Lena in Tanzania

Lena: Kenyan Elections

Many of you have asked for information about the elections to which I have alluded that are going on in Kenya. I wish I had the time and knowledge to fully elaborate on the situation. Here are two BBC articles that seem consistent with what I was hearing within the country before I left.

What was written 3 weeks ago: http://news.bbc.co.uk/2/hi/africa/7092398.stm

What was written tonight: http://news.bbc.co.uk/2/hi/africa/7164890.stm

Here's a couple of Economist articles that I found interesting (but keep in mind that I don't know how long any of these links will last - before you have to start paying for access):

http://www.economist.com/world/africa/displaystory.cfm?story_id=10328292

http://www.economist.com/opinion/displaystory.cfm?story_id=10328986

A colleague of mine wrote this in response to concerns about his safety:

"An uneasy calm has returned in Kisumu today with people walking around either buying food or assessing the damage caused.Most buildings in town have either been vandalized,burnt or both.
I was just in town trying to buy some food when the police started shooting at people.So am hiding out in the office for a while.

We don't know when calm will be restored if at all!
The opposition have called for a meeting on Thursday(3rd) at Uhuru Park in Nairobi so that they can swear themselves in as rightful winners of the election.The government has outlawed the meeting but the opposition is asking 1million people to turn up for the meeting.
One way or the other,am afraid all hell will break loose come Thursday."

Another link with updates about what's been going on in Western Kenya: http://www.latimes.com/news/nationworld/world/la-fg-kenya24jan24,0,6610255.story?coll=la-home-center

An update from the Economist: http://www.economist.com/opinion/displaystory.cfm?story_id=10651817

Lena: Really settling in

So I know it's been a long time since I've written. There are two reasons for this. First internet in Migori is notoriously unreliable... the only internet cafes here connect through the cell phone network and so even when they are working, the connection is quite slow. My second excuse is that being here in Kenya is not as remarkable as it has been in the past. That's not to say I'm not enjoying myself - in fact, in many ways I am enjoying myself more this visit than I have on my previous visits...

This is the first time that I have truly felt comfortable here. The first time I came to Kenya, as a college junior on a study abroad program, I was determined to accept (as best I could) anything and everything that came my way. I really wanted to be open-minded, and I result I wasn't critically evaluating what was going on around me. On my trip last summer to Tanzania, I was equally determined to figure out whether I could live long term in a developing country. I think I may have been overly critical.

On this trip, I feel very comfortable and at ease. I realized upon returning that there are many things that I missed about this place when I am away. In a way, it is like coming home. I feel a sense of contentment and joy. The livestock along the side of the road, the pit toilets, and the children pointing and screaming mzungu, are all expected.

Lena: Images

Fishing boats on Lake Victoria:

Nakumat (the equivalent of Walmart smack dab in the middle of Kisumu):

Maasai in Nakumat (an interesting juxtaposition):

Look familiar? It should to anyone who has ever seen Paul Farmer speak (this is one of his patients):

Thanksgiving dinner (mashed potatoes and all):

Lena: Settling In

I know many of you were worried that I'd wind up spending my birthday alone having ramen noodles for dinner (or maybe that was just me). Anyway, in spite of my fears, I went out with the mzungu team to dinner at the finest (and pretty much only) restaurant in town. Having several vegetarians in the group, they tried to request a chapatti with egg and kale inside - something of a breakfast burrito. I was surprised that by the time the waiter made it around the table to me, everyone in the group had ordered this odd entree. I went for some good ole fried goat. I also had some avocado and pineapple juice, which was unexpectedly delicious. Overall, a nice way to celebrate my birthday!

I've finally moved into the place where I will be staying for the rest of my time here. Each day after our arrival in Migori, there was some reason that we couldn't move in. First there was no gas, then there were not enough beds, then it was too dirty to move in. I began to worry that they were just trying to avoid having to show it to me until the last possible moment. Turns out the place is pretty nice and very close to where I've been staying the past several days. Still it was nice to be able to finally unpack. I'd been repacking my stuff every morning, so that I would be prepared to move whenever it became necessary.

Home sweet home (for the next month).

Olivia, my flat-mate, and I made a makeshift living room setup so we could hangout outside our bedrooms.

We cooked plain white rice to celebrate being in our new flat.

Lena: My Research Progress

Some of you may at this point be wonder how my research is going, as that has been conspicuously absent from my posts. To be honest, I’ve been wondering the same thing. I was really ready to hit the ground running because my ultimate amount of time in country was not as long as I had initially hoped it would be. Unfortunately, and as expected, I’m the only one who seems to feel this sense of urgency. I’ve been trying to be patient and remember that laying a solid groundwork is essential to the success of future endeavors. For the past week, I have been introducing myself to healthcare providers at the facilities where I will be conducting my interviews. I call this building social capital and I guess we will see if it pays off next week, when I am scheduled to actually start interviewing people. ...

I pre-tested my interview guide and questionnaire with a nurse who works at the district hospital on Friday. I was pleased with how it went. It took approximately 50 minutes and seemed to get at most of the issues in which I was interested. Still I found a few areas that may require clarification and I was glad to identify them ahead of time.

Lena: Hospitals in Migori

On Monday morning, we visited our first of the 12 sites involved in the study in Migori. We went to Karungu, a sub-district hospital, on Lake Victoria. It was almost a 2 hour drive from Migori, where we are staying. A 2 hour drive is in itself not short, but when you are in a double cab truck with 7 other people on extremely rough roads (if you can even call them that), it becomes interminable. Now I understand why only 4 of the 12 sites are currently distributing antiretroviral therapy (ART). I had been told it was partially because we didn’t have enough vehicles. When we went to visit the site we brought a host of ART drugs with us as well as TB drugs. In addition, we brought clinical staff with us capable of administering and distributing these drugs. We visit a different site each day (Monday through Thursday) in this way and hence, 4 sites are currently active. When we have another vehicle, theoretically 4 more sites could be activated. I don’t want to oversimplify here, because there are other criteria that must be satisfied as well; for example, they must have at least 50 people who have tested positive for HIV. ...
Karungu subdistrict hospital:

On Tuesday, we visited Muhuru, another sub-district hospital. As on the previous day, I helped monitor the patient records, a talent I developed during my year off when I worked on a phase III clinical trial as well as during my time as a coordinator for the Arbor Free Clinic. It essentially consists of ensuring that information is complete and consistent within both the patient forms and the register that lists all the patients seen. I also helped Janet pre-test some of her questionnaires that she will be using to interview pregnant and post-partum women regarding AIDS stigma. I served as a notetaker/Kiswahili translator. It was quite interesting, sometimes surprising, and a bit depressing. It seems that there is not nearly as much stigma surrounding HIV as I had remembered from 2003. It’s unclear at this point whether this is a trend in the right direction, a difference based on location, or simply a coincidence. Many of the women reported some degree of depression either during their pregnancy or after, and every single women (all seven) reported having been at the very least verbally abused and many were physically abused as well by their partners during their pregnancy.
Muhuru Subdistrict hospital:

On Wednesday, we went to Rongo, which is supposedly the most accessible site because it is located along the main road. This means that we can take public transportation, e.g. a matatu. So we crammed our usual 16 or 17 people in the vehicle and then along the way picked up a few more. At one point, we pulled over and a surprisingly large number of people alighted (as they say here). I noticed that the tout (the money collector and conductor) was actually giving these people additional money back – something I’ve never seen before. I put the pieces together a few moments later, when I was instructed to buckle my seatbelt, another event I’ve never witnessed before. We were approaching a police checkpoint. About 5 years ago the new president at the time had instated limits on the number of people to be carried in matatus and had additionally required that matatus be outfitted with enough seatbelts for every passenger. When I returned, I assumed that these rules were simply being ignored. In fact, rather than simply being ignored, these rules were being circumvented. Matatus had learned where the checkpoints were and made certain to appear as if they had been following the rules. Shortly after passing the checkpoint, we again began picking up passengers and filling the van far beyond its legal capacity.
Rongo district hospital:

We also met with the District Manager of Health (DMOH) for Rongo, which is a newly designated district. He expressed during his satisfaction with the work that FACES has been doing, but also that he would prefer programs that address the whole health of a person, rather than just focusing on one illness, such as HIV in our case. I guess the issue of horizontal versus vertical programs isn’t some topic we just debate about in classrooms. He cited an instance in which a child is prevented from acquiring HIV from his mother who is HIV positive, only to die of malaria before the age of five. Unfortunately, this stems from the realities of funding agencies, which often award grants based on proposals to address specific diseases. On a brighter note, we are in the process of rolling out a ‘food as medication’ program as studies have definitively and repeatedly shown that adequate nutrition is essential to good health – sometimes you have to wonder if research was really necessary to show this – I mean all I can say is duh.

Lena: Update from Kisumu

So I’ve been in Kenya for a week now. I guess it’s time for an update. My first day in Kisumu, there was a team-building event for all of the FACES staff from Kisumu. I wasn’t really sure if I should attend or not, but for lack of anything else to do I decided to tag along. We all piled into a matatu (minibus/van made to seat fifteen people, but usually crammed with at least eighteen people) at the clinic and headed to a place slightly outside of town and upon arriving, we began playing all kinds of games and singing songs that I couldn’t even pretend to know. Many of them involved singling out a specific person to, for example, dance in the middle of the circle. Luckily, I hadn’t been there long enough that anyone knew my name. After several more matatus full of staff arrived, we began the planned activities (I hadn’t realized these weren’t the official team-building activities). We were divided into groups had to do a variety of classic team-building activities ranging from ‘crossing a river’ to a trust circle and untying a human knot. Our last activity of the day was a blindfolded relay race. The first step in the race was to go bobbing for apples and then completely eat the apple, skin and all. For those of you who have traveled abroad, I’m sure you know that this is a cardinal sin: you must drink bottled water and you must peel all fruit and vegetables. I attempted to explain my dilemma to the organizers, but no exemption was given. I didn’t want to let my team down on my first day during a team-building activity, no less. So I decided to take one for the team, literally. Overall, it was a great opportunity to get to know some of the many FACES employees. ...

That evening, Janet, my research advisor, arrived and loaned me some clothes, thank goodness. I had by this point been wearing the same clothing for the last 4 days. I bet none of you can say that you have borrowed a pair of underwear from your mentor. I mean I knew I would have a unique experience while here, I just hadn’t guessed how unique. Fortunately, after numerous phone calls, we were able to get in touch with someone in Nairobi who located my bags. We persuaded them to put them on an early afternoon flight and I got them very shortly before leaving for Migori. I can’t tell you how relieved I was.

I got some additional good news on Sunday that KEMRI, the institution we’re working with here in Kenya, finally approved our study, which was under ethical review. Still we don’t have final approval from the CDC, but apparently as long as we aren’t using a funding from the CDC, I can go forward with my research. Another sigh of relief.

Lena: Background

Map of Western Kenya:

Migori town:

The flat in Kisumu and my mattress on the floor in the living room.

Two views from the balcony of our flat.

More details to come later...

Lena: Arrived in Kisumu, Kenya

After more than 24 hours of traveling, I've arrived and all in one piece (for the most part). I even managed to meet up with my Aunt Jill in London during my 9 hour layover. So that's the good news...

The bad news is that my bags didn't make it. I guess this wasn't completely unexpected, but a girl can hope can't she. Apparently, the same happened to another student who arrived earlier this week. Upon arriving in Nairobi and going through immigration and customs, I had to walk across the street to the domestic terminal. Along the way, I picked up a 'guide' who 'showed me' where the terminal was and in return wanted a tip. Luckily, at this point, this is still a novelty that just reminds me of my past experiences here. I good-naturedly explained that I didn't have any Kenyan shillings and he of replied that he accepts pounds and dollars as well. When I got to the appropriate counter, the clerk at my paper ticket with a puzzled expression. Then she walked off with it, much to my dismay.

She returned eventually and explained that they had signed it over to another airline. Instead of flying on Kenya Airways, I would be flying with East African. Apparently, however, I gathered from some conversations in Swahili, there was no room on the flight and there was no way that my bags, which were supposed to be checked through with Kenya Airways, would make it. One of the clerks personally escorted me to the runway where the plane was waiting. As I was entering, I heard a man complaining that there were no more seats. I glanced at my boarding pass for the first time and relieved that my seat number was illegible (yes, it was handwritten). They eventually found me a seat, but my backpack had to be stowed in a different location. Needless to say, I wasn't excited to part with my few remaining possessions, but again what choice did I have.

I was very relieved to find someone (actually 3 people) waiting for me at the Kisumu airport; during the flight I had begun run through the possibilities of what I would do if there weren't someone there waiting or if I couldn't find them. I considered hiring a taxi, but realized I didn't have an address for where I was going. I then came to the realization that I didn't even really know where I need an address for as I had no idea where I was meant to go. Luckily when I arrived I didn't have to start down the line of my contingency plans.

I went to an ATM and got out some arbitrary amount of Kenyan shillings - at this point, I'm only vaguely familiar with the exchange rate and I have even less of an idea what my expenses will be and how much cash I need. Next, they took me over to the the flat where I'll be staying and it seems nice enough, although it looks like I'll be sleeping in the living room on a foam mattress on the floor. The fact that there's a refrigerator and allegedly running water were enough to make me happy. They tried to convince me that I need to rest, but I'm afraid that if I do, it will take longer for me to get adjusted to the time change. On top of that, I don't have any pajamas and with the daylight, the heat, and my nervous excitement, I don't think I'd be able to sleep anyway. My final ulterior motive was that I actually wanted to see the clinic today and meet some of the staff - I didn't want to be forgotten at the flat or have to find my way on my own to the clinic.

Now I'm at the FACES Clinic (http://www.faces-kenya.org/) where I got introduced to at least 25 people, all of whom I've already forgotten. My guide literally took me from room to room (interrupting patient visits) to meet all the staff. The clinic waiting area, which is outdoors, was very crowded. It's definitely a larger scale operation than I expected and seems to be relatively well equipped. They have a wireless internet connection here in the clinic - too bad I won't be living in Kisumu. I don't expect to find the same luxuries in Migori, three hours from here, but then again I don't really know what to expect at all, I guess we'll see.

Aunt Jill and I having lunch in Heathrow airport during my 9 hour layover - much to my surprise we were able to connect without the use of cellphones.

FACES clinic in Kisumu

Lena: Shocking moments back in America

So now that I'm back in America I've had a few moments that could be called shock. I think only one experience can really be classified as 'culture shock.'

When I walk down an empty street or an empty hallway and I pass someone, I can't help but greet them now. Likewise, if I bump into someone that I know, I feel like if I don't have at least a 10 minute conversation with them, I have been extremely rude. I find myself asking people over and over how they are, how their family is, how their summer's been, how's this and that and the other thing all are? I can imagine that it must sound repetitive and perhaps even nosy. This behavior may not sound that unusual to you, but this friendliness goes completely against my nature as an East Coaster.

Besides that I've only had shocking moments in which I have to remind myself that 'we're not in Tanzania anymore, Toto':

~My initial instinct before stepping outside in the evening is to apply bug spray. As my friends and I walked outside to warm up the grille, I asked, aren't you guys going to put on bug spray? Before they could respond, I realized that bug bites here aren't as serious because there is no risk of malaria (although perhaps people should be more careful with west nile floating around).

~I was filling up my water bottle with ice cubes before heading to the gym, when I found myself ready to dump them out. I had to ask myself why I would do such an irrational thing (because one of the things I appreciate most about being back is nice cold water, straight from the tap). That's when I realized that we are advised against ice cubes in Tanzania because they are generally made from contaminated water.

~Similarly, I was really excited when I got to run my toothbrush under the faucet to clean off the toothpaste, although I flinched the first few times. I had accidentally washed my toothbrush in Tanzania a few times. I must say, it was really nice to have a clean, non-gummy toothbrush to use the next time I brushed my teeth.

~I went out for chinese food and at the end of the meal I was shocked to see that the oranges they brought out with the fortune cookies were actually orange. Oranges in Tanzania are green on the outside and sort of yellowish on the inside. Interesting the Swahili word for the fruit and color is still the same. Once, I asked one of my professors how she could tell oranges, lemons, and limes apart because they're all green. She found this very amusing; you look at the texture of the peel of course, she replied.

When I finally stopped my malaria meds (which I had been taking every day for the past 2.5 months), it finally hit me that I am home for good.

Lena: Host family update

All my nervousness about moving off the compound was unwarranted. My host family was absolutely wonderful and they were very understanding of our cultural differences.

Here is a picture of the Shikobe family, with whom I've been living for the past 3 weeks:

Soon after we arrived, we had a meet and greet with the host families that we were to spend the weekends with. My host father was the only member of my family able to attend. Interestingly, although my host father is only 4 years older than my real dad, he has 4 grandchildren. In addition, he is retired; he worked at the center for 17 years and his wife still works here in the kitchen.

He was really excited to take me to see the house, so that same day, he drove me to the house. This being within our first week, I walked over to the right side of the truck, what I thought was the passenger side, and patiently waited for him to unlock it for me. He politely informed me that he would be driving and that I should probably get in on the other side of the car. I have to admit I was pretty embarrassed, but he handled the situation with grace and good humor.

The house was really nice, although you may not be able to tell from the outside. When I walked into the living room, I was surprised to find two very large teletubbies, prominently decorating the entertainment stand.

The first weekend that I stayed with my host family, one of my friends from the University of Nairobi came to visit. I was a bit uncertain about what to expect and how I would be able to balance spending time with my new family and also with my old friend. My host family made this weekend with my friend, Oposh, so much easier. They completely welcomed him into their home; he spent all day hanging out there with me and he ate all his meals with us. They helped us find him a guesthouse close by that was cheap and convenient. In the mornings they even sent someone to fetch him so he could join me for breakfast and the first night they escorted him back to his room, to make sure he could find the way.

There are definitely more mosquitos as I can hear them buzzing around at night, but I slept the first night in my net and I really didn't like it. It gets really hot and it just makes me feel clausterphobic. I just always keep tossing and turning, plus there is lots of noise outside from the animals and bugs.

Most of the family speaks pretty good English but for the most part I try to stick to Swahili, especially because my host mother doesn't really speak English. We mostly do a lot of mixing and occasionally my host father translates from English for my host mother. They both seem really nice and my host brother and host cousin got stuck with the duty of playing chaperone all weekend because I talked to one of my teacher's about Dan and she said, I'll make sure that nothing happens and she talked to my host parents. It's actually kind of nice, although a little weird.

My host father was going to make his son go running with me in the morning, but I snuck out without him this morning because I felt bad, plus I prefer to run alone. One of the little children in her school uniform starting trying to catch up with me this morning. I think most people were very amused by the fact that I was running when I didn't have to and several people said sorry as I ran by. Perhaps my shorts and bare legs were also a bit shocking.

I taught my host brother and Oposh how to play rummy, memory, and go fish and my host brother taught me a game similar to uno or crazy eights. My host parents went to church and also went to help prepare for a wedding, but I didnt't go in part because Oposh was around. Oposh helped me with the book I am reading for my book report and I definitely felt like I was back in primary school.

My mom from America sent me a care package with my favorite cereal: Cherrios. Because they came during the last week of my time here I brought them to my host family. I ate Cherrios with my host father yesterday morning. He sat and read the entire box the night before and was very impressed that they lower cholesterol. I told them that in America we eat it with cold milk, so they tried to chill the milk after boiling and he was very sorry that it hadn't completely cooled. He ate two bowls and I couldn't tell if it was solely for benefit, or because he actually liked them.

Lena: Host family update

All my nervousness about moving off the compound was unwarranted. My host family was absolutely wonderful and they were very understanding of our cultural differences.

Here is a picture of the Shikobe family, with whom I've been living for the past 3 weeks:

Soon after we arrived, we had a meet and greet with the host families that we were to spend the weekends with. My host father was the only member of my family able to attend. Interestingly, although my host father is only 4 years older than my real dad, he has 4 grandchildren. In addition, he is retired; he worked at the center for 17 years and his wife still works here in the kitchen.

He was really excited to take me to see the house, so that same day, he drove me to the house. This being within our first week, I walked over to the right side of the truck, what I thought was the passenger side, and patiently waited for him to unlock it for me. He politely informed me that he would be driving and that I should probably get in on the other side of the car. I have to admit I was pretty embarrassed, but he handled the situation with grace and good humor.

The house was really nice, although you may not be able to tell from the outside. When I walked into the living room, I was surprised to find two very large teletubbies, prominently decorating the entertainment stand.

The first weekend that I stayed with my host family, one of my friends from the University of Nairobi came to visit. I was a bit uncertain about what to expect and how I would be able to balance spending time with my new family and also with my old friend. My host family made this weekend with my friend, Oposh, so much easier. They completely welcomed him into their home; he spent all day hanging out there with me and he ate all his meals with us. They helped us find him a guesthouse close by that was cheap and convenient. In the mornings they even sent someone to fetch him so he could join me for breakfast and the first night they escorted him back to his room, to make sure he could find the way.

There are definitely more mosquitos as I can hear them buzzing around at night, but I slept the first night in my net and I really didn't like it. It gets really hot and it just makes me feel clausterphobic. I just always keep tossing and turning, plus there is lots of noise outside from the animals and bugs.

Most of the family speaks pretty good English but for the most part I try to stick to Swahili, especially because my host mother doesn't really speak English. We mostly do a lot of mixing and occasionally my host father translates from English for my host mother. They both seem really nice and my host brother and host cousin got stuck with the duty of playing chaperone all weekend because I talked to one of my teacher's about Dan and she said, I'll make sure that nothing happens and she talked to my host parents. It's actually kind of nice, although a little weird.

My host father was going to make his son go running with me in the morning, but I snuck out without him this morning because I felt bad, plus I prefer to run alone. One of the little children in her school uniform starting trying to catch up with me this morning. I think most people were very amused by the fact that I was running when I didn't have to and several people said sorry as I ran by. Perhaps my shorts and bare legs were also a bit shocking.

I taught my host brother and Oposh how to play rummy, memory, and go fish and my host brother taught me a game similar to uno or crazy eights. My host parents went to church and also went to help prepare for a wedding, but I didnt't go in part because Oposh was around. Oposh helped me with the book I am reading for my book report and I definitely felt like I was back in primary school.

My mom from America sent me a care package with my favorite cereal: Cherrios. Because they came during the last week of my time here I brought them to my host family. I ate Cherrios with my host father yesterday morning. He sat and read the entire box the night before and was very impressed that they lower cholesterol. I told them that in America we eat it with cold milk, so they tried to chill the milk after boiling and he was very sorry that it hadn't completely cooled. He ate two bowls and I couldn't tell if it was solely for benefit, or because he actually liked them.

Lena: My Friend, Cory, from the Orphanage

I finally decided to go back to the orphanage. I had just finished two out of my three Swahili reports and I decided that I had earned a break. One of the other girls on the program invited me to go and compared to all the work I had been doing, I decided that it would be a welcome mental break to play with babies.

When we first got there, I really didn't know what to do with myself. Immediately, someone handed me a bowl filled with uji (porridge) and sent me to work. I was amazed at the speed with which these babies eat. Before I was even able to fill the next spoonful, their mouths were open and ready for the next bite.

After I finished feeding the first baby, I began to play with one of the others. I told him to 'nipe tano' or give me five. He got really into and began repeatedly slapping both my hands. After dinner, one of the workers took him to change him into his pajamas. She brought him back out and said that he had been asking for me. She told me that his name was Cory.

We played for the next hour and he seemed to be completely normal, happy child. He's very good at repeating, so we talked about all sorts of things, with me saying things and him repeating them. Playing with Cory really did brighten my day and take my mind off all the work I still had to do.

I later discovered his story. Cory was referred to the orphanage by another baby home. He was one week old and tested positive for HIV.

They do not have the staff to care for special needs babies. When Cory came, he had pustules all over his body, caused by a staph infection. He was put on an antibiotic, which soon cleared up the sores. He got thrush while on the antibiotic.

These days Cory looks a lot healthier:

Lena: To Zanzibar By Motor Car

My favorite picture from my trip to the Coast:

As part of our language practice, we visited a seaweed farm in Zanzibar. After 'touring' their one room facility, where they store a huge pile of seaweed to dry, we went out to the beach to see how and where they harvest the seaweed. As he showed us how they attach the seaweed to something resembling a very low clothesline, a crowd of children began to gather around. I am not sure whether they were interested in learning more about seaweed farming or were just fascinated by a group of white students listening to a lecture in Swahili. I opted to stay onshore while some of my classmates ventured out into the water to see the seaweed growing firsthand.

I quickly befriended this little girl (pictured above), or perhaps she befriended me and promptly attached herself to me. She never left my side and pretty much refused to give up my hand. Whenever I wasn't paying attention to her, or my hands weren't free, she would bury her head in my skirt. For those of you who know me well, you probably know that this was neither expected nor warranted. I never was able to figure out her name, in part because she had the habit of repeating everything I said: "unaitwa nani?"; "unaitwa nani?" she echoed back, instead of answering with her name.

As the crowd of children increased in size, they became more and more difficult to manage, so I began trying to teach them some of the simple Swahili songs and games I had recently learned. As I became more overwhelmed with all the children literally hanging on me, I reverted back to my familiar roots and began to teach them how to play some American games. We started with Ring around the Rosy and Follow the Leader, which went over relatively well.

When I tried to teach them how to play Duck, Duck, Goose however, I failed miserably. I'm still not sure if this was related to the age group or my poor Swahili abilities. I got them all to sit in a circle and then with another student demonstrated: "bata, bata, bata, bata" - I tapped each one of them on the head. All eyes were focused on me as they tried to figure out what I could possibly be doing. When I came to my fellow student, I called out GOOSE! and then began to run. When I turned around, not only was my American friend chasing me, but so were all my little Tanzania friends. I think my professors were all very amused.

After all the other students finally returned from the excursion out into the ocean, we headed back to regroup at the bus. Most of the children were disappointed to see us go, but my little friend seemed more adamant than most and kept hugging my legs. I finally allowed her to escort me to the bus; as we walked by people's homes, I wondered whether she belonged to one of them. I began to worry that perhaps the people we greeted as we passed would think I was trying to kidnap this sweet young girl.

Would she be able to find her way home if I led her too far from where I had found her?
Was someone worried about her right now?
Had she been accompanied to the beach by a sibling perhaps?
I began to wonder what her home life was like: was she so attention-starved that she attached herself to me of all people? When I said goodbye and gave her a hug, she made me it very difficult for me to put her down. She promptly proceeded to stand outside my bus window and wave. I told the other kids around to get her to move because I was actually afraid that when the bus started to move, she might get hurt. I almost took her home. Don't worry, all I actually took was the above picture.

Small town near the seaweed farm we visited:

Along the way we passed many sisal plantations:

Also part of the view on our 9 hour drive:

Beach by the fish market:

View from the rooftop cafe of our hotel in Zanzibar:

Lena: Cross cultural exchange

Today, in the name of cross cultural understanding and in preparation for going to stay with our host families, we had 'a very important session.' We were all taken a bit off guard when they said that the 3 guys in a group would be having a separate discussion. I reasoned that maybe they would tell us about various sex differences in terms of household expectations. What happened next was much more amusing...

They got out a piece of paper that had a pit toliet drawn on it and proceeded to show us how to use it.

Lena: Teaching nutrition

The classroom:

50 students per class:

One of my students hard at work:

Lena: Homestay

Before coming here, I had expected to be living with a family for the majority of my time here. Then when I spoke to the course director on the phone a few weeks before leaving, I found out that we would be spending most of our time in dorms.

Now we have just been informed that in less than a week, we will be moving in with our host family for the next 3 weeks. The center is overcrowded and they no longer have space for us. My initial instinct is of course to throw a fit... how can they simply kick us out? How can an organization make arrangments and then simply change them without any notice or compensation?

Then I took a deep breath and a step back and reminded myself that I in fact hadn't made any arrangements with TCDC, nor had I paid for anything. I took another step back and reminded myself that I had initially been disappointed to discover that we wouldn't be staying with our host families for longer.

For me I think it's all about expectations. I try to go into my international experiences with as few expectations as is possible. I think I was relatively successful in that regard and I was pleasantly surprised when I discovered that our accomodations closely resembled a hotel or a summer camp.

I would have been perfectly fine without any of our numerous amenities, but now the thought of not having constant internet access, hot running water, a choice of food at every meal, and the security to go running in the early morning is a bit daunting.

Right now, I am just struggling with all the unknown... I have no idea what to expect.

Lena: Safari

And now, the moment you've all been waiting for: pictures for the animal parks. We went to Lake Manyara and the Ngorongoro Conservation Area. Conservation areas allow human habitation while providing protection status for wildlife.

Here you can see a Masai herdsman running along his cattle inside the crater:

Ngorongoro Crater, which is the world's largest unbroken caldera, was formed by the collapse of a volcano into itself. The crater is 610m deep and there are an estimated 25,000 animals within the crater (see below). In addition, it has the densest known population of lions numbering 62 in 2001.
We must of seen at least 12 of the 62:

Lake Magadi in the centre of the crater is a soda lake supporting flocks of flamingo:

We also visited Olduvai Gorge (Oldupaai as it's called by the Masai, after the sisal plants that abound there). For those, who like me aren't anthropology buffs, this is where the Leakey's did the majority of their work: here they found Australopithecus boisei, Homo habilis, and Homo erectus. Also nearby they found a famous set of hominid footprints, the discussion of which I found fascinating because of the role anatomy can play in anthropology. The arch as well as the position of the big toe distinguished these footprints from those of apes and suggested that hominids walked upright habitually.
I wonder how they picked this spot to make all these important discoveries:

Tembo:

Twiga:

Kiboko:

Baboon:

Swala:

Punda milia (striped donkey):

Bloody lion among the cars:

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:

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: