 3, thinking that perhaps I could just splash the cold water onto myself, soap up, and resplash. That seemed like it'd be quite a mess, but I reminded myself there was a drain in the bathroom floor - clearly some sort of mess was expected.

Using my patented Splash Method, I managed to get my arms and legs "cleaned" and moved onto the problem of my hair. I decided to cut the hot water a bit by adding mini-bucketfuls of cold water, making bucket 2 tolerable, and positioned myself for head dunking. As I hunched there to dip my head into the bucket, naked and upside down, I thought of how glad I was that the bathroom door at least had a lock.

Hair wetting and shampooing went fine, but rinsing was a failure - turns out it you can't really desoap by dipping hair into already soapy water. Finally, I just grabbed the minibucket, filled it with hot water and dumped the whole thing over my head. This, I can tell you, felt awesome. I emptied the whole of bucket 2 this way, giving myself a sort of uneven hot shower, and I suspect this is what I was supposed to do all along. C'est la vie. I'm not sure how clean I actually ended up, but at least I was warm and vaguely presentable, with dignity mostly intact.

Adventure!