Monday, May 11, 2009

Steen: Back in Dar

Hello All!

I have returned to Dar.  Erin and Chow are in Zanzibar tasting delicious spices and relaxing on the white sandy beaches.

Safari was most excellent.  Well, first, I went out to Zanzibar on Saturday in the wee hours of the morning (taxi picked me up at 4am to go to the airport)... got picked up at the airport by a driver, which took me hotel shopping (though I ended up staying at the first one, St. Monica's, as recommended by an ICAP Dr)... then went to Stone Town and enjoyed one of the best breakfasts ever at Passing Show Hotel, which was a cup of chai maziwa (milk tea with masala spices) and this kitubuwa or some kind of really tasty coconut pancake... all for about 35 cents (400 Tshilings).  It was so good. SO good.  Then, Spice Tour from 9 to 4pm or so.. tasted fresh spices and star fruit picked off the tree!..  also had my first taste of Jack fruit and guanabana.. plus some wandering around Stone Town, getting caught by a papasaai who took me all the way from the edge of Stone Town by the water where I wanted to grab a bite, to New Town, tricking me, but leading me on a bit of an adventure.  Eventually made it back to my streetfood by Africa House Hotel.... Sunday, the next morning, was a walking tour of Stone Town.. going through the markets was most excellent.  Got caught by another papasaai on my way to buy spices, but was much better at dealing with him than with the first guy... he wasn't calling the shots.  Then, headed off to airport to go to Arusha.  Oh, also received a marriage proposal and an "I want to be your boyfriend" from two 20something year old Zanzibari guys...  mmmm.. right.  haha.

6 Day Safari with Erin and Chow was great.  Lake Manyara. Serengeti. Ngorongoro.  Oh, and a day with the Masaai.  Serengeti was most awesome -- 100 elephants in one view, the wildebeest migration (wildebeest and zebra as far as the eye can see!)... and other fun things.  Stayed at an excellent tented camp and discovered that lodges have crappy food during the low season (unedible; and this is coming from a foodie who can't stop eating even when she is full.. if it tastes good.. and most things do... sometimes i left most of my plate; so bad). 

Yesterday, flew back to Dar.  Went up to The Slipway for some bargain shopping, which was fun.  Met some characters.  Ate some kiwi ice cream.

Today, office day.  A trip to the tailor for fittings.  Then, will go to city centre at night for dinner.  

Tomorrow, maybe off to Bongoyo Island... having an Ethiopian food craving, so probably going to Addis in Dar.... 

Flight has been delayed a day (they cancelled my Tuesday night flight), so will return to States Wednesday.  Flight leaves Dar at 10:50pm on Wed.. get back Thursday midday.  Yeps!

No pics for now... perhaps later!

Thursday, April 30, 2009

Steen: Quick Update


Friends! Apologies for lack of blogging. Things have been crazy here. Last week was our last full week in Bukoba and we were out and about on Monday and Tuesday with two big fanfare CTC building openings. Wednesday, we worked to finalize our CD4 Collection Study presentation and then on Thursday and Friday was the Annual Regional Partner's Meeting. We presented the results of our study to a room filled with over 130 clinicians, District/Regional medical officers, pharmacists, lab technicians, etc. It was really quite a rush to be able to disseminate the information we found to the people who needed it the most (the people who are collecting the CD4s).

The weekend was busy with going-away activities and we moved to a beautiful bed and breakfast up the road from Kolping. Wrapped up some work and bought a few last minute items. Also made preparations for a Monday celebration where we made Guacamole for the office!



Tuesday, flew back to Dar. Wednesday, we went on a site visit to another CTC in the Pwani region (Dar region) and worked on our final paper. Thursday, went to the tailor and then are still working on our final paper/debriefing. Tomorrow is a public holiday, and I think we will just wander around Kariakoo market and try to get to know Dar a bit.

Saturday, I am headed to Zanzibar for a day plus most of Sunday. Sunday evening, we head out to Arusha for our Safari, which will start Monday and go for 5 nites/6 days. Then, returning to Dar for two days before heading back to the U.S.!

We are turning in our laptops for safekeeping and thus will have even spottier email access during this time, though we may hit up an internet cafe or two along the way. Just fyi!

Hope everyone is doing great!

love,
Steen

Sunday, April 19, 2009

Steen: Two Photos

No time to write new blogs since this week is so busies, but here are two photos!

Photo caption: Steen first ride on the back of a boda-boda (motorcycle) in Mbarara, Uganda. One of her newfound favorite activities! There are also piki-pikis (motorcycle in KiSwahili) in Bukoba, but Erin and Steen have not had a chance to ride them there.


Photo caption: Columbia Med Students in Uganda! Erin, Steen, and Jake the morning of our hike up Mt. Sabinyo. Heading to Rwanda and the D.R. Congo! This is before we got all wet and muddies!

Steen: On Secondary School Boys

(written during Week 3)

- This (i.e. secondary school boys coming up to us and introducing themselves) was a point of initial amusement that has become an “Ugh” topic for me. The frequency of a certain rehearsed speech has made me wary of their aggressive, seemingly scammy ways.

- Last Saturday (8 days ago), Erin and I were walking up the hill back to our hotel when we met a boy, about 15, on the grounds of the Lutheran Church situated halfway between the center of town and Kolping. At this point in time, we had become used to random people coming up to us in town and being friendly. This boy, M, seemed like one of those people – friendly, curious, and harmless.

- We had been interested in attending church service in Tanzania at some point, just to see what it was like, and we asked him what time service was on Sundays. 7:30am and 10am. Okay, great, we thought, maybe we’ll see you at church tomorrow then and then went on our ways back home. Sunday came around and it was pouring. Neither of us is equipped with a strong enough umbrella for their storms, so we decided to stay in. 10:30am rolls around and we hear a knock on our door. It’s one of the hotel receptionists, who says “M is here for you.” And we think, M from work who we were hanging out with last night? Oh wait.. no… M the schoolboy. How did he find us? Oh yeah, we’re kind of easy to describe here – White girl, Asian girl (or China (pronounced Chee-nah) as they shout to me here..). We step outside our room and we see him in a tan suit waiting for us, telling us he would like to bring us to church. Having a personal escort to church seems like a sign enough to go and the rain has let up a bit at this point, so we grab our bags and walk with him. Then he says, it’s too late to walk in to church since service is halfway through (this makes sense, we don’t want to be rude), but let me show you some things. Okay, that is fine. We walk past the church and he is like.. let me show my home, do you have time?

- Erin and I are a bit more on guard at this point, unsure how to proceed, but seeing as there are two of us and one of him, out in broad daylight on a Sunday morning, figure it should be okay. We walk down a dirt path past the church and then turn left down another road, where we arrive at a small brick house with a sheet metal roof. M knocks on the door. At first nobody answers and so he heads towards the back of the house. Here, we do not follow. He comes back to the front and eventually the front door opens. Come inside, he indicates. I look at Erin with a “Do you feel comfortable?” look, she looks at me with a similar look. Seems okay to just peek. I step in through the front door, careful to leave the door open in the unlikely, but certainly possible event that M is not as harmless as he looks. Erin is right behind me.

- Inside the house was quite a site. We have gone on numerous site visits at this point and seen many of the houses on the outside, but not once have we stepped inside a home. It’s dark inside with old sofas and lots of yarn doilies. There is a small room maybe 8x10 in the front and then a room that is completely dark in the back. The ceiling has a few wood beams, but otherwise we can directly see the sheet metal. From the back room emerges a boy about 16-17 years of age. This is my brother, M introduces. Another boy walks out of the back room; he looks about 6. This is my younger brother, says M. We shake their hands and say hello, nice to meet you, then indicate that we should leave. M agrees.

- At this point, Erin and I recognize that we have reached the limits of our comfort level and both start indicating that we should get going, we have work to do, etc. M appears disappointed, wondering outloud in broken English when he will see us again. We tell him, next Sunday at church. He says he understands and offers to walk with us back to the hotel. Now M has a brooding, concerned look on his face that this point and he says, “Can I tell you about myself before you go?” We say, okay, and he then goes into this story about how a few years ago he met two Swedish women who became his friends and paid his school fees, but one of them had a husband who died and so she had to return to Sweden and never came back and now, he needs to find a new supporter to help pay for his school fees. You understand, he asks? Ah, yes, I understand what all this has been about now. He pulls out a picture of him sitting with a young Caucasian girl, looks about college age (read: not the old woman “benefactor” I was envisioning who might have a husband who died; this girl looks more like a volunteer who came to the region with whom he happened to take a picture in my cynical view), and says that she used to be his supporter and would we be able to be his supporters now?

- Wow, this made me really uncomfortable. In part, because I don’t believe him, but also because part of me wonders if he might be telling the truth. Regardless, I am not about to pay his school fees by handing him money now, so I say that we are also students and do not work and have to pay our own school fees (all true things), so we cannot be his supporters. He tries to tell a bit more of his story, trying to make sure we understand his predicament, and asking “Do you know anyone at the hotel who could help me?” We do not know anyone else at the hotel, we say (which is true). We are sorry. He looks disappointed, but says he understands and then again offers to walk with us up the hill. Halfway up, M says he should head back to the church and we agree that this is best. He asks for our emails and then goes on his way.

- Back at the hotel, Erin and I discuss. Is he for real or is this a scam? Could we pay for his fees – they probably are not all that much. It’s not a solution though, more just a bandaid. But sometimes, we need bandaids to tie us over. I’m fairly certain there must be some kind of organization/NGO or otherwise that would help students with their fees if that is really the problem; they cannot expect all students to go about finding supporters (i.e. – foreign tourists who happen to be passing through town). On principle, I don’t believe in helping just one if it’s a systemic problem, but Erin brings up a good point in that sometimes people just need a little extra help for a period of time, but then her question is even if we did support the boy, for how long would it go? Just the year or all the way until university? And we both wonder if the way things have been handled here by foreigners is feeding some kind of beggar mentality. What about us makes this boy think that we must be wealthy and can or should ask us for money? I think we both conclude that if he really were in a dire situation, and for some reason there were no local organization to help him, we might be interested in trying to help serve as that bandaid. At the same time, we recognize that we aren’t sure if he’s for real. I personally just don’t quite believe him. Something about him seemed too polished. I certainly did not like his aggressiveness in coming to find us at the hotel or how he was so direct in his request. But, the fact that this boy had a suit, lived in a brick house, despite is darkness and bare-bare bones insides it’s not the wood or mud huts we see along the roadsides, and is currently in school now, makes me less likely to believe his story. I suppose part of me was also just made incredibly uncomfortable because the situation shoves some kind of power and privilege dynamic directly in my face and I feel bad for being so skeptical not wanting to help. Yet, I am unwilling to help, because I feel that if I help this one, it is not being fair to all the other boys who need their school fees paid and it’s really just, again, not a solution to the problem. (if the problem is even real!)

- So… that was last weekend.

- This Saturday around 1pm, Erin and I are walking to town when we and suddenly surrounded by a number of secondary school boys walking home after being let out of class. Habari! Hello! Where are you from? What are you doing in Bukoba? They have a bright curiosity about us and what we are doing in their town and also offer to walk with us towards town. At this point, having experienced M last week, I am a bit more on guard. We do not tell them where we are living (we do not want more visitors at our hotel!) or other specific details about our stay in Bukoba (they often ask how long we are staying as well). This week, however, the boy I was walking with was even more aggressive.

- Meet L. He is fifteen. After talking to me for a few minutes, he asks me if we can be friends. Sure, we can be friends, I say. Since we are friends, can I have your telephone number? I do not have a telephone, I say. (not true, but I don’t want him calling me). I quickly realize that if I do not ask him more questions about himself, he will ask more prying questions of me, so I ask him about school, since he is wearing a uniform. He tells me he is in Form 3 and then goes into an abbreviated version of M’s story with slight variation. I need someone to pay my school fees next year as my father passed away and we do not have money. I tell him the same thing I told Marcus, that I cannot support him because I am also a student, do not work, and have my own school fees to pay. Then we walk a little more and I try to find more benign topics to discuss. He asks me if I own a computer. I tell him that I did not bring one here, no. (Also not true, but I don’t need someone knowing I have a laptop here) I tell him that I use the one at work. He asks, when you leave, can you leave your computer with me? (Who does he think I am? Made of money? Giving away computers left and right?) Now I’m feeling really irritated, because I can see that when he sees me all he sees is dollar signs. I tell him, no, I cannot give him the computer; it is not my computer. Oh, company computer, he says. Yes, I say. I do not have money, I am also poor, I say. Finally, he backs off and another one of his friends comes to chat with me. This boy, I don’t quite catch his name, is much nicer. He teaches me some Swahili phrases and then eventually says he needs to go meet his father in town and says goodbye. A nice guy, I decide.

- On this walk, Erin hears half of a school fees story, but the boy apparently does not speak enough English to really convey the story well. So, by and large, she is able to talk about other things and her walk is a bit more enjoyable and benign.

- Sunday, M comes to visit again, to our surprise, though maybe we should not have been that surprised. This time, we are actually rushing to work, so we say, you can walk with us if you would like, but we are busy. He seems to want to spend more time with us, wondering when we will see him again. At church, we say, if we are in town. On the whole, we suspect that he is harmless, given his age and the reputation of this town as being “safe,” but his aggressive and direct nature, his asking us for money, makes us keep our distance. He walks with us halfway down the hill and then says he needs to head home, which suits us fine. He can just email us if he wants.

- In sum, I now feel like these boys really are nuisances as they are trying to scam me (say they have a specific need when they do not) with the same story. At the same time, I don’t doubt that there are students in this region who cannot pay for their school fees. There is poverty left and right, so it’s completely conceivable that students cannot pay for their fees, and I think this is where the conflict in my lies. If their story is true, then I want to help, but I suspect their story is false. Still, given that the story must be true for some, how do I identify those students and can I really help? What is the best solution? Clearly, I believe a systematic solution is necessary if the problem is so pervasive, but in the absence of being able to provide a systems solution which will take time, is it okay to help individually?

- A few more bits of information. A school teacher randomly sat down with us at lunch at New Rose Café on Saturday afternoon and we asked her about these fees. She says for public school, fees are about 20,000 Tanzanian Schillings (between $15-20) for the year. Private schools cost more. Most families can pay, but not all. A lot of the students who cannot pay receive support from donations from abroad through some of the faith-based organizations, like the Lutheran church. We also spoke with Dr. Bertha, our ICAP mentor, who also said that while orphans often cannot pay for school fees and this is a problem in Kagera, where HIV first started and hit hard some years ago, devastating families, these particularly boys were likely trying to scam us and that there are several organizations in this area that help pay for school fees or whatever basic needs children need. This is not to say that the organizations are perfect as a lot of orphanages are in decrepit conditions where children eat one meal a day and much of the money goes to the administrators instead of for the children and there are students whose families struggle to pay their fees (in contrast to students a generation ago under President Nyerere, who made education free for that generation), so the problems exist, but having foreigners hand out money and encourage begging is not the solution. A sad state of affairs, but I have to agree with her. But how to go about fixing such a big problem?

Friday, April 17, 2009

Erin and Steen: We Are Alive!









Photo Caption: This is Erin, Steen, and Jake (Master Uganda Trip Organizer) on top of the second peak of Mt. Sabinyo. It took us five hours to reach this point from the base of the mountain!





Photo caption: This is Mt. Sabinyo from where we started our ascent in the morning on Saturday. We climbed up to the first peak on the left and then from the first peak to the second peak from the left. The third peak that hikers are given the option to climb is right in the middle and is the tallest (as you can see). Erin and her long legs made it to that one. Steen with her itty-bitty limbs headed down after the second peak; she feels no shame in that though, as she is 6 inches shorter than the next shortest person (Ms. Erin) on this 7 person trip! The tallest person was well over 6 feet!

_________________________________

Apologies for the long hiatus in posting!

Erin and I have returned from Uganda safely and have been super busy in the office with our project with little time for internet. This post is primarily to say that we are alive. We may post some pre-Easter Weekend thoughts soon and then will try to write more about our adventures (of which there have been many!) soon.

This upcoming week is very busy. We have finally done all of the data collection for our CD4 completeness project at four hospital sites here in Kagera region and are now in the thick of analysis and putting together a presentation. Next week will be very busy because on Monday and Tuesday there are two "Launches" for new CTC (Care and Treatment Center) buildings. In other words, ICAP has built two new buildings at two different hospitals where they will be taking care of HIV outpatients patients daily. It is necessary to have a big celebration for the opening of these two buildings in order to make the ICAP name even more well known in the region, to patients and also to district government, medical, and religious officials. On Wednesday, there is some important financial training that the office is involved in and then Thursday and Friday is the annual Partner's/Stakeholder's/Implementer's Meeting where representatives from each of the ICAP Supported Sites (CTCs) come together to discuss the HIV care being provided in the region. Erin and I are trying to put together a presentation of our results for this meeting. SO... busy!

Then, we have one more weekend in Bukoba before we fly back to Dar early morning on Tuesday. Then, a few days in Dar and we are off to our Safari!

Monday, April 6, 2009

Steen and Erin: Will be Away

Hello All!

Just FYI that E and I will be without internet for perhaps the next week.  We are headed out to Rubya Hospital for a few nites and then to Uganda for Easter Weekend!

Love,
Steen

Erin: How to tie a baby to your back

All women in Tanzania carry their youngest child with them. Most of the babies look quietly content upon their perch. If you want a quiet happy baby on your back, all you have to do is follow these simple steps:

  1. Find your self a kanga or shawl or any piece of fabric that is at least 6 feet long and maybe 2-3 feet wide.
  2. Place the baby on your back. First, bend over at the waist to almost a 90° angle.  Place the baby (or have someone assist you) with its stomach against your back and its legs straddling you. The head should lie in between your shoulder blades. Support the baby’s bottom with your hand to assure yourself that he does not slide off.
  3. Take your kanga or fabric. Place the top of the narrower dimension over the baby’s shoulders. The bottom of the narrower dimension (along with most of the fabric) goes underneath the baby’s butt. Hold one of the ends of fabric over your right shoulder and the other under your left shoulder (or visa versa). You should now be able to sit up, holding on to the longer ends of the fabric, which is supporting your baby as if in a sling. Note: the arms and shoulders should be covered by the fabric (to prevent mischief) but it’s okay if the legs stick out.
  4. Tie the fabric tightly between your breasts with a double knot.
  5. If your baby gets hungry, or needs some face time, just swing him around to your front. The fabric will continue to support him
  6. If you feel uncomfortable trying this with a baby, try it first with a bag of sugar. It’s not as bad to drop a bag of sugar on your first try than your little cousin.
We will work on getting some pics so you can have a better idea of what we're talking about soon!

Friday, April 3, 2009

Steen and Erin: Our Favorite Things

Here is a short post to share with you some of our most/least favorite things here in Tanzania!

Favorite Things:
  1. Orange mud! 
  2. People turning off their motorcycles to coast downhill in order to save on gas.
  3. Passion Fruit (20 for 80 cents)
  4. "China!" (pronounced chee-na)
  5. Eating fish tongue (its actually quite tasty)
  6. Turning on the fan, and having it  start spinning 30min later
  7. Sister Theresina at Mugana Hospital
  8. Seeing babies tied to their mother's back
Least Favorite Things:
  1. Dirt in the rice
  2. "China!" (it gets old)
  3. Getting overcharged because we are "Muzungu" (foreign/white)
  4. Lake flies
  5. Brown flavorless curry

Erin: Flowers

Steen and I went back to Mugana to collect CD4 data for our study. While we were there, I noticed this flower that really intrigued me. It is a beautiful fuchsia color and the stem and flower look furry. But the flowers grow in this weird fan shape rather than in circles. As I was admiring it, Sister Theresina notices me and encourages me to take some of the seeds home so that I can plant some for myself. I protest, but she tells me that I can hide the seeds from customs. She herself tried to sneak pickle into Tanzania (pickle is an Indian condiment made from many fruits and vegetables that essentially delivers spice to your food) but got caught and they took it from her. “I think they ate it” she said disappointedly.

So if you visit me next year and I have this weird pink fan flower growing in my kitchen, you know where I got it from. I’ve also been eyeing this purple gum-drop shaped flower ;)

Steen: Three Little Pigs' Houses

No, Erin and I are not the three little pigs, although we are always hungries (or super full, sometimes that happens, too, since meals here are so big).

I think of the best way of describing housing construction here as the three little pigs. I've never been anywhere quite like it. There much to say/analyze about it with regards to poverty and inequalities, but for now, I will show you in pictures.

First, there is the STRAW HUT: (this one is also made with cardboard and clear plastic tarp)



Then there is the WOOD BRANCH/MUD HUT: (okay, this doesn't quite fit, but it should be included. Imagine skinny tree branches stacked like Lincoln logs and then filled in with mud/clay).

Then, there is the WOOD HUT: (on the left; probably a kiosk and not a house; made of planks of timber)


Finally, there is the BRICK HOUSE: (with a nice metal roof; probably no other insulation or amenities)

Welcome home?

Thursday, April 2, 2009

Erin: On Driving

Our Tanzanian travel guides have a warning for Americans about driving. Tanzania uses the British system, so everyone drives on the left side of the road and steering wheels are on the right. But in addition to getting used to this (and making sure you know how to use a stick-shift; there is no other way to get up a muddy hill), there are a couple other rules important for both drivers and pedestrians to note.

  1. Speed – There may be a speed limit but it is not enforced. Usually you are limited by the quality of the road, especially as the rainy season has carved gorges into many of the dirt roads. Exceptions include police barricades, which are designed to collect tax on agricultural goods being taken to market before the ‘season’ officially starts for a certain good.

  2. Passing – If you want to pass a vehicle, use your turn signal to indicate your desire to do so (right-hand signal). The driver ahead of you will respond with his own signal by either indicating that the path ahead is clear for you (left-hand signal), or that you should not pass yet as the road is obstructed by oncoming traffic or that its too narrow (right-hand signal).

  3. Right of way – The right of way belongs to the biggest thing on the road. Cars beat out bikes, which beat out people. If bikes or people are not clearing from the intersection, you should honk at them (or ring the bell on your bike at pedestrians). I have seen one man knocked off his bike for leaving not enough clearance between his path and the car’s, but he was not injured. Children also frequently get honked at, even if they are out of the way. I assume this is to make sure they are paying attention and do not run into the road. (Roads here are always filled in the afternoon with children walking home from primary or secondary school.)

Ps. If you're reading this Dad, I think you would have liked our driver in Dar Es Salaam. Before working for ICAP, Manuel used to be a mechanic for racecar drivers on the East African circuit. This was in the 70s, and the races would go around Lake Victoria, through Kenya, Ugandan, and Tanzania. They would take short cuts to get ahead of the racecars, and had to use the bare minimum of parts to get the cars going again. Manuel scoffed at modern mechanics who just go to junk-yards to find replacement parts, he would disassemble the alternator, figure out what was wrong with it, and fix it himself before putting it back into the car. He also raced motorbikes himself in the 80s. Cool, huh?

Erin: Random moments with food.

Have you ever ordered one thing and then ended up with something completely different that what you expected? To Steen and I, that happens a lot. Usually this is because if we order two things on the menu that are too similar, they will end up being cooked in the exact same sauce. Coconut chicken ends up tasting like fish curry for instance (sans coconut). Today, Steen and I went to the Walkguard hotel for dinner and ordered Indian food. She got cabbage with peas, and I ordered spinach paneer. While both these dishes ended up tasting as expected, for some reason the kitchen fixed them with French-fries rather than rice. They didn’t ask us if we wanted French fries like at most other places we’ve eaten, they just kinda do their own thing there. Like the time they brought us two fruit salads when we only ordered one. Or the time when we didn’t even order fruit salad and they brought us two! Funny thing is, we always got charged for them even though we didn’t order them. But because they were tasty and we ate them, we went ahead and paid full price.

Speaking of being overcharged, they also tried to add 1,000/= Tanzanian shillings to my dish and 500/= Tshillings to the price of Steen’s. They said “food cost more,” (than a week ago when the menu still listed the price accurately?). Maybe it cost more because they didn’t make us anything special this time and charge us after we’d eaten it.

And by the way, spinach paneer does not go well with French fries.

Monday, March 30, 2009

Steen: On Advertisements





- Houses are painted bright colors here if they advertise for a cell phone company. The big ones to paint here are TiGo and Zain. These houses are often lime green, magenta, bright blue, or yellow. There are often also ads for the other companies hanging on banners, VodaCom, TCCL, and CelTel. I wonder how much money people get if they advertise for these companies, or is it just that their houses receive a fresh coat of paint? What are the terms of the agreement?
- Cocacola has a stronghold in these parts. Many signs for towns (Karibu Bukoba!), schools (Happy Primary Elemtnary), or whatnot are written in black letters on a white background next to or underneath a big red Coca-cola sign about 2-3 times the size of the sign itself. All the softdrinks we have here are made by Coke. Coke, Sprite, Fanta (Orange, Passion, Grape, Black Current), Krest (Bitterlemon or Tonic), Spar-Letta are all made by Coke. Dasani is one of three bottled water brands here. We have seen a few old Pepsi signs around, but they are far and few between and seem older than the bright Coke signs. We have also yet to taste a Pepsi product in Tanzania.

Steen: On Roman Catholic Church Service in Swahili



- On Friday morning, I went to the Morning Service here at the Bukoba Kolping Hotel, which is run by the Roman Catholic Church. Services are held at 8am on Mondays, Wednesdays, Fridays, and Sundays. Since Erin and I had to leave early Wednesday morning for a daytrip to Nyakahanga, I could not go before Mom’s one year anniversary on Thursday, leaving Friday as the best option.
- The service had elements with which I was familiar having attended some Methodist services back in the States and part of a Catholic service with Preeti. A few of the prayers I could recite from memory and there were a few portions of the service that I had seen before such as Passing of the Peace and Communion. On the whole though, it was a pretty different structure. We started out by reading a variety of morning prayers in English and then the Priest came in and gave a bit of a sermon in Swahili. It seemed like there may have been a Priest in training because two men stood up at the podium, one older and the other much younger. Then there was a period with which I was unfamiliar where the members of the church sang hymns from memory while one by one they went up to the front or to a side room for Confession (I found out later that this was a special service for Lent, not part of the usual routine). This went on for at least 7 songs, maybe more, so about a half an hour to 45 minutes. By and large, they were uplifting sounding songs with absolutely beautiful harmonies. I was really impressed because there must have been at least 3 parts to most songs and everyone sang without any hymnals. After that, there was Communion followed by another reading or sermon from the Priests. Somewhere in there was Passing of the Peace, where I shook the hands of people around me and said “Shalom!”
- The whole service lasted nearly two hours, which I was not used to, since most services I’ve attended have been an hour. I felt a bit antsy at the one hour point, but then I decided to welcome the time, because it just gave me that much more time to sit and reflect. Not being Catholic, I was not about to go up for Confession myself, and so I thought the best use of that time would be to try and remember about all the good times and the bad; at some point it just became overwhelming. My tears really started to fall; I couldn’t hold them back and then I didn’t want to hold them back. In part, it was running through the memories that brought up tears. The knowledge that there would be no more new memories was tough to face even as I have had a year to come to terms with that idea. At the same time, I felt like there were so many moments that I had forgotten about or could only vaguely remember and that too made me sad – that memories were fading. Then I felt like I should try and remember more things, to bring them up to the forefront of my mind, so that next time I sat and tried to remember, they would still be in my repository of memories. After the tears, which came in a few spurts, I actually felt relieved and at a certain peace with the world that is difficult to describe. I suppose tears in of themselves are cathartic. I was thankful for all the many good memories that we did share, some of which made me even want to smile and giggle a little by the end of my reflections. I miss Mom deeply, some times more than other times, but I know usually when I miss her I hold back my feelings in order to maintain composure and move on with my days and life in a way that she would have wanted and that is most useful to me, so this was a good time for me to just sit and let emotions pass through me… and then I felt better. I feel better.
- I am glad that on Friday, through this service offered at Kolping, I was both able to honor and remember my mother and also take care of myself at the same time. I think she would have been pleased. ☺

Sunday, March 29, 2009

Erin: Faith Based Hospitals

ICAP supports two types of hospitals: government run and faith-based hospitals. Among the ICAP staff there is controversy as to which type of hospital runs better, and it can vary from year to year as the salaries offered by either side change. My opinion was swayed by data manager at the Mugana district hospital, Sister Theresina. She was an inquisitive, friendly nun who came to Tanzania in 1985 to volunteer in this impoverished rural town, and was fluent in Kiswahili and the local language of the Hayan tribe. She seemed to have a story about every person we passed that day.

She told us about the work of the 8 nuns at the hospital, and that much of the hospital budget was derived from their salaries after they took what they needed for themselves. The nurses were motivated by more than their salary, including both their faith and their desire to help those in need. Unfortunately the remoteness and the recent increase in government salaries made it difficult to keep nurses and doctors. Some doctors did not like the strict atmosphere of the faith based hospitals, which forbid dubious income-generating acts that supplement their meager $3000 salary like selling medication for bribes, which happens, she states, at the government hospitals.

Besides the difference in mentality of the staff that stayed on at the faith-based hospitals, the atmosphere of the hospital compound felt different to me. The tall, white washed buildings of the government run clinics felt very sterile and imposing. By contrast, as soon as I step foot on the grounds of the faith-based hospitals, the atmosphere feels more comforting. There are manicured gardens abutting the walkways with healthy blooming flowers, roses, daisies, morning glories, and others I couldn’t name, the buildings were colorful and the seating a bit more comfortable. The combination was to create an aura of healing that permeated the medical facilities.

I’m sure I was also swayed by Sister Theresina’s intelligence and care when she provided us with tea, biscuits, and conversation while we were waiting for our car to be fixed. We also had our best meal in Tanzania while at Mugana, with cooked carrots, peppers, pumpkin, rabbit, rice, and matoke (a savory banana dish that I usually find very bland but was very tasty here)!

 Steen and I explored the outpatient care and treatment center (CTC) for patients with HIV/AIDS but have yet to go onto the wards of either faith based or government run hospitals. Perhaps then we will be able to tell you more of our perception of the patient’s experience. 

Steen: Good Morning


03.29.09.

Today is a gorgeous morning. I am sitting out on our porch at Kolping, looking out towards Lake Victoria and watching some birds flapping in the back garden. The sky is filled with today, a stark contrast to the last several days of blistering sun, and I typically dislike cloudy days, but this one is still rather pleasant as there was a satisfying thunderstorm this morning that nourished the ground and when I look out over the horizon, the sky is a yellowish-white as if the sun will emerge soon. The temperature is probably low seventies Fahrenheit with a gentle breeze. I can hear a variety of birds chirping and as it is now about 8:40am, I can hear singing in Swahili from the chapel upstairs; service starts at 8am on Sundays.

I don't have a picture of this morning, but here's another one of our view at sunset.

Thursday, March 26, 2009

Steen: Skype; Video - Roads of Near Bukoba Town

Do people use Skype? What is your Skype Name? I am @ steentsai! Not that Erin and I have all that much internet time, but when we are in the office, it would be nice to chat with some of you!

love,
Steen

Also: a video for your viewing pleasure...

Steen: Ndorage



A short video from our first site visit to Ndorage Hospital outside of Bukoba, Tanzania.

Steen: Remembering Mom




Today, 3/26/09, is the one year anniversary of my mother's death. I have been anticipating this day for some time now, unsure of how I would feel or what I would do to best honor and remember her.

I have started to write a substantial reflection, but for now, it is not yet suitable for blog publishing and ultimately may be too personal (we shall see).

When I was interviewing for this Tanzania elective, one of my interviewers asked me if it would be a problem for me to be over here on this day, away from family and friends or any potential ceremonies. I told her that I had thought about it, but that there would not be a big family gathering or anything, and my personal belief was that I could honor and remember my mother anywhere (and she could "see" me wherever I am in the world), so my ability to be present or absent in the U.S. would not be a deciding factor. I figured I could find a church here where I could pray and reflect. I am thankful that they mentioned it, though, because it made me feel like the program would be concerned and understanding about my feelings on this day.  At the same time, my decision tree reflects how little guidance I have on how to behave this day. Is it like any other day? Something is unique about it, but what is its significance exactly? What does one year passing mean? Having not grown up in a particularly traditional family, there is an element of me that feels a bit at a loss for what to do.

The best I can come up with:
- Take time to reflect on my life with Mom and life without her
- Take time to miss her (although that is hard, because it makes me want to cry and I am at the office, where I feel weird crying; maybe tonight)
- Go to church (Erin and I may go tomorrow morning; Kolping Hotel holds services Monday, Wed, Friday, and Sunday)
- Talk to people
- Keep moving forward; do things that would make her proud. :)

So far, the day has been good. Woke up and had some Chai Bora (Tanzanian black tea) for breakfast, then chatted with Erin on our walk to then ICAP Office. Erin and I are in the office today and not on a site visit outside of Bukoba, and so I have some time to write and think. I had a chance to talk to Dad (hi Dad!) and IM Crystal (hi Crystal!) on Skype, which is really nice, because it helps me feel more connected with my life and identity back home. I haven't really had a chance to talk to anyone on the phone since arriving here in Tanzania, since international calls are confusing and we are often without internet access, so that was really nice to be able to converse. Now, it is time to go analyze some data that we collected at Nyakahanga Designated District Hospital. Erin has been great about letting me just do what I need to do to take care of myself this morning, but now I am starting to feel guilty about not working when she is.. So.. off to work!

Hope everyone is well.

love,
Steen

Steen: General Reflections (from Week 1)



o All in all, this trip has been really incredible so far. To be sure, there have been new sights too numerous to count, but what has really surprised me is how much is actually very familiar. Perhaps it is because we are in the time of globalization and easy travel and information exchange, but I have found more things to be familiar here than unfamiliar. One thing that I have not really discussed is precisely how poor some people are here. The places we have stayed in are relatively modern with running water, electricity, and the occasional Internet access. The ICAP offices and vehicles are all relatively new with no frills, but all the necessary basic components. That said, when we drive along the roads, we undoubtedly see the spectrum of poverty. While some of the houses are made of bricks, others are simply made of sawed wood, and others appear to be made of sticks (big twigs) woven together with mud stuff between the sticks to make walls. Many buildings appear run down or abandoned. Some appear to be only remains of buildings, lacking a roof, windows, or walls. While many women in the city wear vibrantly colored kangas and visanga, which are most beautiful, there are many people with old dirty clothing, some of it clearly imported donations from the United States (i.e. – I saw a boy with a BankOne t-shirt; there is no BankOne in Tanzania, in fact, it doesn’t even exist in the U.S. anymore after it merged with JPMorgan Chase!). There are toddlers who crawl around without pants on. Women cooking for inpatients in Mugana cook in a facility with no chimney, inhaling the smoke from their firewood stoves as they cook all day. There is the occasional new government building or the like being constructed here in Bukoba, but by and large, there is a feeling that things are run down or trapped in the 1960s and 1970s America. Still, despite a lack of facilities, there is certainly no lack of hospitality. Cheerful greetings are made whenever we enter a room – and they laugh at our attempts to speak KiSwahili – all in good fun. People give what they can and I just have a strong sense that people care for each other deeply here, a feeling and a love that is not easily substituted. This love and humanity does not discount the lack of resources, it does not make up for lack of supplies or infrastructure, it does not cure HIV or the problems associated with the disease, but it certainly does bring a certain joy and quality to life here which I admire.

Steen: On the City of Bukoba (Written end of Week 1)



o It is a tiny town with many little stalls filled with knick-knacks, a few restaurants and hotels, and several churches. Most of the ICAP staff appears to attend the Roman Catholic Church, but there is also at least one Lutheran Church.
o Apparently, material items in Bukoba are more expensive than in Dar, which is the opposite of what I would have thought originally as it is more rural. Being rural, however, things turn out to be more expensive because it costs so much more for items to reach this remote area of the country.
o The foliage and landscapes are incredible. I love walking on the orange-red dirt roads, seeing the different plants – banana trees, coffee trees, papaya trees, flowers, etc. From our hotel, we have a great view of Lake Victoria and an island just off the coast. Down by the center of town, one can easily walk to the beach and see the fishermen with their daily catch. On Saturday, we even caught a wedding!

Tuesday, March 24, 2009

Erin: Peer Educators




ICAP has multiple projects underway at over 230 sites throughout Tanzania. While ICAPs main goal is to promote diagnosis and treatment of HIV/AIDS by providing infrastructure and training to healthcare facilities, one of the most interesting programs to me is the peer educator program. Peer educators are HIV+ patients from the HIV care and treatment centers (CTCs) who are trained to be model patients and provide support to patients and health staff alike. They are vital in encouraging adherence to clinical treatment and to reducing the stigma that HIV positive patients face within their families and communities.

Peer educators work on a voluntary basis, but are provided benefits or incentives by ICAP for their hard work, including bicycles, umbrellas, income generating items like sewing machines, and are introduced to ward and district leadership. Their work is intensive and varied. Every clinic day two peer educators design an educational talk on nutrition, care for the HIV patient, or adherence to anti-retroviral therapy, which is presented in the morning to patients and family in the waiting room of the CTC. Afterward they are available for individual counseling sessions with patients per request. They assist the function of the CTC by filing charts and tracking down patients who have been lost to follow-up. They also play an important role in encouraging patients to disclose their status to family or trusted individuals so that they can build a support network to help them deal with their illness, and encourage attendance at village support groups for people living with HIV.

Steen and I were first introduced to some peer educators at the Rubya District Hospital. Two women, Maria and Aurora, spoke with us at length about their own experiences with HIV and ART, and about the stigma that many HIV/AIDS patients experience. Both women had been diagnosed after their husbands passed away. Aurora was tested in the mid-90s and Maria was tested and diagnosed in 2004 after presenting with AIDS, and they were started on ARVs in 2006 and 2004. Maria said she had decided to become a peer educator after health workers talked to her about disclosure of her HIV status. She wanted to disclose her status to all and help to reduce stigma surrounding the disease. Aurora had similar sentiments. After her husband died, she herself had experienced significant stigma; her husband’s father and other family members had come to her demanding their share of her property because they said she would soon die of HIV as well. Thirteen years later, her father-in-law now denies that his son could have had HIV given how healthy she still appears. Fortunately, such attitudes are starting to change, and HIV positive people are less often separated at restaurants or refused rides by taxis or bicyclists, although discrimination at the workplace still occurs.

The women agreed that the hardest part of their job was tracking down those who missed their appointments. Many patients who were unwilling to deal with their diagnosis would put claim a fake address, or travel long distances to a further CTC so that family and friends wouldn’t find out their status. Some patients were afraid of having peer educators to their houses without their neighbors drawing certain conclusions, and so the peer educators would have to befriend them or find other excuses to go visit.

The women we met struck me as being very intelligent and extremely dedicated to their cause. They spoke emphatically about the problems that HIV+ patients had to deal with on a regular basis, and were adamant that the support groups and peer educator programs had been vital in reducing stigma and mitigating some of these daily struggles of people living with HIV. In addition, the CTCs would have much more difficulty operating if they did not share the administrative tasks and provide a friendly, approachable face to the sterile health centers.

Monday, March 23, 2009

Steen: On Poverty


Tanzania is one of the poorest countries in the world, but it's been a bit of a challenge for me to articulate exactly what about it makes it poor vs. simply rural having never really been to another poor country or spent much time in rural areas. It's also confusing because there are some things that are very modern -- many cellphones, internet, etc.

So, this entry is an effort to articulate my observations On Poverty.

1) The buildings are old and often not well-kept. In addition to just being old structures, the paint has largely peeled off many of the buildings, giving them a run down look. Some buildings are being repainted (I noted a man painting the grills on a window), but not all or even most.

2) Dirt is also everywhere, which does not help the place feel clean. The roads are made of dirt and it gets everywhere. People sweep daily, it is definitely not a lack of desire to be clean, but just a reality that dirt gets everywhere; the roads are largely made of dirt and the summer heat dries up the ground so the dirt blows everywhere, giving people a need to constantly sweep.

3) The shops are small and they hang their goods all over the place, leading to a feeling of clutter. People are selling all sorts of odds and ends, laying out their wares for passersby to see, but there is not a sanitary “store window” as we have in more developed parts of the world. I do not entirely mind this, but it does lead to a sense that things are messy.

4) Spaces (esp shops) are small, cramped, and dark.

5) Goods being sold appear second hand or to be cheap items imported from China and other places. In fact, there are these neon plastic mirrors here that I definitely bought on my last trip or two back to Taiwan.

6) Then there is the way people are dressed. The women are often in these beautiful kangas and vitenge – brightly colored cloths that they wrap around as skirts or shirts in the most vibrant patterns. But, then there are people clearly with second hand donations from the U.S. or other countries and others who clearly have not washed in days. There is a sense that things don’t always “fit” right and I am not sure if this is because this is their style or just that they do the best they can with what is available around them – often something that for some reason does not fit well. Men are in suits 5 sizes too big. Other people are in t-shirts that are all dirty on the edges.

Steen: On Weather

o Dar is hot and muggy

o Bukoba is also humid, but significantly cooler between 60 and 80 degrees F and I actually wish I had brought an extra sweatshirt. It rains a lot in the morning, sometimes with intense lightning and thunder, which is rather satisfying. By noon, the rain becomes a drizzle and then it is often quite sunny and pleasant in the afternoon and evening.

Steen: On Site Visits - Week 1


(Written During Week 1)

o This has been the best part of the experience so far, driving for 30 minutes to an hour to visit an ICAP Care and Treatment Center, which provides us an opportunity to see the local hospital and interact with the local staff.

o Work Day 1: Ndorage
• This is one of the better hospitals in the region. We came here to install a new computer, since their previous one was not working. They use the computers to enter in information to the patient database – a national registry of patients with HIV. We learned about their filing system, how patients are given ID numbers based on their primary healthcare facility, their large registry books that follow patients for 36 months, and their electronic database entry.

o Work Day 2: Rubya
• This is the district hospital, is comprised of many buildings, and even contains a nursing school. ICAP opened up a brand new CTC building a few weeks ago. We had a chance to speak with some Peer Educators, which really shed some light on both the advancements of HIV understanding and care in the region. Kagera region was one of the first places where HIV was discovered. We spoke with two women whose husbands had died in the 1990s from HIV, after which they were subsequently tested themselves and turned out to be HIV positive. They described both their work in trying to fight the stigma associated with HIV and to reach out to and educate their peers with HIV. Their work is particularly meaningful as they can often form a bond with other new HIV patients that clinicians may not. Patients may be afraid to discuss certain issues with the nurse or doctor, but will feel comfortable speaking with a peer. I think there is also a strong element of empathy that comes with a Peer Educator that feels very different from the sympathy of a clinician. We asked the women specifically about any discrimination they had faced personally and they described stories of not receiving inheritance because their in-laws thought they would “die soon” (and that was 13 years ago) and mostly people being shocked that they were still alive today. It seems that they have been able to survive and do well for themselves through some microfinancing opportunities. In terms of their questions for us, they were primarily concerned about medications one day not being available or what would happen in the event of resistance. We discussed with them that much of the resistance that occurred was due to single drug regimens and that resistance was much less likely these days as a result of multi-drug cocktails. There are very few patients here on second line drugs, which I noticed is drastically different from the HIV patients I have seen in the U.S., particularly at NYPH, where it seems that a significant number of patients have failed previous treatment regimens. On the whole, I am very impressed with the multidisciplinary aspect of their approach to HIV here. Having peers involved, in addition to medical personnel, I think greatly enhances their ability to reach out the patients. In a place where resources are scarce, the one thing that does seem somewhat bountiful is the human aspect of it, the community that has now formed to support HIV positive patients.

o Work Day 3: Mugana
• Mugana is a faith-based Roman Catholic clinic. We attempted to do some datacleaning here, analyzing the completeness of their database and also doing random checks of their paper files for quality assurance (i.e. – consistency between the paper chart and the computer). There is much to say about the sisters who work here, but I think Erin will write more about it. In brief, we met a sprightly Indian nun, Sister T (pictured above), who had worked in the region for many years that I have come to admire greatly. She has a simple life with few personal belongings, but is far from a simple woman. She had both incredible insight, a pleasant sense of humor, and a strong sense of humanity all bundled into her 4’6” body.

Saturday, March 21, 2009

Steen: On Roads




o There are two types of roads: Tarmack (asphalt) and Red Dirt. We drive daily in these enormous Toyota 4x4s first along some asphalt and then quickly we are often bumbling along on rocky dirt roads. Most of the roads are still smooth, although there is a constant vibration that makes me feel like I am sitting in a massage chair at Brookstone. On occasion, we will hit a road that is in terrible conditions and then the staff will debate whether this road belongs to the regional or local government and who is responsible for maintaining this road. For the most part, in the safety of our large SUV, I quite enjoy the experience.

Steen: On ICAP - International Center for AIDS Care and Treatment Program

On the ICAP Office – Physical Space
o We had a brief glimpse of the ICAP office in Dar, but since it was a Muslim holiday our first day (Tuesday), no one else was around except for us and Sheila, who was helping us settle in. The office is located in a seemingly nice area in between our Onella hotel at the northern tip of Oyster Bay and City Centre. There are other organizations nearby. There is always a guard on duty and the office door is kept secure through a keypad lock. I noted two ICAP SUVs and a golf cart.
o The ICAP office in Bukoba is quite large with a reception desk, an office for Dr. Bertha, two other spacious offices for 2-3 people, and a conference room. There is also a small kitchen. We have two ICAP 4x4s to drive around in.

On the ICAP People
o My first impression of the ICAP Tanzania and specifically, the ICAP Kagera staff were that they were very friendly and committed to serving the region. That said, I wasn’t sure specifically what we would have in common besides ICAP. Was I in for a surprise! Some of their lives have had much more adventure and diversity than mine. Dr. Bertha, our mentor, has studied in Russia and speaks Russian, which I took in high school. Dr. Baldwin, as it turns out, is a Tanzanian who speaks Mandarin Chinese, which I speak at home, because he did his medical training in China up until the year 2000. I expected to meet new and different people coming all the way to Tanzania, but I did not expect to be speaking in Chinese here to someone who is not Chinese! That was immensely cool.
o I am really impressed by the commitment of the ICAP staff to improving HIV care in this region. Many of them are separated from their families as a result of this work, since we are out in the remote regions of Tanzania and their families are in the larger cities of Dar es Salaam, Mwanza, etc. They start work at 8am and always stay until 5pm, but often the days will go even later when there are important work meetings and site visits. By and large, people are cheerful amidst the difficult issues we are dealing with, but I feel that there is also a certain amount of sacrifice being made by most to do this work. I am not sure how common or uncommon it is for people working in Tanzania to be separated from their families, but regardless, it must not be easy.

Erin: Animals We Have Seen: Even Without a Safari!

Pelicans
Long-horned cows
Lizards
Chickens
Crows
Goats
A baby goat!
Turkeys
Mosquitos
Monkeys!
A parrot (caged)
Roaches
Ants
Gnats
Beetles
Spider
Did I mention the monkeys?? (saw about 6-8 while we were driving, it was cool!)
Pheasant
Centipedes
Dogs
Hummingbird
Sheep

Erin: The Match from Tanzania

I’m sure that waiting around for the match has been stressful for everyone, but for some reason, it was a lot tougher for me here than I expected. Not only did we miss supernight and have yet to hear about where everyone else has matched, but since Eastern Standard Time is 7 hours behind me, I didn’t find out where I matched until the end of the work day Thursday. I’m not sure if it actually counts as an extra day, because I probably only found out half an hour after everyone opened their envelopes (thank you Chow & Laura!), but it was almost 8PM!

Just so you get an idea of how I’ve been feeling, I’ll tell you about a dream I had the night before we found out if we needed to scramble or had matched into a program. I dreamt that I had matched into a program called “Girls and the Sea” that I hadn’t even interviewed with. I sat in on a meeting to learn about the program, and it seemed to be a subsection of the Columbia-Presbyterian Internal Medicine, but it focused on skills necessary to become a cultured woman. I worried that I might not get enough exposure to patients and the ICU to feel competent in my medical skills, and I was also worried that I might starve on the strict diet of tea and crumpets.

After all that worry, I matched into my first choice: Albert Einstein-Montefiore! I assume I matched into one of the primary care programs, but I’ll have to check the list to see which one (Monte has 2). It serves 3 free meals a day, suckers! I’m really exited, although it’s a bit strange feeling that much closer to the end of fourth year, knowing that everyone will start moving all across country, and soon after that we’ll be given an enormous amount of responsibility for our patients… I’ll think about that when I get back. No need to scare myself yet :)

Tell us about your match experiences!!

Wednesday, March 18, 2009

Steen: On Greetings










Photo: A house along the road near our hotel. You cannot see it in this picture, but there are 4 cute kids waving at us in the lower left!


o People are very friendly here and often when we are walking up and down the road, they will shout “Habari!” (what’s up?) or “Good afternoon!” to which I respond “Habari!” although I should actually be replying “Nzuri!” or “Njema!” (good). Some people just stare, and I am never sure how to respond, so I will either smile or look ahead again. A few of them, after looking at us for half a minute and making eye contact, will smile and cheerfully say “Habari!” or if they are younger they will say “Shikomoo,” which literally translates to “I kiss your feet” but in reality is just a greeting for someone who is older than you and that you respect. The proper response to that is “Marahaba." Often there is a lot of laughter associated with these greetings as Erin and I try and speak in KiSwahili. Once a schoolgirl in Bukoba touched my hair as she passed me on the street – perhaps she was on a dare by her friends or was just curious to see what it felt like.

Steen: On Food


No blog from Steen would be complete without some comment on the food. My initial entry was on greetings, but I shall put that second. Food first!

o It's a good thing that Erin and I quite enjoy curry, because we have been eating a lot of that here in Tanzania, especiallyat the Kolping Hotel in Bukoba where we are staying. It’s unfortunate that we do not feel comfortable eating raw fruits and vegetables as it means we are eating a lot of meat and rice -- where is our fiber? Most of the food, I would describe as flavorful with an “earthy” taste at times. We suspect that this may be due to the water, which is relatively clear, but with a tinge of rust and may not be fully purified. In terms of hygiene, all I can say is that so far I have thankfully had normal bathroom habits! Erin had a ditty of gastro, which left her feeling uncomfortable for a day or two, but it too has fortunately passed.

o Breakfast is included in our hotel and it contains a good amount of variety. Passion fruit juice, bread with jam or butter or honey, some hot foods such as eggs, sausage or bacon, or French toast and the like, plus instant coffee, cocoa, drinking chocolate, or tea. There often is also a plate of pineapple and watermelon. They typically make their coffee or tea with whole milk, but hot water is also an option. Recently, they have had papaya as well and I recall a funny story told by our mentor, Dr. Bertha. When she first came to Bukoba, she went looking for papaya, but did not find it in the market. Then someone told her, “you want papaya? Just go to someone’s house and ask them for it.” Apparently, there are so many papaya in this region that there is not even a market to sell them – people just give them away! Unfortunately, though, that also means that if you are not comfortable asking someone for their personal papaya, you might not have a good means of purchasing one. I do love papaya.

o The best meal so far: Saturday, at the Bukoba Club, an outdoor restaurant right along Lake Victoria, we had the freshest fish I have ever tasted in my life: whole tilapia freshly caught from the lake (we even passed by some of the fisherman earlier in the day.) The tilapia was de-scaled and then steamed in foil in a mix of tomatoes and peppers with lime and hot peppers and salt on the side. It was absolutely phenomenal. Light, juicy, and tender. A man came by with a pitcher of hot water with soap on top and we washed our hands into a bowl before eating with our hands. As someone who is used to using chopsticks and spoons for nearly everything, it was quite the fun experience! That day, I forgot my chopsticks, but I think eating with my hands was more fun anyways.

Welcome from Steen!


Written Sunday, March 15, 2009

It has been one week since we departed from Washington Heights and much of the week has been occupied by settling in – exchanging money, buying water, adjusting time zones, buying miscellaneous odds and ends – and traveling to our final destination where we will be spending the next seven weeks (first from New York to Amsterdam to Dar es Salaam and then from Dar to Mwanza to Bukoba on a separate day). We spent two days, Thursday and Friday, this week going on site visits to ICAP supported Care and Treatment Centers (CTCs). A bunch of us would pile into an ICAP 4 by 4 and drive for an hour or two before arriving at the site, where we would be greeted by local staff. This week, we went to Ndorage, one of the better hospitals in the region where, coincidentally, one of the staff member’s wife is currently in labor, and Rubya, the Muleba district hospital, where ICAP recently opened a brand new clinic for HIV patients. Tanzania has 25 regions of which Kagera is one and within Kagera there are 8 districts.

There have been many new sights, sounds, and customs. In some ways, life is quite different from our lives in the United States, but in other ways, customs and habits are pretty much the same. I will be posting a slurry of observations/descriptions from our first week now and from now onwards my little thoughts will be posted more regularly!

Tuesday, March 17, 2009

Erin: Our trip to Bukoba (written Wed 11/3/09)

Outside it is dark, and yet my computer seems to be stuck in New York; saying its 12:46 PM. There are crickets chirping high pitched and fast, and a lone songbird, that sounds nothing like the ventilator monitors in the ICU that sung me to sleep last July. I send to you this first entry, typed underneath my mosquito net in the evening of my third day in Tanzania.

Steen and I arrived from New York near midnight on Monday. Exhausted from our day of travel, we found the ICAP driver, Manuel (who turned out to be quite the character), waiting for us to take us to the hotel. We passed thru the black empty streets of Dar Es Salaam, passing the occasional billboard for Vodacom cellphone minutes or Black Panther cologne, a few fellow drivers, darkened ware-houses followed by taller city buldings. All the sudden, the quiet is broken by a voice over a loudspeaker, and as we round the corner we pass a brightly lit field filled with men on their knees. Manuel tells us that the people we pass will be praying all night, and tomorrow most businesses will be closed for the holiday.

On Wednesday, we fly out of Dar to Mwanza, and then take a charter plane to our final destination, Bukoba. Returning back to the airport was a different experience than when we arrived. The streets were filled with traffic, cars creating an extra lane on the shoulder when the procession became backed up. We passed cramped mini-buses, women walking in bright dresses and wraps, and men swinging machetes that were curved at the ends, skillfully to cutting the grass with their other arm tucked behind their back. We had spent the morning rushing to find a bank that would exchange traveler’s checks and our cool driver Manuel was starting to look a little worried about making our flight. Yesterday all the banks had been closed, and the private foreign exchange had quoted us a horrible rate. Unfortunately the ICAP office was also closed, so we did not meet most of our colleagues in the Dar office, and the orientation they had told us about never occurred.

Luckily we caught our flight, and were able to see Tanzania from the air for the first time. Flying over Dar es Salaam last night had been nothing like flying into New York, or Mexico City, or any other city you could think of. There were hardly any lights, and no tall buildings of any sort. In the day, it seemed equally different. Trees growing in the courtyards and on the streets towered over the buildings and made Dar seem to be a very green city. The green and the hills of Dar gave way to brown plains near Mwanza, and finally to the pebbly red earth of the Bukoba landing strip. We had finally arrived at our destination.

Welcome from Erin!


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