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. ☺

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.

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!

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.

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.

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!!

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!

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!

Welcome to our blog!

We apologize for the delay in getting our first post up, it is easy to write posts at home but harder to find the time to get the blog actually started. I'm running out of time to write my intro, only two internet connections and my co workers have started arriving, so I hope you enjoy our writing. Please respond to our posts and keep in touch!