Tuesday, February 3, 2009

CSULB Library, Long Beach, CA, USA

I've been home for nearly two weeks now and I think that I've thought about Tanzania every day since my return. It's been surprisingly difficult readjusting. I've found myself a little unsettled - in a funk that I just can't seem to explain. I feel more restless than ever. I've found myself feeling a little bored and unmotivated at times. It's like running on a treadmill... I don't really want to keep up the monotonous toiling, but I keep pace because the only other choice is to fall off the machine (although one could argue for just pushing the big red "stop" button). I'm also frustrated with the pace of my life. I'm amazed how quickly I was back to the usual hectic routine of the semester. I'm struggling to find the sense of balance that I had while on my trip. I was right when I predicted that I'd probably never look at my life in the same way.

I'm even more uncertain of my feelings today. I received an emailing congratulating me on my acceptance into the MPH program at UC Berkeley. I don't think I experienced the emotions that I expected. Perhaps I am still in shock. For months (well maybe all of my life) I have been eagerly looking towards the next step. I have felt so restless and ready to embark on the next adventure - ready to feel more capable of making a difference. So, I was surprised when I received this news with hesitation. What do you do when everything you've wanted is placed right into your hands? How do you accept that there is no need for contingency plans - plan A is a "go"? I have been so in love with the fantasy of the future (and when in a new environment, I thrived), but I'm not sure anyone is ever prepared for the reality of taking the next big leap. I guess all you can do is jump off the cliff and free-fall, trusting that you'll land on your feet when you arrive at your next destination.

Tanzania was truly one grand adventure for me. I learned so much about myself. I found strength that I didn't know I had and realized that I've become a very capable and independent woman. I can't help but sit here with this tingly feeling rising up inside of me - I am about to embark on another big adventure. I think the hesitation that I originally felt is being replaced with excitement. I realize that I am ready to take on this new challenge. I feel like this trip to Tanzania was just to give me a taste of what my future holds.

Wednesday, January 21, 2009

En route to LAX (somewhere over Vegas, maybe)

We're just about home. I'm actually getting used to these long flights. I thought that would be a difficult part of the trip for me, but after I got through the very first four-hour flight to Detroit, I was fine. I've been catching up on movies I hadn't seen. I almost didn't get on the flight back though. I think I jinxed myself by saying I wasn't ready to leave because when we got to the airport, I was the only person in our group that wasn't listed on the flight. I did end up getting on though, so no adventure getting stuck in Tanzania... hehe.

We had a little bit of time during our layover in Amsterdam, so we took the train to the city centre and walked around a bit. There wasn't enough time to visit a museum, but we did have a chance to get some hot cocoa and a little snack. Such beautiful buildings there! That was my first time in Europe. I'll have to go back and spend some time there. As we were wiating for our flight to LAX, I ran into my biochem professor, Dr. Weers. What a small world! He had been in Holland visiting family (that's where he's from originally) and was on the same flight as us. Crazy...

This trip has been full of surprises. I still don't know if I'm 100% ready to come back, but there is a lot of work to be done at home. We have some major issues to work our with our travel agent and I need to work on the final assignments for this class and finish the last of my grad school applications. It'll be nice to nurse my sunburn and other ailments (which reminds me that I forgot to take my last dose of Cipro and Malarone). I hope someone will be there to pick me up when we get to LAX! :)

Tuesday, January 20, 2009

En route to Stone Town, Zanzibar

Some thoughts on Tanzania:

- As you drive through the villages, there is a very distinct scent of burning brush. I have only smelled fires like this in Tanzania. It's one of those odors that is so unique that I know it will be a powerful trigger of memory.

- I am struck by the contrasting images I have seen here. We left a walled-in beach resort paradise and just outside the gate is a village like any other in Tanzania - half-finished brick dwellings, crude shacks for homes, clothes hanging to dry outside in the sun, while a cooking fire burns with an African woman standing over it. Then there are the hospitals - private clinics, well-stocked with staff and supplies, but empty of patients in stark contrast to public hospitals with no doctor to be found, but crowds of people scattered about the medical compound. I noticed a contrast again between the CDC-run HIV care clinic with their organized files, and the rest of the public hospital campus on which it is located - its file room a pile of boxes with files that are falling apart and its wards that are dilapitated and dingy.

- The locals shout "Jambo! Jambo!" and "Karibu!" to us, but I wonder what they are saying to each other when my limited Swahili prevents me from keeping up with their conversation. I wonder how they really feel about American tourists.

- It seems like Obama is everywhere here. Our new president is on kangas, on posters, and in conversation all of the time. When we say we are from America, the locals say "Obama country!" The world is full of such hope right now, and so supportive of our new leader. I really hope that we don't disappoint our brothers and sisters around the globe. It would be nice if the United States could serve as a beacon of hope, because it seems like the world is falling apart at the seams and we need a light to guide us out of the wreckage.

Amaan Bungalows, Kendwa, Zanzibar

Today we begin the long journey back to the States. First, we have a 1 1/2 hour drive back to Stone Town and then the 2 1/2 hour ferry to Dar es Salaam. We'll fly to Amsterdam from the Dar es Salaam Airport, have a 6 hour layover where we can venture out into the city, then an 11 hour flight back to LAX. I made sure to pack mittens and a hat for Amsterdam and ginger root for the ferry. Turns out that ginger really works to settle your stomach.

I'm not sure how I feel about going home. I know it'll be nice to return to comfort and I'm actually quite ill at this point, but I have so enjoyed who I am when I'm pushed out of my comfort zone. I really surprised myself on this trip. I wasn't quite sure that I had what it takes to be a world traveler, but now I know that I can handle pretty much anything. I was actually surprised that I felt so good for so long. It's only been the last few days that I was feeling back and I had to finaly start on Cipro last night. I'm also pretty sunburned.

Yesterday was an incredible day, but the sun is fierce, especially when reflecting off of the water, and I got pretty fried despite the sunscreen. We went out to go snorkeling yesterday. It was so cool. We were on a small wooden boat called the "Prince" with a crew of four African sailors. I was amazed at the skill and strength they had in sailing this boat that lacked all of the technical advantages of these hig-tech modern sail boats. We were a little concerned when we looked out from the shore and saw a man bailing water out of the vessel they said we'd be on, but it turned out to be really neat. The boat was pretty much all wodd and rope, with some holes drilled through beams and only two wooden pulleys. The crew had to use pretty much their whole bodies to hoist up the sails. I'll refrain from turning this into a romance novel, but I will admit that one in particular looked very good while doing all that hoisting. Haha :) We sailed about an hour and a half our to the reef where we dove from the top of the boat (which was extremely fun), and snorkeled for a half hour or so. While we swam, the crew made lunch. I watched them clean, cut, and prepare the fish on the way out and they barbequed it right on the boat. Lunch was postponed a little bit though because poor Alex got stung really badly by a jellyfish on the way back to the boat. We were really worried about him, but he's doing okay now. They stopped at a nearby island and had Gina take him to get some medical advice. While they were gone, the crew assured me that he's be just fine and gave me a plate of food to eat. It was pretty darn good. I've actually gotten a lot of cooking tips on our trip to Tanzania. We went straight back to our resort so Alex could rest. I was really impressed with how well he held himself together because he was in A LOT of pain. That jelly got him good.

It really has felt a little like paradise here on the beach with the clear, warm water, but I think I've had my fill of sun and holiday. I wouldn't mind seeing more of how people in Zanzibar and Tanzania really live and the health concerns, but I've found that I can only take so much vacation. I need to feel of use, I guess.

Sunday, January 18, 2009

Amaan Bungalows, Kendwa, Zanzibar

So we have definitely hit the "tourist on holiday" portion of the trip. I am sitting in a chair made of bent branches on the porch outside our room, looking out at palm trees surrounding little bungalows with thatched roofs, as the evening breeze blows gently from the ocean.

I was actually able to attend church this morning in Stone Town. Tina and Lacey went back with me to the Anglican church built at the site of the old slave market. It felt so good to sing old hymns and speak aloud about praise and commitment to God in a room filled with other Christians. They're scare on the island of Zanzibar, a mostly Muslim area. Christians and Muslims seem to live peacefully together here, but for a moment I thought twice about wearing my cross necklace while in Zanzibar. I stand out enough as a white woman without a hijab and I'm not sure it's always safe to flaunt "otherness", but I am proud of my faith and comforted by it. So the necklace stayed on and everything seeemed to be okay.

After church we went to the big market and bought spices, coffee, and mangoes. I LOVE the mangoes here. I didn't eat any breakfast because I'm still having GI problems (I figured it was bound to happen at some point), so that mango was much appreciated after walking around Stone Town all morning.

At noon (well 12:00... they don't have "noon" here... haha) we left for the other side of the island. We arrived at a beach resort and spent the day getting our fill of surf and sun. The Indian Ocean is beautiful. The water here is so clear and clean. Lacey and I swam out to where some boats were anchored in the distance. My body was definitely saying "thank you" for the nice opportunity to work and stretch my muscles.

I am so conflicted about this part of the trip. Despite our day at the IAVC, I feel like I haven't been able to get a sense of life for the people who live in Zanzibar. All I know is that 90% of them seem very happy to welcome tourists (and the income they bring in) shouting "Jambo!" and "Karibuni!" as we walk by. I jokingly thought to myself while in the shower earlier that this must be the cause of the water shortage in Africa - all the water is used to provide Westerners withe shower and flush toilets in the hotels. I know that this is a complex issue with many causes, but I can't help but be conscious of the fact that, despite my conservation efforts, my 3-5 minute shower uses as much water as many Africans use in a whole day for all of their activities. I don't think that I'll ever look at my life and my experience in this world as a white, middle-class, American woman in the same way again.

I realized as I was listening to some of my favorite worship music that my faith has become increasingly important to me on this trip. It seems strange for someone who had turned away from the Church for so many years. I feel my relationship with God growing so much stronger. I think it's because I've had to depend on it so much more. I'm away from my home, away from everything familiar - all that I have to tie me to my life in the U.S., I carry in my heart. Away from everything that I might use to define who I am, I have to define myself by what's deep inside of me - the part of me that is strongest, most consistent, unchanging even when everything around me is changing constantly. I thought that it was interesting that I had found it difficult to worship in a traditional setting since starting at Halogen. I haven't been able to get that same sense of vulnerability and intimacy. But, I didn't have that problem this morning. I was so moved emotionally and felt like I was just sitting there, talking to God. I thought about why that was and I think it was because that's all I had. It didn't matter what music we snad or the language used or the format of the service. I just needed to worship with other people. I needed to affirm my faith in the presence of more than my own heart. And, I realized that it's my own heart that is what makes it a genuine experience. All I need is to carry God in my heart. He resides in everything, in any church building, because He is always with me, " residing in me, as me". I can't remember where I got that quote, but I've always loved it. "God resides in us, as us." Not only does it tell me that I am never alone, but also that I am enough. God is with us as we are at this very moment, as imperfect as that may be. I really felt tugged by God to be here and I feel like this is only the beginning of the purpose I am meant to use my life for. I am so happy for this passionate, loving, and adventurous heart that I have been given. It is what drives me. It is what defines me. I don't think I have often been able to see much goodness or worth in myself, but in this moment, I can honestly say that I have so much love for myself. I feel like I appreciate both my strengths and faults. It is good to be able to see yourself as God sees you. I feel like this whole trip I have been praying a silent but fervent prayer for Him to allow my eyes to see the world as He sees it. It's like my favorite Brandon Heath song. I want to see the beauty in my world and the people in it, but also be able to see the suffering and have the strength to do what I can to alleviate it in some small way.

Saturday, January 17, 2009

Safari Lodge, Stone Town, Zanzibar

So yesterday, once we got to Zanzibar, we set off for the Integral Assistance for Vulnerable Children (IAVC). They are in dire need of financial support. In the building that they rent, there are two desks with chairs and one computer. They offer breakfast for the children, but no longer have the means to provide other meals except on rare occassions. They can no longer house the children they serve, so they live with relatives and pop into the center when they are able to provide services. The children have to apply to the program and they can only shoode the neediest to accept. They currently have 30 boys (6 who are HIV+) and 36 girls (8 who are HIV+). Many are orphans or street children. We brought them a laptop computer, digital camera, and toys for the children. We sat and colored and talked with the kids (which is not easy when most speak only Swahili), while a female staff member went to purchase food for us to prepare. We paired off with the kids and I sat with a shy 13-year old girl names Tatu. At first I thought she wouldn't talk to me, but then she began drawing me a sort of picture dictionary, teaching me more Swahili words. Then, I joined her and a few other girls (along with our professors) in preparing the meal. We had limited tools, so my pocket knife came in handing (for about the hundreth time on this trip). I cut vegetables for about two hours. The girls were laughing at me as we cut onions and tomatoes for the salad because I couldn't get the slices very thin with my knife. A lot of people in our group were feeling sick from the ferry and not eating all day, so we left before the meal was completely finished.

I think that many people are ready to go home, but I could stay here for another year I think. :) It was a pretty rough morning for most, but it was such an incredible experience to just sit around a pot with these young girls doing something so orniary - something that is done in any culture I can think of. Women and girls bond around the ritual of cooking a meal, sharing stories and traditions. I felt so honored to be allowed to participate in that with them.

After leaving the IAVC, we went back to our hotel (no roaches to be seen so far... haha), and then explored the city. Lacey and I found an internet cafe, thanks to the gentlemant that served as our guide, and then found our way to the Pagoda Chinese Restaurant, where our professors and their husbands joined us. The food was delicious, although two of us are experience "GI quickness" this morning. We passed by so many beautiful building and some interesting boutiques that we intend to explore later. I'm hoping that we'll go to a reggae show that is happening tonight. One of the men we passed on the street was telling me about it.

Friday, January 16, 2009

Safari Lodge, Stone Town, Zanzibar

As we got off the ferry today, the tourist information guy said, "You have arrived in paradise"... and boy, he wasn't joking. I'm not sure I'll be able to leave this place. It is like a whole other world from the mainland of Tanzania. It definitely caters to tourists and they are used to seeing (and making a living off of) Europeans, Australians, and Americans. I can't get over how friendly everyone is here. Even the children are not shy at all. They run down the narrow streets yelling, greeting us, and giving us high fives. There's always someone willing to give you directions (and even walk you all the way to your destination), and everyone you pass will say "hi". A young woman, soaking wet from a swim in the Indian Ocean, came up to me wanting to chat and to take a picture of us together on my camera. The buildings are absolutely beautiful, the nightlife is sizzling, and the stars that come out after dark are absolutely breathtaking. Across from our hotel is a woodworking shop and we enjoy chatting with the med as they work.

Getting here was not so easy. Many people in our group got extremely sick on the ferry, due to the rough waters. We spent a long day at the Integral Assistance for Vulnerable Children (IAVC) and many in our group were too tired and sick to even leave the hotel and see the town this evening. I'm too tired to write about out day, so my summary will have to wait until morning.

Thursday, January 15, 2009

Restaurant in Dar es Salaam

Everytime I catch a glimpse of the news here in Tanzania it is reporting on the war in Gaza. I'm not sure if it is because of the large Muslim population or because it is an objective, uninvolved country, but the sympathy for Palestine is clear. I can't help but wonder how the U.S. media is portraying this fiasco. According to the Al Jazeera news that I am watching, the death toll is over 1,000 people in Gaza and 13 people in Israel. This is a massacre. One third of these were just children. Bolivia and Venezuela have cut diplomatic ties with Israel. How long with the U.S. stand by and let this happen? Will any of our politicians apologize for their blind and unfaltering support of an oppressive nation? Will this conflict ever end?

En route to Dar es Salaam

I'm listening to a road trip symphony - Eddie Vedder playing on my iPod, the warm wind blowing by my ear, and our driver yelling over the CB radio in Kishwahili - and I can feel the emotions rising up within me. I am holding myself back from breaking down into the tears that I can't explain. I'm not unhappy. I'm not homesick. I'm not having any trouble with this trip. But, I am beginning to feel very emotional about this whole experience. I hate to think that I will be leaving Africa in a few days. I am afraid that my own life and my home will never be the same for me. This has been such an eye-opening experience and I can never look at the world in the same way. There are so many people that just don't have a clue what our world is really like... they haven't had an opportunity to see anything beyond themselves. And then there are some that get the chance to see a country like this and they are distracted by cockroackes, unpredictable availability of electricity and hot water, heat, strange foods and threats of unfamiliar diseases, their own homesickness and discomfort. Nonw of that concerns me right now. I feel that I have no right to have any more than the citizens that have been kind enough to host me in their country. I've never felt so guilty to have so much. In America, we live with such excess and I feel like we don't even appreciate that. We always want more. And I wonder to myself, how could I be as unhappy as I've been at times, when I am so fortunate? How can I be anything but grateful? There is such a horrible distribution of wealth in our world. So much money is spent on things that only do harm, while many people in the world find it impossible just to get their basic needs met. In my conversation about American politicians with the restaurant manager yesterday, we were talking about our thoughts on President Bush. "Too much killing... too much war", he said. We, as a country, have squandered away our money to fuel evil in the world. I never realized how difficult it is for a country to have basic infrastructure and there is too much destruction of infrastructure through ware. I wonder what the world would be like if we used the money spent on destruction to build roads, hospitals, sewer systems, wells, water treatment facilities, safe homes, schools... We are capable of so much more good than we realize. The human heart is fierce. Despite struggle and oppression and dismal situations, it refuses to give up dreamind, loving, beating... All over the world, hearts are longing for the same thing. They are shouting our in song and dance and prayer. The human heart is truly the world's most precious resource. This is one thing that I have learned in Tanzania. I think after that, water is the most important thing in life. I will never look at water in the same way. It is so easy to take for granted. I have never been so conscious of my water usage as I have been in Tanzania. There are so many things that I have come to appreciate so much more. There are really only a few things that we need in life and it is those things that I will hold close to me and thank God everyday that I am blessed enough to have them. I hope that I will not forget the things I have learned here. I want to live more freely, live more passionately, love more fearlessly, pray more fervently, and view the world around me with more clarity. Please God, help me to keep my heart focused on these goals. Asante sana, Mungu.

En route to Dar es Salaam

Yesterday was packed with activity. The CDC site visit was incredible. It was great to meet with people who have the careers that I am working towards. We first met at the CDC-Tanzania office and were briefed on PEPFAR and the President's Malaria Initiative (PMI). We then went out to a site where they perform larvacide to control the mosquito population. It was great to see that they're using biological insecticides. I wish we used them more often in the U.S. instead of the harsh chemicals. Tanzanians seem to be very cognizant of issues relating to environmental impact.

Next we visited a CDC-sponsored HIV treatment and care center at the Mwananyamala Hospital. It was both sad and incredible how many patients they see (1,600 total; 200 each day). The waiting area was filled with a crowd of people, mostly women, some of whom were very young. I was impressed when the staff reported that it is rare that a patient would miss an appointment (and they always have a good excuse if they do miss it). It also doesn't seem like they have any issues with adherence to treatment regimens. When I interviewed a nurse practitioner at the CARE Program in Long Beach, she reported just the opposite for her patients. The staff at the clinic were shocked when I told them how common it is for HIV+ patients to miss their appointments and not take their medications in the U.S. As we were comparing prevalence rates in Tanzania and the U.S., it made me sad to think that I work with a population that has rates comparable to one of the poorest nations in the world. What exactly is our excuse? In Tanzania, prevention efforts seem to be having a lot of success because of the aid of the PEPFAR funding. Why can't we do the same in our own country? Seeing these results does make me realize that G.W. Bush may have done one good thing in his presidency. I'm also starting to wonder how we'll figure out a solution to poverty, so that countries like Tanzania can maintain these programs while reducing their dependency on foreign aid (to prepare for when our economy completely implodes and we have spent every dime on wars so we have none left to do any good). I really hope that our new administration will continue to support these efforts abroad, while developing a domestic plan to combat HIV as well. I think that just having our government start an open dialogue about it is a good place to start. I can't imagine G.W. and Laura Bush having a publicized HIV test like the Tanzanian president and his wife did. All of the district politicians in Tanzania did as well. That, to me, shows incredible leadership.

After our meetings we were on the road again. We took a little vacation from the craziness of Dar es Salaam and drove four hours our to another national park. On our way, we stopped for lunch and met the very charismatic restaurant manager. He was asking me about our politicians: G.W. Bush, Barak Obama, Arnold Schwarzenegger). Everyone we meet in Tanzania is very excited about our new president. This man also seemed to be pretty interested in my thoughts on our governor. He likes his action movies. :) Haha.

We ended up at the Genesis Motel - a nice lodge. We weren't staying in luxury, but it had such a great vibe. We were greeted with glasses of fruit juice and had a night of pure fun and socializing. We had a great dinner outside and drank beer, stretching out the evening lazily. I love the short rains that we've experienced periodically. As we were sitting at the long dining table, the skies opened up for just a few minutes, sprinkling down a refreshing rain. Lacey and I made up a "Name That Tune" sort of game, after which we played charades. A few of us stayed up talking and didn't go to bed until very late.

Surprisingly, I had no problem waking up at 5am to go on an early morning game drive in Mikumi National Park. The animals are much more active before the afternoon heat, so we saw impalas, giraffes, and zebras running across the savannah. We got a great view of some lions and elephants too. There were also a lot of colorful birds in this park.

We're now on our way back to Dar for a dinner meeting with the WHO Tobacco Control. Tomorrow, we'll catch the ferry to Zanzibar and finish our trip there. I am excited to work with the children there. I almost can't imagine leaving this place. Despite the expected issues with traveling to a developing country, I haven't been unhappy once this whole trip. Even some of my classmates have commented that there seems to be nothing during this trip that I haven't approached with enthusiasm. I have never felt so alive and filled with a sense of adventure. The cockroaches, heat, dirt, and pit latrines are all a part of this incredible experience.

Tuesday, January 13, 2009

Royal Mirage Hotel, Dar es Salaam

I am finding myself frustrated. In the States, I get frustrated working in HIV prevention because it seems inexcusable that transmission still occurs. I am also finding myself frustrated with the situation in Tanzania. HIV/AIDS is a topic that is openly discussed. Due to efforts of politicians and prevention campaigns, many people test for HIV. The government provides HIV education, condoms, and free anti-retroviral medications. Prevalence rates have decreased over the last few years (from 7 or 8% in 2003), the the incidence is still around 4.9% (that's the number that people kept quoting me, but research after my return home indicates rates closer to 6%). To put it in perspective, the overall prevalence rate for the U.S. is around 0.3%. However, depending on what studies you look at, in certain populations of MSM in the U.S., prevalence can be anywhere from 8-25%! I think that the incidence rate among the population that we tested at our agency was about 4% in 2007. So, although it is easy to assume that HIV is not an issue in the U.S. and is only a really catastrophic problem in Sub-Saharan Africa, in certain populations, rates are comparable to those in Africa. Yet we don't have PEPFAR to help prevent and treat HIV domestically. In addition to combating HIV in developing countries, we really need to be amping up prevention efforts domestically as well. It's too easy to believe that HIV can't touch us here, but it does... everyday, in great magnitude.

I keep asking people here why HIV is so difficult to prevent despite the availabiliy of education, condoms, testing, and ART, but I keep getting vague answers like "people are people". I understand that people aren't using condoms as consistently as they should and abstinence is not a realistic goal, but I want to understand more about specific obstacles people face, so that creative (and hopefully effective) prevention efforts can be implemented. I understand a bit about the population that I work with in Long Beach. I can see how certain factors are exacerbating the problem: drug use, fatalism, perceived invincibility, the idea that HIV can be managed by drugs, cultural influences in disproportionally affected minority communities that may limit open discussion about HIV and sex, prostitution, poverty, the role of women as caretakers (neglecting their own well-being), incarceration, popularity of high-risk behaviors like barebacking, the phenomenon of gift-givers and bug-catchers... the list goes on and on. I want a list like this to explain to me why HIV persists in Tanzania. I know that there might be some factors that differ from what I see in Long Beach, and I'm sure that there are many that intersect as well. The most I've been able to elucidate is that there is a struggle with monogamy (it is acceptable for men to have several wives/sex partners), women have difficulty negotiating condom use, and women have low social status that limits their freedom to test and they may also face domestic violence issues. I want more answers than this.

The water situation is really very dire. There is such a huge need for clean water and proper sewage and waste treatment. We really take water for granted in the U.S. We visited with a couple men from Engineers Without Borders to see what they are trying to do to help with the problem. We visited a village to see how they get their water from a well and even carried buckets of water on our heads as they do. The severity of the poverty in Tanzania is becoming more and more apparent to me. When I think of the excess we experience in the U.S., it makes me a little bit sick. For as much money as we spend of stuff we don't need, we could probably provide water and sewage infrastructure for a whole country.

I have remained in high spirits and have had no problems adjusting to our travel (even when things aren't going super), but I find myself secretly outraged at this crazy world we live in. This hotel has TVs and watching the news about Gaza has literally made my stomach turn.

I'm too tired to write any more tonight. More tomorrow, when we'll have visited the CDC programs for malaria and HIV. Yay!!

Royal Mirage Hotel, Dar es Salaam

I just killed our fourth cockroach. The third one was actually in Lacey's bed, so we tried to wipe off any roach fecea and put something over our pillows in case there was lice. Unlike some of the girls, Lacey and I haven't exactly been screaming and insisting that we can't stay here, but we did both have to take medication to sleep and we agree that we would rather be camping. I'm much happier in rural areas with trees and the animals and people living simple, happy lives. Dar is like any other big city. Poverty surrounding huge sky-rises. Dirty and dangerous, there are dark alleys with crime and pickpockets waiting for an unaware tourist. I guess yesterday was the Tanzanian Independence Day, so that was why there were so many cars and people everywhere. I'm curious to go out and see more of the city, but wary too. I'll have to stay close to the group because at this point I have NO voice AT ALL and won't be able to yell if I need to get someone's attention. I do love the humidity though... tropical.

Monday, January 12, 2009

Royal Mirage Hotel, Dar es Salaam

Dar... hmm.. well Dar es Salaam is a very big, very crowded, very busy city. It's the biggest city in Tanzania. It's by the coast, so we could immediately feel the shift into high humidity. I'll have to write more about our little friends (cockroaches) staying the night in the BIG city. The Ambien that I took has kicked in big time and Lacey says it's time for me to get to bed now. I'll write more tomorrow. Lala salama, cockroaches!

En route to Dar es Salaam

We've been driving across Tanzania from Arusha to Dar es Salaam all day. We miss Hussein, but our new drive, Abdallah, is nice as well. Our bus is the best!! We have Bill, Gina, Tina, Anna, Alex, and myself in our group and we've been playing games almost the whole trip. It's probably the hottest it's been since we arrive in this country, but I like the warm wind. How did I gorw up in SSF and love hot weather so much?

It's pretty neat traveling through this country. There is so much open space in Tanzania. Most of the time we are traveling through land that may have a few scattered farms or crude huts if anything at all. And then we'll drive through a quick pocket of civilization in the form of a village, with bars and farmers markets. The highway is nice and smooth. Tanzania has either rough, dirt roads or really nice highways. They keep up the roads well and are constantly making new improvements to facilitate the tourism that seems to be the lifeblood of Tanzanian economics. We have yet to see any homes that resemble what you'd find in American suburbia and the poverty that Tanzanians live in is apparent, but I find myself forgetting this fact during our travels. In general, Tanzanians are warm and friendly, and it is easy to feel like there is nothing to worry about... hakuna matata. While it is important to have improvements in sanitation, nutrition, and disease prevention, it is clear that we are accustomed to a society of excess. Americans determine their quality of life by the amount of unecessary things we have - TVs, designer bags, multiple cars, etc. Being here forces one to consider what is really necessary for health and happiness - which is surprisingly little. Even in these "roughing it" conditions, I feel so at ease and comfortable. For all of the luxuries and comforts that we have in the U.S., we make ourselves sick with stress and anxiety. After only two days here, I realized that I stopped needing to crack my neck all of the time. I think I carry my stress in my neck and shoulders and I have felt no stress pretty much this whole trip. I don't know if I can go a day in the U.S. without being anxious about something. I've had no need for the coping mechanisms that I usually resort to in order to deal with the stress and I am feeling happier than I ever have. I think that I have been so restless, especially these past few months, and now I realize that I am the sort of person that needs to see the world and live a life filled with adventure and new experiences everyday. I am REALLY enjoying learning Swahili and hope that I can find a way to expand further when we return to the States. I know it sounds cheesy, but I had a feeling that this would be a life-changing experience and I think that was a correct prediction. I don't really know how to explain it, but I feel changed inside... like I'll return home at the next stage of personal matamorphosis.

I'll probably also return without a voice. I'm feeling super healthy, but I think perhaps the dust has irritated my throat. I've been feeling more and more hoarse all week and have had some minor asthma symptoms and today my voice is nearly gone. Hakuna matata, though. I don't think that everyone else is having this smooth of an experience. Several people have gotten motion sickness (although everyone in our truck is pretty chipper, even when they don't feel well). A few people also had run-ins with a stinging nettle and one person got some pretty bad fly bites. I have two little bites on my knee, but they don't hurt unless I touch them and they are healing well with antibiotic cream. Anna drew a smiley face because she said they look like eyes, so now it makes me smile everytime I look down at my knee.

One thing that was a little difficult today was passing by a very bad bus crash. Sheila was telling us that there were lots of traffic accidents in Tanzania, but this was the first that we have seen. Gina suggested that we stop and help, since we have so many nurses in our group, but I guess the drivers decided to keep going. It was hard to get back to our games for a while after that. I felt frustrated that we just drove by when we could have done something to help. The whole front of the bus was crushed so I'm sure there were casualties. We saw a few policemen and a crowd of people standing around, but I'm not sure if or when medical help would arrive. Just thinking about it now makes my stomach turn again. The whole reason most of us are interested in careers in health is because we want to help and it is so difficult to just pass by someone in need.

To cheer myself up just now, I started thinking about my plans to partner with those Australian students and distribute the shopping bags made by the women at Angaza. I am serious about trying to help Kami if I can, too. I hope that I can use some of my connections to see if he can study at a university here. I wonder if our conservatory has a program in music production? There is so much that I want to do. I just realized that I have already reached my goal for this trip. Before coming here, I felt this vague sense that I wanted to be helpful in some way... any way. I had hoped that this experience would show me some specific purpose that I might have, and already I have several ideas for good things I might be able to do... some specific ways I can positively affect my world. I wouldn't trade this experience for anything. I don't think that in eighteen years of study I have learned so much in such a short amount of time.

Sunday, January 11, 2009

Arusha Naaz Hotel, Arusha

I looked back at my last journal entry and laughed. I wanted to write by candlelight, but I really couldn't see. So, I had writing scrawled in big, messy script all over the pages. Now, we are back in Arusha under mosquito nets (no need in the crater because the elevation is too high for mosquitos). I haven't been sleeping much and I think it might finally be catching up to me. This is the first day of our journey that I am really exhausted. Safari can really wear you out. Oh, and I learned that "safari" means "journey", not "white people in khakis taking pictures of lions". We had another day of animals. We started with a game drive at the Lake Manyara National Park. We saw some of the same animals as yesterday, but also lots of giraffes and many different types of monkeys. Just exiting Ngorongoro in the morning, we came across a whole pack of baboons in the road at the gate! A small group of us also went to a snake park and saw many types of snakes found in Tanzania, as well as birds, crocodiles, and tortises. We learned that the crocodile eggs at the top of the pile get the most sun and will become male crocs, while the eggs at the bottom stay cooler and become female crocs. I think that my favorite snake was the python. We saw pictures of pythons that had been caught and cut open to reveal whole men that they had eaten (the men were dead by the time they were released, of course). The Black Mamba is probably the deadliest snake. Tanzanians call it the "seven-step snake" because after being bitten, you can only walk seven steps before you collapse and die. They also call it the "one cigarette snake" for the same reason, but that also shows just how common smoking is here too. Our snake man, Lottie, helped catch the Black Mamba that is living in the park! He also brought us a non-poisonous snake for us to hold, which was awesome.

We also stopped to buy souvenirs, of course. We are getting to be shrewd bargainers. This was the last day with our driver, Huseein. He taught us a song that we sang ALL day and then when we stopped at an orphanage to pass out toys, the kids sang it to us and we joined in. Turns out that it's a song welcoming foreigners to Tanzania. We are learning so much Swahili. It was night to spend the weekend in the parks. I'm not a huge fan of the city of Arusha, but maybe I will like Dar es Salaam better. Lala salama!

Saturday, January 10, 2009

Rhino Lodge, Ngorongoro Crater

Today was yet another incredible day. I'm currently sitting on my veranda at the lodge and looking out over the park, as water buffalo walk by my balcony. Staying at a safari lodge feels like such a luxury. I think I'd feel more guilty if that shower wasn't so wonderful. I feel really clean for the first time in days.

We set off from the UAACC early this morning. I felt so sad to leave. It has come to feel so much like home. We drove most of the day. On our way to the park, we passed through rural areas with Masaai tending cattle and colorful markets on the side of the road. We had a couple stops on the way to the lodge (one to a curio shop and another at the park visitor center to learn about the crater). After being wowed by our accomodations, we started on our game drive into the crater. I can't remember ever having so much fun. I have retracted my previous statements criticizing the amount of tourist activities planned for this trip. The ride itself was so much fun as we pushed the top of the truck up so we could stand and take pictures as we went along. The road was so rough and it was like we were off-roading. I ended up pretty banged up by the end of the day, but it was worth it.

We stopped at a Masaai village and were greeting with a song and dance. The women had us try on their necklaces and dance with them. The guys went with the men and were taught how to jump the way the Masaai men do. We visited the witch doctor's hut where they had sacrificed and cooked a goat. We were then shown a Masaai hut and purchased some of the Masaai crafts.

In the crater, we saw many wild animals: zebra, Thompson gazelles, hippos, elephants, birds, lions, warthogs, water buffalo, wildebeast, etc. We pulled right up next to a lion! The views were spectacular - beyond description and our picutres cannot even begin to do it justice. The crater is so luch and green. The dirt in the park (and on the way to it) is red from the volcano. The contrast between the red dirth and green flora is striking. Some drama unfolded as we exited the park. We were three minutes late and found the gate closed. Two armed rangers argued with our drivers. They wanted bribes - 20,000 TSH per person. After an hour their boss came and let us pass, so all was well in the end.

Everyday has been such an adventure and I am learning so much. I'm surprised at how much Swahili I've picked up in only three days here. Both our group and the Tanzanians we've met are thrilled with our attempts at speaking Swahili. Tomorrow is another game drive and then back to the city of Arusha. It will be good to exchange some more money and some people need to visit the post office, but I'm not a huge fan of the city. It is too crowded and fast and rough. And I'm sure that this is nothing compared to Dar es Salaam or Nariobi, Kenya! I prefer the beauty and quiet of the rural areas. I could not help but thank God over and over again as I sit here looking out over the park. Asante sana, Mungu... asante sana.

Tanzania feels more like home than any place I've ever been. I can close my eyes and see it all with such vivid clarity. It is difficult for my mind to focus on one image. My brain seems to fly through the images like a video recording. I am trying to figure out what the significance of that is. I'm also trying to figure out the meaning of a nightmare that I had about an old Masaai man last night. I can't remember what happened, but it was antagonistic and frightened me. This man was very elderly and was a bad man - and evil man, it seemed. I was shaken by his image when I woke up. He had no ears, but instead had the inner parts exposed, flat against his head. The skin wasn't human, but insect exoskeleton and seemed to be decaying and slimy. I woke up struggling to breathe, my heart racing. It was such a strange dream to have when I have been nothing but at ease here. Hopefully I will have no scary dreams tonight. Lala salama!

Friday, January 9, 2009

UACC, Arusha

It's only the end of day two here in Tanzania and I feel as though I've been here forever. Today was an incredible day. We started at the Ngurdoto Dispensary and Clinic. It's in a rural area outside Arusha and they do HIV testing there and also maternal health and delivery. We moved on to another rural clinic after that - the Usa River Clinic. We were given a tour by the physician there and even got to sit in on a consultation with a two-year old who was crying because she had a fever. I was struck by the lack of resources in the laboratories at the clinics we have visited. Even at the nice private hospitals, they are lucky to have the basics - a machine for CBCs, a machine for chemistry, a centrifuge, and a microscope. There is a great need for capacity-building in regards to laboratory technology.

We then went to the Angaza HIV Testing Clinic. It's run by the Lutheran Church. Judith, one of the counselors, gave us a great overview of their procedures. As I asked her questions, I realized that their program is almost exactly like testing here in LA County. They focus on building rapport, respecting confidentiality, being client-centered in their counseling, and using a referral network for HIV+ results. They seem to have many of the same challenges as well - stigma, low status of women, poverty, etc. Although it is reported that cases are generally transmitted through heterosexual sex, I wonder if homosexuality is not common, or if it is just not acceptable to discuss. There also seems to be a low incidence of injection drug use (although marijuana and alcohol abuse are common). In Tanzania they have a universal testing procedure using rapid tests. Although they do store them in a refrigerator, there doesn't seem to be any quality control procedures.

We met a group of young Australians who had set up a program in Ghana where women with HIV made bags that were sold at the Australian university. They are now starting up an identical program in Tanzania (today was day one for them). I got contact info from them, in hopes that we can collaborate to distribute them in the States as well. I am so impressed with the work that they are doing.

We also got to see a man in Arusha that was an herbalist. He makes herbal medicines to treat all sorts of diseases. His specialty is a treatment for dental problems. It was an interesting experience - a run-down building with dark, dirty hallways, smelling of excrement. The doctor seemed more like a salesman, according to some people in our group. He did make a point that I agree with - that more research needs to be done to evaluate the efficacy of herbal treatments. He talked a lot about treatment for "male weakness" (ED).

The evening back at the UAACC was even more remarkable. We shopped for goods made by the students here and I spent some time with a young man named Kami. He is a musician and producer that Mama C has taken under her wing. He's had a tough life. He was born in Kenya, never knowing his father. His mother moved him and his younger sister to Germany with a step-father that he did not get along with. When his mother died, he had to leave his sister with the step-father (who she got along with well) and moved to Tanzania. He does not even know where his sister is anymore. He took a group of us to show off the small recording studio where he and Mama record their collaborations. He does the beats and she sings poetry. Mama is using her CD sales to help him raise money to come to the U.S. to study music production and he is also going to work on his own album. He then led a discussion with us and some African students here on topics like global warming, education, and HIV/AIDS. Kami is an incredible young man with big talent and big dreams. I hope to be able to help him with his goal of coming to America. Listening to Mama's music feels like being wrapped up in a hug.

SOME OBSERVATIONS:
- Don't stand outside money exchanges or large, fancy hotels. You will be harassed by people selling things.

- Tanzanians love their cell phones. There are ads everywhere. As Sheila pointed out, "Even though they may not have running water, EVERYONE here has a cell phone."

- There are bars and petrol stations everywhere. People really seem to like their beer and gasoline.

Thursday, January 8, 2009

UAACC, Arusha

Sites visited: AICC (private hospital)
Old Arusha Clinic (private hospital)
Mt. Meru Hospital (public hospital): Mental Health Clinic

What a day! We’re back at the Community Center surrounded by children. Blues Clues is on TV, kids are drawing and playing with balls (as we inflate them), and next to me a young girl is singing and learning to play guitar. There is so much joy and peace in this place. Driving through the colorfully painted gate feels like entering a sanctuary. It feels a little like summer camp here. Eight of us are in a room of bunk beds (the other eight in another, identical room). Dr. Piane (sleeping next door) commented on our chattiness as we were getting ready for bed last night. Even though we’ve only just met, our group had bonded closely. A few of us picked up a game of HORSE on the basketball court (I don’t think I made a single basket!).

The day started with a light, but delicious breakfast at the UAACC and then it was off for a day with our drivers. Nothing really seemed to go as planned, but it was amazing anyway. We started out at an originally unplanned stop – the AICC. This was a private hospital. It was great to talk to the physicians and nurses about common ailments that they threat, but we left with the suspicion that this hospital did not give us a clear picture of the reality of the healthcare system here. There were almost no patients, but we were told that Saturdays are busy because a lot of specialists are at the hospital on that day. Most patients stay in two-bed rooms and the facilities were clean and pretty well-stocked. They even had private VIP rooms. They had a fairly advanced x-ray machine purchased from the U.S. a year ago and a small laboratory. They are even able to send out specimens for HIV PCR testing if necessary (but I got the sense that this was a very rare occurrence). In Tanzania, the procedure for HIV testing is an algorithm using up to three different rapid tests to confirm a positive result. They also check CD4 counts and their priority is getting patients started on ART (much like in the U.S.). One difference that I noticed is the types of opportunistic infections that are common. Of course PCP and cryptococcal meningitis were mentioned, and TB was high on the list (I think it’s less common in the U.S.). I thought it was strange that KS wasn’t mentioned. I’m not sure if this was just overlooked, or if it is more common in the U.S.

The Old Arusha Clinic was more of the same (also a private hospital), so we were interested in seeing the Mt. Meru Hospital (a public hospital) to compare. We weren’t allowed to visit the actual hospital, but we visited the Mental Health Clinic there (an NGO, funded by donations, so the hospital has less oversight). Sheila, the Irishwoman that runs the clinic (also a psychotherapist) explained some of this secrecy to us. She was actually very helpful in explaining a lot about the people in Tanzania, the healthcare system, government, and the patients they see. Of course there are cultural differences, but for the most part, people are people no matter what country they’re in. Tanzanians suffer from the same problems we experience in the U.S.: domestic and sexual abuse resulting in PTSD, addiction, depression, struggles with power, struggles to save face and protect reputations, and various stigma to be fought. She was really a wonderfully genuine woman with a lot of insight and a kind heart.

It’s a little difficult in the city to fight off people peddling goods and difficult to adjust to thinking in shillings and exchange of currency, but it’s helpful to have our drivers to guide us around. I’m also struggling to learn a few Swahili words and phrases. I’ll list a few I’ve learned:

Asante sana
– thank you very much
Habari – something like “how are you?”, but literally closer to “what’s the news?”
Response: nzuri – good
Habari za asubuhi – good morning (literally “what’s the news of this morning?”)
Response: nzuri sana – very good
Jambo – general greeting to foreigners
Hujambo – How are you? (literally: “nothing wrong with you, I hope?”
Response: Sijambo – I am well (literally: “there is nothing wrong with me”)
Mambo – slang greeting like “whaz up?’
Response: Poa – cool
Karibu – Welcome (to invite people in) or you’re welcome (in response to asante)
Karibu/asante tena – you’re welcome/thank you again
Hapana – no
Ndiyo – yes
Rafiki – friend
Duma – cheetah
Simba – lion
Kiboko – hippo
Pole – I’m sorry
Pole pole – slow/careful
Tafadali – please
Ubarikiwe – bless you (after someone sneezes)
Twende – go
Simama – stop
Sasa – now
Marisha marefu – cheers! (literally: long life)
Maji – water
Kidogo – little
Kidogo kidogo – a little bit
Kwa heri – goodbye
Jina lako nani – what’s your name?
Response: Jina langu…- my name is…
Mungu – God
Mzungu – white person/European
Safari njema – good journey/bon voyage!
Lala salama! - goodnight! (literally: sleep in peace)
Hakuna matata - no worries (yes, they actually say this here... I didn't just get it from The Lion King)

UAACC, Arusha

I woke up this morning to birds chirping and a rooster crowing. It is so peaceful and I feel so comfortable here. Mama Charlotte (the woman that runs the Center) is such a wonderful host – a warm and inviting woman who I feel immediately at ease with. We had a brief conversation as I came back from my morning walk, and discussed HIV/AIDS in Tanzania versus the U.S. We both marveled at the irony that in the U.S., where sexuality is openly displayed in popular culture, the reality of sex is a taboo topic. Here in Tanzania, there is a more modest culture, but HIV/AIDS is an issue discussed with relative freedom and ease.

RECAP: I survived the long series of flights to get here. I was concerned at my anxiety after only the first four-hour flight to Detroit, but six hours into the second flight to Amsterdam, it didn’t seem so bad. As we flew over Europe, we cross an area of clear sky and lights of the city centers clustered like constellations. It was really quite beautiful. Disembarking after the final flight was like something out of a movie. It seemed to fulfill all of my romantic fantasies of world travel. We arrived at Kilimanjaro Airport and walked down the stairs as warm winds gusted, pushing us off the runway and into the airport building. It had almost a colonial feel with its open space, covered in beautiful hardwood floors with fans overhead.

We were collected by our drivers and made the forty-minute drive to the United African Alliance Community Center. As the vans traveled down first a smooth paved road and then a rough dirt road (which we equated to the Indiana Jones ride at Disneyland), our group discussed our dreams of and experiences with world travel and the challenges in garnering support from family as we pursue travel and careers abroad. At dinner we met a group of people with (AIDS Africa?), including a fellow Bay Area native (Devon, from Walnut Creek).

Today we’re off to visit a couple clinics. I can’t wait to see what the day brings.

United African Alliance Community Center (UAACC), Arusha

So I finally got myself tucked into bed, surrounded by mosquito netting – which, as it turns out, is not that easy to arrange around you. Although I am excited to be halfway around the world, I feel so at home here. The people at the Community Center are so warm and friendly, and we arrived to an excellent dinner. The long flight was certainly worth it. Lights out… more tomorrow.

Wednesday, January 7, 2009

En route to Amsterdam, Flight NW 36

I was looking out my window, down into the sea of blackness that we are flying through and I was struck by the realization that I am incredibly far from home – farther than I have ever been. This still feels like I am in a dream. I am excited, but I feel a tinge of other emotions – fear maybe. I have absolutely no idea what to expect from this experience, but it feels as though I am standing at a precipice with my whole life stretched out below me, getting ready to jump. It may sound a bit melodramatic, but I suppose that’s what happens when you do something that you have felt seep in your bones that you were ABSOLUTELY meant to do in your life. I have never felt more sure of anything. I am exactly where I’m meant to be – in this moment, set firmly on the path God meant for me.

Tuesday, January 6, 2009

En route to Amsterdam, Flight NW 36

We make it to Detroit with just enough time to RUN through the airport to catch our next flight. Who knew that just getting to Tanzania would be so exciting? Six more hours and I’ll be in Europe for the first time in my life!

En route to Detroit, Flight NW330

Even now, I’m not sure if the realization that I will be in Africa tomorrow has really sunk in. The preparations for my trip have kept me distracted and I think that there is something surreal about being at a point in my life where I am doing EXACTLY what I’ve set out to do. For some reason, that reality is difficult to accept and I’m sure that my excitement is further tempered by the extremely long flights necessary to reach our destination. I’ve only made it through the first three hours of the shortest flight – four hours from LAX to Detroit. I think that I still need to grow accustomed to this aspect of international travel. We still have two more eight hour flights before reaching Kilimanjaro. You would think that after staying up all night it would be easier to sleep.