June 2006

Lena: Dispensary

Every morning we learn about a particular topic: the vocabulary, the grammar, and the culture surrounding it. Then in the afternoons we visit a place that exemplies that component of society.

Monday: We learned about "children from difficult backgrounds" and then we visited a home for street children.
Tuesday: We learned about weather and farming and then we visited a place for mixed farming.
Today: We learned about health and then visited a dispensary.

Just to clarify what a dispensary is: it's a clinic provided by public or charitable funds according to the Compact Oxford English Dictionary. I would say that it was sort of the equivalent of a walk-in outpatient clinic, where they also supply medications and fill prescriptions.

We were told to go into a random room to find the doctor we would be talking with. Upon knocking and entering, I was surprised to find he was with a patient and all my cultural knowledge of the importance of greetings in Swahili culture went out the window and I began apologizing and attempting to explain who we were.

The doctor would have none of this and interrupted me with the traditional greetings. As he asked to sit and we all introduced ourselves, I began to wonder if perhaps the woman in his office was not a patient at all.

Just when we all began to feel a bit more comfortable, he proceeded with his consultation, pausing occasionally to explain various aspects to us. Eventually it became clear that this women was having problems with her menses and he was going to give her some fertility drugs.

At that point, the three other students in the room became extremely uncomfortable. I felt the sames light unease that I usually feel when a large group of student is privy to the intimate details of a patient's personal life. After the patient left, he said you just observed aibu, or shame.

Afterwards, all the students could talk about was how awkward and uncomfortable they had felt and what a violation of patient privacy it had been. It seemed odd that if the doctor knew the patient was feeling embarrassed and ashamed, he should have done something to ameliorate that feeling, but proceeded with no compunction. In additon, he hadn't asked the patient if it was okay for us to observe beforehand, but then I began to think that even if he had asked her, she would have agreed despite her personal discomfort.

Unlike the rest of the students, I was struck by a number of other things. Firstly, the similarity in the way one takes a history and gathers information from the patient was remarkable. Despite all the differences in health status and disease profiles as well as all the cultural differences, this doctor was modeling the same kind of clinical thinking that I had learned in the past year. He used open-ended and close-ended questions, and things like how long as it hurt and can you point to the exact location with your finger.

He also talked a good deal to us about what the most common illnesses were and had a handwritten chart on the wall of the disease burden from 2003. Interestingly, malaria, acute respiratory infections, and minor surgeries (i.e. tonsilectomies) were the most common diseases seen in Usa River. I noticed that HIV was not on their chart, nor was tuberculosis, two diseases that I thought would be relatively prevalent.

He seemed to think nothing of it, opened a book and said that they have documented 84 cases of HIV. I asked what kinds of services they provide, he again seemed to think it was obvious that they provide treatment with ARVs (antiretrovirals) and home-based care including nutritional support as well voluntary counseling and testing (VCT).

All in all, I found it to be an enlightening experience, with several surprises.

The dispensary from the outside:

The doctor's office inside:

HIV/AIDS related posters in the waiting room:

JoAnn: Safe and Sound in Malabo

First, some background. I am here in Equatorial Guinea to do research related to malaria prevention during pregnancy. I'll spend my days in the Family Planning and Labor and Delivery areas of the city hospital, where I'll interview and collect blood samples from pregnant women.

I'm assessing the prevalence of anemia and malaria, and collecting qualitative information about women's attitudes towards prophylaxis during pregnancy. I'll be working with a team of organizations called the Bioko Island Malaria Control Project. The project's partners include the local ministry of health, Medical Care Development International (my connection), and is financed by Marathon Oil.

Back to my journey: My Spanish host dad, JuanJo, accompanied me to the airport in Madrid. I think he was a bit nervous about leaving me there--a naive-looking blanquita on a plane full of strangers.

I must admit, I was nervous, too, but soon after we took off, I struck up a conversation with the nice lady next to me, and was calm for the rest of the six hour flight to Malabo. I landed safely at the Malabo international airport, which consists of one gate and one terminal. I passed through customs with no more hassle that I expected, and met Jaime, one of the directors of the malaria control project.

A few other Americans (Marathon employees) arrived recently, and Jaime took us on a minibus tour of Malabo and the surrounding areas. We picked up the others at the Marathon compound, which is totally secure. I had to give my passport as collateral to enter. We went directly to the ex-pat's residence, which has the eerie feeling of a deserted suburb.

The Marathon executives live in Western style houses all situated on one road. There is a pool, tennis courts, a bar, but nobody seems to be around. I met the others, almost all Texans with southern accents, and we hopped in the minibus and began the tour.

The area directly outside the compound felt like something from Jurassic Park--hotels under construction, thick foliage, giant prehistoric-looking trees. Instead of taking the main highway into the center of town, our driver veered onto a dirt road, straight into the jungle. We drove past a few little settlements, called Patios, of ten to fifteen houses build from found wood and scrap sheet metal.

Kids with swollen bellies ran around in their underwear or in nothing at all. Groups of young men parked their cars next to muddy puddles, and used pieces of cloth to wash their cars with the mucky water. A bustling market sold meat (antelope, porcupine, monkey), cheap things imported from China, second or third-hand t-shirts. Certain stands at the market had hand-painted "Bar" signs, and sold San Miguel beer. Others advertised haircuts and braiding.

We stopped at a place called "Cold Wata" where people come to get water and wash their clothes. The women soaped up their things and smacked them against the concrete to slap out the dirt. We passed through the hospital, which consisted of about 15 buildings, all housing different specialties: Pabellon de Pediatria, Pabellon de Planificar la Familia, etc.

We drove through the center of town, where the Spanish colonial influence is most apparent. There are mission-style houses (crumbling), a cathedral, and a wide road that runs parallel to the harbor, where three or four large ships are docked. We drove by some bars and restaurants where expats like to go with names like Paradiso, Tropicana, etc.

After the tour, we retreated, back to the compound. After having seen both the city and the compound, I felt glad that I was staying with a host family, and not going to be cooped up for my time here.

Jaime took me to meet my family. Within the center of the city, it's hard for me to distinguish between the poor and the very poor areas, so arriving at the house, I didn't really know what to think. I was lead through a narrow alley strewn with old car parts, springs from a mattress, and lots of trash. A hen and her chicks seemed out of place in the urban neighborhood.

My host mother, Elizabeth, met me at the door of her house and greeted me with warm "You are welcome!" I was incredibly impressed with the house--new-looking ceramic floors, a television and dvd player in the living room, ceiling fans, a clean bathroom. This is going to be fine, I think.

My room is very nice. For the first time in five years, I have a double bed, and my little balcony overlooks the neighborhood. Very fine. I met my little host brothers Ryan (4) and Bethel (2). They were just waking up from their nap, and were little angels.

After about an hour, my host father, Lucio, arrived home from a soccer game. He is from Nigeria and pastors a church near the house. When I thanked him from his hospitality, he said, "Thank God."

"Do you like Nigerian cinema?" Elizabeth asked me. I didn't know they were making movies in Nigeria. Elizabeth put one called "Don't Dare Me," in the dvd player. It was set in the 1940s in Nigeria, and touched on all subjects: temptress femmes fatales, choosing a wife, pleasing one's husband with good food. It was cheesy and full of dancing, but not boring.

This morning I was awakened by two sounds: the rooster crowing from below my balcony, and my host father leading the family in the morning prayer songs. I believe this family will take good care of me. Today I meet the ministry of health director of Malaria control--more to come.

Asya: Russian Summer

For updates on Asya's adventures in Russia, check out her blog at:
http://asyagu.blogspot.com/

If you want to see her pictures, go to: http://www.mumrik.us/

See excerpt from her blog below.

I've been in Russia since Monday and its definitely a very interesting country. I already have some stories, including grandma's selling flowers, policemen, and adventurous teenagers at their high school prom/graduation bonanza. But more of this later, when I get back from a much needed trip to a cooler, less crowded dacha (summer house) outside the city.

Impressions of Moscow:
Although this isn't typical (so I'm told), Moscow is HOT this time of year. It's hot, crowded, and there is no air conditioning for anyone but the very wealthy and the particularly picky tourists. The city streets remind me of pictures I've seen of busy Chinese cities: cars parked 3 deep so there's only one lane for the enormous amount of traffic, many people, pretty dirty. But despite this, Moscow is a beautiful city. In the center of town, everything is old, historic. I can walk around there for hours, given I don't attract the attention of a hungry policeman who wants some lunch money. So far, I seem to do ok blending in if I keep my mouth closed. As you know, this is sometimes difficult for me.

Anyway, I'll post more later, but if you're curious what Moscow looks like and where I live, go see my pictures at http://www.mumrik.us/ (don't laugh, my dad made the site, in dedication to my cat). Click on the photos link and then look at the Russia 2006 album. You can sort the pictures by date, etc on the upper right hand side. If you want to see what the life of high school students in Russia is like, click the Russia 2006: Sasha Graduation album to see pictures from our friend's high school graduation. There are some very interesting dresses. I will keep updating this page with new pictures, so check back later for more.

Hope you enjoy!

posted by Asya @ 12:49 AM

JoAnn: Madrid me mata!

Hello friends. As many of you know, my Pre-Malabo itinerary involves a brief stopover in Madrid to take a descansito and catch up with my host family from a 2002 study abroad experience here. Two things have impressed me about my return to Madrid: first, how wonderfully little my host family has changed, and second, the art.

This awesome family of four contains Andrea (a German, progressive, tapestry artist/stay-at-home mom), JuanJo (a bearded Spanish gentleman, with radical tendencies, who's studying to be a lit professor), Lea (a 12-year-old pixie who's read everything and who's going to be the most interesting 25-year-old in the world), and the new addition, three-year-old Ulysses (who speaks way more German than Spanish and who replies with an adorable, Vas? to all my questions).

We've been enjoying my favorite foods: jamon Serrano, queso manchego, tortilla Espanola, vino lambrusco, along with a few German additions including a delicious kind of seeded bread.

To comment on the artistic highlights, I've seen a Picasso retrospective spread out over the two major museums, a remarkable series of giant color photographs by Yann Bertrand installed in the Retiro Park, and this amazing exhibit from Korean artist, Kimsooja, who used mirrors and transparent light-diffracting film to turn the park's Crystal Palace into a giant prism. I also saw "Volver," the newest movie from Pedro Almodovar (Spain's big cinema dude). I leave tomorrow for Equatorial Guinea (!). Visiting Madrid is a bit like coming home, but Malabo will be an entirely new adventure. Stay tuned for more medically oriented postings!

Mike: Solstice in Alaska

What better day than summer solstice to submit my first blog entry. The reason I'm indoors is that it's quite rainy and windy, and essentially feels like a really long winter day. I braved the conditions and went for a paddle, which reminded me why I love this place. The bald eagles are incredibly thick this time of year (mating?), I can see over a dozen of them playing in the wind as I type this.
I start at the hospital on friday.
MP

Lena: Orphanage

Next to 'the compound,' as I have begun to call it, is an orphanage called Cradle of Love Baby Home.

While exploring the neighboring environs, we bumped into some of the staff getting off work and they invited us in. Inside, we came upon a room literally filled with babies, probably 25 or 30. The orphanage only houses children under the age of 2 because they require the most attention and are the most difficult to care for.

Unlike America, here it is easier to find home for children after the age of 2 because they are a bit more independent. Quickly one of the ladies who works there hands each of us a baby and the room gradually becomes quieter. For a brief while, we were mesmerized by all the adorable babies, but then our host begins to introduce them to us.

Telling us their name, their age, and how they got there. "That one's mother died during childbirth, too much blood, and that one's mother died during a car crash, that one's mother simply abandoned him, and that one's mother died of HIV/AIDS."

When asked if many of the children here are infected, she precedes to point at all those in the room who are, including the one that I am holding.

Suddenly, staring into the face of this adorable child, that had lightened my day only moments ago, my mood darkens. While in Nairobi, I visited an AIDS orphanage in the slums and although it was a profound experience, this was the first time I had held an HIV positive child in my arms.

I could tell that one of the other girls in the room was pondering whether she wanted to be holding or having physical contact with an HIV positive child. Another one of the girls asked me what happens to babies that are HIV infected. I told her that the same thing that happens to adults happens to babies, except sometimes it's faster.

Another suggested that she had heard that in some cases children can go back to being negative, after being HIV positive. At this point I had to interject, I was appalled that anyone would think that you could 'get rid of' HIV. I tried to explain that it is possible to completely suppress viral replication, but there was no way to ever completely eliminate the virus from one's body.

Afterwards, I was so upset by this suggestion that I looked online and lo and behold there are articles that say that babies seroconvert from positive to negative: BBC article and Newsweek article.

After reading these articles, I realized that this girl was talking about a situation where a child had tested positive as a result of passive transfer of antibodies from the mother to the child, rather than as a result of actual HIV infection. I guess it is just really important that such articles be clarified, so that there aren't such misconceptions floating around.

I can't believe that women are still dying of blood loss during labor. In some ways that is as appalling to me as all the AIDS orphans that I have been focusing my attention on in the past few years. Both the parents that die of AIDS and those that die during labor don't have to die and their deathes could be prevented.

This visit gave me a lot to think about and really put a face on some of the issues that I have been considering. It was such a heart-wrenching experience that I still haven't decided if I will go back to help out at the orphanage or not.

Lena: Market

Two days a week, near Arusha, there is a huge open air market that sells primarily vegetables and fruits. Our assignment was to go and practice our Swahili as well as our bargaining skills. They gave us 500 Tanzania shillings (Tsh), which corresponds to about approximately 40 cents, and 1.5 hours to spend it.

For the first 30 minutes, I simply wandered around, trying to get the lay of the land, and more accurately, being too intimidated and too indecisive to talk to anybody. That didn't stop people from talking to me.

One person called from one of the stalls, in perfect English, "I love you mzungu." I tried to ignore him, but a lady closer by said, "did you hear him, he says he loves you?" When I made eye contact, she said, "he's my husband." I couldn't tell if she was joking or serious... I replied, "Kwa nini? Hanijui. (Why? He doesn't know me.)" and continued on my way.

As I continued to wander, I noticed a small boy, about 9 years old, following me. I found this a bit unnerving and tried to evade him, but he stayed with me as I walked more purposefully.

I turned and said "mambo," a slang greeting to him. Now it was his turn to be taken off guard. He repeated my question back to me, and I responded "poa," meaning cool. He began to laugh and then disappeared, but this was not the last I saw of him. He returned with 3 other boys and whispered something to them. One of them tentatively asked "mambo?," I responded again, and they all doubled over laughing.

Still empty handed, I bumped into a group of 3 other students, all with hands filled with bags of vegetables. I decided to tag along with them for a bit, and with their encouragement, I managed to bargain for 8 tomatoes, 2 very large avocados, 6 lemons, and a bag of hot peppers for my 40 cents. My little friend from before reappeared when I needed a bag to carry my prizes, and I paid him 4 cents for it.

All in all, I would say it was a successful day in the market, and between the 15 of us, we brought back enough supplies to last the kitchen here for awhile.

My fruits (all for 40 cents):

Outside the market:

Lena: President of Ireland

Today the president of Ireland is coming to visit MS-TCDC. Apparently there is some sort of exchange program here with a school in Ireland and she wants to take a tour of the campus. There has been an influx of people, many of the them are wazungu (white). I saw her with her security team and reporters walking around the complex.

In other news, we started our first day of actual class today and much to my surprise, I was not in the lowest group. I made it into the middle level, which was a much needed boost to my confidence as I was beginning to feel that I was the least competent Swahili speaker here.

Now I am beginning to suspect that many of my colleagues are also clueless about what is going on, but they just don't admit it as freely as I do. I seem to be the only one here who ever acknowledges that I don't understand.

I think since going to medical school I have realized that there will be lots of times when I don't understand, and if I don't speak up, I likely never will understand.

Lena's Itinerary in Tanzania

In case you're wondering what I'm doing in Tanzania:
I'm on Fulbright-Hays Intensive Swahili Group Project Abroad in Tanzania... what a mouthful. For more information, visit: http://uga.edu/afrstu/gpa/

For those of you whose African geography is a little rusty: Tanzania is considered part of East Africa and has a coast on the Indian Ocean. It also shares borders with Kenya, Uganda, Rwanda, Burundi, Democratic Republic of Congo, Zambia, Malawi, and Mozambique.

June 18: Arrive in Arusha, Tanzania
June 30-July 1: Manyara & Ngorongoro Crater (Safari)
July 15-18: Dar Es Salaam and Bagamoyo (Coast)
July 19-23: Zanzibar (Spice Island)
August 4: Leave Arusha, Tanzania

Contact Information (in case you want to send me a care package):
MS Training Centre for Development Cooperation
P.O. Box 254
Arusha, Tanzania

Group Cell phone: 011-255-787-915525
Center phone: 011-255-27-2553837
(if you want to call me, send me an email first so that we can setup a time, as both of these numbers are shared)

Lena: MS-TCDC (Training Centre for Development Cooperation)

Our accomodations are much nicer than I was expecting. We have running water, private bathrooms, laundry service, 15 computers that are hooked up to the internet, wireless internet, and the list goes on. The downside is that we are in a gated complex 18 km from Arusha proper. The good part of that is that it's safe and I can run in the mornings without concern of being harassed, except by the monkeys.

See pictures below.

Here's the room I will be sharing with Leslie for the next 7 weeks (mosquito nets and all):

This is what the building looks like from the outside:

The monkeys joined us for tea:

Naresh: mmm.. Mangoes !

So.. the Mango tree in my house which was planted when I was in middle school by our now very old Gardener has given its first set of fruit ! And its delicious.. almost as good as the expensive varieties crowding the stores now... i'm in Mango heaven :-)

Its actually the one advantage of coming to India in the summer. The weather is about 95 deg and humid, and the hospital i'm working in for my project is about 110 deg and humid inside (no air con)..Actually walked through the labor ward today with my friend (a recent graduate), and the women were writhing in labor on these metal beds in a long row with a hole in the middle and a bucket underneath to catch the "products of conception" beyond the child.. quite sad.. but then again there were like 15 doctors and an ultrasound machine and people taking care of them in that gunk and filth, so it wasnt a totally bad picture after all..

Home is fun, but all my friends are working in the booming software industry, so very little time to hang out.. a few of them have recently left for Atlanta, Boston, Paris, etc. and the numbers in India of my batchmates are going south very quickly.

Trav scholars work began today, but i'll be able to post more once i'm going full swing later this week

cheers everyone !

~Naresh

Lena: Finally in Tanzania!

Hello all,

I am a bit new to this whole blogging, but I figured I would give it a try (just remember it is a work in progress). So after 3 flights and 24 full hours of travel, I have arrived at my new home for the next 7 weeks. It has been pretty intense so far, with all our instructions being given in Swahili. I can understand what is said mostly, but I often lose the details. Anyway, I have to run, but will write more later.

Lena

Welcome!

Many of us, this summer, are setting up shop in lands ranging from remote Equatorial Guinea, fabulous Alaska, magical India and well... other lands in the traveling scholars brochure.

So we have one command for you. Post Away!

Yours,
Organization for International Health

(write lenawine@stanford.edu, nareshr@stanford.edu for login/password details)

Also please see http://stanford.blogster.com/ for additional posts.