Tuesday, September 16, 2008
So in lieu of a good wrap-up touching on life, the universe, and everything, here's a short list of how the summer ended: Kiana came to Tanzania. We stayed in Usa River, Arusha, Moshi (on the Mainland), and Stone Town and Kendwa Rocks (on Zanzibar). We went on safari to Ngorongoro crater, Terengiri, and Lake Manyara, hiked on Mt. Meru, Visited Kibosho Hospital and ate lunch with the Dr. Tan and his wife. We explored Zanzibar and enjoyed three relaxing days on a gorgeous beach. Kiana met Joshua, Simon, Ben, and Cory at Cradle of Love. (There were no siafu this time.) Kiana's shoes were stolen out of her bag by the staff at the Zanzibar airport (I should have tipped the x-ray lady) and we made it safely home to the U.S. on August 25. Kiana's bag (which had all the gifts in it) did not make it home until September 10. It apparently got sent to Paris instead of Seattle and had its own two week vacation before deciding to return home. I guess I can't blame it for wanting to see the world.
That's all. Go travel. It's a big world, and you'll be better off if you see some of it.
Saturday, August 9, 2008
|I'm writing this post in the computer lab at TCDC. We left the mountain this morning (a bit groggy after last night's farewell vist to La Liga, Moshi's premier dance club/wazungu hang-out) and descended into the semi-arid plains that up to now were just an interesting view from our apartment balcony. It's been warm on the mountain these last two days - yesterday it was actually clear enough that we could see Mt. Meru off to the west, and right behind us, finally visible after a month, the snow-covered peak of Kilimanjaro. After a month of rainy mornings and cold nights in an unheated, uninsulated apartment, I thought a little sun was a welcome change. As we drove down the mountain, my pleasure soon turned to discomfort. It finally feels like Africa now: hot. I'm Norwegian. Norwegians don't do hot. My arm and face got sunburned from riding shotgun for an hour with the window rolled down. At least I'll finally get to use all the SPF 50 I've been needlessly dragging around for the last two months.|
Our last week at the hospital was quite eventful. By applying a level of persistence that we hadn't been comfortable with during the first weeks we finally found some medical equipment that was listed in last year's inventory but that the staff had been heretofore unable to locate for us. This was particularly frustrating because some of the equipment was broken, and we could have fixed it if we'd known it was there three weeks ago, but instead we have to leave it as is.
There were successes, though. We delivered an electrosurgery unit (ESU) that EWH had sent with us to donate. Before it could be used, we had to fashion a reusable part to replace the single-use part that the instrument was donated with. An ESU works much like an arc welder: high frequency, high voltage electricity is delivered to an object (say, your abdomen) by a metal "pen", passes through said object, and exits at a point where an electrical contact completes the circuit back to the instrument. The narrow tip of the pen delivers all the voltage to a single point, cutting and/or cauterizing the flesh. A broad conductive pad at the exit point disperses the current and the flesh there is unharmed. The ESU we brought was donated with one single-use pad. In the West, this pad would be replaced after each surgery, thus ensuring both a sterile surgical field and a healthy flow of cash to the instrument manufacturer. Since these pads are not available anywhere in Tanzania, a more permanent solution was required. The answer was found in a pile of abandoned medical equipment in the operating theater that included, among other things, a non-functional electro-cauterizer unit with a perfectly functional set of re-usable conductive pads. A few minutes' work with a pair of pliers put these pads to good use. Dr. Tan, an M.D. from Singapore who is a full-time volunteer surgeon at Kibosho Hospital, tried it out on a patient and is quite happy with his new toy. He says it's easily the most advanced piece of equipment in the operating theater, and is already planning to use it for brain surgeries that he could never before do at Kibosho.
My favorite project of the whole summer was an analytical balance (that's science talk for a really really accurate scale that can measure down to 0.0001 g) that looks like it must be at least 40 years old. We found it collecting dust under a sink in the back of the lab, unloved and unused. The power cord didn't have a plug, which is easy enough to fix, except for figuring out which wire to connect to which prong of the plug. Typical convention is that the "hot" wire is brown or red, the neutral wire is black or blue, and the ground wire is green. The wires in this power cord were black, red, and grey. I figured that since grey, green, and ground all start with "g", grey must be ground. I wired the plug with grey to ground, red to hot, and black to neutral. Nothing happened when I plugged in the balance. When I touched the balance, however, I took 220 V right to the thumb. That really hurt. We unplugged the balance and took a peak at the guts. Turns out the grey wire was meant to be neutral, the black wire was meant to be hot, and red wire, which was meant to be the ground, was attached directly to the metal chassis of the instrument. (I later asked Wilbard which color he would have guessed to be the hot one. He said he would have checked to see where the wires attached before plugging them in. Smart man.)
After fixing the plug, we spent a while putting various counter weights back to where they'd been carefully suspended before the balance was tossed about on a trans-Atlantic voyage and stored on its side in a cabinet. Unlike modern balances, this balance is entirely mechanical with an analogue read-out; only the light bulb for the display requires electricity. It's a thing of beauty to a science geek like me. Using it is not at all intuitive, and I couldn't imagine how I was going to train the lab staff. I'd love to take it home with me and just buy them a mid-range electronic balance. Until then, however, this balance is the best they've got; their only other balance is an electronic kitchen scale that can't even measure differences of 0.1 g.
I took it back to the lab and conducted a little training session with three of the lab ladies (all the lab techs are female; some of them are nuns). I did the training entirely in Swahili, so my instructions were limited to phrases like Kwanza unahitaji kumfanya sifuri. (First you have to make it zero) and Unahitaji kuona namba hapa. (you need to see number here). It took some doing, but they got the hang of it eventually. The next day I returned and trained a nun/lab tech to use the contraption to weigh out reagent for a staining solution that will be used to diagnose malaria. In addition to being able to speak English, she's pretty smart, so I feel fairly confident that they'll be able to use the balance after I'm gone. Just in case, I taped a card with my email address to the top of balance along with a note that read Shida? Uniandika barua pepe (Problems? Write me an e-mail.)
The week wrapped up with a day of paperwork cataloguing all of our work of the last month. The list of fixed equipment feels pathetically short compared to my ambitions for the summer, but I have a feeling that, as is usually the case with trips like these, what I've learned is far more important than what I could realistically have expected to contribute. After all, I'm not an engineer, or even an engineering student - I'm a chemist with good intentions and a soldering iron. Kibosho Hospital is lucky that I fixed more than I broke. What I'm taking away is an education that I couldn't have gotten anywhere else or in any other way. What I've learned about Tanzania and its culture, about hospitals and medical science in a developing nation, about the difference between what's donated and what's needed - this is why I came, and I haven't been disappointed. I can't wait to get back to Seattle and get to work in the lab learning more science and getting my PhD so that I can get to work on the kind of science that will help hospitals like Kibosho.
But first: Ninapumzika (I'm taking a break). My wife is in the air en route to Kilimanjaro International Airport as I write this. Zanzibar, here I come.
A chemist in Africa
Saturday, August 2, 2008
Time has a funny way of speeding up and slowing down for me. When I'm dreading a deadline (such as when I was preparing for my 3rd year exam just before I came here) the weeks fly by. When I'm looking forward to something (such as when I would wait for Kiana's visits to Seattle or my visits to Fairbanks during our long-distance engagement) I count the days and hours and minutes and everything drags. When I'm busy, time flies. When I'm bored, time drags. This trip has had all of the above, plus some new factors.
On August 1st, Zev and I both found it hard to believe that we'd spent the entire month of July in Tanzania. I remember July 4th very clearly because it was a rather eventful day, and it seems like a very long time ago. I remember arriving in Tanzania on June 10, how excited I felt and how strange everything was. That seems forever ago. I've only been at Kibosho Catholic Hospital for three weeks, yet it sometimes feels like I've always been here. When I left Seattle, it seemed my return would be in the far distant future.
On the other hand, to realize that I have only 5 more working days at Kibosho comes as a bit of a shock. Have I really been gone so long? Could so much time already have passed? Most of the other EWH students will be home in America inside of 10 days. Before I came, I couldn't imagine what it would be like to be here in Tanzania. Now, I can't imagine what it will be like to be home again. Pole pole (slowly), hamna shida (no problems), TIA (this is Africa) will no longer apply. I'll have work waiting for me when I land in Seattle, work that can fit into schedules and to-do lists and that will require multi-tasking and will not stop twice a day for tea.
Still, I have 5 days. We've got needs finding interviews to do, an inventory to polish off, a few more instruments to fix, some quick start manuals to write in Swahili, and who know what else will pop up? Between all that and having drinks with our Tanzanian friends a few more times, this week will fly by. But that's okay. Kiana gets here in 1 week, and then I get to show her this country I've gotten to know for the last two months. I hope those two weeks that she's here go pole pole.
Thursday, July 31, 2008
I'm not sure if I've finally gotten used to the pace of work around here or if I've finally figured out how to make myself useful (probably a bit of both) but for this last week Zev and I have had all the adventures, projects, and learning experiences that any eager volunteer could ask for. It seems that a good deal of the initial work any volunteer faces when beginning a project in a foreign country falls into the category of Swearingen's Three R's of Development Work: Relationships, Research, and Relaxation (feel free to quote me on this - the book deal's in the works). This theme has been running throughout my previous posts, but it's worth repeating here.
- Relationships: who are you trying to help? If you find that the work you're doing is unwelcome or unappreciated, either A) you're unwelcome and unappreciated, B) the people you're trying to help don't yet realize how they can benefit from the services you're offering, or C) you're not offering the services that are wanted and needed. Knowing the people you're living and working with is key to overcoming this first obstacle. Kiana can attest to the fact that I've been a bit petulant lately, wondering when I was actually going to get to do some real work, actually use my skills. But compared to some, I've actually been lucky. There are some Scottish medical students at Kilimanjaro Christian Medical Center (outside Moshi, where some of our EWH folks are working) that tell us they've been in country for 7 weeks and haven't done anything. There are plenty of stories from Peace Corps volunteers who have spent the whole first year of their assignment tilting against windmills. Some of the stories have happy endings. Some don't. I'm not at all sure yet what separates a successful project from an unsuccessful one (my boss says that the key to success is to be able to define the parameters by which your success will be measured), but I do know that all the good work we've had this last week has been the direct result of meeting people on the bus, having drinks with the doctors, or just showing up over and over again until people realized we hadn't left yet and they should give us something to do.
- Research: I already hit on this above - what are the actual needs? When I arrived here, I expected to find a warehouse full of broken equipment that needed my technical expertise. This has been the experience for several EWH volunteers at other hospitals. We arrived to find a competent electrician and several mechanics on staff. For the first week, we thought there was nothing for us to do here. Eventually we discovered that there was broken equipment stashed all over the place, we just had to go looking for it. We also discovered that there were other needs we could meet. We just had to ask around and be available.
- Relaxation: I'm actually kind of serious about this. Zev and I often joke that we are walking the line between patience and indolence. What we mean is that we have yet to do a solid 8 hour's work (all at once, anyway), but that's no fault of our own - that's just not the way things work here. I imagine that if I were to stay here for a year, I would find enough long term projects and develop enough relationships to keep me busy all the time - this was the experience of one EWH student who worked here in Kibosho last year and then spent the next 12 months working at hospitals in the area. But being a 4-week volunteer is essentially a working vacation, or a vocational safari, for all the reasons I've described above. Until I realized this, I was stressed and depressed. Now I'm having a blast, just in time to leave (only 6 work days left!). And I'm actually more productive than before.
Okay, enough motivational material (I'll leave that to my friend Chris Guillebeau - see the link for A Brief Guide to Wold Domination on my link list at the right of the screen). My adventures and activities this week:
- First white people to enter an ancient cave. This has yet to be externally verified, but it might be true. On the dala dala the other day we met a young woman doing a master's degree in archaeology through University of Tanzania Dar es Salaam. She and two other students are studying the defense systems of the Chagga, the tribe that populates the slopes of Mt. Kilimanjaro. We visited one of the sites they'll begin excavating soon, a tunnel ("bolt hole" is apparently the archaeological term for it) that the Chagga could escape into when under attack. Although tunnels like this are known to exist, this one was only re-discovered this year by a farmer digging a pit on his land. We used this pit as an entrance. The tunnel is about 8 feet underground, and is speculated to be several kilometers in length (running from one river bank to the next nears one) although we could only access 200 meters or so due to cave-ins. At its largest the tunnel was no more than 5 feet high, and we had to crawl on our hands and knees to get through other places. There were a dozen "rooms" carved out at certain places, with small indentations in the floor and ceiling that suggest sticks had at one time been placed vertically to create a gate or wall. The archeology students say the tunnel could be as old as 500 years, although we're not sure how they know that. According to the oral histories they are currently taking from local Chaga tribespeople, whole tribes would hole up (no pun intended) for long periods of time, keeping goats and even cattle with them and surreptitiously collecting water from the rivers at the tunnel entrances. There were airholes every 10 feet or so, as well as the occasional narrow vertical tunnel up to the surface so that a spy could check on things above. These openings are so well concealed by rocks at the surface that the students haven't even found them yet. This was only the second time the students had entered the tunnel. When their work is done and they have published a book about the Chagga (which will be the first ever), the site will become the property of the Tanzania government. Until that time, it is only known to the locals, three grad students, and us.
- Zev gets electrocuted. There are two examination chairs in the dentist's office, and two weeks ago we repaired the lamp on one of them. This week the lamp on the other chair quit working, and Wilbard told us to check it out. The problem was simple: a burned out fuse. But why had the fuse burned out? It could have been just a power surge (normal around here) or a bigger problem. Wilbard advised us to check it out. In order to measure the current, I devised a tool I've taken to calling the Swearingen Device. Basically, I used a screw driver, some wires with alligator clips, and a bunch of electric tape to make a tool that I can stick into the fuse socket. When the gator clips are attached together, the circuit closes and the lamp works. I can use the gator clips to put a digital multimeter in series with the circuit and measure the current passing through the fuse socket. We had the Swearingen Device in place on one of the chairs, turned on the power, and saw that the lamp worked. Zev then grabbed the gator clips in order to disconnect them from each other and put the multimeter in the circuit. He hadn't turned off the power yet, so each of his arms became multimeter leads and he became the multimeter, measuring 220 V AC right across his chest. He jumped pretty high. He seems to be alright, but now he has a new respect for electricity and an irrational fear of dentist's chairs.
- I become an electrician. There are several construction projects going on at Kibosho Hospital these days, including a new wing for the nursing school. As with construction projects anywhere in the world, this one's running behind schedule. The problem is, the grand opening's on Sunday (the Bishop is coming to bless the place) and 4 days out they still didn't have the lights up. So, rather than fixing scales and dentist's chairs, Zev and I have spent the last two days playing apprentice to the electricians, which mostly involves pulling wire and handing tools up to guys on ladders. It's not exactly biomedical engineering, but it's been fun and (I think) we've actually been helpful.
We've also tinkered around with ancient medical equipment, watched a few surgeries, attempted to translate a sonogram manual from German to English, and started a poker game with some British Medical students. Good times.
Saturday, July 26, 2008
I have no idea what to write. My world view has pretty much completely changed since my last post, and I'm at a total loss as to how to transcribe even a portion of that into any sort of intelligible paragraph within the next 14 minutes of my purchased internet time. What follows will be free-form and chaotic. My apologies.
Patience, patience, patience. One must be patient when working here. I knew this, I was told this, I was ready for this. I'm not a terribly rushed person, I enjoy working at a leisurely pace...but seriously! I nearly went insane after the first week as we attempted to complete an inventory of the hospital's medical equipment. We'd be told "come back later", and when we did, we'd be told "come back tomorrow", at which point we'd be told "come back later". We'd make appointments which wouldn't be kept, wait two hours for someone who wouldn't show, come back again and again and again until we felt like we were just being obnoxious. Lesson 1: multi-tasking doesn't work in a world with no schedules.
But this is their home, not mine. I've met several volunteers here from all manner of NGO's. The cranky ones are those who thought they could teach the folks here a thing or two, who thought that if they were persistent and kept showing up from 9 to 5, the Tanzanians would eventually start to as well. Cranky volunteers, these. The happy volunteers, like the nice Irish teachers from Kimmage University Dublin who have been coming back to teach NGO governance classes for the last 15 years - these folks are patient. They try to teach the Tanzanians values like fair pay for fair work, financial transparency, and respect for those under you (a big task in the face of the values system instilled on this country by a century of German and British colonization), but they don't force. The know that you can only teach someone what they want to learn. This is universal. If you don't believe me, ask a math teacher. Lesson 2: You can only help someone who wants your help.
Kibosho hospital is beautiful, a beautiful campus in a beautiful country full of beautiful people. A reward for patience is developing relationships. Among the many things that I was told before coming and thought I understood but realized how much I didn't when I got here: you can't just parachute into a hospital on the side of a mountain on the other side of the world and just start kicking butt and taking names, thereby single-handedly reversing the tide of poverty, oppression, and inequality in public health. I guess I thought that I would walk into the hospital on Monday morning and find a giant pile of broken equipment that I could fix as easily as that Shop-Rite scooter back in Arusha. For one thing, they've got a pretty good electrician at Kibosho (Wilbard) who fixes most of what they bring him. For another, there is a NGO medical equipment repair shop in Moshi that fixes what Wilbard can't fix. What really slowed us down, however, is that the hospital didn't tell everyone (or anyone?) "The Americans are coming, please bring out the dead instruments so the amazing wazungu can make your life better." It turns out that the needs actually were there, but we had to go looking for them. The staff here have gotten quite used to making do with very little, and broken equipment is not rare, so in order to find things to fix, Zev and I and our poor Swahili had to go looking and returning later (and returning later and returning tomorrow) and talking with people and making friends until we found the secret stashes of broken, 1950's era medical equipment that had been given up for lost. Lesson 3: you've gotta make friends.
What we have accomplished so far: finished most of our inventory (still coming back tomorrow for a few departments); repaired an infant scale by fabricating missing linkage pieces from Coca-Cola bottle caps (with the help of our new friends in the work shop); refurbished and repaired an ancient electric aspirator pump (the type used for sucking fluids out of baby lungs and surgical openings); and repaired the wiring on a dentist's chair, thereby doubling the number of available chairs at the hospital (from 1 to 2). And now that we've demonstrated our eagerness to fix things, our list for Monday is looking pretty good: we've been asked to (attempt to) repair and train the staff in operation of a sonogram, an anesthesia machine, and an electrosurgery unit. Lesson 4: be careful what you ask for.
Random crazy story: Second or third day here, we're trying to do the equipment inventory, frustrated and stymied by language barrier. We'd been scheduled to do maternity earlier in the day, but they got really busy when a woman began having complications with the delivery. We heard someone say "C-section". Wilbard finds us, offers to take us over the the main operating theater and help us out (he speaks English pretty well). We walk through the main door and see 3 nurses and a small, still baby. The baby is laying on a brightly painted wooden table under a hand written sign reading "resuscitation table". They chat and laugh as they use a foot operated suction pump to remove fluid from the kid's lungs, then proceed to perform CPR. The baby starts crying. I guess it'll live. We look through a large window into the OR - they're sewing up the mother from which the infant has just been extracted via C-section. Wilbard waves in to the head nurse, motions for her to come out and see us. We protest, already feeling like we're invading some place we're really not supposed to be, but he ignores us. The head nurse comes out, introduces herself (Lucy), checks on the newborn, and cheerfully tells us that she'll be right out as soon as they finish with the mother. I stare into the OR. I never realized how much, ummm, "stuff" they have to cut through to get a baby out that way. I've never seen anything like that in my life. I'm not sure that I need to again. We've been invited to scrub in and observe a surgery next week. Zev wants to do it. I'm going to go hang out in the lab. Lesson 5: don't look through the window.
Rest assured, dear readers, that I am keeping a detailed log of my exploits here and taking plenty of pictures which I will happily force upon you when I return home. Lesson 6: if you want someone to go away, feigning interest only encourages them.
Monday, July 14, 2008
They found us a room in a dormitory that is currently empty, but will next week be full of nursing students. It's a concrete structure with high ceilings that feels very European, not least because the only decoration is German movie posters (though mostly for American films). The acoustics are nice and echo-y, so I spend a lot of time playing my guitar and enjoying the reverb.
Yesterday Zev and I took a daladala down the mountain to Moshi. It's a good 20 minute trek down the steep mountain side to reach the actual village of Kibosho, then an hour-long ride in the van, packed as usual with ~25 passengers. The ride was slow at first; the driver didn't even turn on the engine, preferring to roll down the bumpy dirt road. Gas here is more than $USD6/gallon, so it seems like a good way to save money. However, when a competing daladala started to gain on us from behind, the driver turned on the engine and began hurtling down the road as fast as we could go. It became a race to pick up as many customers as we could before the competition could pass us and start stealing fares. The passengers sensed the urgency and were quick to load, I suspect because they knew if they got stuck on the daladala behind us that wasn't getting any fares, they might end up sitting somewhere for a while, waiting for new customers to show up. That's the nature of public transport around here: full cars go fast, empty cars wait until they're full. And full means really full. You won't even start moving until you've got at least 22 people in the van.
Moshi is nice, a bit less hectic than Arusha. The touts are just as aggressive, but there's more room to breath, and the tourist district is smaller. I'm back in Moshi again today, writing at an internet cafe. I haven't tried the interent at the hospital yet, but Joanna (the EWH student who worked at Kibosho last year) said it's the slowest she's ever seen in her life. This morning we met the staff and then came down the mountain to bring a broken sterilizer back to the shop where it was repaired. The shop turns out to be where Joanna worked all this last year after her initial EWH stint at Kibosho. It's a small shop on the grounds of a Lutheran radio station. Wilbard says it services hospital equipment from 4 states: Tanga (on the east coast), Kilimanjaro, Arusha, and Manyara. I'm told they are never lacking things to fix.
We're back up the mountain now. I don't know if we'll get around to fixing anything today, but that's alright. The more important task is to get to know the staff and the grounds, get a feel for how things work in our new home, and start making plans accordingly. Hamna shida (No problems).
Friday, July 11, 2008
I'm ready to go, I think. I wish I knew more Swahili, and I certainly don't feel like a qualified biomedical engineer, but I feel like the instructors have taught us as much as they can. Now it's time to get my hands dirty.
Saturday, July 5, 2008
I've had some good reminders of home recently. The first: Two nights ago (Tanzania time) the stars aligned and Kiana was able to call my cell phone via Skype. It was a clear night and I was able to see The Big Dipper, the seven star constellation that, with the North Star, adorns the Alaskan flag. We Alaskan ex-pats tend to be more than a little patriotic for our homeland, and seeing The Bear up there filled me with warm feelings as I thought of family, friends, and a wife on the other side of the world. It was still late morning in Seattle, so I told Kiana to keep an eye out because I was sending our friend The Dipper over to say hello from me. That night in Seattle was clear (a rare occasion), and Kiana returned home from a late night at work to see our friend hanging in the sky above our apartment.
Another reminder of home: American food. Now, usually when I travel abroad I make it a point to avoid American food, not so much out of snobbery (well, not anymore), but simply because I enjoy attempting to assimilate to the culture as much as possible. I made an exception for the 4th of July. Nich (my roommate) and I decided to cook an American meal for our host family. But what to make? All my favorite foods come from other places: boiled potatoes and fish, Thai red curry, pasta, burritos. We settled on hamburgers. Locating ground beef in Tanzania is a bit challenging, but we eventually found a European-run deli in Arusha. (Dog meat was also available, although I'm not sure for whom, since Tanzanians don't eat dog.) Of course we couldn't find hamburger buns, but we did find some dinner rolls with sesame seeds on top, and even some imported New Zealand cheddar. Tanzanians in this part of the country don't use a lot of spices, so I mixed up the meat with egg, a bit of bread, and garam masala (potentially the world's first Indian hamburger served in Tanzania). The nanny made chips (the term the rest of the world uses for French fries), and our host brother procured a bottle of Heinz ketchup (made in Holland and imported from somewhere in the Arab world). The burgers turned out rather tasty, I thought, and the family seemed to enjoy them well enough. I'd have no idea if they didn't, since not taking seconds in this culture is about the rudest thing you can do, but hardly anyone ate the back-up meal the housekeeper had prepared.
There was a big dance with a live band after dinner. It was actually for a TCDC class that was graduating, but we Americans took advantage of the coincidence and drank some toasts to the good old US of A with Kilimanjaro lager and Konyage gin.
My friend from Seattle, Phil Woodward, asks whether I'm proud or ashamed to be an American as I celebrate the 4th in Tanzania. It's a good question. There's another group of Americans studying Kiswahili here at TCDC, Fulbright fellows, all African studies majors and other varieties of Humanities undergrad and grad students. In contrast to the EWH kids, many of them are extremely left-leaning, some of them vocally decrying celebration of the 4th of July (anywhere, but especially in Tanzania). They're having some internal difficulties as the more staunch among them accuse others of cultural insensitivity and inappropriate behavior. Coming from Seattle, I know more than a few folks like these hard-liners. Recently I've even found myself prone to adopt such a self-deprecating attitude, openly denigrating whites in general and Americans in particular. This particular evening, however, I was proud to be an American, and I felt no shame in celebrating a proud day for my culture. In light of recent experiences, conversations, and readings (especially Paul Farmer), I am becoming more convinced that liberal piety does not guarantee execution of social justice, and may in fact easily take the place of action. I can't change the fact that I'm white, or a man, or an American. I am not proud of many things that my country has done and is currently doing to oppress the poor of the world. But it is precisely because I was born in America that I have had the opportunity to learn science, to do research, and to travel to the other side of the world and attempt to carry out the sort of foreign policy that I wish my government would choose to spend its efforts on. It would be just as ridiculous to pretend not to come from America as it would be reprehensible to hide there and pretend that the rest of the world doesn't exist.
I'm becoming rather fond of the saying "The only true country is humanity". It's a big planet, but it's starting to seem smaller as I get to know more of my fellow earthlings.
Coming home from the dance, I saw The Big Dipper again, back from his visit to The West. He said "hi" from all of you.
Tuesday, July 1, 2008
We’ve nearly completed the solders and circuits portion of our technical training. For the remainder of the 10 days we are here at MS-TCDC our afternoon sessions will focus on the reality of working in the developing world: how will we interact with the staff? What will we actually do in the hospital? What can we hope to accomplish? Today we discussed the causes and symptoms of poverty. We focused on the Human Development Index, a scoring system that combines life expectancy, adult literacy, school enrollment, and GDP. Norway scores highest of 177 scored countries; Sierra Leone comes in last. The U.S. comes in at #8, Tanzania at #162. We were asked to discuss which indicators we thought truly identify a poor nation, which indicators we thought were missing, and what we believed causes poverty in the developing world.
As you can imagine, the debate was heated and, in the end, inconclusive. Most believed that lack of education is a good indicator of poverty, and certainly one of its causes. Others, however, argued that enrollment in school by no means indicates quality education. They went on to say that lack of education doesn’t always lead to poverty. What about Masai cattle herders who measure wealth in cattle, not shillings? One might even argue that forcing children to go to school and learn in a Western-style classroom (in the case of the Masai, in boarding schools) hurts their families who need them to look over their estate.
One student proposed that perhaps lack of work ethic was to blame for poverty in the developing world. Maybe, he said, some people are just used to living in squalor and don’t feel like changing. He was thoroughly excoriated for this comment. Not long after, though, very similar sentiments, couched in more palatable terminology, were expressed by other students. After years of corrupt government and oppression, they said, how can we expect people to suddenly adopt industrious attitudes? They cited the inability of the people of Ghana to run basic infrastructure (let alone build an economy), and the tendency of some Central and South Americans to prefer to steal rather than work.
All of the prosperity indicators listed above (and several others that weren’t listed, such as women’s education, infrastructure, corruption, and wealth distribution) were met with ambivalence. Yes, X is important, but is it a cause or a symptom of poverty? Does the metric used to quantify it actually measure something significant? Do we have the correct definition of poverty? If we wish to end poverty, where should we start? Should we even try? Emotions ran hot, loud people yelled, timid people shut down, and I had flashbacks to freshman year philosophy. The instructor’s suggestion that we leave the conversation behind was met with enthusiasm, and we set to work fixing ECG’s and pulse oximeters.
I’m currently reading Mountains Beyond Mountains, Tracy Kidder’s account of Dr. Paul Farmer. Founder of Partners In Health, Farmer is a Duke- and Harvard-educated medical doctor who has dedicated his life to providing modern medical help to the impoverished people of Haiti (#153 on the Human Development Index). As I listened to the debate get more and more heated, I wondered how Dr. Farmer would respond to these questions and ideas. Here are some excerpts from the book:
“And don’t think they don’t know [that they’re poor]” [Farmer] said. “There’s a WL line – the ‘They’re poor but they’re happy' line. They do have nice smiles and good senses of humor, but that’s entirely different.” [By WL Farmer means White Liberals.] "I Love WL’s, love ‘em to death. They’re on our side. But WL’s think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.”
“[Political correctness] is a very well-crafted tool to distract us. A very self-centered activity. Clean up your vocabulary so you can show everybody you have the social capital of having been in circles where these things are talked about on a regular basis. [Some academic types would ask] ‘Why do you call your patients poor people? They don’t call themselves poor people.’ [We would reply] Okay, how about soon-dead people?”
“The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don’t want you to look like them. They want you to dress in a suit and go get them some food and water.”
“[There is Haitian proverb: God gives but doesn’t share.] This means that God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid upon us.”
[Tracy Kidder says] “Some people would ask ‘How can you expect others to replicate what you’re doing here?’ What would be your answer to that?” [Farmer] turned back, and, smiling sweetly, said, “F#$% you.”
So what do I think? I’m still processing. I will say this, however: before coming to Tanzania, I heard a great deal more about the needs of the developing world from WL’s than from the people who actually live there. I don’t think it’s my job to decide what Tanzania needs. However, I know of a hospital in Kibosho that has asked for someone to come and fix a few broken instruments so that they can help the sick and injured get back to living their lives as free as possible of pain and disease. I’m glad to help.
Thursday, June 26, 2008
06:30 - Wake up and shower so that I can get into the computer lab right when it's unlocked at 07:00. The traffic on the connection is slowest early in the morning and late at night, so I can use Skype to call Kiana. It's 21:00 the previous evening in Seattle, so I give her a heads up about how the next day is shaping up.
08:00 - Breakfast: two eggs, sunny-side-up. The first night I was here, my host mom asked me what I like to eat. I mentioned that I like eggs for breakfast, sunny-side-up. The next day, she actually came home from work to show the nanny how to make the eggs for me, and that's been my breakfast every morning since. They have this red pepper sauce here that I really like to put on my eggs. It's called Crystal, and all the writing on the label is in Arabic, except where it says "Made in Louisiana, product of U.S.A."
08:30 to 12:30 - Mimi ninajifunza kiswahili (I learn Swahili). They developed an intensive Swahili course for us that focuses on the basic grammar and vocabulary that we'll need to function at our hospital assignments. I can now say things like "I don't like siafu. Siafu like to eat me. I am going home now for the meal of the afternoon." The language course is very effective, and I occasionally give myself a headache trying to conjugate. Fortunately, we get 30 minutes for tea and peanuts at 10:00.
12:30 to 13:30 - Lunch. I stay at the home of MS-TCDC's marketing director, who lives on the compound, so I get to come home and have re-heated leftovers for lunch. The students who live off-campus have lunches packed for them, usually a boiled egg, PB&J, and a banana. They tell me that next month I'll be living with a bachelor and eating in the hospital cafeteria. I'm going to miss this place.
13:30 to 17:00 - Engineering. For the last week we've been learning how to build power supplies. We built our own full-wave bridge rectifiers (a device to convert the AC from the wall to the DC required for most electronic equipment) and added capacitors to filter out the noise, as well as a voltage regulator to allow adjustment of the output from 1.2V - 24V DC. Today, we took each other's power supplies, broke them, and gave them back to each other to fix. It was a lot of fun. If that sounds like fun to you, you might consider a career in science. If that sounds like something that only a nerd would enjoy, you would be correct.
17:00 - Beer and guitar. There's a little room off to the side of the cantine where they sell beverages and snacks. 500 mL of beer sets me back 1200 Tanzanian shillings, or about US$1. I can choose from among 7 different types of lager. Or I can have a Coke. I choose Castle. Phil, another EWH student, usually joins me for a drink and a jam session. He plays guitar but didn't bring his. He did bring a harmonica, so we play every song in C major.
18:00 - Band practice. There is a band made up of MS-TCDC staff members that practices on the lawn outside the gym several days a week. I've made friends with them, and I often hang out at practice and attempt to learn African music. The rhythms are complex, and a bit hard for a Norwegian like me to grasp, but I have fun. Today they let Phil and I pick up some guitars and play with the band. We were in the middle of teaching them to play the blues when some siafu started crawling up my pants. Everyone thought I was just dancing until I started screaming. They all got a kick out of that. "Did you get a 'good morning?' " they wanted to know. Apparently, that's local slang for a visitor in one's drawers. I was more fortunate than little Ben was in the same situation, and the visitors did not make it past my knee.
19:00 - Dinner. The best part of the day. Beans, rice, meat spiced with garam masala, chapati, and, of course, bananas. They have an avocado tree outside that's producing more fruit than they know what to do with, so we've been having avocado and (insert fruit here) juice with every meal. It looks funny, but tastes good.
20:00 to 23:00 - Chill. The TV and radio are always on (at the same time), and I sit in the living room working on homework, blogging, and absorbing Swahili. The one-story, three-bedroom house is currently home to 8 people, so there's never a quiet moment.
23:00 - Sleep. I have crazy dreams. I don't know if it's the malaria meds or what, but my dreams lately have been like surrealist epic films. My favorite so far was about the tiger who became an Old West sheriff and kicked all the British Colonials off the beaches. On good nights I dream of Kiana (sometimes she's a pirate).
Wednesday, June 25, 2008
I'm really glad I'm here.
I guess the purpose of this post is to remind myself and anyone else who is considering this particular brand of adventure that good work is not always easy work, and that there's a level of sacrifice that differentiates a vacation from...whatever this is. The EWH organizers told us right from the beginning that every single one of us would experience culture shock and homesickness. I didn't believe them then. I do now.
In a funny way, though, it's sort of a relief to be tired and homesick. It means I'm ready to get down to business. I've been here two weeks, which is longer than most people spend here on vacation. The honeymoon is over, but as Kiana and I can tell you, the end of the honeymoon is the beginning of the good stuff.
Tutaonana baadaye (We'll see each other later)
Saturday, June 21, 2008
Upon arriving at Mt. Meru we were led to a small workshop next to the hospital's equally small supply room. The room and the veranda in front of it were littered with non-functional equipment in various states of disrepair. Zev, Jason and I first tackled a blood pressure cuff that wouldn't hold pressure. By submerging the hose in a bucket of water we discovered the leak to be coming from a small crack in the tubing right at the hand bulb. 30 seconds' work with a pair of scissors returned the BP cuff to full working order. Other projects were repaired with equal speed: several other BP cuffs, a scale, some foot-powered vacuum pumps, and a centrifuge were repaired with a quick adjustment, reattachment, or other such simple maneuver. I learned that Mt. Meru, despite its size, has not a single technician on staff. We have no idea how long some of this equipment has been sitting (or how long it might have continued to languish) just waiting for someone to take the time to attempt a repair. Time is one of the many luxuries staff at this hospital lack.
Not all the repair attempts had such a happy ending. Two autoclaves (high pressure steam sterilizers) befuddled us and were relegated to the scrap heap. One particular victory, though, was the high point of my day: a scooter for the mobility impaired such as you see at a grocery store. The batteries were fully charged, the horn worked, but the motor would not go. Ben, Ian, Phil and I set about removing every bolt, screw, and coupling we could find. More than one on-looker reminded us that we'd have to put it all back together. I replied that the day fear of reassembly prevents me from attempting a repair will be the day I go home. Some of the plastic cowling proved especially difficult to remove. When it seemed we could go no further, I remembered some wisdom passed down to me by my father, an electrician: "There is no obstacle that cannot be overcome with brute strength and ignorance"; and "Beat to fit, paint to match". After much beating, cranking, and a bit of breaking, we finally uncovered the problem: a small wire had broken off from the potentiometer dial that controlled the motor speed. Ian and I re-soldered the wires, reattached the batteries, and...success! We reattached the wheels and batteries, and, with wires and straps and parts still hanging loose, proceeded to drive victory laps around the veranda.
If only successes came this easily in chemistry research.
Wednesday, June 18, 2008
The visiting policy at CoL is pretty relaxed – come in any time during normal hours and the kids take care of the rest. I hadn’t been inside the gate 5 seconds before a little kid ran up and hugged my legs. I leaned down to say hello. He pulled on my beard, informed me that his name was Ben, and then called over his buddies Simon and Cory to share his new friend. These boys were all 3 years old, (or so they told me). Ben and Cory both speak English very well. I couldn’t tell if they speak Kiswahili, as they always responded to my questions with quizzical looks and kept on talking in English. Simon speaks only Kiswahili, but wasn’t too interested in my attempts to speak in his tongue. All three were quite intent that we needed to get out of the sun and off to someplace more interesting.
The Cradle of Love orphanage is situated in a large, lush, well-kept and fenced-in compound. The boys took turns holding my hand and riding my shoulders and led me to a house that they wanted to show me. The door was locked. I told them that it was okay. Simon decided that that was a good place to relieve himself. Ben followed suit. Cory was riding my shoulders, so I decided to let him down and to suspend shoulder rides for the rest of the afternoon in case of further urinary spontaneity.
The boys took me to several other places that they liked: an empty swimming pool (with a fence around it), generators, a workshop. One of the boys decided that I should have a lemon, and after a bit of arguing over the best way to get there, we found our way to a tall lemon tree in the middle of a well-manicured lawn. The boys each found ripe lemons that had fallen to the ground and proceeded to tear into them, laughing and making faces at the sourness.
Then everything went to hell. I noticed a tickling on my leg, then a sharp pain. I pulled up my pant leg to see what I had been most afraid of since leaving the paved path: siafu. Siafu are horrible, horrible army ants. They are not poisonous, but they have been known to kill children due to their unrelenting attacks and sheer numbers. The bite on my leg had drawn blood. I turned to grab the boys and run, but it was too late. Ben screamed. I picked him up and pulled off his shoes, but he kept screaming. We ran to a safer place and I put him down, but now his screams had turned blood-curdling. He was gripping his crotch while tears streamed down his face. There were no staff people anywhere in sight. If it had been my little brother, of course I would have helped him get rid of the painful invader. But what would it look like if the orphanage staff had come running to the sound of a screaming child to see a mzungu taking his pants off? I led Ben and the other boys back toward the gate where the orphanage staff as well as the other children and EWH students were. A staff member came and took Ben and helped him out of his clothes. I explained to her as well as I could (she didn’t speak English) what had happened. She seemed to believe me. She just gave me that look that all the orphanage staff gave us: slightly worried, slightly annoyed.
Ben and Cory didn’t talk to me or smile at me the rest of the afternoon. They hung out with me a bit more, but soon found other, less painful people to talk to. Simon didn’t care. He hadn’t been bitten at all, so he still thought I was alright. He was the only one of us who hadn’t been wearing shoes.
We soon took all the kids inside for their dinner. The three-year-olds fed themselves, but all the toddlers were seated in a line in front of a long bench. The EWH students each grabbed a bowl of hot porridge and sat down in front of a kid to feed them. Hoping to redeem myself, I grabbed a bowl and sat down in front of a little girl. She took one look at me and started screaming. A staff member scooted her away from me and put another little girl in her place. The previously happy child soon took up the same tune. I got the look again.
I sat down on the floor across the room and watched as the rest of the clean shaven, short-haired, non-pierced students fed the happy children who hadn’t been attacked by ants. I wondered what I was even doing there. Then Simon came up, wiped his dirty hands on my face, laughed, and leaned on my back. His little friend Joshua, a toddler with a face that makes you believe he’s thinking very deep thoughts, walked over, poked my nose, and sat down on my lap.
Maybe I’ll have another go at this tomorrow. I’ll just stay off the grass.
Saturday, June 14, 2008
We walked for several miles over the lush green mountain side. One stop on our trek was a traditional home compound of a Masai family. We in the west usually hear about the nomadic cattle herders of the plains. Today we learned that some Masai long ago found their way up into the mountains and took up agriculture. They live in large, round, thatched-roof huts with walls made of a mixture of manure and clay. At night, the cows and goats are brought inside to help keep the family warm. The mother shares the bed with the youngest child; the father sleeps at the door. Young boys will sleep at the door with the father, but when they are too old the parents build them another hut next door. Every seven years, the adolescent boys who have been deemed ready make a temporary hut and stay there for a month or more, receiving training and wisdom from their elders in the way of the Masai warrior. Then they are circumcised and welcomed back into the community as men, the caretakers of their society. (Female circumcision was practiced in the past, but is now illegal in Tanzania and quite rare).
As we learned about and saw this way of life, a few of us began to wonder if our own culture is missing something by not having such an obvious rite of passage into adulthood. Not that I'm advocating adult circumcision without the benefits of anesthesia. But I do wonder if a lack of a real and meaningful mark of adulthood doesn't have something to do with my generation's inability or unwillingness to confidently assert the title and responsibility of adulthood.
Another question, quite unrelated: what is it that we (EWH students, Americans, NGOs) hope to accomplish here in Tanzania? The West calls places like this "developing nations" or even "under-developed nations", implying that we feel Tanzania ought to develop. Into what, I wonder? Will a developed Tanzania have room for the Masai of the mountains? Already their culture is disappearing, their religion being replaced by Christianity, there round mud huts by square brick shanties. Will Mt. Meru one day look like the terraformed neighborhoods of Seattle? I came here to fix medical equipment. I'm sure the residents of this neighborhood would appreciate that, as they do visit the hospital when very sick or injured. The society that builds ECGs also builds high rises. Given the opportunity, I wonder if the Masai would prefer to live in a mud hut or a house or a condominium. I suppose my work here will help to give them that choice to make. They certainly don't have it now.
Lala Salama (peaceful sleep).
Friday, June 13, 2008
Eat up, ladies.
Thursday, June 12, 2008
Tonight I spend my first night in Tanzania. This has been the longest journey I’ve ever taken in one go. After more than 24 hours moving across time zones and spending nearly an entire Tuesday (that, depending on how you calculate the time change, may never have existed) 30,000 feet in the air, where it is impossible to see the ground (or water) being covered, I’m almost as far away from Seattle as I can get on this globe while still being on land.
The trip had a few hiccups. One of my checked items was a used electrocardiogram (EKG) wrapped in blankets and stuffed in a duffel bag. It weighed in at 52 pounds, 2 pounds over the limit, which should have set me back $50, but when I explained to the lady at the Northwest/KLM desk that it was for a hospital in Tanzania, she waived that fee and my $25 second bag fee. (Yes, Northwest now charges $25 for you to check an extra bag.) I spent a few hours in the labyrinthine London Heathrow awaiting my Virgin Atlantic flight to Nairobi. Several wi-fi networks are available (I ended up going with boingo), but it cost me 4 pounds for 60 minutes. I ended up waiting in the crowded main passenger lounge much longer than I thought I’d have to because Virgin has this odd practice of waiting to announce the gate you’ll be boarding from until a time of their choosing. I was supposed to have boarded at 1915, but 1915 found me sitting and staring at the flight status sign (which said it would announce my gate at 1920). At 1935, the sign finally updated to tell me that my flight was boarding at a gate 10 minutes’ walk away. Virgin is also quite strict about you getting to your gate on time (gates close 30 minutes prior to departure), so I rushed to my gate only to discover that I needn’t have worried – they were running behind. We left an hour late, which meant I emerged in the hot and crowded Nairobi airport just in time to hear that my final leg, Nairobi to Kilimanjaro, was boarding right then. I made the flight. My bags didn’t.
Our Precision Air Service (an ironic name, if you ask me) turboprop let us out right in front of the rather tiny Kilimanjaro (JRO) airport and we entered through the door labeled “foreign arrivals”. Customs consisted of one man who looked at my passport, took my $USD100 cash, and gave me my tourist visa without asking for my proof of vaccination or any sort of declaration of goods. I had though myself quite the savvy traveler for having procured and brought with me two very nice passport photos for my visa, but the man just looked at me tiredly and told me to put them away and look into the webcam he had set up on the desk. I walked past his desk into the next room, which is where my bags should have been. There were no other customs agents; all one has to do is collect one's luggage (uninspected) and walk out onto the sidewalk.
Then again, I didn't have my luggage. The lost luggage people were as helpful as they could be, but they had no way of directly communicating with the other airlines or airports, so they couldn’t tell us where our bags were. They used some archaic-looking computer program to send a request for our bags to Nairobi, but they couldn't tell me if the request had been received or what good it had done. I had met up with another EWH student in London who’d been on the same Virgin flight, and as his bags hadn’t made it to JRO either, we decided to sit and wait another hour for the next flight from Nairobi to arrive, hoping it would have our bags. A nice breeze was coming into the baggage claim room through a doorway which opened right on to the tarmac. I stepped outside to enjoy the perfect weather and saw that the door, which was labeled “domestic arrivals”, was about 30 feet from the “international arrivals” door that I had originally entered through, with no fences or guards in between. Apparently, customs at Kilimanjaro airport are optional.
Our bags didn’t make it on the next flight. We filled out the necessary paperwork and left the airport (again, no security or further customs) and our driver, who had been there for more than two hours waiting for us, took us to the MS-TCDC, where we passed a long, indolent day wandering around the compound (more about this place later) with the only two other EWH students to have arrived that morning. We rode back to the airport in the evening when the driver went to pick up the remaining 16 students, all of whom came in on the KLM flight direct from Amsterdam. Unlike my disjointed, three-carrier route which practically guaranteed that my luggage would be lost, they had arrived on a large jet packed with all the tourists I had found conspicuously absent on the tiny turboprop that had dropped me off. I was relieved to find that my bags had finally made it in a bit earlier that evening, so now I’m in my pajamas about to go to sleep under a mosquito net in the home of the family whom I’ll be staying with for the next month, and all of you are probably about to have your afternoon coffee break. All's well that ends well. Hakuna matata (yes, they really say that here).
Monday, June 9, 2008
Here's the itinerary they cooked up for me at Passport Travel http://www.passport2travel.net/:
Dep. Seattle 20:05 6/9/08, Arr. London 16:15 6/10/08 (Northwest/KLM)
Dep. London 19:15 6/10/08, Arr. Nairobi 6:06 6/11/08 (Virgin Atlantic)
Dep. Nairobi 8:00 6/11/08, Arr. Kilimanjaro 8:50 6/11/08 (Precision Air)
Total travel time: Just over 24 hours. And I don't get a Tuesday this week. The whole trip rang in at just over USD$2000, which isn't bad. I think I got the cheap ticket because I'm routed through Nairobi. There are direct flights from London to Dar Es Salaam, but those itineraries run about $1000 more from what I've seen. I'm glad I got a travel agent this time (thanks, Kathy).
For the trip, I'm bringing two books and a can of wasabi peas. That should keep me entertained for a few hours. Right?
Monday, June 2, 2008
That's about the extent of what I know at the moment. I feel excited, a bit nervous (though probably not as much as I ought to be), and totally unprepared (I'm not even packed yet). They tell me that I'll have regular access to internet, so I'm bringing an old laptop equipped with wi-fi and a digital computer, and with any luck I'll be posting here regularly with stories and pictures.