The Adventure

The Adventure: For ten weeks from June until the end of August, I will be working with Village Life Outreach Project in the surrounding villages of Shirati, Tanzania. VLOP works on health, education, and life enhancing initiatives for the people of the Rorya district of northern Tanzania. To check out all the great projects VLOP has, go to http://www.villagelifeoutreach.org

From the end of September until the end of the year, I will be completing my final (Capstone) project for the Clinton School in Lima, Peru. I am working with Minga Peru, an NGO that works with women, children, and entire communities in the Peruvian Amazon to increase awareness of health issues, reduce violence, train women in leadership and health information, and build communities through the empowerment of women, income-generation projects, and establishing of municipal partnerships. For more information about Minga, go http://www.mingaperu.org

Monday, October 3, 2011

Week 1 and the Wine Exposition

My first week in Lima is complete.  There's nothing too exciting about my day-to-day life so far.  The Minga office is about a 30 minute commute from my house: 5 minutes to the bus, 20 minutes on the bus, then another 5 minutes walking.  For curiosity's sake I walked on Thursday and Friday and it's about 50 minutes walking and great sightseeing.  Miraflores is basically the South Beach of Lima; very touristy, upscale, on the coast, and there are casinos EVERYWHERE.  Beside the fact that everyone speaks Spanish rather than English, it feels like an American city.

No one shows up to the office until 10:30 or 11am, so my typical day involves waking up at 8am (my body is trained well), running, breakfast and catching the news on CNN or CNN en espanol.  Since we come in so late in the morning, I generally leave the office around 7:30 or 8pm.  I have my desk in my own office room with a nice big window.  The neighborhood of the office is very bougie and reminds me of Florida in the 70s (just a little different from my office space with Village Life).  I have to admit I prefer the open air of the Roche office, but this experience will be good training for having a real 40 hour/week office job.  My coworkers are wonderful, one of whom (Noemi) is 27 years old and very eager to introduce me to Lima.

Yesterday, I went with Noemi and some of her friends to the Lima Wine and Pisco Expo.  I was expecting a modest neighborhood street festival; I couldn't have been farther off.  The Expo was held at the Chorrillo fairgrounds and was HUGE! Over a hundred vendors from around the region providing free tastes of all of their wines, dancers showing off their salsa and tango skills, and great music. 


Next door was the Pisco tent with about 20 pisco vendors.  -Pisco is a Peruvian alcohol that is similar to a tequila, used with sweet and sour drinks or simply taken as a shot. Pisco Sour is a sort of national drink, with lime juice, egg whites, and bitters...sooo good!- There are multiple types of Pisco: Acholado, Quebranta, Torontel, Italia, Mosto Verde (the premium), each with their own purpose...for mixing, shooting, sipping, etc.  Great first cultural experience in Lima!

Wednesday, September 28, 2011

Two Spencers in One Airport

According to the UN World Urbanization Prospects report, Lima is the 27th largest metropolitan area in the world with almost 9 million people living in the metropolitan area, so it would be crazy to think that I'm the only Spencer in Lima.  But who would have thought that there were two Spencer's landing at the Lima Airport at midnight on given night? I sure didn't when I was looking for the taxi driver that my host arranged to pick me up.  I saw a sign with "Spencer" on it and when I asked if his name was Gaspar he smiled and nodded (evidently not understanding me).  Beside the taxista asking me how my flight from Quito, Ecuador was, nothing seemed out of the ordinary.  We had a wonderful ride (approx. 40 minutes) to Miraflores, and I got a bit of Spanish practice telling him about my project and learning about his family.

Then, we pull up to the Lion Backpackers Hostel and he tells me this is it..."No, this is not it, I'm staying with a family." And all of a sudden, the light bulb clicks.  The sign he was holding at the airport also said Andrew on it and in my daze of traveling all day I just ignored it; he wasn't wrong in asking me how my flight from Quito was.  Turns out two Spencers with arranged taxis to accommodations in Miraflores (one of 49 districts in the Lima metro) landed at the Lima airport at midnight on September 26th.  Unfortunately, I chose the wrong one.

This would not have been a problem if I had been prepared and had written down Laura's contact information OR better yet, taken down the address.  But I had figured the taxista would take care of that... Luckily the manager of the Lion Backpackers Hostel was very helpful and allowed me to use their internet to look up Laura's phone number and then called Laura for directions to her home.  So, an hour and a half after picking up "my" ride home, I finally made it to my house for the next three months.  We never found out what happened to Spencer Andrew but hopefully he made it to the hostel.

Home sweet home in Miraflores, Lima, Peru. 

Tuesday, September 27, 2011

Back in Business for a new experience

Well, everyone, after an unfortunate 8 weeks away from the blogosphere, I'm back in business.  The last few weeks of my project work in Tanzania were very busy as I completed my 80 hut-to-hut surveys and conducted multiple stakeholder interviews with village leadership, school faculty and staff, and even with the Rorya district primary school officer. Once back in the US on August 30th, I barely stopped moving, never in one place for more than 4 or 5 days: Fayetteville for the first Razorback game of the season, Hot Springs and Lake Hamilton for Labor Day and quality family time, DC for a wonderful reunion with close friends and some professional meetings, NYC for the Clinton Global Initiative, and in between a lot of short periods in Little Rock (ALL IN ONE MONTH). 

On September 26th, I packed up my bags again (much lighter this time) and headed off to Lima, Peru
to begin project work with Minga Peru.  I am developing a study tour program for the organization that will bring undergraduate and graduate Communication students to Lima and the Amazon to learn about Minga's work and to meet the women and children with whom Minga works.  Although Minga looks to work with multiple universities in the future, we are currently planning on a pilot program with UALR for this coming May. The deliverable of my project is a program guide for the organization outlining not only the programming and lessons for the May trip but providing a framework so that Minga staff will be able to coordinate programming and logistics for future programs as well.

Not only does this next experience look to provide numerous lessons in program development, organizational management, and fundraising, but also will be a great comparison to my work this past summer in Shirati.  Whereas in TZ my project work was in the field and I was working in the field most days, my work in Peru will be based out of Lima.  I will only have one opportunity to visit the Amazonia communities (for a week) and so will have to take advantage of that week to gain as much insight as possible into the programs, the people, and the dynamic of Minga Peru in the Peruvian Amazon.  Here's to the next adventure! Salud!

Thursday, August 4, 2011

"It's a Small World after All"



After snorkeling, I hopped a cab to Mangapwani, where classmate Derrick Rainey has spent the past ten weeks doing his IPSP.  Well, my original intention was to take a dala dala (public bus) up there for a mere 1300Tsh ($.88), but the cab driver that was taking me to the station talked me into riding up with him after bargaining him down by about $12 for the round trip.  Turned out to be a good decision because he was fascinating!  Born in Stone Town, his father left the family, leaving him to live with his mother and grandmother, both of whom had no income.  In order to help his family he started working and saved up to put himself through English school and then driving school, which allowed him to become a taxi driver.  Eleven years later, he owns his own cab (very clean!), a taxi business that contracts with other cabbies, and has bought his own house for his wife, two children, mother, and grandmother…cool story! He was fascinated with the projects that we do for IPSP and Capstone, and I think we have inspired him to start an NGO in Zanzibar assisting villages with their lack of clean water.

Anyway, I was able to visit Derrick in his village and received a full tour of his IPSP partner, Creative Solutions, an organization that provides education in English, art, carpentry, sewing, cultivating, and now thanks to Derrick, music, to young adults and pre-schoolers in Mangapwani.  The complex is fascinating as every structure is artistic, colorful, and utilizes local resources.  It seems like he has really had a great time and been very successful.  With the help of our friend, Margret, one of the students at CS, we went to the famous slave chamber, where Arab slave traders would hide slaves after the trade had been outlawed in the area.  The chamber was protected by the cliff on which it sits.  After the chamber we headed to the beach for a swim in the west coast waters, a bit different of an experience but a beautiful sunset.  It was great catching up with Derrick and hearing about the upcoming wedding that I will unfortunately miss.  Congrats to Derrick and Lonnie!

Turns out my day with Derrick was his last full day in Zanzibar, and coincidentally our flights off the island were only fifty minutes apart, so although we did not realize it until he showed up to the terminal and saw me standing in the gift shop, I was able to be Derrick’s last familiar face before heading back to the states! 

My next story of connections occurred at the Dar airport in the security line to get back into the airport (no matter whether domestic or international, all those flying into Dar must exit the terminal and re-enter the airport).  I was standing in front of two Americans and as all mzungus in Africa seem to do, we started talking.  They tell me that they are graduate students from Berkeley who spent the summer doing graduate research in Kampala, Uganda (where two of my classmates are).  I excitedly tell them that I’m also doing graduate work and that two of my classmates are also in Kampala.  As soon as I tell her that I’m a student at the Clinton School of Public Service, she says, “oh yeah, isn’t that in Little Rock?”  I’m incredibly impressed/surprised that she knows this, and she quickly explains that she met a guy at an internet cafĂ© in Kampala who went to CSPS...Andy Lewis, my guess is you’re that guy.

Finally, I landed early evening in Mwanza and was picked up by none other than Ben Mwangi*, an old family friend of CSPS classmate, Shamim Okolloh.  We had only met through Facebook, so it was an interesting waiting period outside the airport, wondering if he was actually the guy standing right next to me, but we easily found each other thanks to cell phones.  It was a great time getting to know such a close friend of Shamim’s and Mama Shamim’s, my two favorite Kenyans, and I think that I’ve almost talked him into coming to Little Rock for our graduation next May, so we’ll see if he follows through.

Wednesday, August 3, 2011

Finding Nemo!


So Wednesday was to be our touristy day of snorkeling, souvenir shopping and touring the town.  We set up for a fisherman to take us out to Prison Island, just off the harbor of Stone Town, and after about an hour ocean ride in a small fishing boat floating through crystal clear turquoise water, we arrived.  There were about six of the same boat hovering around the expansive reef around the island, so we took the back edge of the reef and had a field day.  As wonderful as snorkeling in Costa Rica was, this far surpassed it.  The fish swam around us as if we were one of them.  Oh! And I found Nemo!  I was following this really pretty black and gold fish (obviously a Sigma Nu fish) when I saw a clown fish hanging around an anemone.  Although the clown fish here are more black and orange with a little white, they’re unmistakable and upon a closer look, I found Marlon and his wife (who was not in fact eaten by the shark) and then in the back corner of the anemone there was little Nemo, a baby clownfish no bigger than the size of a small paper clip.  Anyways, the aquatic life was amazing, and I can’t wait to get a book of tropical Indian Ocean fish so that I can be a dork and identify all the fish I saw.  Finally, I was amazed by the urchins.  All the urchins that I’ve experienced are an ugly brown color but these were jet black with a button-like middle that was neon orange encircled by five white dots.  It was terrifyingly beautiful; I still stayed far away.

Tuesday, August 2, 2011

The Fish Market (F.A. Post for Week 7)

This might be the definition of food heaven on Earth.  Every night in the Fordhani Gardens, tens of vendors set up tables, grills, and presses for 5-6 hours of food, drink, and fun.  I have a feeling that it’s mostly done for tourists, but I don’t care; I’m amazed!  Each fisherman table is covered with skewers of kingfish, tuna, barracuda, lobster, squid, octopus, prawns, shrimp, mussels, scallops, beef, and chicken.  Then there was chipati, coconut naan, regular naan, massive lobster claws, whole octopus tentacles, potato cakes, fish cakes, sambusas, fried plantain, ALL on a 6’ X 2’ table, and all mostly under 5,000Tsh (~$3.33) except for the lobster claws.  You point to all the different skewers you want, they load it onto a white Dixie plate and then take it to the grill.  When cooked, they load it back onto the plate with a backup plate and cover it in this chili sauce that although it practically makes you cry, it has the perfect sweet taste to compliment the seafood.  Our first vendor was a man named Mr. Polite, and boy was he!  My friends made fun of me for dwelling on this, but after two hours of eating, I went back to Mr. Polite for one last lobster skewer as he was packing up.  With only two skewers left, he laughed at my love for the lobster and gave me the last two for the price of one! 

Mr. Polite's Fish Stand


In between the fisherman tables, there are stands with sugar cane juice flanked by big mechanical presses that siphon the juice squeezed from the sugar cane into a basin that is then emptied into a bowl and sold.  It’s fascinating the preciseness of the way the men fold the cane over and over to get all available juice out of each stalk.  Finally, there is Zanzibar pizza.  Much like a crepe, it’s thin dough fried but with toppings cooked into the dough.  My first attempt was with a chicken pizza and unfortunately I saw the massive amount of mayo that they spread on it, so although good, it wasn’t my favorite. But THEN I had the mango pizza and it was divine: just the right amount of sweet but with light dough that reminds me of a good ol’ peach cobbler.  Needless to say, we went back the next night and although I did not spend too much time at Mr. Polite’s table, I found a guy with comparable food who even had fresh lemon juice.  Needless to say, food coma ensued.

Monday, August 1, 2011

Something off of a National Geographic

Bwejju Beach - Indian Ocean to your left

That is exactly what Zanzibar is: National Geographic or Travel + Leisure, their cover of “history meets culture meets beauty” or “most beautiful beaches in the world”.  A quick lesson about Zanzibar: located on the east coast of Tanzania, it has a long history of being a stop on the Arab slave trade corridor and so has an incredible blend of Arab, Indian, African, and oddly enough Italian culture and food.  It is the “zan” in Tanzania, since the merging of Tanganyika and Zanzibar in 1964 and has its own Vice President.  Told by a local, Zanzibar is like looking at the palm of a hand: the main part of the island is the palm and four fingers together and the east has a thumb with a bay in between the thumb and pointer. 
Bwejju Beach at low tide - Notice how far out the waves are and the numerous "clam diggers"

Bwejju is on the outside of the thumb; Stone Town is at the bottom of the pinky.  So, we got a taste of the inlet between the island and Dar AND the east coast of the Indian Ocean.  The beaches in the east are like something off of a poster.  The land is lined with palm trees growing out over the beach, the sand delicately gives underneath your foot, and the shellage is diverse and abundant (my mom would be lost for HOURS!).  The crazy thing about this coast is the low tide literally recedes for about a mile leaving a marsh-like space in between the regular beach and the water.  I tried trekking out to the water during low tide and made it about 30 feet before being totally stuck in the muck.  The view, however, is incredible.  Hundreds of women are scattered from beach to ocean, dragging big bags and filling them with what I would guess to be sea life that didn’t make it out with the tide, hanging out in the small puddles that make up the barren ocean bottom.  However, when it’s high tide, there’s barely any beach or sand at all, and when we were in Michamvi (at a hotel with a GREAT bar and restaurant that should be visited by all) the tide actually came onto the hotel property and up to the deck.  This part of the island is surprisingly very isolated and quiet, few tourists, and incredibly peaceful, a great place to get away.

Sunday, July 31, 2011

"Smile Ur in Zanzibar"

As much as I love Shirati, I am at my core a city boy and so I have gotten very restless in the small, rural community of Shirati and the outlying villages.  I’m running out of things to peruse at Monday Market, I’m running out of reasons to go to town, and although I will never run out of books to read (Esther has a library that rivals DC’s), my mind needs something new.  The cure?  A mini trip to Zanzibar!  I’ve heard awesome things from CSPS Class 5ers and three of my SHEDmates have planned a trip, so I tag along.  Plus, with the internet capabilities in Mwanza and Zanzibar, I plan to download all the necessities for the database I’m trying to build for Roche Health Center.  I’ve tried downloading it on “Shirati-net” twice only for it to give up on me after about 15%, so this trip is dubbed: business.

After a 5 ½ hour cab and bus ride to Mwanza (the second-largest city in TZ), an 1 ½ hour flight to Dar, and a 20 min puddle jump, we arrive on the famed “spice island”, ZANZIBAR!  And what is the first thing we see?  A nice topiary that reads: “Smile Ur in Zanzibar.”  Damn right!  What a great and positive greeting!  I think for CSPS orientation we should have a topiary that says “Smile Ur at the Clinton School.”  What do you think, Dean?  The three of us left in Shirati joined our friend, Avi, a recent visitor of the Kilimanjaro summit and headed to the beach.  We are to spend two nights on the east coast (yes, my first experience with the Indian Ocean!) in a beach village called Bwejju and then two nights in the capital and main city, Zanzibar Town, more commonly known as Stone Town.  However, before heading to Bwejju, we decide to grab dinner and a drink.  Avi: “So do you guys want to be next to the beach or ON the beach?”  Hmm…when he said “ON the beach,” he was serious.  We enjoyed the evening at a restaurant where I literally had my feet in the sand.  This is a great start to the trip.

Of course, there’s always a catch.  As we’re heading out of Stone Town, we notice that a lot of the restaurants and clubs are dark.  After inquiring, the cabbie laughs and says, “Do you guys not know what today is?” –No... “The first of Ramadan.” –Wow, way to go team! This should make for an interesting trip as Zanzibar is 95% Muslim.  Let the good times roll…

Friday, July 29, 2011

The Kuku Kollektors

To add to the craziness that was this day, the hostel experienced the arrival of what we lovingly called the kuku kollektors (kuku = chicken in Kiswahili).  Ante and I were on our way to meet Josiah and head to the hospital when we noticed about 30 men and boys all standing around the Kawira’s house, and almost every one of them was holding a chicken.  One guy even offered one to Ante.  We ran into the house to ask Dr. Esther what the heck was going on, and she had no idea.  Luckily they didn’t seem angry, actually quite the opposite.  Our guesses were either they were there to celebrate Dr. Esther’s return from 10 days in Cyprus OR they were members of the local poultry federation and needed some meeting space.  We were wrong.  After sending Josiah out to figure out the craziness, he informed us that they were a sort of tax collectors.  Evidently today had been a mandatory work day for all men in Shirati to report and help fix/build a road in town (according to Josiah, the leftovers of the ol’ socialist government).  Josiah had not reported and thus owed a chicken to the town council.  These men had been the ones to work and now were going to the houses of the families without a representative working.  The fine? Either a chicken, 3,000Tsh ($2), or something of similar value and removable (such as a plastic chair).  Really, folks, I can’t make this stuff up.  Well he had just killed his last chicken for lunch and he couldn’t give up one of our chairs that we use every morning when waiting for the Hilux, so he paid them.  You might wonder what they do with the chickens that they’ve collected.  Oh, they hold an auction immediately after all fines are collected and the money raised goes to…  So, Josiah gives them enough money to buy three of the chickens up for auction along with his and Manine’s fines.  Thus is the first strike of the infamous kuku kollektors.

Giving blood in Africa

What began as a totally normal day of not getting the requested data from schools and hut-to-hut surveys quickly turned into the craziest day I’ve yet to have in Africa.  We arrived back from Roche later than usual and as I’m resting a little, I hear crazy commotion coming from the secondary school.  This is where the Chapakazi soccer team practices, so, wondering if they’re playing a game, I call Wiklife who informs me that his school is in a match with a rival secondary school.  Well, I like little more than school sports so I arrange to meet him at the game to watch and enjoy some friendly competition.  On my way to meet him, I run into Dr. Esther who flags me down and asks me what blood type I am.  I tell her that I’m pretty sure I’m B+, and she quickly shows excitement for my answer.  They need to give a blood transfusion to the boy with BL before they can begin chemotherapy.  Loyce (pronounced Lois), one of the nurses whom Ante and I love…she’s hilarious…is compatible, but they need one more person.  After confirming my blood type with my mom I tell her I’m in.  Now, one may say, “Spencer, are you crazy? Giving blood in Africa?!” Well, Dr. Esther, Ante, and Elizabeth (all medical professionals) assured me that it is perfectly safe and that I will see them remove the sterile needle and bag from the plastic packaging.  In between committing to donating blood and the actual blood donation, I run over to the soccer fields to see the game…it is crazy!  There are hundreds of people (students, parents, general fans) standing on the sidelines.  And every time either time gets even close to scoring the girls go crazy and run on to the field, only to quickly retract and run back off, scurrying out of the way so as not to interfere with the players coming at them.  Then I witness a goal by Wiklife’s school, Kuturu, and you would’ve thought Elvis had entered the field, as every female student ran onto the field screaming and jumping celebrating the goal. 

At 6:30pm, I left the game to head to the hospital.  Josiah and Ante are joining Loyce and me for moral support and the experience.  We arrive at the hospital to find a single lab tech in the lab.  His name is Tobias, and you would’ve thought that he hadn’t seen a human being in years.  He was overly excited to see us and incredibly welcoming.  We explained that we needed to take a pint of blood from Loyce and me so that we could give BL boy a transfusion.  He quickly informed us that they have a lot of blood in their fridge, to which Loyce snapped back, “Well, why don’t you just give it to us?!” (This was to be her first time giving blood and I don’t think she was totally stoked about it).  He explained that since he was not a patient of the hospital that he couldn’t provide it for free; however, if we gave two units he would switch out two units; this will work.  So we begin the process; and what a process it was.  Tobias is obviously very good at his job and greatly enjoys it.  He talked us through EVERY. SINGLE. STEP. of his job.  He explained how he was going to prick my finger and remove my blood to test blood type and for HIV (no worries, I’m proudly negative).  He explained to me how he could tell which type my blood was and the purpose of the control (thank you, sixth grade science).  Finally we make it to the phlebotomy room and he sets me up for the donation.  Now everything had been very similar to giving blood in the US minus a few technological luxuries mostly for comfort that we use in the US; that is until the needle.  As usual, he was licking his chops at my nicely large, easily findable veins, when I looked up as he was about to put the needle in, and I immediately gasped: it was HUGE! Huge and metal.  I guess I’m spoiled with the mini butterfly needles or whatever they’re called.  I made it through the insertion, and one great thing about a huge needle is it pumps a lot of blood very quickly.  I loaded up a pint bag in about 3 minutes!  (My fraternity brothers and I used to race to see who could fill up a bag the fastest, and I’m pretty sure the fastest was about 5-6 minutes).  Once the bag was full, needle out, and pressure applied, I rested for a few minutes. 



Then I had the great idea to take a “picture with my pint,” and so got up and went to ask Tobias if I could (here I have found that they’re much less strict about privacy and certain standards that would never fly in the US).  This was a mistake.  I don’t know if I was still recovering from the blood loss, hadn’t had enough water, or simply got up too fast, but within about a minute of being in the main room, I started sweating badly and felt a little woozy.  So, as I have done before for my parents, I announced to everyone that I was about to faint.  Josiah and Ante ran to catch me as my knees collapsed, and poor Ante quickly realized that I was much heavier than I look and handed me off to Tobias.  What did Ante do next? Ran to grab my camera; most would be mad at this…I was happy that I have some great documentation of the ordeal.  I never passed out or lost vision or hearing, but I quickly found myself seated in a chair, Tobias and some random nurse (where she came from I have no clue) holding my legs up above my head and Tobias fanning me with a blue medical folder.  Typical.  I remain more or less in this position for the next 10 minutes on Tobias’ orders (as he laughs the entire time).  Yes, I spent ten minutes lounged in a chair, feet propped up, and a nurse (I soon found out her name was Leonida) fanning me to keep me cool; the only thing missing was a palm leaf, which of course I asked for…she didn’t get the joke. 

Impressive response and recovery care from almost passing out (insert palm leaf)

Meanwhile, Loyce had given her pint and was already walking around worrying about me.  I felt pitiful.  Even with Tobias demanding that she sit and rest, she refused, saying that women can handle blood loss a lot better than men; after all, they’re used to it from childbirth.  So we end the night Loyce and I a pint of blood down, BL boy a pint up and looking much livelier.  All in a day’s work.
As the needle goes in...I swear, it was HUGE!

Thursday, July 28, 2011

Encountering a pediatric cancer patient in Tanzania

Burkett’s Lymphoma (BL) is a cancer prevalent in East Africa that is thought to be caused by EBV (Epstein Barr Virus).  It is seen mostly in children who experience tumor growth generally in the face or abdomen.  Dr. Esther and SHED are currently participating in research and treatment funded by the National Cancer Institute through a program called EMBLEM and there is actually a Burkett’s Lymphoma center across the street from the SHED complex.  When arriving in Shirati, I was excited to hear about this and was interested in anything I could do to help (I’m really missing my CARTI Kids, especially since I missed the trip this year…in Chicago of all places-Go Cubbies!).  There was a patient admitted into the center when I got here, but unfortunately soon after my arrival he died from BL.  This past week, however, Ante came across what she believed to be a boy with BL.  He and his father came in to the clinic because the boy’s foot was swollen (like a baseball) and severely infected.  After Ante helped them with the foot, the father mentioned that the boy had a big lump in his lower belly.  The lump felt just like a tumor, so we brought him back to Shirati with us for observation and possible treatment (it blew my mind that the tumor was actually a side-note of the visit and thanks to Ante, they were able to identify another very dangerous complication for this boy).  Turns out he does have BL and after an ultrasound of his abdomen, we know that the tumor is very big and wrapped around his spleen.  This is a complicated situation because before the tumor can be treated with chemotherapy, the infection in the foot must be controlled.  Over the past week, we’ve been soaking the foot, he’s been heavily medicated with antibiotics, and the swelling and infection are slowly going away.  The boy has been a champ, especially considering that a week ago his life was totally normal (besides of course the massive, painful foot that he had) and now he’s a young teenager having to battle cancer, the effects of chemo, and a weakened body.  I will keep updated on his progress.

For more information regarding BL and the EMBLEM study, visit the SHED Foundation at www.shedfoundation.org

Tuesday, July 26, 2011

A different culture of record keeping

Today, I am supposed to be picking up data from the schools regarding attendance records and national exam scores for the past 6 years (the three years before the start of the Uji project and the three years since).  This proves to be much harder than expected.  Upon my initial visit I discussed with them some of the records that would be available for me and after some extra thought, I outlined in a later phone conversation the types of data that I would need (through a translator, of course).  This was almost all lost in translation.  The first school had a packet ready for me, produced by the district education office outlining the scores and rank of the school for 2008…only 2008.  Turns out they were numero uno that year in the district but were not for 2009 and 2010, so I have a feeling that they only wanted me to see that one year.  The next school’s product is even more pitiful, only giving me a sheet of paper with the number of students who took the exam.  Although each of these documents is helpful and shows good trends for the evaluation, it’s not enough.  Thanks to my faithful Rosie, we’re able to explain again everything that we need and confirm with them that they can provide it.  They explain to me, however, that much of it will have to come from the district office, as they don’t keep a lot of those records on file.  I have quickly realized how different the systems of reporting are here.  Turns out, even though all students take national exams, the only schools that receive their results in paper form are the top ten schools in each district.  The others are informed (I guess by phone?) and that’s it.  Also, they do not keep student-by-student attendance records, only total amount and only calculate annual averages.  In no way do I intent to bash this system because they do the best they can with the resources and lack of technology that they have.  But I have learned a lot about the flexibility I must maintain in conducting an evaluation here, and it’s good to recognize these road blocks in trying to develop practices that will help VLOP monitor the Uji project.  My next step is pursuing if there’s any possibility of working directly with the district office…we’ll see how that goes.

Monday, July 25, 2011

The not-so-sweet sounds of Shirati in the morning

Never growing up in the country, I got my share of farm animals and early wake-up calls only at Boy Scout camp.  To make up for this lack of exposure, I am living in Shirati, Tanzania, where there’s pretty much no such thing as sleeping past 7:30.  On the rare occasion that you’re in a dead sleep, you may make it to 8 am.  This has been an interesting transition, as the only sound I’m used to waking me up in the morning is one of our five dogs barking or my mom screaming at them to be quiet and not wake me up.  Shirati, I believe is more active and bustling in between 5 and 8 in the morning than 5 and 8 in the evening.  First call of the morning is the Bunda bus: 5am, leaving for Bunda (about 3 hours away) but rather than quietly leave Shirati, it announces its departure with honking and some sort of music that sounds like those god-awful ringtones that the original Nokias had.  It drives on the road that passes right in front of my hostel, and there have been mornings in which Fernando and I thought it was coming through the window.  Next, comes the rooster: 6-6:30am, not only making his presence known but multiple times, as if I had been able to sleep through the first 4 announcements.  Then, the children: just before 7am, they all start arriving at school and talk and scream as if they’re just getting back from summer vacation…every day.  Our hostel is neatly positioned between Mkoma Primary School (I could literally spit onto their playground) and Kuturu Secondary School (outside of which the political party blasts propaganda, evidently recruiting future supporters).  Finally, the gong: 7am, school is beginning and a noise resonates from either school that sounds like every Tibetan monk is in unison banging their peaceful gongs.  I’m interested to attend school with Wiklife so I can witness what the damn thing actually is.  Once the “bell” has been rung, there’s no going back (to sleep) because then begin the morning announcements for each school, the dogs barking, cows are awake thanks to the rooster, and the whole barn is welcoming the morning; and so, I do too.  Luckily, my housemate goes to bed no later than 9pm, so I have no excuse to stay up late.  Thus, I am paid back for my quiet, peaceful childhood of sleeping in the city.

The not-so-sweet sounds of Shirati in the morning

Never growing up in the country, I got my share of farm animals and early wake-up calls only at Boy Scout camp.  To make up for this lack of exposure, I am living in Shirati, Tanzania, where there’s pretty much no such thing as sleeping past 7:30.  On the rare occasion that you’re in a dead sleep, you may make it to 8 am.  This has been an interesting transition, as the only sound I’m used to waking me up in the morning is one of our five dogs barking or my mom screaming at them to be quiet and not wake me up.  Shirati, I believe is more active and bustling in between 5 and 8 in the morning than 5 and 8 in the evening.  First call of the morning is the Bunda bus: 5am, leaving for Bunda (about 3 hours away) but rather than quietly leave Shirati, it announces its departure with honking and some sort of music that sounds like those god-awful ringtones that the original Nokias had.  It drives on the road that passes right in front of my hostel, and there have been mornings in which Fernando and I thought it was coming through the window.  Next, comes the rooster: 6-6:30am, not only making his presence known but multiple times, as if I had been able to sleep through the first 4 announcements.  Then, the children: just before 7am, they all start arriving at school and talk and scream as if they’re just getting back from summer vacation…every day.  Our hostel is neatly positioned between Mkoma Primary School (I could literally spit onto their playground) and Kuturu Secondary School (outside of which the political party blasts propaganda, evidently recruiting future supporters).  Finally, the gong: 7am, school is beginning and a noise resonates from either school that sounds like every Tibetan monk is in unison banging their peaceful gongs.  I’m interested to attend school with Wiklife so I can witness what the damn thing actually is.  Once the “bell” has been rung, there’s no going back (to sleep) because then begin the morning announcements for each school, the dogs barking, cows are awake thanks to the rooster, and the whole barn is welcoming the morning; and so, I do too.  Luckily, my housemate goes to bed no later than 9pm, so I have no excuse to stay up late.  Thus, I am paid back for my quiet, peaceful childhood of sleeping in the city.

Friday, July 22, 2011

Let the surveys begin!

Yesterday, I began my hut-to-hut surveys on usage and satisfaction with the Roche Health Center and Uji Project.  The first day was slow to begin.  After an issue finding transportation, a very bumpy ride in a corolla station wagon that should never traverse those roads, and a punctured tire outside Roche, we finally made it to Migeko, the subvillage I’ll be interviewing first. One of the nice things about the punctured tire is it happened in front of the home of a nice couple, Joyce and Helon Amolo.  Helon was a Mennonite minister for years and now at the ripe age of 80, he and his wife now enjoy a quiet but comfortable life in the country.  His wife was wonderful.  She offered me their choo (toilet) and demanded I eat some uji because I looked thin (sounds like back home).  Her uji looked very different from that at the schools, so I was hesitant – a reddish, brown color.  It was quickly explained to be made out of sorghum and millet rather than corn or flour.  It was great, much sweeter than the school uji!  I drank it out of a bowl made from a dried gourd (Mom would have loved the bowl!)
Melda and her children who live in Migeko subvillage.


The surveys went well, although slow, as we were led by the subvillage chairman, Otieno (Agnes’, my committee member, husband) and Paul, chairman of the education committee.  They took us all over the subvillage, passing many homes.  When I explained that we needed to just pick a spot and proceed hut-to-hut rather than pick and choose homes, they told me that if we only did one area, villagers on the other side of Migeko would be jealous.  This could be a problem.  Three and a half hours later, we finish our fifth survey, and as it is already late, I figure we’re walking back to the car.  Nope, Otieno takes us to his home to interview his wife (Agnes – this survey will probably have to be thrown out due to bias).  After a long interview, only extended by the late, late discovery of a second wife, he invites us into his home to eat.  It’s so late, but this hospitality is necessary in their culture and of course, I never turn down food (very similar to the Southern hospitality, I feel right at home).  Agnes brings out a bowl with ng’ombe (beef) and broth and then two plates of what looks like bread.  I grab it and realize that it is very soft, not like bread, and realize I’m wrong; it’s ugali. YES!!! (Things to do in TZ: try ugali. Check! My TZ/African experience is complete) Killian explains to me that ugali to Tanzanians is like the potato to the British, bread to the French, pasta to Italians, and rice to Asians.  He instructs me to grab a piece, roll and mold it in my hand into a bowl, stick my thumb in the middle to make an “ugali bowl” and then dip in the broth.  It is SO GOOD!  Although it has the consistency of cookie dough and so is very chewy, it has a soothing feel to the pallet, yet is a little tough to swallow.  Whereas I miss pizza, fried food, and tortilla chips, Tanzanians miss ugali when they are away. 
My first meal of ugali na nyama (lamb meat) with Paul-VLOP committee member, Otieno-Migeko subvillage chairman, and Killian-my faithful translator (left to right)

The second day of surveys goes even slower with us only making it to seven homes in four hours.  It turns out Migeko is the largest subvillage and so the homes are much more spread out.  It’s interesting dealing with a translator because half the time, I wonder what all he is saying to the family.  It takes about three times as long for him to ask “Have you been to Roche Health Center in the past three months?”  But Killian is a great companion and knows his languages well!  After survey #7 (which went half as long as all the others because Killian was tired and ready to stop) Nyamusi picked us up, only for us to be ushered to the town center to meet with Otieno.  Again, we were ushered to a meal with Otieno and Paul of ugali and meat.  Today, though, the meat was chicken, and it was wonderful!  There was a lot of meat, much different from the chicken we had in Shirati, and flavor was nice and salty.  They made sure to give me the wing with the most meat, but then followed it up with another piece of….I’m still deciding whether it was the chicken liver or testicles.  Either way, I was pleasantly surprised.  It was very different from normal chicken meat but tasty.  I hope that this is a tradition present in all subvillages…I could get used to this wonderful food.  It’s also a great time to get to know the leaders better and talk about the project, albeit through a translator.

Wednesday, July 20, 2011

Update on William John and nursing school graduation

You may remember William John from my experience at the Mennonite Church about three weeks ago.  It’s okay if you don’t; I didn’t.  Or at least I didn’t recognize him. 

I went to the Zappa Kindergarten, where oddly enough they do photocopying, to copy my survey.  Yes, it is finally printed and ready to go!  While there, one of the others waiting starts talking to me, and asks if I remember him.  Oh crap!  This is one of my most feared questions.  I have met so many people in this town and the villages and have done a good job at remembering my committee members’ and village chairmen’s names, but there are just too many to remember everyone.  My answer? “Of course! How’s everything going?” Phew, crisis briefly avoided.  We discuss my project, Roche and the health center, as well as his nursing school regimen, and he mentions religion and Jesus a few times (all the while I’m trying to figure out how I know him and more importantly his name).  His knowledge about RHC doesn’t narrow too much down, but nursing school does and the religious references even more so.  Finally, I ask him, “now, remind me your first name again?” (This is an okay question because many here go by their last name) His answer: “William.”  Ding, ding, ding!  Light bulb has gone off!  I’m sitting next to William John, the kind soul that translated and explained the Mennonite Church service and fundraiser to James and me.  It was great.  I knew exactly who he was now, and he had no clue that anything was ever wrong.  He went on talking for another HOUR (it evidently takes forever to make 50 copies of a 13 page survey – that’s 650 pages), explaining his educational background, how he’s graduating in three weeks, and that he is printing off his final project report.  Their final project involves picking a family in a village, observing them, noting all health problems, and then assessing the causes and cures for these problems.  They must then educate the family on how they can treat and prevent these problems in the future.  It’s a very cool application of their learning.  Nursing school here has just as much of a focus on counseling and education as the actual medical knowledge, which is a nice addition.  I then make the mistake of asking where he did his project.  He misunderstood and thought I asked where his project paper was.  This prompts him to get his paper and page by page, word by word, read me his report.  AAAHH!  This is including title page, table of contents, acknowledgements, abbreviation pages, everything! Luckily, by page 12, my copying is done and so we must end this wonderful moment.  It was good to see him, and I have now seared into my head what he looks like.  Maybe, I’ll get to witness a nursing school graduation here…we will see.

Movie night with the mzungus

The past two nights, Fernando and I have watched movies with our buddies, Emmanuel and Wiklife (the coaches of the soccer team).  We’ve been setting this movie night up ever since I got here, but something always falls through.  So we finally pick Monday night, only for the power to be out.  We push through anyway.  Wiklife is big into war movies, but the closest things I have to all-out war movies are Last King of Scotland and A Few Good Men.  The latter I think is a little too much talking, and although the former is a little intense and not a lot of fighting, it’s about Idi Amin and Uganda, something close and relative, that they know a lot about.  I’m not sure whether they enjoyed it as a whole, but I could tell that they liked some parts and were following everything easily. 

The next day, by the grace of God, Elizabeth found The Lion King in Esther’s bookshelf!  As clichĂ© as it is, we have been wanting to watch it ever since we got here.  And so, movie night #2.  We invite Wiklife and Emmanuel again, and this time Emmanuel’s brother, Joseph, joined.  It was glorious, and although I wasn’t allowed to sing along, I enjoyed every moment of it.  I’m not really sure what they thought about it since Joseph fell asleep and the other two were silent the whole time (probably thought, “Why are we watching a cartoon of animals from the Serengeti talking?”).  Oh well, I think it’s interesting for them to see what many Americans envision when they think “Africa.”

Tuesday, July 19, 2011

Killian Killing a King Kobra

My African experience is almost complete.  I have seen a king cobra and subsequently its death (thank goodness!).  We were on our way to Roche for clinic and my school visits, the Hilux is packed, and so Sam, Harry (Rosie’s husband and my driver/translator for the day), Fernando, Marta (a Dutch med student tagging along), and I are all in the truck bed, enjoying the breeze.  All of a sudden a HUGE black snake crawls into the road and before we can do anything we run over it.  Nyamusi immediately slams on the brakes and backs up.  In front of us is a snake, easily five to six feet long and about two to three inches in diameter.  Before we know it, Killian and Nyamusi are picking up massive rocks, throwing them at the snake.  The snake is in the middle of the road – its middle section was squished by a tire and so stuck to the ground – getting beaten with big rocks. It is about a minute in when it raises up about a foot and splays its cobra crown.  Oh s***!  This is when Harry and a couple of villagers join in on the stoning of the snake.  Within another minute, the cobra is dead, only its tail twitching, and Killian is holding it swinging it around.  I will remind all that in no way am I embarrassed that at this point I am still frozen in place in the truck bed, only having moved to grab my camera.  Once Killian put the snake back down, a woman from the hut right off the road ran up to it and through one last rock on the head, obviously thinking, “Take that, damn cobra!”  We soon learned that the snake had been terrorizing the locals for months and so it was a big public service (Killian should receive an honorary degree from CSPS) to kill the snake.  We also found out that the cobra was not only a king cobra, but a spitting cobra! Again, it was intelligence not fear that kept me in that truck bed.  Let’s hope that this is my only experience with a snake while in TZ.

Finally visiting the schools!

My first taste of the porridge served at primary schools in Roche...tastes like cream of wheat!

So after four weeks of waiting, I finally get to visit the primary schools that host the uji project!  The first three weeks I was here, they were on summer holiday, and last week they were busy getting students back into school mode.  So here I am, spending the day meeting with administrators at Migeko, Ratia, and Roche primary schools, the three msingi of Roche village.  Quick background on the project: in 2008, VLOP began supplying these schools with flour and sugar to make uji, the previously mentioned porridge, to be served for lunch.  The cooks are to be volunteers from the community, so that there is no added cost to the school or students.  Public schools in TZ do not provide lunch to students and so they must walk home for lunch every day.  Some of the distances are so far that many never return for afternoon session; others stay at school with nothing to eat.  The idea is to provide students with a meal to keep them attentive so they can learn throughout the day but also keep them at school for the entire day.  My task for the schools is to develop a monitoring system so that VLOP can keep track of important outcomes and indicators of success/failure with the project.  I’m also evaluating the current issues and needs of the program at each school.  I begin at Ratia PS, then Roche PS, and end at Migeko PS.  At Roche Primary, we arrived as the Standard 2 (second grade) students were taking their uji – they don’t begin school until 11, so they take their uji later than the rest of the school.  I asked if there was enough for me to try the uji just so I could relate to them and the project.  Cecilia, the Standard 2 teacher, says “of course!” and is surprised but excited that I would be willing to eat it.  And….it’s really good!  It’s basically cream of wheat in the US (Things to do in TZ: try uji. Check!  Now I just have to get to ugali).  The teachers were so welcoming and helpful at all three schools, and I greatly look forward to spending the next month working with them.  I didn’t get any time with the kids, but that will come next week.  They need to be focusing on their school work.

The students of Roche Primary School getting their cup of uji for the morning break

Sunday, July 17, 2011

Proving that mzungus CAN dance

This afternoon, Fernando’s football team threw a party for his departure.  The party was enhanced by the fact that they won a big game yesterday (against an older, supposedly more skilled team also from Kabwana) with a score of 3-1 (well, really 4-1, but evidently arguing with the ref can get a goal reversed…I question whether some money was exchanged).  The party was held at the home of Joel, an 8 y.o. badass who is the lead scorer for the team and is easily smaller than everyone else who plays with or against.  His mother owns a shop in town (where they sell the great sambusa!) and so they have a very nice home: a living room that can seat comfortably 15 or so people, 25 if they’re small (like the team is); a satellite for TV (one of the signs of wealth here), a separate hut for cooking; and very nice decorations.  The party included the numbering of the new jerseys that they received thanks to their donor, Mr. Fernando, the serving and enjoying of maraga na wali (YES!), some Luo dancing by none other than Benatus and Joel’s little brother, and then a cup was sent around for everyone to donate towards their buying of cleats for the whole team.  In the end we raised $15,000Tsh in total; not there yet, but every little bit counts.  Finally, there were speeches by Joel’s mother welcoming us to her home and thanking us for coming; Wiklife, who spoke for the team; a few other teammates; and Fernando.  It was a wonderful party, and I was honored to be included.  I look forward to the next five weeks of hanging out with my TZ friends.  Upon the conclusion of the party, we were all outside hanging out, when Benatus started dancing again.  I couldn’t help but jump in on the action.  Luo dancing is basically “walking it out” done solely on your toes and a little lower than the American version.  Utter shock.  They all went crazy, screaming in Luo, probably saying, “WHAT?! Mzungu can dance?!”  Yes, Mzungu can dance.  I think I earned a little respect there on that patch of dirt.

Culinary Lessons of Tanzania (F.A. Post IV)

When traveling to a foreign land, one of the concerns, excitement mixed with fear, is the food availability and culinary selection of where one is going.  This is an even bigger concern for Americans, as we are used to ungodly quantities of whatever we’re eating, ease of acquisition by simply driving up to a fast food restaurant, ordering, grabbing a box from a window, and driving off, and a selection about as vast as the Grand Canyon.  None of that describes Shirati, Tanzania; and, as I will pretty much eat anything except for chocolate, mayonnaise, and muster, I have been enveloped in the food culture here.  So, to my parents, do not worry, I am not starving or losing a ton of weight; actually, it’s been quite the opposite. 

Much of the diet is based on what can be farmed and raised by the family: corn, millet, cassava, cow, goat, sheep, fish, and chicken(/egg), all of which are combined to make the different meals.  Those are the foundation of the NW TZ diet.  Those who are fortunate add rice and beans (I wish I had my Lizano veggie sauce from Costa Rica with me), a wide array of fruits dominated by the banana, pineapple, and mango, potato, and peppers.  Other than that, it’s pretty simple.  The two basic meals are ugali and uji, the second of which you may recognize from my project with VLOP.  Whereas ugali is the bread of the diet, uji is porridge; yet they have the same ingredients, just cooked differently: one baked over the fire, the other cooked with water.   Ugali is probably THE quintessential base of the Tanzanian diet, and I have yet to get to try it or the uji…not cool.     

We have enjoyed much of the above food: marage na wali (red beans and rice); goat/beef/lamb with rice and cabbage; chapatti, the Tanzanian version of a tortilla, served with anything; flat pancakes; mondazi (fried dough); lots of egg for breakfast; fish and chips (French fries), which is the “pub/restaurant food” here; goat/beef/lamb/fish stew; and others.  One thing I can definitely say about SHED is they provide a good variety of local TZ cuisine, meals with a little American flavor, and meals considered luxury to anyone.  To tell you all the culinary novelties that I have enjoyed would be ridiculous and inefficient.  I have learned, though, of one thing that I DO NOT like:

This morning we had a great breakfast of pancakes, jelly, sugar, and tea.  The pancakes are by far my favorite breakfast and are not like American pancakes, as I don’t think they use baking powder here.  They are light, thin, and easy to eat A LOT OF.  You could put a tall stack to shame; try three or four tall stacks.  After breakfast, though, Robert brought out a container of fruit.  Inside was an orange melon-looking fruit sliced into crescent shapes…cantaloupe?!  I jumped up so pumped about having cantaloupe and quickly cut off a piece and popped it in my mouth.  As the bite was going in my mouth, I noticed there was a small, thin skin on the fruit (uh oh, cantaloupe has rind, not skin).  I then bit down onto it, and the taste that came only secured my disappointment that this was not cantaloupe.  Not only was it not cantaloupe, but it was one of the worst tastes that I had ever had come from a fruit.  It only stayed in my mouth for a few seconds, but in that time, my taste buds were totally horrified, my tongue confused with whether it was touching a fruit or the sweaty armpit of a hairy man who has just run a half-marathon in the desert.  Yes, that is exactly what it tasted like.  So, from now on, please, oh please, do not EVER let me eat PAPAYA!

Friday, July 15, 2011

A gathering of leaders....eventually

Today, I finally am able to get a meeting with the Roche village council, also including the committees.  The day begins a little rough as Rosie must work at RHC with it being a man short, but it works out well as I begin my work with Killian, the famous translator of SHED.  Used and loved by all, I’m excited to get a full day with Killian.  The Hilux drops us off at the village office (where the meeting was supposed to be held), but within minutes we realize that beside the two of us and Ongoro, one of the VLOP health committee members, no one is around (it’s 10:15 and the meeting was “supposed” to begin at 9).  The village executive secretary shows up around 10:30 and informs us that it is at RHC, not the office.  So we begin the hike to RHC.  Although it was over an hour in the blazing sun, it was a great trek through the farms and fields of cassava, corn, and grass throughout Roche’s subvillages Darajani and Nyataya.  I was shown the bore hole to provide water for the village (it provides enough water for about one subvillage) built by ESA, a Swedish NGO that used to do a lot of work in TZ but became frustrated with the response (or lack thereof) they were receiving.  As Killian put it, Tanzanians are hard-headed and don’t like change once it’s given to them.  I also was shown the foundation for the secondary school that was to be built on the now-VLOP property that will be used for expansion of RHC.  Evidently the school had started construction when a wealthy man from Ratia (subvillage east of the property in Nyataya) paid for the school to be moved and built closer to him.  Luckily for VLOP, the school was moved and so the land was given for RHC’s construction.

Around noon, the meeting finally gets underway (remember, African Standard Time, which actually goes well with my sometimes unpunctuality in the US) in the living room of a home just behind the health center.  There are about twenty-five villagers present including the village chairman and executive secretary, Killian, and me.  Those present were committee members or chairmen from all five subvillages representing health, education, and water interests, a meeting of the village minds, if you will.  The meeting is begun just as any city council, school board, or official meeting in the US, with the typical formalities, welcomes, and quick news.  I’m introduced and thanked for my presence and future work.  As the meeting is handed over to me, I take the opportunity to introduce myself in Swahili (a repeat of my first meeting with the chairman), but as I haven’t practiced it in a week, it’s a little rough, and most smile or laugh at me – I think more in a cute, pitying, but appreciative way.  The meeting in my mind went very well, as I received a lot of input, opinion, and stories from many of the present leaders.  One major cultural aspect that I noticed and appreciated was that when someone spoke to give me their thoughts (whether positive or negative), they began by expressing how thankful they were that VLOP and SHED had helped them build the health center and provide lunch to their children and how important the projects have been to the community…everyone.  The comments are also very redundant, but it appears to me that the purpose of this is not to be redundant as much as reinforcing.  It seems they believe that by “seconding” and repeating what someone has previously said, they are showing how true and important the point is.  I really respect this, especially from an evaluative perspective in that it’s always good for showing that one person’s comment is (or is not) the opinion of the whole.  After three hours of discussion, questions, justifications, answers, and logistics, Jackson, the village chairman, ends the meeting by thanking me for my future work, my passion, and informs me that upon my departure in six weeks, we must reconvene so that they can show their happiness in giving to me (what, I do not know) as I am giving to them…very cool!  Huts of Roche, here I come!

Thursday, July 14, 2011

Hitting the ground running

This entire week I’ve spent finalizing my survey and getting everything ready to begin hut-to-hut and villager interviews.  Monday morning, I woke up bright and early and began inputting patient information and data regarding treatments, diagnoses, and other patient-specific activities of the Roche Health Center.  It’s very interesting how high the number of patients were for the first couple weeks of the center being open.  It was made quite obvious how great the need for a health center in this area was and the anticipation of the opening of RHC.  Although there is little to no follow-up on most patients, the fact that many have not had to come back for further treatment hopefully is a good sign that the two-day clinic is helping residents receive quality health care.  Another observation is that the patients are not just coming from Roche, but from neighboring and far off villages in TZ and Kenya (remember RHC is only about a 20 minute walk from the border).  Finally, it seems to me that there is some valuable information in these records but compiling it from paper records is tedious (as I have found out over the past two weeks), and so I wonder the benefit of computerizing the records into a database that Daniel (the Nurse Assistant who lives at Roche) could keep up with and once a month transfer to VLOP and SHED’s hands for monitoring and research purposes.  After talking with Dr. Esther and hearing her enthusiasm, I’m interested in pursuing the possibility further.   Evidently, no hospital, clinic, or dispensary in the entire country keeps computerized records, and as district and government officials ask for paper records, the priority is for written documents.  However, the possibility of RHC being the pioneer in moving TZ health care to a more digital phase would be so cool!  We’ll see how this works out. 

I spent much of midweek formatting my survey (which takes a much longer time than one would hope), and tweaking, deleting and adding questions and sections.  I received some helpful guidance from Rosie and Dr. Esther, who informed/reminded me of things that I just simply would not know or consider because of cultural differences.  I’m excited to receive further input from the committees, as I’m sure I am missing a few things, but feel that they survey is pretty comprehensive in evaluating satisfaction with RHC and the uji project.  This time next week, I’ll be in the field putting it to work!

On the lighter side of things, I saw my first rock hyrax on Thursday evening while on a run towards the lake.  Kyraxes are rabbit-sized rodents that can only be found on or closely around the large rocks that are scattered around the countryside of Shirati, most well-known for being on Eboke, the “mountain” behind Shirati.  They’re cool little creatures, and where we were we find multiple hyrax hanging out on top of the rocks staring at the sunset…obviously a romantic spot for the male  hyrax to bring a hot date.

Sunday, July 10, 2011

Crazy bus trip to the border II

Our bus ride to TZ began MUCH better than the last; keyword: began.  We knew better this time and arrived at 9 (rather than 6), and we left promptly at 9:45am. Thus ends the normalcy.  I must confess that we went against one of Mama Shamim’s rules of busing in E. Africa and had to sit in the back of the bus; we now understand why it is a rule.  Thus begins my list of things that I will never do again after the bus ride.  First, I will never ride in the back of a bus in East Africa.  There are no such things as “shocks” on the bus that we’re on and so we feel every single bump on the road, especially the speed bumps.  Secondly, I will never complain about speed bumps in Little Rock, Arkansas, or anywhere else for that matter, because those in EA put all others to shame; I’m talking mini mountains.  The only two images that come close to the feeling of being in the back are: infant Spencer in the Johnny Jumper bouncing up and down, up and down; and when cartoon characters are shot out of cannons and such, flying across a road or ground bouncing as they come to a stop, only there was no suspension pulling me back up and the ground was not a cartoon but a hard, uncomfortable seat killing my butt.  Finally, I will never think twice about bringing an animal in transit with me.  The lady on the back row (directly behind us and next to my right side) brought a chicken with her on the bus; yes, a live chicken.  And by damn, if any animal behaves as well as that chicken did for six hours (minus the first 2 minutes of freaking out before it was put on the floor), it’s allowed to travel with me.  It was so well behaved that at one point, everyone started screaming, “where’s the chicken?! Where’s the chicken?!”  What?!?! You’ve lost the damn chicken, unbelievable.  No worries, though, after five minutes of searching it was found against the back wall sleeping. 

Anyways, I unfortunately conclude this post on a sad note.  The bus was less than 10 minutes from the border, actually in Isebania’s jurisdiction when all of a sudden the bus driver SLAMS on the breaks, swerving, as our bus quickly leans to the right, about to tip over into the ditch on the side of the road; I’m talking about two wheels off the ground tipping.  Luckily, most of us are on the left side and it comes back to earth and comes to a stop.  Terrified we gather ourselves and start figuring out what happened.  We quickly realize things are bad.  There’s a piki in the ditch on its side and right behind it a man on his back screaming, one leg going the wrong direction, people are running from all directions to the front of the bus screaming, and we soon realize that they are running to a man lying dead in front of our bus.  The best we can gather is that the man had stumbled out into the street, was hit by the piki, both of which were hit by our bus.  It’s an odd feeling being on something that kills a man.  For the past 5 ½ hours, we had been bitching about how fast the driver was taking the bumps, and yet, his speed in the end possibly played a role in a man’s death.  Part of me wonders if things would have changed if one of us had said something to the driver, but especially coming from a mzungu, I’m sure he would’ve changed little.  We actually had multiple people back in Shirati act like it was no big deal, for deaths along the ride happen like that all the time.  Needless to say, shaken up and kinda out of it, we finally make it back to Shirati and SHED, and I find myself thinking, “thank god, home sweet home.”