Don't Scratch

I think I could feel the mask slipping down my face. I tried to wriggle my nose to keep it in place, but I may have been making it worse. With my hands resting against my chest, I tried not to move and touch anything, including the itchy patch of my head just above my right ear. The itching was the worst part. I had never had to just stand there, not scratching. But it was going to be well worth the uncomfortable minutes.

The Monday started out pretty normal for a day at Machame, except for the two other Cornell students, Jenny and Danielle, who had come to pay me and Brenna a visit. They were dying to see a birth, and had ventured to the labor and delivery ward around 10pm Sunday night, hoping to catch a woman in labor. Disappointed, they returned at 5am Monday morning, only to just miss a woman who had to undergo an unsuspected c-section. I had seen my share of births and stayed tucked under my blankets to avoid the chill of a Machame dawn.

After the morning devotions, the Patron of the hospital stood up to tell everyone about a woman in the ICU who had an extremely low hemoglobin count due to internal bleeding and would probably pass if she did not receive a blood transfusion. There was only 1 pint of blood in the blood bank that matched her blood type. Things didn’t look too good. Jenny, one of the other Cornell students, mustered up enough courage to donate blood for this poor woman. As O+, Jenny is a universal donor and the woman’s body should accept her blood. I thought about donating, but was unaware of my blood type and the thought of African needles, although I had seen them in their sealed packages, still frightened me.

The rest of us left to get Jenny some more sugar so she would be fine in the upcoming surgery that would start around 10am. We brought her some sugary, fried dough from the hospital canteen and then returned to the guest house to eat as well. Finishing up around 10 (things don’t normally start on time in Tanzania), we met Jenny and headed to the sterilization room to change into scrubs so we could watch the orthopedic surgeries that day. I thought I had heard the morning report mention another child that was to be prepared for a cleft foot operation, and two young men who were to undergo hand surgery. One had fractured the proximal phalanx of his left index finger, and the other had a severed the extensor tendon to his left index finger. A bad day for left index fingers I guess. I remembered this last case from the surgeon’s orthopedic clinic the Thursday before, and as we approached the orthopedic building, I pointed the girls to their changing room and went to put on my scrubs.

We were a little late for the first finger surgery, but our tardiness didn’t stop all of the staff from greeting us warmly. As I began to hover over the operating table, I could see Dr. Lyimo begin to put a wire through the proximal phalanx into its corresponding metacarpal bone. With the wire in place, the two fractured pieces of bone should fuse and the man should heal in a few weeks. I looked around during the surgery to make sure Jenny and Danielle weren’t feeling bad or on the verge of passing out, as Lauren had done the previous week. They were feeling fine and as Dr. Lyimo began to sew up the man’s hand, they began to ask Brenna about the time. As they could only stay at Machame until the early afternoon, they wanted to check in on labor and delivery one more time. Brenna agreed to be the martyr and walk them to ward and I stayed to watch the anesthesiologists try to bring the unconscious body back to life. I think they had over-sedated him because it took a very long time for the guy to breath on his own.

I decided to leave the operating theater and go and sit with the nurses outside. After joking about Brenna’s lack of rhythm, one of the nurses, Margaret, asked me why I had never scrubbed in and assisted in the surgeries. I responded that I had never scrubbed before and didn’t really know what to do. Instead of taking my response as an indicator that I was under-qualified to assist in surgery, she told me that she would ask Dr. Lyimo if I could assist. I didn’t think he would agree, but I hoped that he would while she walked over to talk to him. After a minute or two, he called to me and said it was fine if I assisted with the next surgery, the same case I remembered from the orthopedic clinic.

Finally it was time to scrub. Margaret and I walked to the two sinks and she began to describe the hand and arm washing technique. Fives minutes of washing elapsed and then I walked with my hands aloft into the theater. She then directed me to the sterile, metal container which contained my gown. Unrolling it, I timidly put my hands into the sleeves, trying to only touch the interior of the gown. Without any gloves on, the exterior of the gown was cleaner then my thoroughly washed hands. Margret then described how I had to hold the cuff of each sleeve with my thumb as I slipped my hand into the glove. My first attempt failed and the cuff slid down to my wrist, with the glove’s elastic base conforming around the cuff. I asked if I could try again but putting on another would contaminate my hands and it wasn’t worth starting over. I succeeded with my second attempt, with the cuff resting just below the base of my thumb. Then I was told to wait with my hands across my chest. Margret had to help set up all the utensils and it wasn’t yet time to don the second pair of gloves.

This is when things began itch. First it was a spot right above my right ear. Then it was a spot right under the mask, on my nose. Helpless, I stood waiting, twitching slightly so that my hands remained where they were but enough skin would move so that the itch would go away. I tried to direct the itch with my mind to at least move to my feet and legs, where I could shift my weight and scratch with my surgical boots or step on my own feet. Thinking back, this period of waiting seemed longer then the actual surgery itself. But after enough waiting, I was assisted into my second pair of gloves and the surgery began.

Making an ‘L’-shaped cut around the left index finger knuckle, Dr. Lyimo exposed the inner workings of the man’s hand. At this point, it was time for my first and major roll in the surgery. I was handed a small metal instrument that had very sharp, little teeth that were curved under and back toward the handle. Using this distorted fork-looking tool, I held open the skin while Dr. Lyimo worked. My left hand rested on that of the patients, holding everything steady. His skin was remarkably cold under my multi-gloved hands and it shocked me at first. I looked up to check the blood pressure, but I realized it was just the tourniquet halting the majority of blood, silently doing its job. After some quick flicks of his wrist, the surgeon had exposed the two separated ends of the tendon and began to suture them back together.

My next task was to flex the index finger so that Dr. Lyimo could see how his sutures were holding. With a satisfied little hop and a sigh, he took the patient’s hand and moved the finger back and forth, noting how the tendon moved. From my incredibly close viewpoint, I could see the small black markings of the sutures on the tendon move forward and aft along with the finger’s movement. His work under the skin was done and now it was time to sew up the dark outer covering.

Removing the tourniquet, the man’s flesh began to retain its red and pinkish hues. Observing that there were no capillaries to cauterize, Dr. Lyimo asked from another suture set and began to tie the skin back together. With every puncture of the skin a little bit of blood would ooze out, creating another job opportunity for me. Accepting gauze from Margaret, I dabbed at the cohesive liquid and allowed Dr. Lyimo to continue with his work. With the last suture in place, Dr. Lyimo tied off the strands, cut the lines, and asked the anesthesiologists to bring the man back. Allowing the medication to taking its time, the doctor began to take off his scrubs and hinted that I should do the same. Alas, my time in a surgical gown was over.

Although I did make another small mistake and took off a glove when I wasn’t really supposed to, I was able to help form the patient’s cast. Holding the limp hand in the air, Dr. Lyimo was able to use both of his hands to maneuver the Plaster of Paris bandages and create a smooth, white cast for the Tanzanian. Even though this part of the operation wasn’t quite as exhilarating, I still got a kick out of helping beyond my normal duties (tying gowns, wiping off aprons, getting gloves, etc).

I am not sure if I should have been assisting in an orthopedic surgery or not, as I have received no formal surgical training, but it was awesome actually scrubbing in and holding instruments while the doctor performed his magic. It is just beginning to dawn on me that this is my last week in this incredible country, and I may have reached a high point on that Monday afternoon in the orthopedic theater of Machame Hospital.

Machame Hosptial

     After returning from Zanzibar, I spent one final night with my host family in Moshi and then was driven to my internship placement at Machame Hospital in Machame, Tanzania. Only about a 30 minute drive from Moshi, Machame is a collection of villages on the slopes of Kilimanjaro. At roughly 10,000 feet, I now am always wearing pants and the one bright green Patagonia fleece I brought with me.

            It was a sad goodbye leaving my host family in Moshi. Although at times I felt like I was an intruder and completely out of place, it now feels like a home and I think I would be warmly welcomed back when I return.

            The Machame Hospital is a very different organization than KCMC. When I had my stomach rash (which has now subsided altogether), I walked through a very busy regional hospital that was constantly filled with patients and had clearly distinct wards. Machame, a private hospital set up by Lutheran missionaries in 1904, now beds about 50 – 60 patients, of which the majority are women preparing for childbirth. I often feel like there is not a lot going on, especially when there are no surgeries. I expressed this sentiment with one of the newer doctors, Dr. Garrison, and he said that when he first came to Machame, he felt bored because he had finished all of his work by about 1 every day.

One cool aspect about Machame is that it caters to the Maasai women from all across northern Tanzania. Many will walk for days to get to admitted to Machame, spend a month or two before the delivery, have their baby and then walk home. “Typical” Tanzanian life (cooking, clean, farming, childrearing) is hard on women, especially the Maasai because of the environment in which they live, so the month or two at Machame before childbirth is often a much needed break.

            Another interesting aspect that I have had to deal with is the daily morning devotion. Every morning, at about 7:45, the majority of the staff gathers in the hospital church located at the very bottom floor of the building, fairly close to my house. After about 20 minutes of singing and a small sermon, all of the non-medical staff are dismissed and the nurses and clinical officers (like a Nurse Practitioner) that were on duty the previous night stand up and state new cases and give an updated total of the patients in the hospital. Often, the doctors critique the nurses and clinical officers for their diagnoses or try to get the staff to get in the habit of stating all the necessary information regarding a certain patient.

It is during this time that I find out if there are any interesting surgeries that day or if a person has come in with a new sickness. I also use this time when all the doctors are together to ask if I can follow a particular doctor around on his rounds to the wards or if I can accompany them in surgery. I have spent most of my time in surgery but am hoping to spend these last two weeks seeing other aspects of the hospital, including the pharmacy, laboratory, and radiology departments. I find the orthopedic surgeries the most intriguing so if a particular surgery comes up, I may sneak back to the surgery theaters. So far, I have seen: two c-sections, a re-circumcision, a screw/plate removal from a woman’s ankle, two pins put into a fractured elbow, a pin placed into a dislocated finger, a hysterectomy, and a cleft foot operation. I think the hysterectomy and the cleft-foot operations where the coolest so far.

I think the hysterectomy surgery was technically an incomplete hysterectomy because they did not remove the woman’s cervix in addition to the uterus. The entire uterus was removed because of benign tumors that were causing internal hemorrhaging and pain. After its removal, the doctors noted the size, which was about the size of a soccer ball when it should have been the size of your fist.

A cleft foot is a condition found in about 1 out of every 1,000 births in which the tendons and ligaments on the medial side, or inner arch of the foot. This makes the foot point inward and the person becomes very pigeon-toed. To correct this problem, Dr. Lyimo, the orthopedic surgeon, sliced the ligaments and tendons down the middle, cut one of the strips closer to the foot and then cut the other closer to the leg bones. By tying these two strips together, he was able to lengthen the ligaments and tendons and with a cast, correct the issue.

Spending so much time at a hospital and around patients has really affirmed my desire to go to medical school. Seeing surgery, I constantly want to learn how I can perform these operations and help people. I feel useless a lot of times because I see someone with a distinct predicament but I don’t know how to fix it. Hopefully now, with a lot of hard work, I’ll end up at a medical school.

A Little Bit Of Tourism

 Although I have been mainly focused on the class that I finished on June 24^th, I have been able to spend a little bit of my time in Tanzania as a tourist. Two of the other Cornell students were placed into a host family in which the father, Bwana Chuwa, runs a Tanzania tourism company. Bwana Chuwa must know everyone there is to know in Tanzania, because he hooked the group up with an awesome safari and trip to Zanzibar.

            Maybe not quite as densely populated as the Serengeti, the Arusha National Park had a decent amount of fauna including a lot of giraffe, zebra, water buffalo, baboons, and colobus monkeys (they look a little like skunks but with really fluffy white tails). At one point during the safari, we got out of the car and climbed up a hill to an overlook from which you could see a crater from a collapsed volcano. I was a little upset that I didn’t get to see any other big game, like lions or elephants, but the safari was worth the day’s travel.

            The Zanzibar archipelago is located off the eastern coast of Tanzania and is composed of many islands of various sizes. Technically, the name of the country in which I’m currently volunteering is the United Republic of Tanzania because back in the day, the mainland, Tanganika, and Zanzibar were two different countries. When they decided to team up, the president of Tanganika became president of the United Republic and the Zanzibar president became his Vice.

            If anyone can afford to go to Zanzibar on a holiday, I would definitely recommend it. A two hour ferry ride from Dar Es Salaam places you on a beautiful island that feels entirely different then the African mainland. With about 95% of its inhabitants Muslim, the island definitely shows off its Arab influences. This was also the first time I had completely immersed into an Islamic culture, although I’m guessing that it would be very different to be a tourist in a Middle Eastern country.

            Walking through the small corridors of Stone Town, the prominent town in Zanzibar, I felt as if I was back in Europe, walking through alleyways that have endured countless generations of people. One difference between Stone Town and it’s European counterparts are the elegant, carved wooden doors of the Stone Town buildings. Each door is said to symbolize the wants and desires of its original owner, and some are older then the buildings in which they live. Many also have metal spikes protruding from the doors, additions borrowed from India that were once used to prevent elephants from breaking down the buildings.

            Like Moshi, Stone Town also has a very lively outdoor market, but with a complete different set of staple foods. Zanzibar, once the spice capital of the world, offers an enormous variety of spices to the public. The fish market is also a sight to see, and a smell to experience. Like the fish section of Wegman’s on steroids, I had never seen so many types of fish on display. I will admit that the smell was a little strong for me so I couldn’t stay in the market too long.

            With pristine white sands and turquoise water, the beaches on the Northern coast were incredible. Like pictures on the Discovery Channel, the scenery included small wooden Dhows (the name given to Zanzibari boats) dotted the horizon as they fished for local fare. After lunch, five of us decided to trust a local entrepreneur and went snorkeling out on the nearby reef. Although it wasn’t the most colorful, we were still able to see a good amount of wildlife. I have taken a lot of pictures from this beach day and I’ll try to make an album on picasa soon.

            Leaving Zanzibar on possibly the worst 9 hour bus ride of my life, I was a little disappointed that I couldn’t continue my tourism and see all of the other incredible sights Tanzania has to offer. I would really like to see the inner region of the country, as that is where the majority of the population lives and I would really be able to see the livelihoods of these warm and welcoming people. I guess that’s another reason to come back.

            

It takes a village

            The electricity is out again. The family had brought in a woman trained in the art to lead the ceremony. With the help of the house girls, they all surround Catie, my young host sister of 6, carefully picking at her head but still cautious not to block the candle light. Every few seconds, the two blades of the scissors come together with a resounding “click”. I sitting a few meters away on the couch, trying to eat dinner. As the steam rises off of my meal, I am mystified. I had wondered about the actual actions, but this was my first time witnessing anyone getting extensions.

            My first day walking the streets, I was a little shocked to see that almost every single child under the age of 10 had a very short buzz. My only clue to the sex of the kids is their school uniforms: shorts for a boy, a skirt for a girl. Slightly puzzled to why the girls have short hair I tried to come up with an explanation. Only later did one of the other Cornellians explain that everyone keeps their hair very short so they do not get lice. To make up for the lack of natural hair, a lot of the women and girls get extensions or put their natural hair in tight braids that run along their scalps in varying directions.

            What captivated my attention the most from the extensions process was the way in which everyone chipped in to help. Although the house girls could have spent this choice amount of free time relaxing, they both decided to help the woman with Catie’s hair. This helping sentiment seems to be prominent throughout Moshi.

            Lincoln, the 1 year old, can be a handful at times. However, this doesn’t stop the whole household from taking care of him. And by whole family, I mean the two house girls, the parents, young daughter, and even the guard. I would expect, and hope, that a child’s immediate family would take care of their blood, but I wouldn’t really expect this of a man whose sole job is to watch the property for thieves. This Saturday, when I came back from town, I was greeted by the guard who was bouncing Lincoln on his knee.

            I was trying to express how everyone in the house cares for Lincoln when one of my peers in Tanzania stated that the same thing happened in her house with a young child named Ibu. I have met Ibu before and he looks like a 2 year old version of Jay-Z (Brenna has a picture of him with her sunglasses on and he looks incredible). Initially I thought that Ibu was another child of Brenna and Kathy’s house mom, but it turns out that Ibu is living with his grandmother, who resides in the house directly behind Brenna and Kathy’s. Although Ibu isn’t directly related to their host mom, Mamma Grace, this doesn’t stop her from feeding and taking care of him. I would expect the same from an American mother who has a neighbor roughly the same age as one of her children, but Ibu is 5 years younger then the youngest in Mama Grace’s family.  

            I wonder if it is the hardships these people go through that draw them closer, or they are just generally nicer and more caring people. Whatever the cause, I’m happy that there are multiple sets of eyes looking over Lincoln and Ibu so that one day, they can become the next leaders of Tanzania. Hopefully then, they won’t have to live their lives continually contracting malaria, an infection that my house father and Brenna and Kathy’s host father have contracted over the last few weeks. 

Lincoln & Catherine.... But Mainly Lincoln

Hanging with the kids

Tanzanian Vittles

African food. Try to conjure up that image. I had no idea what I would be eating for two months this summer, but now I am very familiar.

My first experience with Tanzanian cuisine was actually at Cornell toward the end of the spring semester. I was taking a semester-long prep course for the trip and we were all invited to eat lunch one Saturday at our professor’s house. Lunch was prepared by two Cornellians who spent 13 weeks last summer volunteering at the Weill-Bugando hospital in Mwanza, Tanzania. They cooked ugali, a polenta-like paste made from corn, a shredded collard greens-ish dish, and an egg dish that had red peppers and cheese. Unfortunately, I haven’t had this egg dish yet.

Unlike the variety of foods that my incredible cook of a mother makes, and the interesting dishes the infamous Deb produces, I have had basically the same meals every day. During my first breakfast with my host family, I was greeted by a large spread of hard boiled eggs, hotdogs (this seems to be a morning food item), tea, natural orange juice, bread, butter, and jelly. I poured my self a cup of the tea, let it cool, and then tried the jelly. The first wave of flavor was intense. I think the closest description would be to take a fruit medley jelly from the U.S., add a cup of sugar and Gatorade’s Fruit Punch ready-mix powder. I continued to eat the jelly for a while, until I felt like it was eating the enamel off my teeth. I starting bringing a jar of peanut butter to the table, and it eventually made it into the breakfast rotation. I really enjoy hard boiled eggs, but two every morning are starting to take its toll on my taste buds. I am thinking about waking up early to cook myself an omelet or some scrambled eggs.

Unlike the U.S. system of 3 meals daily, the Tanzanians have added half a meal in between breakfast and lunch, known as Tea. One thing that I am not sick of is the Tanzanian tea. Locally grown, the flavor is unlike anything else I have tasted. Most of the locals drink it with whole milk but I prefer a cup with a spoon of sugar. With tea, it is common to have some form of fried dough. It’s pretty interesting to note that at one of the most respected medical campuses in Tanzania, there are no baked or boiled goods sold at the campus Canteen. The one healthy alternative is a bowl of fruit salad that is not always available.

For lunch, I have had some form of banana and / or rice every day. The lunch places make a dish called “pilau”, which is seasoned rice and beef that tastes pretty good. Ndizi is another dish that I like, which is cooked bananas, covered in a somewhat salty banana sauce and beef. With one of these meals comes a form of vegetable, sometimes the collard green that I mentioned above, or often shredded cabbage. There is also a complementary piece of uncooked banana which I think is the highlight of the meal. I have never tasted such good bananas. The Chagga, the prominent tribe in the Moshi area, are known to make most of their essentials out of the banana plant (food, beer, houses, etc) and I think they have perfected the art of banana growing.

Dinner everyday is basically the same. The meal is usually rice covered with a sauce, vegetables, and a meat. The meat is either chicken, fish, or beef, but most often beef. The fish is… interesting. I think the first time I had the fish was about two weeks ago on a sunny Wednesday. As I was walking back from KCMC, I passed a woman sitting on the side of the road selling whole, roasted fish about 6 – 8 inches in length. I’m not much of a fish person and but I wasn’t the first to say that these fish did not look very appetizing. I thought about the lack of local water sources in the area, and then tried to dispel the thought of eating the animal. That night, atop my heap of rice was one of those fish, cooked in some type of spice. Not to upset my hosts, I ate as much as I could, but did not come close to sucking out the eyeballs as did my host parents. It actually wasn’t as bad as I thought it would be, but I would rather eat as little of it as possible.

To me, the highlight of dinner is dessert. Where as Americans most often enjoy foods like ice cream, cake or cookies for dessert, the Tanzanians choose to eat fresh fruit. Although they have many more seeds then the fruit I normally eat back home, I think the fruits I have eaten here have more flavor and possess a natural sweetness that I don’t taste in America.

Overall I have enjoyed all the foods I have eaten so far, but am looking for a change. I look forward to Thursdays when the Cornell students go to our professor’s house and she bakes us some sort of American dessert. The first time we had cookies, followed by strawberry shortcake, and then last week was chocolate-zucchini cake. I am hoping this time it will be cookies again, or if I had my choice, Popsicles. I also heard that one of the Cornell girls brought some Gatorade mix, so I’ll have to investigate that. Hopefully, next weekend’s trip to Zanzibar will bring out some new dishes.

Additional bracelet. I traded the coffee bean one for this one. Technically #5

More Pictures

As per a request, here are some pictures of my living quarters

The family room

My room / bed

Front of the house

Host family's banana trees

Pathway to my host family's house

New Bracelet. Aquired in deal for other gifts

Roman Catholics, Second in the Eastern Division

This Sunday, I went with my house mother, Lincoln, and the house girl to church. Unbeknownst to be before I arrived in Moshi, but my host family is fairly religious. I may have mentioned this before, but I often come home to see my Mama Catherine watching the gospel channel on TV.

This week’s service was a little different then last weeks. Last Sunday was the Pentecost and the church was significantly fuller. Although a there was a good amount of Tanzanians there this week, no one had to sit in sections that were actually outside the church.

The building itself is fairly small, at least according to American Roman Catholic standards. Arranged in the classic cross formation, each of the three wings looking at the alter area have about 30 pews. Mama Catherine likes to sit to the right of the altar, probably because when Bwana Theophile is home, he sings in the choir which is located in that wing.

Opposed to the elegant buttresses and arches of large churches I have seen, this particular one has ceiling tiles, occasional colored yellow, turquios-ish green, and red in the shape of crosses. If they are working, the ceiling fans spin freely and add a cool and soft breeze to the chamber. There is a number of stained glass, although there are no scenes in the glass. The colored glass is either arranged in a mixture of purples, yellows, greens and pinks, or complementary colors in the shape of what else but a cross.

When everything began around 10:30am, I couldn’t help notice the similarities between the service and a basketball game. It sounds like a weird connection but it kind of fits. Here goes the explanation:

On the interior walls of the edifice hang pictures of Christ, like banners of past championships or advertisements preaching life lessons. The pews, or short wooden bleachers, wait for the spectators and are filled at random. At the center of the three wings is tile, or hardwood, that is separated from the churchgoers by a low metal barricade. The music, brought to you by the choir, provides entertainment before the actual action begins and announces the start of the ceremony.

Although there is only one team in this game, the players come in one at a time, waiting for their cues from the choir. First come the bench players and main assist leaders on the team, the alter boys. Swinging the golden Censer, one presents the game ball to the audience. I envisioned these young kids as tiny fragments of Scottie Pippen, ready to help out the superstar. They kneel at the altar waiting for the rest of the team.

Next comes the badass, the one who likes to look different, the Dennis Rodman of the team. With his sweet brown cloak and hood, like an outfit from Monty Python’s The Holy Grail, he arrives at the altar next, kneels and waits.

Last and certainly not least, here’s the superstar. I think the choir’s music is slightly different at this point. I hear them saying “number 23, Mmmiiiiccchhhaaaeeellll Jjjjjooooorrrrddddaaaannnn!!!”. In strides the priest, clad in an all white garb, decorated with two small chalices on the very front, the hero of the team. He kneels at the altar, says a few words and instead of chest-bumps, they all rise in unison.

The choir ends its singing and the game is underway. I don’t exactly know what went on most of the time, mainly because the entire service was in Kiswahili and I’m still not fluent. However, I did understand a little, mainly the words “takatifu” which means saint, and “kazi”, the word for work.

About halfway through the service, after a few iterations of the crowd standing and kneeling, I decided it was halftime. And what happens at but the cheerleaders, or nuns, entertain the crowd while the team takes a quick break. One of the sisters walks up to represent the entire squad and begins a sermon on family. I think I understood something about it doesn’t necessarily matter the size of the family, as long as it is close and everyone loves one another. But I could be completely wrong. Her speech is a little long and I can see a few members of the audience nodding off. But they didn’t come to see the cheerleaders; they came to see the Lebron James of their Roman Catholic Church perform.

Michael Jordan said a few more prayers and the choir chipped in. And then, Dennis Rodman got a few rebounds in the form of a monotone prayer that lasted about 2 minutes. The small Scottie Pippens helped by ringing a bell, bringing in the Censer, and holding the Bible for Michael. The entire service was definitely a team effort.

Towards the end of the service, the team asked if any of the fans would donate to their cause. The majority of the congregation said yes in the form of Tanzanian shillings. I even decided to kick in about 100 Tzs. And at the very end of the service was communion. I thought that since I am not a loyal fan of this team, I shouldn’t receive Christ’s body so I sat in my seat while Mama Catherine went and received her portion. I didn’t sit alone, as the house girl did not receive communion as well.

All in all, I thought it was a fine service. I enjoyed the singing from the choir, probably because I didn’t really understand what they were saying and they harmonized well. The Waiters would be proud, but I don’t think it was quite up to their standards. Taking an anthropological view of the experience definitely helped me get through an event that I would probably not have gone to otherwise.

Thinking about religion in this country, I wonder about its origins. When did people start to say, “Yea, our tribal views are silly. We should believe in your religion, with only one guy who has supernatural powers”. I imagine that mission trips have something to do with it. I would think that Islam would have a larger pull in the mainland, as the Arabs made a larger influence in Tanzania’s history from the beginning. For example, many of the Swahili words have Islamic origins. I should talk to Bwana Theophile’s father, Babu Theophile (babu means grandfather) since Bwana Theophile said his grandfather was Muslim.

I was thinking about going to an Islamic service while in Tanzania, to see something that I have never witnessed before. Maybe my globetrotting cousin who also went to Cornell could give me some advice?

All in all, I see religion as an extremely interesting topic. I don’t really want to express all of my views on the subject, as I might offend some people. However, if you do practice, good for you and I hope that turns out for the best. To put all of your faith into actions from thousands of years ago is truly a strong belief. And if you don’t regularly practice, then I’m right there with you.

Health in Tanzania

In my first blog entry, I wrote a little about the course I am taking while in Tanzania. During the second week of class, we were given a presentation about the healthcare system of Tanzania by Dr. Njau, one of the doctors and professors at Kilimanjaro Christian Medical College. In his presentation, he stated that the healthcare system was failing at the link between regional and referral hospitals. In order for the system to function effectively, individuals should first be seen by the district hospitals and if they can not handle the case, they are directed to the referral hospitals. KCMC is one of the few referral hospitals in the north-eastern region of Tanzania. However, many are skipping the district hospitals and going straight to the referral hospitals.

To respond to my question as to why exactly the system was failing, Dr. Njau responded with a number of reasons. For one, the surrounding population knows that referral hospitals like KCMC have better facilities and often better personnel. Secondly, the regional hospitals are often understaffed, as the best doctors like to stay at hospitals with superior facilities. Thirdly, the doctors at the regional hospitals receive the same wage no matter the number of patients they see, so they often refer as many patients as they can to referral hospitals in order to work less. Such added numbers are increasing the burden on the doctors and facilities at the referral hospitals. I was able to see KCMC in action during the early part of this past week.

Last Saturday, all of the Cornell University students and a Cornell professor in Moshi for the week decided to take a tour of traditional Chagga culture. (The Chagga are the most prevalent tribe in the north-eastern region of Tanzania. All of Cornell students are staying with Chagga families). During the tour, we saw a traditional Chagga dwelling, crept into a cave that the women and children would hide in during battles with the Maasai, and were briefly told how to make the traditional Chagga brew, mbege, which is made from bananas. Most of the things the Chagga traditionally ate, made, constructed, etc. came from the banana tree.

After the next morning, I noticed that I had some sort of rash on the inner regions of my arms, between my forearm and biceps. I thought it was some reaction to a bug or an allergy that had been triggered during the tour. Suspecting that it would go away shortly, I put some Cortisone cream on it and tried to ignore it.

Tuesday came and it had gotten worse. It had spread to the abdominal region of my torso and oddly enough, no where else. After explaining my condition to one of my professors, she said that we would go to the dermatology department during a class break. 11 o’clock came and we headed the short distance to the clinic. My professor said she knew the head doctor in dermatology and began to search for this illusive doctor. Returning a few minutes later, I was told that the dermatology clinic is not open on Tuesdays or Thursdays. I guess people don’t get skin issues those days.

Stating that she knew a general practitioner (GP), she made a phone call and we headed up to the central hospital. Walking up various flights of stairs, we passed a wide array of people. There were a few Maasai, with their shaved heads and enlarged earlobe holes, walking into the eye clinic, to young children being wheeled around on gurneys, to elderly men waiting by the pharmacy. I had taken a tour of the hospital, visiting a number of wards, but being a patient had a different feel.

At the fourth flight, we walked into an office filled with ex-pats. I was escorted to a corner of the room and given a very informal examination. After a few questions and a few pokes, the doctor stated that it was most likely a fungal issue and I should use the Lotramin that I had brought with me. Walking back to the classroom, by stomach began to itch again.

The next day, Wednesday, I told the professor that I wanted to go to the dermatology clinic, as the itching hadn’t stopped. The professor couldn’t go with me again so she asked a Tanzanian student to accompany me. Peter, a 25-ish Tanzanian with an ever-present gapped-tooth grin, said that he would help me. Walking to the clinic, Peter said we would take a small detour to grab his medical coat. With the coat, he claimed, he looked more official, and we would later need his doctor persona.

The first stop was to the file office where I had to open a file. So now, if I get sick again, I’ll have a medical file in Tanzania. And I guess there is now some legal document / proof that I actually went to Africa. The file clerk wanted to charge me more then the 4000 Tanzanian shillings (Tsh. Roughly $3) to open the file, but I told Peter that another Cornell student had opened a file for that amount so the 4000 was paid and the file was created. We then headed to the dermatology clinic where instead of waiting among the other Tanzanians with some sort of skin issue, Peter escorted me through a hallway among examination rooms. He said that I should wait here while he found a doctor. As he searched, I tried to avoid the obvious fact that I was out of place and shouldn’t have been standing awkwardly in the hallway, within direct eyesight of the Tanzanians I had skipped in line. I was feeling guilty, but still itchy.

After some pleading and being dragged into another examining room to learn a little more dermatology, Peter escorted me into a room where a Rwandan doctor was just finishing up with an elderly Tanzanian woman in a brightly patterned body wrap. Taking a seat, I began to describe my issue to the doctor. He said that it was probably allergic eczema and after writing a script, I should come back in a week as a checkup.

Leaving the clinic and picking up a cream, we headed to a specific pharmacy that could administer the pills I had to take. Waiting for the pills, I finally felt that I wasn’t cheating the system. I had to wait my turn, among the locals for my medication. I wasn’t receiving any special treatment that the woman with her tiny infant to my left, or the grey-haired man to my right couldn’t get. I was back among the general public. (The cream was about 1000 Tsh and the pills 1500. The whole trip cost about $5)

Before I had taken this adventure as a patient at KCMC, my professor had used the term “white privilege”, meaning that no one really questioned your actions if you were white at KCMC. As other local youths were being stopped by KCMC security, the Cornellians quietly walked past. At the hospital, this “white privilege” had truly taken shape. I was brought to the front of lines and skipped people that probably had more severe problems than me. I feel bad about this fact and slightly ashamed that I had let it happen, especially as a hopefull doctor, I should be aiding those that need care, and not skipping them to get care myself. I wonder if I had been a Tanzanian myself and a friend of Peter’s, would he have taken the same strides to ensuring such speedy treatment as he did for me, the white American? Possibly. And if so, then a phrase I hear back in America rings true. It’s not necessarily what you know, but the people you know.

Some Pics....

The view from the new building being constructed at KCMC

The third bracelet

Kilimanjaro.....

Infrastructure - Or lack there of

I’m beginning to feel more at home in my homestay and in Moshi. Although I am still receiving a lot of stares while walking to class, I receive a lot of friendly greetings. However, I will not begin to let my guard down.

Not a huge amount has happened since my last post. My group members and I have started to develop our own case study that we will examine throughout the next three weeks. We have chosen the topic of “Health & Body Image” in Tanzania and will focus on the social conceptions of body image, as well as creating recommendations that will encourage healthier consumption choices.

Traveling into the central town of Moshi, my fellow white students and I receive a lot of attention from the street peddlers. Waving strands of beaded bracelets and necklaces, they continually say that they will give you a “great price” for their items. Last Friday, we all went to the city and I bought a small bracelet from a young Tanzanian who brought me into his shop to show me his paintings.

While waiting for a daladala (crowded van that serves as public transportation) ride back toward the hospital / our classroom, another street peddler tried to entice me into buying another bracelet. Beginning to tell him that I already had one, I thought it’d be interesting to see if I could trade him. I wasn’t extremely interested in the bracelet I currently had and looking back I think the trade worked out in my favor.

I have now developed a game that I play with the local peddlers. It involves trying to see how often I can trade for a new bracelet without spending any money. Today in town I managed to trade for a new one which is made entirely of coffee beans. I have posted a picture of it on this blog. It is my third bracelet thus far. The second one had coffee beans and yellow, black, and blue beads, while the first was slightly thicker and had red, green and yellow smaller beads and large pink beads. Not my favorite. I’ll try to take a picture of every bracelet I acquire. Hopefully this game will add some enjoyment to the tiring act of dealing with the street vendors.

Also, I finally found a gym in Moshi. After class this Monday, I ran to the Agme Lodge with Brenna and Chelsea and we signed up for a monthly membership to a fairly small gym. I wasn’t really concerned about the equipment, as I was simply happy to have some weights to swell with.

Over the course of my trip, one thing that has come to my attention is the infrastructure of Tanzania. Turning from a popular street to a side road, the ground turns from tarmac to compacted dirt and rock. The prevalence of rock creates very bumpy car rides and unhappy joints during runs. This lack of infrastructure also creates economic difficulties that businesses can not afford.

This past Saturday, I went on a tour of traditional Chagga culture with Professor Moseley and the other Cornell students. There had been a few light showers early that morning, creating a thin layer of mud on the unpaved roads. While taking a rented bus to the tour location, the bus got stuck in the mud, tires spinning, sliding centimeters at a time down the slope. At one point, I stepped out of the bus to help a group of local men push the automobile up the hill. To avoid an additional delay to our trip, we ended up walking to the tour location.

If the roads and other infrastructural issues on the way to the tour location were addressed, it would definitely increase the amount of tourism that could reach the remote location. Also, it would make the local coffee growers in these areas more accessible to coffee traders, thus promoting the general economy.

Along with the dirt roads throughout Moshi, I have noticed a lot of trash scattered throughout the streets and walkways. Where does all this trash end up? Probably in the drinking water and crops that lie within meters of the trash piles. If sanitation practices of this area were increased, it would help to relieve the health demand on the local health workers as well as possibly increase the agricultural yield of the local farms.

I think I mentioned this in my last post, but at the beginning of my trip I began reading “Mountains beyond Mountains” by Tracy Kidder. The book is about the life of the famous Paul Farmer, founder of Partners In Health. Dr. Farmer has his M.D. as well as his PhD in anthropology and spent a majority of his undergraduate and graduate life in Cange, Haiti working to promote the health of the towns’ inhabitants. The author states that Dr. Farmer continually expressed how easily the town could be improved if it had adequate infrastructure, such as paved roads, running water or sanitation. An entire town can be revitalized with simple improvements in infrastructure. I guess these issues are potential projects that I can work on if I return to the Moshi area.

And so it begins....

Hello everyone, and welcome to my blog of my summer trip to Moshi, Tanzania. As we say in Kiswahili, karibu! First of all, I have very spotty internet so I will try to post entries when I can.
So briefly, what has happened so far: the flight over from Atlanta was fairly uneventful. The first leg was easy and I met up with my fellow Cornell students at the Amsterdam airport. To relieve some tension, Brenna, Rosie and I grabbed a culturally appropriate Heineken at one of the bars in the airport. The second leg was also uneventful, although I did sleep for a little.

The first night in Tanzania, we stayed at a hotel that had a hot shower. My last hot shower for probably a while. The next day, we had a brief orientation meeting at Professor Stoltzfus’s house, our contact while in Moshi. Later that night, we were brought to our host families.
I wasn’t really given any information about my host family before the orientation, apart from the family structure. The family consisted of two parents and two kids. The older child, Catherine, or Katie, is six and the younger child, Lincoln is one. The father, Bwana Theophile, is the head guide at the tourism company that leads climbs up Kilimanjaro, and the mother, Mama Catherine, is a personal assistant for a business man in town.

When I first arrived at Mama Catherine and Baba Theophile’s house, Baba Theophile was leading a group of English girls up Kili so it was just Mama Catherine, myself and the kids. It was a little awkward at first, especially when she asked me in very fast Kiswahili if I spoke any of the native language, only to reply with “kidogo” or “a little”. She chuckled at my response and began to cook dinner. Apart from Bwana Theophile, or maybe equal to, I have had the most contact with Katie, the six year old. She was hesitant at first to talk to me, but now she rambles off to me in Swahili. I think my gift of Jenga really broke the ice.

The next day began the first day of the Cornell and KCMC (Kilimanjaro Christian Medical College) class. The morning consisted of general information and many introductions. The Americans and Tanzanians were commingled and placed into teams to work on policy recommendations for the case studies we were assigned to read before the start of class. Information about the class was also not given before the trip, although now I know it focuses on a wide range of policy issues that are affecting most of the sub-Saharan African countries at a multitude of levels.

Today, Honest, Patricia (two of the Tanzanians) Danielle, Chelsea and I presented our policy recommendations for the HIV/AIDS, Food Insecurity, and Gender Issues case study. While working on this presentation, a lot of interesting sub-Saharan African gender role issues were brought up, like the castration of women, or the cultural acceptability for women to not have a choice when it comes to sex. For the rest of this entry, I thought it’d be interesting to look at the gender rolls in my host family, and in the Moshi environment that I have seen so far.
During the first night with my host family, Lincoln was crying and causing a fuss. To quench his tantrum, Mama Catherine began breastfeeding him on the couch within three feet of me. In America, it would be very uncommon for a mother to breastfeed her child directly in front of a man that she had just been introduced to.

In contrast to this outward display of the bosom region, the Tanzanian culture is very conservative when it comes to the revelation of the upper leg area. While playing Jenga with Katie, her skirt rose maybe a few centimeters above her knee and Mama Catherine gave a strict demand to lower her skirt. This issue of the woman’s upper leg also came up when the girls in the group wanted to run and were concerned about wearing gym shorts because the were cut above their knees. However, Prof. Stolzfus told us that running has become more acceptable and it would be fine for these girls to wear the shorts as long as they are running.

Another gender observation came about during meals with the host family. Mama Catherine does all of the cooking and cleaning while Bwana Theophile sits and waits for his meal and doesn’t clean. This is not entirely different from American culture, as there are many households in the U.S. where the mother does all of the cooking and cleaning.

This morning, May 28th, I did see an exception to this gender division. For the past few days, Bwana Theophile has stated that I should gather my laundry soon. Last night I placed my really dirty clothes into a bag and placed them in a designated corner of the living room. From past experiences at Tanzanian homes, I have seen all completely feminine house help. Based on these observations, I suspected that the individual doing my laundry would be a female. To my surprise, and to your assumptions based on my introduction, the individual doing my laundry as I left for school was a male. I would assume that his socioeconomic status is forcing him to perform tasks that would otherwise be performed by a female. I’ll have to make some more observations on this issue as my time in Tanzania continues.

So other interesting observations so far:
- Tanzanians don’t eat dessert, at least from what I can tell. There is usually a small piece of fruit with dinner but that is all.
- There are earthquakes in Tanzania. We felt a small tremor about 2 nights ago. I thought someone was shaking my bed in the middle of the night only to find out it was an earthquake.
- Most of the people I see on the street are very friendly. As opposed to other developing nations, such as those in South America, that make cat calls to girls, the girls in my group of many different skin tones have been more or less respected.
- Food is cheap. Lunch is about a dollar a day for a large plate of spiced rice with beef, and soup made out of coconut milk and tomato juice.
- Soda is very popular. I would guess that 85 – 90 percent of the locals I see eating are drinking soda, predominately coke.
- Tanzanians like to play music in the morning when they wake up. This morning I was woken up by an unfamiliar song around 5:30.
- The water in Moshi isn’t that bad. I’m brushing my teeth with the tap water but am using my SteriPen for the drinking water.
- No ice. I knew this would be the case but a glass of ice water would be awesome.
- Alcohol is very prevalent. I was given the opportunity to try a traditional Chagga home brew the second day in Moshi, right before I was taken to my host family. It was made from Bananas and Millet, and was actually quite good.