Nyumbani

Four time zones, three flights, two Tube rides and one terrifyingly late taxi later...I am home. Back to my toddlin' town.

I will write a bit more tomorrow, when I can remember what day it is and where I woke up more clearly. The absent weeks were spent adventuring with Dad and Alex in the Serengeti region (heck yes we saw elephants!) and Zanzibar (during Ramadan, no less - daytime water is for the weak). The trips were excellent - really amazing parts of the country, truly. Good photos to share.

But now I have to try to begin adjusting to my new apartment, where my room is full of moving boxes and the sound of TV seems terribly jarring. I'm a bit discombobulated; it took me a good two minutes to figure out where I was and what was going on after my nap this evening. Hopefully all will seem more reasonable in the morning.

Karibu, Baba na Kaka

You know that feeling you get when you think you've reached the botton of the staircase, but there's actually one more step? And you experience a half-second terrifying shot of adrenaline before hitting the ground?

That deeply unnerving feeling of having the ground briefly disappear out from under you - that's sort of like what my Dad and brother went through 48 hours ago. (Although theirs was much more expensive.) Approximately 20 hours before they were planning to depart for Tanzania, my brother Alex realized that instead of buying plane tickets for the first leg of their journey for Wednesday, he'd actually gotten the same flight for Thursday. Which meant they'd be 24 hours late to London. Which meant they'd miss all subsequent legs of the trip to Dar es Salaam, including the flight to begin our safari on Sunday morning.

Instant terror adrenaline surging on all fronts. They tried to just move the flight up a day; Continental said no. (Or rather, no unless you give us $6000.) They tried to buy a one-way flight to London in order to be on time for their second flight; Continental said their policy is to cancel the return tickets for anyone who doesn't check in to their outgoing flight. It is now 8 AM on the day they must depart.

Long story short, they had to buy brand-new, day-of tickets to get to London in time, stopping in Canada on the way. Oy. But they made it! Picked 'em up at the airport this morning and then let them go straight to bed. (Although I did wake them up to have them eat lunch at the office with us. Everyone said we looked alike. "You all have merry faces," announced Christine. "You smile from your hearts.")

Another day of jet lag adjusting tomorrow (and of course the Dar es Salaam annual charity Goat Races in the afternoon), then off on safari on Sunday. Send me an email if you want me to bring you back a baby hippo.

You gotta fight for your right to...go to clinic

Good God. I promise to never complain about my commute again, even when it's -17 degrees and I'm trying to bike over the ice to school.

For I have seen the Posta-Masaki daladala on a weekday morning.

It is completely and totally out of control. I've had fairly good luck getting out to CCBRT before via the Posta-Masaki route, but I think before yesterday I've been riding a little after the peak of rush hour. The number of buses on this route is completely insufficient given rider demand, so big groups of people are already running alongside the bus as it pulls up to the Posta station, masses of hands clutching at door frame. People inside the bus trying to disembark have to literally fight their way out - I saw one woman actually get trapped inside the bus by the entering mob, unable to get out the door. As soon as (most) people inside have exited, the door hangers (mostly young men) go absolutely nuts, shoving each other and throwing themselves up towards the door in an attempt to get on board, giving no quarter to kids or the elderly or small women also trying to get in. Particular tenacious teenage boys jump up through the open back windows. A huge chunk of the waiting crowd is always left behind (usually those unwilling or unable to shove), hoping to wedge onto the next one. It took me three tries to board a daladala yesterday (I think the trick is to come at the door at an oblique angle). It'd be funny if you didn't have somewhere to be, but if I had to do that everyday on the way to work I'd go crazy. Or I guess maybe I'd start shoving.

But I finally made it to CCBRT hospital again in the morning, probably for my last visit. (Though maybe not - I feel rather welcome and wanted at this point, so much that I'm considering visiting on the day before I fly home. The nurse gave me a hardboiled egg yesterday! Nothing says appreciation like a hardboiled egg. We'll see.) I arrived mid-ward rounds again. Dr. Robert greeted me by announcing that several women were leaking urine that morning - he termed it a "disaster" but didn't strike me as that concerned. Later patient file review seems to indicate that leaking is not that uncommon for fistula patients that later experience full recoveries. Ward rounds are kind of funny: Dr. Robert kind of acts like a sardonic uncle figure to all the patients. At each patient's bed he cracks jokes, mostly making fun of her, and she and all the other women giggle. It's like The Today Show for the fistula ward.

After ward rounds, Tuesday clinic commenced. Last Tuesday I was surprised that only one true fistula patient showed up; this time, there weren't any true fistulas at all. Or at least no clearly obvious ones. But I do think that the kind of women who end up at the clinic give a sort of representative snapshot of life as a woman in Tanzania. At one end of the spectrum was an 80-year old woman who arrived with her two daughters, incontinent and a bit senile but clearly well-cared for. The nurse noted quietly to me, "Look how much those two ladies love their mother." Seemed to be true: their mom was confused, stubborn, and clearly feeling the pangs of a hard-lived life (her permanent hunch made her about 3'5" tall), but the good-natured daughters kept her clean and rather sharply dressed. At the other end of the spectrum was a 10 year-old girl with painful urination; it was unclear to all involved why she'd been sent to the fistula surgeon. Off to urine analysis she went.

Then, in between these two extremes, we saw two women of childbearing age whose main problems had actually been inflicted by the Tanzanian medical system. One woman, complaining of incontinence, had obviously had some massive surgery in the past. She wasn't sure what the doctors had done, but the scar on her abdomen was enormous and Dr. Robert pointed out the marks of at least three drains on her belly. "In these cases, we have a song," said Dr. Robert. "You know 'Return to Sender'?" So back she was sent to her original Kilimanjaro hospital. The second woman was suffering uncontrolled urination after her delivery in a Dar es Salaam hospital three weeks ago. The C-section scar was clearly fresh - so fresh, in fact, that the nurse discovered a bit of suture still in the skin that the doctors had simply forgotten to remove. That's hygenic, I'm sure. Oy. Dr. Robert suspected that her problem might actually be due to the C-section itself: every so often doctors will detach the ureters during a C-section surgery and reattach them in the wrong place, leaving them to drip urine into the abdominal cavity and causing incontinence. The problem is technically considered a type of fistula and can be repaired at CCBRT, at least, but she'll need more tests.

And finally, the dye tests. Dye tests are the moment of truth for fistula patients: after two weeks of post-operation rest, their bladders are filled with bright blue dye to see if there's anything leaking out. Two ward patients were up yesterday. One was a success: no blue leaking, even with pressure, so when she fully heals she'll be on her way home. The second, sadly, was a no go - bright blue dye came seeping through her stitches almost immediately. She'll have another two weeks of waiting around with a catheter in hopes that things will spontaneously heal. It seemed very unfair, particularly for this woman: she's 30 years old, but it's clearly been a hard 30 years. She looks to be in her early 50s. And she's all alone - the one child died during childbirth, and her husband left. She deserves some good luck at CCBRT at least. Fingers crossed.

Ladylike

Perhaps fittingly, my last weekend in Tanzania before the arrival of my dad and brother was a supergirly weekend. Yet supergirly in a distinctly Tanzanian way, I think.

For one, I went to a tailor. A tailor! The anti-Target. I've never had anything tailormade; it always struck me as simultaneously glamorous, old-fashioned, and entirely out of my price range. But the majority of women here have at least a few tailormade outfits, usually a fitted top with short sleeves and bum-hugging long skirt to match. Almost all are made from kitenges, these durable and super colorful fabrics you can buy in 6-meter swaths (minimum length) from jampacked little stalls just east of Mnazi Mmoja park. The purchasing process alone is a lot of fun - lots of sifting through bright patterns and feeling up material and hemming and hawing over whether this one is just the right one for you. (All the salesladies have opinions.)

Back in Kongwa, Mama Elizabeth (the Reproductive Health coordinator) had lent me a shawl with a really pretty cowrie shell design all over it. The same fabric popped up again a month later, for sale in a narrow little store on Uhuru Street, so I decided it would be mine. Hoping to get a simple dress made, I took the fabric on Saturday to an equally narrow tailor's shop deep within the complex of stalls near the Morocco gas station. The tailor didn't speak any English but seemed rather enthusiastic about the project. We'll see how things turn out on Thursday. Adventure!

If girliness includes clothes, it must also include hair. But luckily, not my hair. Nina and Magdalina had decided a week or so ago that they wanted to try out a specific style of tiny braids sported by lots of women in the city, including our housemate Happy. This specific style is actually a traditional Maasai style - in fact, it's the traditional Maasai men's hairstyle. (Maasai women go bald while the men sport long, waist-length braids. Interesting gender reversal.) But it's non-Maasai Tanzanian women who want their hair done, not with the traditional beads and stuff but with the hundreds of tiny braids. Thus, quite a number of young Maasai men in Dar make their living by going to private homes and spending a few hours braiding ladies' hair.

So that's what I came home to on Friday and Saturday: one German girl cross-legged on the porch positioned between two twenty-year old Maasai guys, her hair being heartily yanked back and forth as they steadily twisted and spun and pulled it, all the while smoking cigarettes and drinking Konyagi. (That stuff is seriously foul.) It took them - I kid you not - 7 1/2 hours to do all of Nina's hair. Oy. Magdalina got away with only 6 hours, lucky girl.

But after the men headed off back into the city, the girly part took over: all of the women of the house, which I think included at least five countries, helped out by braiding the braids and dipping them in hot water to seal them in place. All of the boarders, plus the house matrons, plus a few of the house matron's visiting sisters - everyone pitched in. It was good times on Kibasila street.

And despite residual two-day headaches, Magdalina and Nina look pretty nifty. When they first made their plan, we three talked how Europeans and Americans tend to view braided hair on white women with disdain, as a sign of wannabe-Africanness. It made them a little reluctant to go forth. But now that it's done, it seems that all the African women here think it looks fabulous on them. Walking around with Magdalina yesterday was really fun, with random strangers on the street continuously shouting "Unapendeza!" ("You look nice!") at her. There's no way I'd ever do it (7 hours? I can't even sleep for 7 hours without getting a little bored), but I'm happy to be associated with them.

Last week of work. Dad and Alex arrive on Friday morning (and have already been invited to lunch at the office). Looking forward to adventuring with them.

This post is worth 1000 words

Put some new photos up on Picasa, including the marvelous zebu cattle and the Pugu Forest Reserve that wasn't:

http://picasaweb.google.com/colleen.denny/

There are some various and sundry recent photos also up there, from Bagamoyo and such. Fancy cameras I have none, but some of them turned out fairly well, I think.

The first data fix is free...

Quick afterthought post for all you data junkies out there:

I'm researching this week about child marriage and its relationship with maternal morbidity and mortality. Turns out that 14 year old mothers aren't a great idea, healthwise (and probably many otherwises.) Go figure. But check out the UN Data on legal age of marriage throughout the world:

http://data.un.org/DocumentData.aspx?id=126

I think that a couple countries are tied for the oldest minimum age, with the groom needing to be at least 22. Please note the "exceptions" column for Trinidad and Tobago, where the minimum age for the bride (with parental consent) depends on whether you're Muslim (12 years) or Hindu (14 years). Also, apparently there are US states where you can marry off your daughter at 13 with parental permission. I am disturbed.

Meat and Greet

There is a place of legend in northeastern Dar es Salaam, a place whose very mention seems to cause uncontrolled salivating in a large percentage of both the local and expat population. That place is known simply as...Morocco Burgers.

The actual set-up for Morocco Burgers is quite humble. There is, for example, no official sign; "Morocco Burgers" just becomes the default name due to its location near the Morocco daladala stop and its single menu item. Nor is there any indication that food of any sort is available within. You just have to know. Burgers are served from inside what looks to be an old train car, painted bright red and permanently parked in the back lot of Morocco petrol station. There is no place to sit or eat (save the concrete curb), no posted prices, and no speaking of English, but the place smells unbelievably good and I've never been there when there wasn't a waiting line. (Or rather, a waiting cluster. Tanzanians don't really do lines, per se.)

I was rather shocked by that delicious aroma when I first passed by Morocco burgers (sadly, on my way to dinner elsewhere). I've been a vegetarian for about three or four years now, and I don't really miss meat - I never ate it that much to begin with, and the smell of meat cooking is usually something I can take or leave. But goodness. That scent eminating from that little red box reminded me of those Saturday morning cartoons, when a good smell becomes a pair of long fingers that tickle the character's nostrils and float him through the air towards their source.

Despite the vegetarianism, I decided before coming here that I would be content with eating Tanzanian meat. For one, I (correctly) figured it'd be a significant part of the culture that I'd be missing out on. For two, I reasoned that the animals that become food in Tanzania tend to live happier, more animal-like lives. There aren't any factory farms here, or feeding of antiobiotics to livestock, or any of that stuff that freaks you out in "The Omnivore's Dilemma." Your typical American cow would never see anything as wide open as the Pugu Hills cattle market, but it seems that most cattle here take such big expanses for granted. In fact, my daily living space in Dar intersects with that of livestock fairly often - there was a rogue chicken in our courtyard last night, for example. Goats are kept in front yards. Daladalas swerve to avoid cows on the roads. The urban arena probably isn't the most salubrious environment for them, but it reassures me that animals raised for food in Tanzania at least have room to move. And that simply makes me feel better about eating them.

And then for three, I suspected that it might be considered rude not to partake in meat - or if not rude, exactly, at least one of those things that would be a weird, white person thing to do. This turns out to have been mostly correct as well. The typical Tanzanian meal is: green veggie, non-green veggie (bananas count), and meat with sauce, all dumped over rice. Fruit is always served for dessert. If I try to order this combo at a Tanzanian restaurant without the meat centerpiece, I am met with consternation. Am I sure I don't want meat? How about chicken? Or fish?

This same combo has been my lunch at the Women's Dignity office every day that I've been here, and although the exact identity of the players changes, the basic line-up is always the same. And the sassy mama lisha who serves our food, Mama Salma, already intimidates me. There's no way I'd dare to tell her to hold the meat. Not a chance. Telling her to hold the china (a spinach-peanut thing to which I am allergic) was already scary enough. Man, did I get the Eye.

So I have been making my way through a fine variety of meats at work lunches. And I haven't been sick at all, though I do get a little grossed out every so often. Chicken and fish are pretty easy, although eating them always involves handpicking the edible bits out from the bones and skin. The chunks of beef and goat are a little harder to stomach - they're no longer on the actual animal carcass, but big bits of gristle and often bone are still attached. Luckily, I haven't yet found myself presented with octopus at work. Octopus is fairly common here - it's on sale from street vendors all over Dar, with little orange tentacles dangling over the edge of their trays. But putting aside the wisdom of eating raw octopus from a street vendor, I think my love of cephalopods may be just a little too great to eat one of their numbers. We'll see if the situation presents itself on Zanzibar.

No, the only meat of Mama Salma's that really throws me off is liver. Liver is my food nemesis, I've decided. The smell is disgusting. The texture is way too homogenous (I thought I was eating a mushroom on my first bite). And the taste is somehow both bland and sour, vaguely menacing, just a little too similar to the taste of blood in your mouth when you bite your tongue. Ick. Yes, liver is gross. I've taken to hiding it under napkins or papaya rinds when it comes through the rotation, so as not to incur Mama Salma's ridicule.

Aside from the vile liver, I think my summer meat adventure is going fairly well. But I still expect that when I get back home, I'll switch fairly easily into my old veggie ways. The things that pushed me into vegetarianism in the first place still hold, to the point where I notice that the things that particularly ick me out about meat are the things that remind me that it's meat - gristle, bone, skin, the things that tend to be absent in American meat. I figure that if I don't like eating the parts of an animal that remind me it's an animal, that's probably indicative of some sort of internal denial.

So last night Johann, a dutch fellow housemate who works out near Morocco, kindly brought us all back burger dinners. I haven't had a burger for two or three years, I think, and I have to concede that my meal was pretty darn delicious. And if that's the last burger I have for another two or years, by golly at least I went out on a good note.

I think I shall make my future clinic staff call me "Dr. Colleen"

Just after I posted the last entry, my office rat reappeared! He scuttled out of the closet and miraculously wedged his chubby little body under the door to the hallway. I'm not sure what his presence means for the hygiene of our nearby kitchen, but at least I feel reassured about opening the closet again.

Spent the morning at CCBRT's fistula clinic, trying to counterbalance my surgical time with a little straight-up medical experience. Dr. Robert (the surgeon who struck me as a bit of a curmudgeon last week) is the presiding physician at the Tuesday clinic, assisted by a very kind nurse whose nametag is always, always backwards. I will have to learn her name by sneakier means.

I arrived just as the two of them were making their way through daily checkups for the 25 or so women currently in the ward as inpatients. Some women were waiting for surgery, but most were recovering post-operation; turns out Dr. Masemga made it through an impressive 16 repair surgeries during his visit last week. The checkups were pretty quick - as Dr. Robert quipped, "We have really only two words in this clinic: 'Well' and 'Dry'." True story. The nurse wrote that phrase down for every single post-surgical patient.

The ward is a pretty peaceful place, save for the blaring television in one corner. (Everytime I've been there, it's showing some sort of American music video channel. Beyonce has fans everywhere.) The recovering women sleep and rest and occasionally shuffle around, carting their catheter bags with them in plastic tureens. I did note a rather sweet scene near the ward door, where a patient was sleeping with her little infant curled up alongside her. Every so often, it seems, babies who get stuck in labor do make it through OK, even if mom's a bit worse for wear.

With all inpatients seen to, the clinic for new arrivals began. A group of women had assembled outside Dr. Robert's office wall, waiting patiently on the outdoor bench until he yelled their names through the window shutters. (HIPAA would be aghast.) The clinic was rather surprising for me in terms of clientele: Although women are referred to CCBRT from all over the country for reason of suspected fistula, only one woman of the seven or eight we saw actually had a fistula. A few had natural incontinence due to various causes. One seemed to have had a botched earlier surgery that had become problematic (the woman herself wasn't sure if she'd had a surgery and had to ask her husband - gives you an idea of how much physicians in this country actually explain things to their patients). Another woman was actually a nun, who'd had to undergo surgery for an iatrogenic fistula after doctors accidently poked a hole in her vaginal tissue while trying to remove a bladder stone. Extraordinarily bad luck, really. You'd think a nun, of all people, could avoid worrying about fistulas.

So lots of significant and quality-of-life-impinging health problems, but not particularly problems that the CCBRT fistula ward is designed to solve. And of course CCBRT itself is not designed to be a general care hospital. If you don't have one of a rather short list of conditions, there's no one there able to take care of you. Unfortunately, referrals are pretty thin on the ground in Tanzania; the woman with the botched surgery, for example, was simply told to go back to wherever it was that she'd been orginally treated. (I hope her husband remembers, at least.)

Dr. Robert seemed to warm up to me a bit as I asked questions, so I've been invited to next week's clinic as well. (Hoping to learn a good Swahili phrase for "It's ok/Don't worry/Try to relax" in the interim; Dr. Robert's style of pelvic exam, where he mostly ignores the woman and certainly doesn't warn her about what he'll be doing, seems to cause a bit of understandable anxiety in the clinic patients.) The recovery period for fistula surgery is usually about 14 days, so I'm looking forward to seeing the patients I saw in surgery getting to go home.

Hoofin' it

Wow, a rather large rat just launched himself across my office floor and into my closet. This is problematic for two reasons: first, there's no way I'll dare to take anything out of that closet for the next week. Second, my uncensored reaction to seeing this rat was to gasp "Oh my goodness!" and put my hand over my heart. "Oh my goodness"? Who am I, Mrs. Doubtfire?

So it turns out that the Pugu Hills have a lot fewer day visitors from Dar es Salaam not because they're a hidden gem, but because...well, they're pretty lame. Suffice it to say there were NO elephant shrews, despite the very prominent photograph of one on the Pugu Hills website. Blatant false advertising.

It probably didn't help that our little band of travelers (me, Nina, Magdalina, and Zalha, a Tanzanian med student) got lost repeatedly throughout the course of the day, always in a situation that meant extra time being rather too hot. And we started our routine of getting lost early, right off the bat. Despite the daladala driver huffily insisting that he knew exactly the intersection where we were supposed to disembark, we completely blew by our stop without a peep from him. Zalha and the other passengers gave him a thorough tongue lashing (there's really a certain moral superiority you get when fellow riders of public transportation take your side), but we still had to ride all the way to end of the line just to double back. And pay again.

And then we got all turned around on the throughly signless walk to the Pugu Hills conservatory, missing turns and wandering through chicken-filled yards and ending up at one point at what seemed to be a gravel quarry. (Several surprised-looking ladies there kindly inquired if we needed any gravel. Not today, we replied. They nodded wisely. Sometimes one just wishes to inspect gravel, not buy.) Lots of uphill trudging in the unfiltered sun before we finally arrived, only to discover that 1) they'd given our reserved guide away and 2) the actual forest was, in fact, closed to hiking. But would we like a Coke? Well, yes. We would. Love that real sugar soda.

With no forest, we chose the next best option, an hour-long walk to a huge regional cattle market. Even in the early stages of heatstroke I tend to be delighted by the prospect of livestock, so I was happy to go. The sun was still being all sunny and stuff, but hey, at least this time we were walking/sliding downhill. But we clearly hadn't picked up on the "Getting Lost" theme of the day - our assigned "guide" had actually never walked this route before. So we spent quite a bit of time walking down suspicious-seeming paths, then stopping, then waiting as our guide had a hushed cell phone conversation with someone, then turning around to double back the way we'd come. The one upside of this was that his detours often took us through people's small backyard orchards. I can now identify cashew trees, baby coconut saplings, and cassava bushes, thanks to Zalha's instruction (and frequent quizzes).

We finally did make it to the cattle market, which I have to say was pretty exciting. These were not your typical boring Jerseys or Holsteins - these were zebu cattle! With huge horns! And these delightful fat-filled humps that kind of jiggle whenever the animal starts trotting! Man, I wanted to poke those humps. But it's rather intimidating to be stared at by a 250 kg animal with two-foot horns, even when that animal is of the bovine persuasion. The market is just a huge courtyard, with humans and cattle milling about unchecked, so most of my time was spent trying to keep an eye on all cattle in my vicinity without getting too close to any one. Plus it wasn't as if I could casually blend in - there were virtually no women at the market, and certainly no other mzungu women, so my poking would not have gone unnoticed. (Zalha was constantly fielding offers from various cattle salesmen - they'd seen our group come in and tried to figure out why we were there. Were we interested in buying this bull here? Very good price? Perhaps the Germans were looking to acquire a small herd?)

We stopped briefly on the edge of market to hide from the sun and to enjoy a small snack of Coke and Nice brand cookies (in keeping with the day's healthy diet), then boarded a long daladala ride back to Dar. We arrived at the legendary burger stand outside the Moroco gas station, the tastiest burgers in town - only to discover it was closed on Sundays. Ah, it kills ya. We stood staring uncomprehendingly at the closed serving window for awhile, stuck in that state of mind when you're too tired and hungry to make another plan of action, until we finally mustered up the energy to head downtown for some traditional Tanzanian grub. Oh, savory banana stew. We will always be friends.

So my official recommendation, if you must go west from Dar, is to skip the Pugu Hills entirely and head straight for the cattle market. If you play your cards right, I can get you a good deal on a nice steer. Though he may not fit in your carry-on.