"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…

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!

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

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.

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.