Thursday, July 31, 2008

Getting to work

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

The man on the mountain

Hello! Back in Usa River, regular internet access allowed me to post regularly, which really helped me to process my experiences as well as keep a journal for posterity. Now that I live on the side of Mt. Kilimanjaro my internet access has been quite limited. I've rather missed these exhibitionist soliloquies. I'm in Moshi at the moment, enjoying the hottest day I've yet experienced here, letting my poor mzungu skin get a rest in a cool, dark internet cafe...

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

Hospital on the Mountain

This is as high as I'll make it up Mt. Kilimanjaro on this trip to Tanzania. Zev and I arrived at Kibosho hospital on Saturday morning. The trip only took a few hours, less than I had expected. We dropped off 4 EWH students at Kilimanjaro Christian Medical Center (KCMC), a huge Lutheran hospital complex at the edge of Moshi. We soon left the paved tarmac and bounced up the mountain side. The weather was noticeably colder, as was the reception: the people at Kibosho didn't realize that we were to arrive that day, and they weren't quite sure what to do with us. We found Wilbard, the technician we're supposed to stay with. He didn't have a room ready for us yet, so he took us to meet the head nurse to see what she had in mind. She welcomed us warmly, then informed us that there would be a $USD50 "registration fee" that she had "forgotten" to tell the EWH organizers about. We called Michelle Garst (the on-site trip organizer) to tell her about the situation. She didn't sound the least bit surprised. Apparently, this is par for the course around here. TIA.

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

Into the woods (and out of contact)

I leave tomorrow morning for Kibosho Hospital. I don't know much about the place - google maps shows it as a dot on the side of Mt. Kilimanjaro. I'm told that the hospital itself is a compound outside of the community of Kibosho, and that it's fairly large by Tanzanian standards. I and one other student (Zev) will be the only EWH students there, maybe even the only Westerners in the whole region. We'll be staying with Wilbard, the hospital's lone technical staff. I'm also told that internet may be slow or non-existent at the hospital. The nearest internet cafe is in Moshi, about an hour's drive away, so this will be the last post for a while.

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

The Messenger and the Fourth

Happy 4th of July! It's now the 5th of July here, but most of you who read this are probably just going to sleep with fully bellies and sun-burned faces.

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

Who's to say?

The basic purpose of development is to enlarge people’s choices. In principle, these choices can be infinite and can change over time. People often value achievements that do not show up at all, or not immediately, in income or growth figures: greater access to knowledge, better nutrition and health services, more secure livelihoods, security against crime and physical violence, satisfying leisure hours, political and cultural freedoms and sense of participation in community activities. The objective of development is to create an enabling environment for people to enjoy long, healthy and creative lives.-United Nations Development Program (2003)

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.