Save The Last Dance For Me

Wednesday, 08/13/14, 10:33 a.m.

Dar es Salaam, Tanzania

Swahili speakers are really into their methali, or proverbs, and there’s one I’ve been thinking about and saying a lot lately: Milima haikutani, lakini binadamu wanakutana. Mountains don’t meet, but people do. It basically means that goodbye is never forever, and that’s true. It was a comfort to me during all the goodbyes back in Ifakara at the end of last week, knowing that with my Swahili proficiency (ain’t nobody calling me fluent yet) and interest in public health I have to return to East Africa. Plus, my Swiss running buddy, Sabine, summed it up perfectly when she said that the kind of people who travel keep on traveling, so you end up bumping into these people all over the world. Nonetheless, last week was more than a little bittersweet. 

For my last Ifakara weekend, I didn’t end up attempting to make a Slip-n-Slide (probably for the best, let’s be real here), but instead was invited to go see what work is like for the non-profit Msabi (Maji Safi kwa Afya Bora Ifakara=Clean Water for Better Health Ifakara). The plan was to do a survey of a potential water point out in the village of Kiberege in order to start drilling a well that week. However, when I arrived at their small office last Saturday morning, somebody had forgotten to call the community to let them know Msabi was coming that day. This would not do, so the survey was postponed. Jesse, the rugged Australian engineer with a bright red beard who had invited me along, turned to me and said, “You wanna take the motorbike out for a scoot anyway? It’s a beautiful ride.” Heh. He called it a scoot. This is why we are friends. He gave me a helmet that made my head feel invincible, but also about as heavy as all the rest of my body, and I clambered my way onto the back of the pikipiki in typical awkward-Taylor fashion. We headed out to Kiberege, about 40 kilometers away, anyway to check out a primary school where there was Msabi’s special kind of water pump and a latrine that Jesse had designed. 

It was indeed a beautiful ride! It’s crazy how fast the scenery can change when you go to different areas around here. All the vegetation on the rolling hills became greener and villages became smaller and more sparse. Robert Pirsig, in his philosophical book Zen and the Art of Motorcycle Maintenance, says that you can’t really appreciate a journey from inside the confines of a car, and that the only way to do it is to be part of the scenery yourself on a motorcycle. I loved being whipped by the breeze and feeling the sunshine. Although it generally isn’t as safe a mode of transportation as a car, I’ll have to agree with ZAMM. Especially in places like this, sometimes taking a car is impossible because of the roads. Well, “roads.” That’s why Msabi only uses pikipikis, and while I was white-knuckling the handle at my hip and sitting so close to Jesse that my helmet kept thunking against his, I wasn’t complaining. Conversation was a bit difficult, though, over the engine and through two helmets. Jesse turned his head a little back towards me.

“WLEKFJLSDKFUJJNHS.” 

“WHAT?”

“WSLKDJFLKSDHLUJFM.”

“I CAN’T HEAR YOU.”

“HERE COMES THE DUST.”

And just like that, we hit a wall of dust on the unpaved road. Okay, so maybe Pirsig had never been to Tanzania when he denounced car travel. Between the bouts of dust in the air, the powdery dust on the road, and trucks that seemed to fly like bats out of hell, I was glad Jesse was such a good driver. There’s a certain amount of fatalism among truck and minibus drivers here, which is shown through signs on the vehicles that say things like MUNGU AKIPENDA--basically, if God is willing. You know, you really don’t have to drag God into this if you’d just SLOW THE [EXPLETIVE] DOWN. Luckily, we got to Kiberege just fine and parked outside the primary school, sparking the curiosity of a handful of children playing on the grounds. Jesse showed me how the Msabi pump worked (“This rope acts as a piston...” “Mmm yes, I am definitely an expert in the physics.”) and we were able to clean some of the dust off our arms and faces. Then, we ventured behind the schoolhouse, giggling kids trailing behind, to see the latrine painted with pictures of children cheerily reminding the real ones to always “Wear shoes when you use the bathroom!” and “Use soap and water to wash your hands!” What’s actually special about this latrine is that it collects rain water to use for hand-washing and converts fecal matter into compost by letting it decompose and removing pathogens. Voilá, nutrients for the school garden. So cool! And all of this in a facility that’s much cleaner than the dilapidated old latrine down the path that seemed far too small to address the needs of hundreds of schoolchildren. So, apparently, Jesse does more than drink whiskey, which I suppose is a good thing to know about one’s friends. 

Wednesday, 08/13/14, 9:57 p.m.

Doha, Qatar

Well, Qatar Airways apparently finds it necessary to board everyone over an hour before takeoff (we just really want you to spend more time with that man hacking up a lung while kicking your seat, that’s all), but I’ve now completed one flight! Only one more flight to go, even though it’s a doozy at 13 hours. But back to the story...

The next day, last Sunday, Jacquie and I rode our bikes to KATRIN, which you might remember as the agricultural research institute where I went in my last entry. This time, we had a hand-drawn map in tow from a friend and were more set on making it to the actual back gate of Udzungwa National Park, where apparently the Lumemo River makes a little pool where you can swim. As a captain in the Australian army reserves (something I wouldn’t have originally guessed from her pearl earrings and cocktail-party-hosting), Jacquie makes for a great companion for wandering in the wilderness. I just bumble around filled with the spirit of adventure and not much else, not unlike the little boy in Up. We used her compass and the help of a few locals, and finally made it where Innocent and I could not the week before--a little Tanzania National Parks building down one last very rough hill! And to think my Stupid Whore Bicycle actually made it over rocky terrain this time. A guard with an AK-47 (as are so casually carried around here) materialized out of nowhere and showed us the walking path to the river. No pool, but the guard said there were crocodiles in there anyway. Needless to say, we quickly took our pictures and scurried out of there, assuming this pool people keep trying to find must be some sort of Holy Grail. And, just as mysteriously as he appeared, the guard dissolved back into the forest, so we set off again. Could that be what a Tanzanian fairy godmother looks like? Up for debate. 

The excursion wrapped up at the house of Novatus, a local Tanzanian who works for Msabi and who invited us over for lunch. We gratefully piled our plates with homemade coconut rice, greens, and chicken while a Chuck Norris movie (yes, really!) blared on the TV screen. In Tanzania, it seems like a status symbol to have your TV playing loudly all the time, if you have one. Same with speakers blasting the same Bongo Flava song on repeat literally day and night. Kennett Square doesn’t have a lot going for it, but no one has ever been able to accuse it of being too loud, and for this I will be grateful tomorrow. However, it was wonderful to be so generously invited into someone’s home for a meal, especially when our legs were so tired.

As I mentioned last time, work had pretty much wrapped up by my last week. Dana, the Harvard post-doc, sent me an article on how to code qualitative data (from my interviews) for analysis and threw me off the deep end to try it out. It’s an important skill in research, and while it’s a pretty mundane task involving big Excel spreadsheets compared to field work, it appealed to the part of me that organizes all the crayons in my Crayola 64-pack and writes to-do lists all the time. It’s encouraging to me to know I like all parts of the process! I also wrote up a prose report of the interviews, which will help Dana write the official paper that gets published about Saving Brains. With time to spare, I was also able to go with Tom to the entomology lab’s field site in Kining’ina to help set up an experiment with the mosquito colony’s viluilui (best Swahili word ever), or larvae. In the screen houses, they have made a perfect mosquito environment so that they can study them. Lots of plants, standing water, and mock huts. Mind you, these are the same mosquitos that feed on someone’s arm twice a day, and get a cow brought to them every evening. That day, we put rat glue on overhead projector sheets (you don’t need fancy equipment to do science!) and put them in buckets of water with the larvae to see if the glue harmed them. It was a slightly banal, but necessary, follow-up to an experiment in which they were catching tagged adult mosquitos with these clear sticky sheets to make sure the glue itself wasn’t messing up results. Satisfied that I had shadowed at least a couple of other projects in Ifakara before leaving, I visited Nurse Neema to observe one last clinic assessment before completely wrapping up my brief but memorable stint at the Ifakara Health Institute. 

I joked with people before I left that my ukulele skills when I returned home would be inversely related to how many friends I made in Tanzania. I can now sing and play at the same time...but the two nights of goodbye dinners were when I really felt special and realized what great friends I had made this summer, despite being sent out to Ifakara completely by myself. On Wednesday, after one last round of Frisbee, Geofrey and his roommate Felician invited me to their house for a meal of a hearty potato and tomato stew eaten with our hands and a semisweet, thin pancake. To show my appreciation, I brought the aforementioned ukulele to entertain them while they and our friend Fatuma cooked (So many men cooking for me that week! How progressive!), which is when I found out that all of them loved the song “Save the Last Dance for Me.” After the first time they heard it, I must have been asked for six encores throughout the evening. It seemed so appropriate as a goodbye song, as an homage to my Ifakara summer, so I was happy to oblige. The candle on the low table we ate upon flickered and lit up features of happy faces, from such different backgrounds but brought together by things everybody loves: food, togetherness, and song. For my official last night, Thursday,  about ten of us went to a restaurant (It was actually indoors! How fancy!) for cassava ugali, fish from the Kilombero, and one last round of goodbyes before I headed off on the 9-hour drive to Dar es Salaam early Friday morning. 

Not much to say about Dar, as the city has about as much charm and culture as a Payless Shoesource, but I stayed in a cute and simple B & B near the IHI Dar office before flying to Gombe National Park on Saturday. I had four days to play with before this journey back to America in which I could either go lie on a beach in Zanzibar or go out near the Congo/Burundi border on Lake Tanganyika to track chimpanzees. As a Human Evolutionary Biology major who works for Harvard’s chimp behavior lab, this was hardly a dilemma. Although Kigoma (the nearest town) is west of Ifakara, you have to go back to the coast to Dar and fly if you want to get there in a reasonable amount of time since it’s so remote. I spent some time wandering around Kigoma midday (much to the consternation of locals and other travelers who couldn’t understand that I was actually speaking Swahili and confidently doing things by myself) before getting on the local lake taxi to Gombe in the afternoon. It’s only accessible by boat (and in a remote region, at that, making tourists few and far between), so you either pay $300 for a charter boat or 4,000 Tsh ($2.50) for a trip on a wooden motor boat piled high with people, sacks of rice and sugar, luggage, and all kinds of knickknacks people want to take back to their villages up the coast. I could deal with this and the lack of a sunshade, so after at least four men shoved pieces of paper in my face to sign to get on their lake taxi, I sat on the side of one swinging my legs into the hull of the boat, above some sacks and a chicken in a black plastic bag. Its owner had second thoughts and tied the knot around its neck instead of over its head, and placed it below a plastic chair out of the direct sunlight, but it was still grotesquely comical. Buddy, someone out here’s got it in for you. Escape and rejoin your fowl friends! This chicken seemed to be woefully inept at receiving my telepathic advice, though. Her loss. The 3-hour ride went relatively smoothly, with fisticuffs only breaking out once onboard, and I was able to ward off a persistent suitor with my mild case of Bitchy Resting Face, expertly harnessed for the occasion (I can thank Grandpa Weary’s genes for this). I quite enjoy living in the twilight zone of understanding a fair amount of Swahili but people assuming I don’t know any, because it’s great for eavesdropping. “You should stop that,” another young man sitting near this pest warned him. “She’s getting angry.” No more marriage proposals and mockery all the way until landing at Gombe. Where, I might add, the boat operator took my shoes off my feet as I was trying to get off the boat and chucked them ashore, sending me jumping off the boat and splashing down after them. But I had made it--Gombe National Park, site of Jane Goodall’s famous research, and a worthy pilgrimage for any HEB student!

Thursday, 08/14/14, 8:05 p.m.

Kennett Square, PA, USA

It seems like this story will take two days and three countries in order to tell it. I’ve basically been awake since 11:30 p.m. EST on Tuesday at this point (I don’t sleep well on planes), and am starting to get delirious, but I feel compelled to wrap this up before I pass out face-first into my keyboard. Now, shall we?

My Sunday morning chimpanzee tracking was an awe-inspiring experience I’ll remember for the rest of my life. My guide, Husseini, and I started at 7:30 a.m. in order to see the chimps together before they all dispersed for the day, and made our way from the rocky lake shore inland to the mountains. At 52 square kilometers, Gombe is Tanzania’s smallest national park, but the hiking is strenuous. I muttered about leaving my hiking boots at home as we traversed steep slopes the whole way, all covered in a layer of dry leaves and dirt that shifted underfoot just when you needed to secure your footing the most. The chimp trackers who had gone ahead of Husseini and me informed him of chimp whereabouts through a walkie-talkie, and we shared a significant look when after half an hour of hiking we heard some unmistakable hooting coming through. Some people spend several hours hiking before they catch up with the chimps, so I was considered lucky. Pretty soon we came to a clearing, and my breath was literally taken away. Less than 20 feet away was a family of chimps sitting on the path while lazily grooming each other. I lamented my lack of a good camera as my pictures kept coming out blurry in that primeval forest’s half-lights, but it meant that I could just sit there observing and committing them to memory. They all have names instead of numbers, a tradition started by Jane Goodall that was unheard of before her, and Husseini told me all about the who’s-who of Gombe. It’s one thing to know that chimps share over 98% of their genome with us, but it’s another thing entirely to see them up close, looking and acting more human than it seems even I ever could. One scratching his butt, another sticking her finger in her ear and inspected said finger afterwards. Caressing, fighting (A big fight! The only time I was nervous about walking amongst them was when a large male came barreling past me on the trail), and reconciling, all according to an elaborate set of societal rules. 

Fortunately for the chimps, but unfortunately for their human visitors, park rules say that once you find them you can only stay with them for one hour, but Husseini apparently told the guides I was a “biologist who studies chimp behavior” (sure, we’ll go with that) so I was allowed to stay for double that time. I was drinking in as much as I could absorb as motivation for another semester of Excel up on the fifth floor of the Natural History Museum. The time still flew by quicker than you can say Pan troglodytus, and Husseini asked if I’d like to go see the waterfall and Jane’s Viewpoint. Of course I eagerly said yes, but I understand why most prefer to just return to the rest house for lounging on the beach. The hiking only got harder, with steep inclines and climbing on our hands and knees under fallen trees and wayward branches, but the subsequent vistas of twinkling Lake Tanganyika, the second deepest in the world, were spectacular. You could almost convince yourself you saw the Congo off on the horizon, despite how massive the lake really is. After the hike back to the rest house, I sat outside and got some more quality primate time because the local baboons, who are quite habituated to humans as well, were playing on the patio. Their mannerisms while playing kept reminding me of my dogs, and one even sat under my chair for awhile! The downside of this total lack of fear, though, is that they can be quite aggressive about food. You’re required to keep food in the dining room to avoid baboon theft, but as I sat at a table to eat the lunch I had packed, a midsize baboon opened the door, hopped on the table, bypassed several food items for the sake of my Ziploc bag of peanuts, and started to make a break for it. Now, I want you to have the image of this situation in your head. Imagine me, covered in dirt and forest, chasing a nimble baboon around a room while clapping my hands loudly and yelling, “BAD MONKEY! BAD MONKEY!” to try to startle it into dropping the bag. This was less than successful on the impudent simian, but suddenly a worker ran out after the baboon and somehow returned the bag, now sporting a large hole, to me. In case you’re wondering, the peanuts have since been consumed (triumphantly; +1 point for the hairless weakling), but I am keeping this bag as a keepsake. The rest of the day was spent enjoying my private beach, since tourist season is coming to a close, and making my way through Heart of Darkness for the first time, realizing that this was an uncanny but uncomfortable set of circumstances for starting such a book. Beach read, amirite?

I was told by different people that the lake taxi would pass Gombe anywhere between 6 and 7:30 a.m. the next morning, so I decided to get out there at 6 and just watch the sunrise if I had to (I had been falling asleep before 9 each night of this mini-trip like the party animal I am, so no big deal). At 6:30, the lake taxi arrived, but so did Husseini. At first, I thought he was coming to see me off and was touched--he had been such a great guide the whole time! When he asked for more tip money because the trackers were apparently angry there wasn’t enough for them, too (I never saw them outside the forest!), I was crestfallen. Is there no proverb here about gift horses and their mouths? I understand most of the visitors must be wildly wealthy, but I didn’t have to give anything in the first place. It put a small smudge on the experience right as I was puttering away, swinging my legs down into the boat’s hull again while sitting on a board placed sideways across it (you improvise a seat), but I tried to shake the bad feeling off. Three hours of leg-swinging later, I arrived back in Kigoma and wandered my way to the fishing village of Ujiji, where the famous “Dr. Livingstone, I presume?” encounter happened in 1871. Historical British explorers aside, the village is also interesting because they make wooden boats there completely by hand, the way they’ve been doing it forever, and I was able to watch this out on the beach. 

When I had had my fill of sightseeing and mzungu-heckling (which only gets worse as you leave Ifakara and people just assume you’re a normal tourist), I checked in at the Kigoma Hilltop Hotel, because I figured I’d have one 4-star-hotel night in Tanzania as a last hurrah. A beautiful pool and outdoor restaurant overlooking the lake (they weren’t kidding about the hilltop thing), semi-tame zebras grazing on the grounds, and my third day in a row of private beaches. This beach ended up coming with a hidden caveat emptor, though. After a wonderfully restful afternoon of sunbathing and swimming while listening to the waves lapping and a few goats bleating, I walked the 20-minute hike back up the hill to the hotel compound, when I came to a gate that had been opened for me by a guard on the way out. This time, the guard was nowhere to be found, and the gate was locked. Cement wall, high fence here, electric on top...this can’t be happening. It’s already 5:30, so what if nobody comes back and I’m stuck out here on this wild hillside all night? I just wanted one night without spiders, that’s all. I started to shout at the top of my lungs (which, as you may know, is a decibel level that means serious business) in both English and Swahili, “HELP! HELP ME! IS ANYBODY THERE? I’M STUCK ON THE OTHER SIDE OF THIS GATE! CAN ANYBODY HEAR ME? HELP!” No answer. After the better part of an hour, my throat started to get scratchy, but I heard a gate creak open and close farther to my right. This is not okay. If I can hear your stupid gate, you can hear my screaming. I decided to test my luck against black mambas in the bush and climb through in my shorts and flip-flops to follow the sound along the wall, shouting the entire way. Finally, I could even hear voices of other guards. This is REALLY not okay. I am now pleading for help right on the other side of the wall and you are deliberately ignoring me. I finally had to make it explicit in Swahili, “I NEED HELP. I CAN HEAR YOU. TALK TO ME,” to draw a response out of this numbskull. “Oh, pole sana. Sorry. I don’t know where that guard is. He is Maasai and lives farther away. Go back to the gate and I’ll let you in,” he called back casually, with not a trace of remorse in his voice. He was even smiling when I met him at the gate, although I had steam coming out both ears and was tearing him a proverbial new one. THIS IS HIS JOB I DON’T CARE IF HE LIVES ON THE MOON IT WILL GET DARK SOON WHY DID YOU IGNORE ME WHAT THE HELL IS WRONG WITH YOU THE GUARDS ARE TERRIBLE HERE YOU OUGHT TO BE ASHAMED OF THIS SERVICE all the way back to reception, where the young man at the counter was also just smiling and brushing me off, looking more worried about how this appeared to the small cadre of Tanzanian businessmen waiting to check in. Good, I hope this is embarrassing. Until I left the following morning, I kept trying to let it go and accept that the rest of the experience there was really quite good, but it was a fly I just couldn’t get out of the ointment. Each additional frustration on this trip was making me more and more eager to return to America and not have to fight for myself all the time anymore. 

After a stiff goodbye at reception the next morning, I was on the dinky propellor plane again on my way back to Dar es Salaam. Jacquie was staying at the same B & B because she was judging a national high school science fair, so it was a big relief to have dinner by the waterfront (Indian Ocean this time) in the same place where I was taken to get drinks on my very first evening in Tanzania a short but crazy two months earlier, and to be able to gripe to someone who understands. Foreigners like Jacquie who work in Tanzania full-time must have limitless patience. She likened it to driving an old lemon; you just expect that it’s going to break down every so often and cause you problems, and that’s just how it is. I would just be angry a lot more often, which, unfortunately, is a pretty effective modus operandi. We both felt better after downloading a bit (she had been having a frustrating work week), but also both agreed that as a whole, we love the meaningful work we do, the wonderfully gracious people we meet,  and the truly inspiring places we go. It was nice to hold out on that one last Ifakara goodbye until the very end, and then I was off to the airport once again Wednesday morning. Tired but replete. Frustrated but sentimental. Having a lot more answers than when I arrived in June, but having twice as many new questions to ask myself and the world now that the curtain is falling on this show, now that the orchestra is playing the finale. The houselights are coming back on, but this certainly isn’t the last time I’ll be on this stage. There will be more adventures and misadventures, and therefore more stories to tell, for as long as I can keep it up. 

Thus ends the third installment of the Taylor Goes Global blog. My grandma keeps telling me to get these made into a book, but I think that until I can come up with a more publishable title than That Baboon Grabbed My Nuts! (and other stories) I’d better hold tight. I can’t claim yet to have any big revelations about how this summer has affected me, because I think that will only come with some hindsight. I have substantial stripey tan lines on my feet from my Chacos sandals, hair that now resembles the Beatles circa American Bandstand, a head full of more real visualizations of my future career goals, and a heart full of memories. All I really can know now is that I’ve been at home now for 12 hours, and it’s hard not to be already thinking about the next endeavor.

Biker Chick

Friday, 08/01/14, 2:18 p.m.

Happy August, everyone! It’s a month of change, but strangely it’s change that causes a return to normalcy. I’ll leave Tanzania, which will have been my home for 9 weeks, on the 13th, and a couple short weeks after that I head back to Harvard Square to start the cycle of another school year all over again. Saving Brains, our follow-up to the three-year-long NEOVITA study on Vitamin A, wraps up entirely in October, and everyone will be figuring out what to do next. I’ve gotten an offer to help co-author the paper or even write another one myself using the data if I’m so inclined (I think I’d just stick to co-authorship at this point). 

As of this morning, though, I have officially finished all of the work I was sent over here to do. That includes:

• observing both home and clinic visits, leading the conclusion that I don’t even have the 2-hour attention span expected of these toddlers (which explains my infamous movie-induced narcolepsy) so I don’t know what that says about me.
• translating supervisor comments about child trauma and disability from home visit forms.
• translating nurses’ comments from all of the clinic visit forms.
• back-translating the home visit form from Swahili to English, which is a necessary part of any bilingual study, and for Saving Brains must be done by someone from an American cultural upbringing but who knows Swahili. What, no other takers?
• learning what the heck a cognitive interview is (conducting an interview with an interviewer about the interview they do...so meta) and, after writing up an interview protocol, I did them with six supervisors, three nurses, and Geofrey, who oversees the supervisors.
• drowning in PubMed articles about the effects of neonatal Vitamin A supplementation on HIV-exposed infants in order to hopefully find something that doesn’t just say lol idk i dun think it duz anything. Not particularly successful, except for the few that have seen a (currently inexplicable) rise in mother-to-child transmission in some cases.
• finding the HIV status of 8,534 women from the Kilombero and Ulanga districts who gave birth at the St. Francis Hospital (a stone’s throw away from where I write this right now) so that the NEOVITA team can see what happened with our cohort. A thumb’s-down from Dr. Wafaie Fawzi, head of the Global Health Department at the Harvard School of Public Health, would be the last nail in the Vitamin A-as-easy-intervention coffin.

I guess it’s time to take me out behind the barn and shoot me. Well, I still have to write up a report on what I learned from the interviews, but it’s essentially all downhill/smooth sailing/your favorite metaphor from here. Since finishing a couple of hours ago, though, I’ve started to feel this great sense of relief and accomplishment come over me in a way I usually don’t feel with schoolwork, except for probably the largest papers or exams. I think I feel even better because I know my work is going towards something bigger than just my personal grades and resumé. I’m really excited to see the final results of both NEOVITA and Saving Brains. Also, I was incredibly nervous about arriving here and immediately being left in the dust, since a) I’ve never done research quite like this, b) I wouldn’t call myself fluent in Swahili by a long shot, and c) I’ve never had to deal with living somewhere this rural for this long. Kennett Square, PA, you’re a close second. I am, actually, constantly covered in dust, but I’ve been surprised at how well things have been going, how helpful I’ve been able to be (I was willing to accept being the dopey, naïve intern), and especially how much I enjoy doing this kind of work. I can totally see myself doing public health research where I get to work in a lab and then go out and do fieldwork every so often. The Ebola outbreak in West Africa right now, which has recently killed its first American and infected two more, is the worst in history and is a reminder that there’s a lot of work out there that could be done. Someone’s gotta go work in those PC3 (diseases with aerosol infection) labs and look fabulous in a hazmat suit. I’d even be down for a PC2 lab to hang out with some lil’ squishy vector-borne parasites. Applying for college the first time around was so exhausting that I didn’t even consider until recently that I’m about to start my junior year and could start thinking in more detail about grad school sometime soon. So many things to think about...we’re so busy saving brains, but who’s keeping track of mine?!

I had to work through the Eid holiday everyone at IHI got from Monday to Wednesday, but the hours spent poring over the labor ward registers while I heard people splashing in the pool outside my window are now totally worth it. It did mean, though, that I couldn’t go with Geofrey to Dar es Salaam for the long weekend, but I was still able to jam-pack it with outdoorsy adventures. See, if you’re the kind of traveler who prefers fine cuisine, people-watching at cafés, and exquisitely-curated museums, you probably shouldn’t sign up for a trip to Ifakara. On the other hand, if you like hiking, biking, camping, and generally having your feet smell like a wet dog with a bad case of the meat farts (looking at you, Oreo) there are so many things you can do! 

On Saturday, Innocent (who is probably reading this right now...Hi, Innocent!) and I rode our bikes to KATRIN, the agricultural research institute that used to be German-owned, but has recently been handed over to the Tanzanian government. Doesn’t seem too interesting, and, indeed, we only passed through the institute itself, but it’s contiguous with the Udzungwa Park so the scenery is very pretty. And they even get elephants coming over to graze on their grounds every so often! Our goal was to hit the Lumemo River, which feeds into the mighty Kilombero. Since Innocent is Ugandan and thus isn’t fluent either (much to the chagrin of the locals, who actually get angry at him for being black and yet unable to speak Swahili), we mustered all our vocabulary, with some charades thrown in for good measure, to ask people we met along the way to give us directions. It was a circuitous journey, but I certainly wasn’t complaining as we passed fields of sunflowers and the shade of tall trees. When we made it to the river, we sat with our feet in the clear water, flicked away small spiders, and chatted with the local men who were passing to go bathe. On the way back to Ifakara, we stopped at a fancier restaurant for a late lunch. By “fancier,” I mean it’s the only place in town that sells burgers. I didn’t order one because I didn’t want to be disappointed (or, you know, get a pet E. coli colony), but let it be known that when I get back to America all I’m doing is eating for a few days. Like, don’t touch me or you’ll lose a finger. When we got back on our bikes to head back home, I was thinking about what a great day it had been. I love long bike rides! The weather is so beautiful! I have great company and I feel awesome and--when all of a sudden, I heard Innocent let out a little gasp behind me.

“What happened?” I called back.

“A gray snake about a meter long on the side of the road reared its head up and was coming towards you, but turned back at the last second.”

Well, that would have colored the day a bit differently in my memory. Still not a black mamba’s meal, amigos, or at least not yet. Come back to me on that one. That night, some of my friends made homemade pizzas so good I wanted to cry (these things happen after seven weeks of only beans and rice) and we planned for a biking and camping trip for Sunday.

Before leaving for the biking trip the next morning at 7 a.m., I heard a sound like water running coming from my bathroom. Was I so intoxicated by bacon gorgonzola pizza that I left the water running all night? was the (honestly, quite valid) question I asked myself. When I went in there, though, water was spraying out from the place where the knee-high shower faucet meets the wall. Of all the days for this to happen! Obviously, no one was working yet on a Sunday morning, so I ran around trying to find the security guard. After finally tracking him down, I explained the problem in Swahili and begged him to take my key and get a fundi bomba (plumber) as soon as possible. He agreed and I set off more happily for the Kilombero River with Jacquie, an Australian woman who works in the next office over on water sanitation, and Paul, an American Fulbright anthropologist who knows a lot about primatology and the people who work in my department, which was exciting to find out. The three of us haggled with fishermen at the river to take a dugout canoe five hours downstream to the village of Mkeregembe, where we wanted to start our bike ride and end up back where we started, except on the other side. The boat was unloaded of its small bounty of fish (but not of the smell) and our bikes were placed precariously upfront. It was a lazy morning winding down the river, snacking on cashews and bird-watching. We also saw some not-birds, like a farmer getting his cows to swim across the river, which seemed to be annoying them greatly, and a 3- or 4-meter-long crocodile sunning itself on the bank. At least it wasn’t also in the water, right guys? ...Right? 

When we finally arrived in Mkeregembe and stretched our legs, it was 1 p.m. and we tried to find somewhere where we could get lunch. Apparently, no one in the little smattering of shacks on the sand was cooking. 

“Is there anything at all?”

“We have beer.”

“Okay, well, is there a bathroom somewhere?” 

“Nope, msituni. In the woods.”

“Uh huh.”

We ended up buying some cups of chai and maandazi before setting off on our ride from the funny little village. My little pastel pink town bike (hey, it was the right size and actually had working brakes) which I rented for my time here worked just fine for the ride to KATRIN and back, but this quickly turned into some serious mountain-biking neither I nor my Stupid Whore Bicycle (explanation forthcoming) was prepared for. The bike path was a very narrow trail of dirt or, more often, rocks or sand, that took some serious precision to follow, especially when the overgrown tall grass on either side kept slapping us in the face so much we couldn’t see the path in front of us. Luckily, my hand-me-down DG Harvard-Yale sunglasses (thanks, Laura!) kept my eyeballs anchored to the rest of me. Every so often we would go into stretches of forest, where we still had to navigate the tiny trail while also ducking as far down as possible to avoid being clotheslined by low-hanging branches. I definitely understood why a doctor at St. Francis who had done this trip last time broke a rib! We stopped to rest after we got out of the last stretch of forest, and a man on a motorbike with a large bag of rice came up from behind us. He couldn’t believe we had just come through there on bikes--there are lions and elephants in there! I’m skeptical about the lions, but we did pass some hefty piles of elephant droppings on the way. He was being very friendly and talkative for awhile, until he said, “Can I have your phone numbers? I love having mzungu friends because they are so much smarter than I am!” and I knew we had to exit either gracefully or otherwise. I absolutely hate that very widespread assumption here (weren’t we the ones who just biked through the elephant forest?), although it’s often not said outright like that. It’s this horrible inferiority complex that’s linked to an assumption about wealth, too, so as the one Swahili speaker I asked him to please go ahead of us, before he had the chance to ask us for money. I’m glad that there are things like the Tanzanian Training Center for International Health at IHI to build empowerment, because while colonialism was a horrible, horrible thing, in 2014 I can see that sometimes Africa is Africa’s biggest obstacle. 

As we started off again, something was wrong. Ka-thump. Ka-thump. Ka-thump. “Paul...something about my bike doesn’t sound right.” Jacquie was far up ahead, but we stopped to check out out.

“Well, that’s because you have a puncture.”

My Stupid Whore Bicycle letting me down. So unfaithful, just giving up like that. Granted, she was probably stolen from China, like so many bikes here, and maybe she wasn’t prepared for a trip like that, but come on. Whore move. I had to ride at least half an hour to the next village, in the hopes that there would be a fundi baiskeli there. Every revolution of the wheel knocked my tailbone which was already smarting from the day before, and pretty soon tears were stinging my eyes. Trying to get it through the sandy parts was the worst. Just a little while longer...imagine how good of a blog entry this will make! Luckily, when we reached the next tiny village, a man was able to patch up my inner tube and pump up my tire, and while she was still a Stupid Whore Bicycle, the ride was much smoother all the way to Kivukoni, our destination across the ferry from Ifakara. It was after 5 p.m. when we got there, and it took until sundown to get a dugout to take the three of us to the sandbank where the rest of our friends were camping for the night. It felt so good to sit in the sand (can I patent Tempur-pedic bike shorts?) and eat real food, and I think we all slept well that night. 

In the morning, we rode back to IHI, and when all I wanted to do was shower my dirty, sandy, scratched-up self, I found out that lo and behold! my shower was still spraying water. All over the entire bathroom. Apparently it takes a mzungu girl foaming at the mouth and yelling in Swahili to get something done, because the plumber came right away and fixed it. He apologized and said he didn’t have the right tools when he came the day before in the afternoon (mind you, a long time after 7 a.m.), to which I inwardly said DO YOU NOT KNOW THE MEANING OF ‘EMERGENCY?’ but outwardly said that it was fine. Despite the misadventures, it was a fun weekend trip, but I was indeed happy to be back. 

Now, I’m heading into my very last weekend here in Ifakara (erp!). Tom, the entomologist from Louisiana, and I are scheming to somehow make a Slip-n-Slide work. Gotta get a little bit of that Classic Summer in before it all draws to a close...A 

Better Late Than Never

Thursday, 07/24/14, 9:02 p.m.

Oh jeez, I know it’s been awhile since I last updated this. If you were awaiting the next post with bated breath, please seek medical assistance immediately. I have to admit that my mind has been elsewhere lately...the past several days have brought a barrage of difficult news from both family and friends back in America. I simultaneously wish I could hop on the next plane home and also never go back again, and since neither of those are possible or even helpful, it’s just sort of distracting and leaves all my thoughts with a slightly bitter aftertaste. I’m alright, though, and grateful that satellites and, more specifically, iMessage are a thing. Thanks, NASA!

In other news, it’s also been a crazy busy couple of weeks at work. The last thing I want to do after nine hours of entering so much data that I leave the office cross-eyed is look at my computer some more to write a blog. We finally got access to the huge labor ward registers, brown and tearing on all the edges so that they look more like something that’s been at the bottom of the sea for 200 years instead of sitting in a hospital for about two. Thankfully, Alfa always goes to drop off and pick up the books, so I haven’t been back in the labor ward theater since that first time. I think Alfa may have picked up on the fact that I didn’t like it in there. What gave me away? Eyes wide like saucers and white knuckles? I’m not subtle. When open, the books are so wide that in order to read them I have to stand up (yes, all day long) to pore over columns such as weeks of pregnancy, birth weight, c-section (actually quite a lot, but St. Francis is a referral hospital, so you get sent there if you’re already having problems), volume of blood loss...and the golden nugget, maternal HIV status. The mothers either get a “1” for positive, along with a note about which PMTCT (prevention of mother-to-child transmission) drugs they received, a “2” for negative, or a “-” for unknown. Seems pretty simple, right? Wrong. 

For one thing, you try following a row three feet long from the mother’s name to PMTCT all day without accidentally veering into another line. Also, there isn’t a lot of importance placed on how people spell their names here. It’s kind of, you know, whatever you feel like. Although Starbucks hasn’t made its way into Tanzania yet, I’m convinced they’ve parachuted in their baristas to write down these mothers’ names in the labor ward. And they all have cotton stuffed in their ears and used to play in metal bands, too. I once spent a long while looking for a certain Angela Kassim (forgive me for breaking confidentiality, but it’s a very common name), only to find her hospital alias, “Enjo Hassimu,” after saying it a couple times aloud. Rachel moonlights as “Lecho,” Michael as a last name can be “Maiko,” and Simon just wants to be “Saimoni” sometimes. They have taken creative liberties with plenty of traditional Tanzanian names, too, but those are just harder for me to remember. No one ever seems to have issues with my favorite name, Scholastica, which is actually quite common among the large Catholic population here. I would absolutely love for that to be my name, and to take on its common nickname, Scola. It speaks to me, man. I end up having to do a lot of detective work, cross-checking their village name with a code we’ve given them for the study, or date of Vitamin A dosage, which has been helpful every so often. My Excel spreadsheet I’m supposed to fill in lists “family name” as well, whereas the books list husbands’ names. These rarely ever correspond with each other or the mothers’ names, so I’m still trying to figure out what the custom is around that. With less than two work weeks left, I know that if any are too elusive I should skip them and possibly come back to them later. And they say you don’t learn anything during standardized testing! Luckily, one of the Harvard researchers from the Vitamin A study tells me that my numbers are coming out right: 4-5% positive (compared to the 9-10% national average--I think having IHI and the St. Francis Hospital here helps), about the same percentage unknown, and the rest negative. So although by the end of the day my feet hurt and I’ve started to talk to the mothers in my head (Oh man, Rehema, you can’t hide any longer because I am going to FIND YOU. Or, Hadija looks like she’s negative, weeeee’ve got a winner! *balloons drop from the ceiling*), something is working.

To shake things up a bit, this week I also started interviewing the supervisors about their thoughts on the Saving Brains questions, in order to improve them for the next pilot. As of today, I’ve spoken with all six! I was extremely surprised each time I finished another interview and realized that there was never a time during that hour in which I was completely lost, even though they were conducted entirely in Swahili. I held my own and was able to conjure follow-up questions on subjects as esoteric as early cognitive development and parenting strategies on the spot. I think I’m going to have to thank all of my Swahili teachers over the last two years, formal and informal, for that. I recorded each one on GarageBand, just in case I needed help understanding what they were saying, and compared to the supervisors, I sound like a total valley girl. In Swahili, if that’s possible. It’s mortifying and hilarious. However, given my closer proximity to the actual Valley during my formative years, I think I have a good excuse. 

Not only is this the single most challenging task I’ve had to do in Swahili, I have also learned a lot about how seemingly simple concepts in English can get entirely lost in translation (“do they lose attention easily...you mean, do they lose consciousness?”), and even about Tanzanian views on parenting. Everyone here loves children so much, although it can look a bit different to an outsider (“Why would you read books to a child this young?” or the many examples the supervisors used which started off with “Let’s say you’ve beaten the child...”). It’s nice to know the learning is reciprocal, because two of the supervisors told me they were happy to be working on Saving Brains, because it helps them as parents to know when children can do certain things. I’m happy to know I’m working on a project that is actually useful and appreciated; it makes the hours typing into Excel, writing up interview notes, and translating and back-translating forms feel worthwhile. I still have yet to interview Geofrey (who, while a great English speaker, insists on doing his interview in Swahili to watch me struggle) and the nurses, but those will be much shorter and easier. These interviews are my main assignment for my internship here, and I’m glad they’re turning out so well.

It hasn’t been all work and no play, although the scale is definitely heavily tipped in that direction. In the last week, I’ve been able to enjoy a goat roast, a cocktail party (who knew the sheer presence of a blender could be so freakin’ exciting?) which went with viewing a wedding video, and a Scrabble night. I’ve been accompanied by Aileen, an American grad student at the London School of Tropical Medicine, on my runs in the mornings, and I’ve been hanging out and harmonizing ukulele songs with a bubbly Swiss girl named Emi who came to volunteer at the hospital these past two weeks. Aileen, Emi, Geofrey, and I all went to hike at Udzungwa National Park last Sunday, which I think has been my favorite activity here so far. The Udzungwa Mountains, as well as the Kilombero River, are the two main geographical features of the area. Biodiversity is really high because the constant climate in the tropical rainforest there has been perfect for making endemic species. Ever the Human Evolutionary Biology nerd, I got really excited about a species of mangabey and a colobus monkey that are only found here. There are over 2,500 species of plants in the national park, and about a bazillion birds is my scientific estimate. Our goal was Sanje Falls, which is itself over 200 meters high, and we hiked all the way to the top to take in the view of the flat valley below dotted with toy villages and tiny spires of smoke. The blue sky stretched itself out luxuriously overhead, and the famous Selous Game Reserve beckoned to us off in the distance. On our way back down, we went swimming at the base of the waterfall, its waters roaring in our ears and making a frigid, but refreshing, pool beneath. On the way back home, we caught a minibus that was going in our direction. Dust immediately flew out of the air vents as soon as someone switched on the fan. “Turn it off! Turn it off!” people cried in bilingual pleas. I watched little mud houses and lines of banana tress pass by in that warm late afternoon night that gives everything a golden, romantic glow. The ride was mostly uneventful, the squish-factor waxing and waning at each stop, until the bus just stopped about 10-15 minutes away from Ifakara. Apparently we had run out of gas, but the bus didn’t even have a gas gauge on the dashboard. Surprise! The driver and conductor wandered off to some roadside stand or another to fill water bottles with gas, and sooner or later we made it back home. 

I think my next excursion out of Ifakara will happen either tomorrow or Saturday, as we have Monday through Wednesday off for Eid, the end of Ramadhan. Eat, (don’t drink), and be merry again during normal human daylight hours, everyone! But no one knows exactly when Eid is yet, because it depends on the moon. That’s why IHI just gave everyone the boot for three days. Geofrey wants to go back to Dar es Salaam to tend to the mushrooms he’s growing (the culinary kind, if you thought this story just took a 180-degree turn) and visit his siblings, so he invited me to come with him. At first he was apologetic because he doesn’t live close to the tourist attractions and fancier mzungu areas, but I assured him that I’m not interested in that. I’m really not. If Harvard has taught me nothing else, it’s to hate tourists. Unfortunately you can’t get a degree in that, though, but it never hurts to talk to Special Concentrations. Now that I’ve finished my most important interviews and over half of the data collection, it’ll be nice to get away for a little bit to get my mind off things. A change in scenery, especially one that involves driving through Mikumi National Park and seeing roadside giraffes, never hurts. Well, for me, at least. 

One last thought: there’s a group of Swiss people around my age here who seem to be volunteering at IHI, building who-knows-what or doing some groundskeeping job. It’s ridiculous watching these puny kids grappling with pieces of timber as a Tanzanian worker they’re probably supposed to be “helping” breezes by them. It makes no sense to me--there are people at IHI whose entire jobs are to do these kinds of things! Why would they come all the way here just to take this work away, and probably do it so poorly that it will have to be fixed when they leave? Have they seen the immaculate hedges that spell “Karibuni IHI”-- “Welcome to IHI, we love your grant money”? IHI’s doing just fine, thank you--dare to venture into the actual village if you really want to be helpful.

But Taylor, one whines, I just want to have pictures on Facebook of me saving Afr---

And that’s when I smack the jauntily-placed fedora off his dumb head. I guess I’m making too many assumptions about the traits and intentions of those who wear fedoras, but I don’t think I’m too far off the mark. I know some of the volunteering I’ve done myself in the past may not have been as meaningful in the grand scheme of things as some of the other ventures, but I’m happy that the investigators for my study here are not interested in “saving poor African babies so we can go home and preen ourselves amidst showers of praise and glory.” Especially after processing an onslaught of unhappy news this week, I know that in life there’s no time to waste on that kind of nonsense. When you do something, make it actually count. No, moving timber around at IHI does not count. Truly improve something, anything, with your presence. To do things for others with genuine unselfishness, to touch people’s lives in a truly good way, without seeking accolades in return--I believe that’s the kind of mark one should try to make on the world. A mark that glows from within, like the sun, rather than relying on the reflections of others, like the moon. I’ll get off my soapbox now, but I think it’s important for anyone doing this kind of work to analyze one’s real, even subconscious, intentions.

Otherwise, you know, someone might smack your hat off your dumb head.

Doxy Dreams & Labor Screams

Saturday, 07/12/14, 2:40 p.m.

I wake up every morning from nightmares.

My alarm goes off at 6:20 a.m., and rather than getting up grudgingly, I see it more as a merciful reprieve from the long series of very vivid anxiety dreams throughout the night. My morning run is more than just exercise, but also a way to dispel the chases, killings, and overall strange happenings from my churning mind. It wasn’t real, it wasn’t real, it wasn’t real accompanies the rhythmic cadence of my shoes on the dusty road. The dreams certainly are not a result of any kind of stress here--on the contrary, life is quite peaceful and work is easy. They’re actually the evil machinations of my daily anti-malarial pill, an antibiotic known as doxycycline. It’s a common one for malaria (and the cheapest), and is even used for things like Lyme disease and bad acne back home. This is my fourth time taking it on a trip, and, come to think of it, I’ve always had the crazy dreams, but chalked it up to the effects of travel until doing some Google browsing this week. I was surprised, because more-expensive mefloquine is the famous one for causing hallucinatory dreams! A good or bad side effect, depending on your disposition. I just don’t want to feel like I spent the whole night battling a Kraken (that happened) instead of happily inert.

Oh well, I suppose it’s not so bad (I haven’t experienced the other common side effects, like sensitivity to the sun--a good thing in an equatorial region), and I’m even safe in the event that someone mails me anthrax! I realize this necessitates actually acquiring a mailbox and an enemy, two things I have yet to accomplish, but you can never be too careful. Oh yeah, and that whole malaria prophylaxis thing is cool, too, I guess. There are big research projects here at IHI on malaria and mosquitos, and thus there are medical entomologists, so I have it from the best authorities that the particular mosquito species that lives in this area is the prime spreader of malaria. Everyone’s gotta be good at something. However, I was also told that, based on mathematical modeling for the Kilombero region, I’d need to be bitten 100 times in order to make one infectious bite likely. 

I don’t think I’m quite up to 100 yet, although after last weekend it did feel that way. We also had a three-day weekend here, not for the Fourth of July on Friday, but rather a Tanzanian holiday called Saba Saba (Seven Seven: July 7th) on Monday. Rest assured that the few Americans here did force everyone else to humor us by playing baseball on Friday evening with Lisa’s cabbage ball and a locally-carved cricket bat, which rudely aborted the game when it decided to split in half. Saba Saba originally marked the creation of the first democratic political party in Tanzania, but now that there are multiple parties, it’s a day of celebration for businesses large and small. There are exhibitions, mostly in big cities like Dar es Salaam, and lots of sales. The only change in Ifakara was that we got Monday off work, so on Sunday afternoon, Lisa, her husband, Tom, Geofrey, a Ugandan Ph.D. student named Innocent, and I headed to the nearby Kilombero River to row out to a sandbar to camp for the night. We paid a fisherman to take us there in his wooden dugout canoe, and for him to stay with us overnight to take us back in the morning. As he pulled us along with a long stick he struck into the riverbed below, we fortunately/unfortunately did not see any hippos or crocodiles, which are apparently pretty common sights (and attackers) in the Kilombero. We made it safely to our idyllic little patch of sand and wandered around following animal tracks, looking at birds through Lisa’s binoculars, and playing Frisbee. 

When the sun started on its quotidian descent, we set up tents (girls, boys, fisherman), played cards, and built a fire to start cooking Holy Sausages we brought from Ifakara. (Okay, I can’t confirm they’re actually holy, but a nun from the St. Francis Church makes them in her home, and if you knock on her door and say sausage she’ll sell them to you.) We had beer and homemade bread with honey as well, and the campfire conversation progressed delightfully into the night. At one point, I was urged to bring out my ukulele (because when, if not campfire-side, is a good time for a ridiculously tiny guitar?) and trusty three-chord songs like “You Are My Sunshine” and “I Walk the Line” accompanied the crackling fire and the more quiet murmurs of the river in front of us. Geofrey held a lantern up so that I could see my music, which immediately attracted every insect in a 20-mile radius, and soon I felt them all over my body. If you feel like you have bugs crawling all over your skin, in America, chances are you probably have a meth problem. In Tanzania, chances are you probably have bugs crawling all over your skin. I’m going to credit years of marching band for the discipline to just keep playing! However, almost a week later, I’m still shaking pressed bugs (ooh, scrapbooking!) out of my Daily Ukulele. We watched the fire die out, retired to our tents for the night, and returned home the next morning after bananas, some more bird-watching, and a rousing match of let’s-use-these-tiny-rocks-and-the-slingshot-to-hit-that-water-bottle-over-there.

But back to those mosquitos. Lisa said she heard one whining around our tent in the middle of the night, and I believe her, because I woke up with bites literally all over my hands. It was like Achilles and his pesky heel--I had applied bug spray the night before holding the can in my hands, and then had forgotten to give them a once-over afterwards. And see how well it worked out for Achilles! Rookie mistake. For most of last week my hands itched with a vengeance that no amount of After Bite could soothe. I’m going to say that’s why it’s been awhile since my last post, but no, I’m just plain lazy. In their brainless malice, though, mosquitos fascinate me. Worldwide, they kill more people each year than people do. I hope all the research efforts that are going on here and everywhere else will figure out a way to stop their rampant destruction. Tom, a medical entomologist on a grant from the Clinton Foundation who sports the DDT molecule tattooed on his arm, has invited me to spend a day at his lab’s field site, where they have a screen house that holds a mosquito colony they are studying. (There’s also a screen house on the IHI compound near my apartment, but I’d rather not know exactly what’s going on in there because it quite literally hits too close to home.) The way they feed the mosquitos is crazy--someone sticks their arm in twice a day for them to feed, and at night they bring in a cow for the same purpose. Every other day or so they switch people. How do you decide that? Draw straws? Not positive about the poor cow. Similarly, when studying mosquitos you often do something called a “human landing catch,” where you sit out at dusk to count (and smash?) how many mosquitos come looking for noms. Apparently these sado-masochists are ethically allowed to do this because there is treatment for malaria. You can’t, let’s say, do a human landing catch for Ebola virus particles (and thank you to those who have been concerned, but the Ebola outbreak has not made its way here from the West. Tanzania came out with a statement saying they will stop anyone who is infected at the borders, to which I say lol k good luck doodz). It’s really important research, though, and it would be something I could see myself being a part of later on. Just as long as someone else has to stick their arm in, of course.

Side note: malaria isn’t the only disease with which I’m grotesquely fascinated here. A good night’s entertainment comes from reading the “Rarities” section of my Lonely Planet Africa: Healthy Travel book that the Global Health Institute gave me during pre-departure orientation. I just can’t seem to stop reading about all the crazy parasites, or anything that could leave me with a bad case of the deads. Oh yeah, those really rare meter-long Guinea worms that burst from your skin--I could totally get one of those! And is this blister healing properly, or will I get sepsis? I don’t technically have enough doxy, so cerebral malaria is coming, like, tomorrow. My stomach rumbled, I DEFINITELY have giardia. I think this is akin to the hypochondria everyone seems to develop during medical school, since I’m learning rapidly about so many things that could possibly happen to me. In reality, I’m probably fine. I have the immune system of a veteran preschool teacher, and rarely get sick, even while traveling. 

Meanwhile, at work, there’s not a lot of time to worry about invisible assaults. Alfa, the study supervisor who organizes the logistical side of things, is finally back from his two-week vacation, so I met him in person for the first time on Tuesday. Ever since I was stuck in Dar es Salaam my first week, the plan was to get permission for me to go into the labor ward of the St. Francis Hospital and collect HIV status data about the mothers who were initially enrolled in the Vitamin A study, and are now part of Saving Brains. We weren’t able to get permission from the hospital until this week with Alfa’s help. HIV status wasn’t a variable they initially accounted for, but there is now evidence to show that Vitamin A might actually be harmful to some infants because it sometimes increases the risk of mother-to-child-transmission of HIV. No one’s exactly sure how it works, but lipid-based Vitamin A might increase the number of a certain receptor (CCR5: holla at my LS1a peeps!) on the membranes of lymph cells, making it easier for the virus to attach itself. If we can confirm that this is happening in our cohort as well, the WHO would alter recommendations about neonatal Vitamin A supplementation. It would be a shame if this very inexpensive, nutrition-based potential intervention ended up being useless or even detrimental, but going back to the drawing board is better than risking an increase in MTCT.

On Thursday, Alfa and I went to visit the head of OB/GYN, Sister Natalia, who happened to do her medical internship with Alfa years ago. Connections! We were invited inside the labor ward theater, and as soon as the door opened, I was shocked to see a very-soon-to-be mother, her large, naked body lying on a bed, knees bent and apart, right in front of the door. I was embarrassed to be a stranger there at such a vulnerable time for her. I hurriedly followed Alfa the few steps over to the office, which was just the same room separated by a small wall that didn’t go all the way to the ceiling. While waiting for Sister Natalia to come see us, through a small window in the wall I saw latex gloves covered in blood, and I heard the mother groan, Aiiiiiiiii oh mama, mama, mama. I don’t think the baby was coming yet, but my heart started pounding uncontrollably and I was very uncomfortable. I didn’t want to bear witness to her pain, especially if something went wrong. Where was Sister Natalia? I wanted this to be over as soon as possible. I looked over at Alfa, who seemed as serene as a tree stump. Some lyrics started playing in my head, over and over.

I got no deeds to do, no promises to keep...

It seems that Ifakaran work philosophy is just about Feelin’ Groovy. I don’t know how groovy this woman over on the bed was feeling, but luckily Sister Natalia came in and was very impressed by my Swahili greetings. I gave her a letter from Dr. Masanja, OK’ed by the St. Francis medical director, and she said it was fine if I collected this data. This was a big relief for us, because originally the hospital was wary of a non-medical person having access to this very sensitive information. However, for whatever reason, Sister Natalia trusted me, and said that because the labor ward registers are so huge there wasn’t anywhere I could do this work in that office. Would I mind taking one book at a time back to the Saving Brains office to do this work? This, of course, was more than fine with me, as I don’t want to spend any more time than I have to in that labor ward theater. Geofrey told me his office for the Vitamin A study back in Dar was attached to the labor ward, and he would hear the doctors yelling at the mothers. And surprisingly, female doctors are the worst culprits! I remember being told by a woman from the School of Public Health in my Swahili class that there’s a similar problem in Kenya. She has transcripts of recordings of these perinatal harassments. You slut! I hope you liked it when he put that baby in you, because now it’s going to hurt a lot! I wish I had made that up, but my mind just doesn’t work that way. Really, truly horrific things that should never be said to anyone, but especially at a time when the woman is probably scared out of her mind already. Geofrey said you could bribe your way into better courtesy for as little as 2,000 Tanzanian shillings ($1.33). Remind me never to have a baby here? At any rate, I’ll only have to go in there to drop off one year of births and pick up the next, years 2010-2013, so hopefully I won’t personally witness any of that either. I’m a little nervous about going back in that room on Monday to get the first book, but I’m excited that after a month of waiting I can finally start on this data collection that could have some big implications at the international level.

As for Saving Brains itself, on Wednesday I sat in on an entire day of clinic visit assessments at the St. Francis clinic. Unfortunately, one of the nurses quit all of a sudden to pursue a more stable government job (IHI just works on contracts), so poor Nurse Neema saw five toddlers basically back-to-back all day long. Only one little girl was stunned into silence by the mzungu in the room, which I was thankful for, because while I want to observe the visits, I know my presence itself is distracting. The cognitive and motor skill tests involved lots of brightly colored blocks, rubber ducks, balls, and a big picture book with some more culturally-appropriate pictures taped on top of the original Bayley Scales ones. Kids here don’t really have toys at home, so most of them were very excited to play with Nurse Neema, and it was a joy to see when they figured out how to do some task or another. 

Oh, and I did my own laundry this morning in a bucket. It makes you appreciate washing machines! I had a lady come and wash my clothes a couple weeks ago, thinking that while I have done it myself before I might as well support her, but my clothes came back not much cleaner than when I handed them over. I can’t get them completely clean either, but why should I pay someone to not do something I can’t do either? Reminds me of certain TFs of intro life science courses. A good benchmark of knowing you’ve scrubbed something enough is if the skin on your knuckles starts to peel, and by the end of a load you should have some charming stumps for hands. As I hung up my t-shirts on the line, I couldn’t decide whether it was better or worse than the mosquito bites of a few days before.

So it goes. 

It's Off To Work We Go!

Wednesday, 07/02/14, 9:07 p.m.

Well, it happened. People here in Ifakara have finally caught on, which means I better pack up my bags and bow out. 

A man passing me on a bicycle during my run yesterday called me chizi--crazy.

This, of course, does not faze me, as my friend Gus has been calling me chizi kama ndizi (crazy like a banana) since freshman year. The rest of you have been calling me crazy since antediluvian times. But it means that I have now been here long enough for the locals to get to know the real me, which, in my opinion, is the real crazy thing. I suppose tomorrow does mark the beginning of my fourth week here, which means that pretty soon I’ll be halfway through these two months in Tanzania. 

To be sure, I actually had never met that man before, and he probably only called me that because I was being so quintessentially mzungu by exercising for fun (still keeping it up, every weekday morning at 6:30 a.m.!). In fact, while the word mzungu refers to “white” or “European,” it technically comes from the word for being dizzy. The first nutjobs showed up and no one knew exactly why they acted so funny. Heck, the other mzungus here don’t even run. However, Diana, who is a young Tanzanian woman studying to become a doctor at the training center on the IHI compound, just told me today at the Ultimate Frisbee game that she wants to start running and will join me tomorrow! Not only will I enjoy her company because I admire her for her sweet nature and impeccable dressing (even during exercise), it will be interesting to see if anyone calls out to us. Mzun-wait, what? 

Let’s see, more updates. I finally have a stove! After I told the building manager (or whatever you call him when you’re not at Harvard) last week about the pitiful effort of my previous one, an electrician came and said it was a problem with the electrical system. They yanked the whole darn thing out and replaced it with a gas stove, but, lo and behold, I was told there was a gas shortage in Ifakara. Of course there was. I got free meals in the guest house restaurant for a whole week while waiting for gas to arrive. Not such a bad thing, considering how minimal my cooking skills are, but I worried about all that produce I bought and the things I schlepped from Dar going to waste. Monday evening, they finally hooked up the gas, and it all worked great! Although it is embarrassing to admit, Geofrey had to come and give a lesson entitled How to Light a Gas Stove with a Match So That--Oh God Taylor Don’t Do That You’ll Burn Your Eyebrows Off. Bear Grylls disapproves of everything that I am. I’ve now made sautéed vegetables and canned beans, and good old spaghetti--my friends’ blogs describing the food they’re eating in Europe puts my summer cuisine to shame. But it was a much-appreciated belated birthday present from IHI!

Speaking of my 21st birthday, I had a great time! In an ironic twist of fate, I had absolutely no alcohol on Sunday, and was asleep by 10 p.m. I’m planning on spending my 81st birthday in a similar fashion. (But not my 91st. If I make it that long I’m throwing a freakin’ rager and doing body shots off my more supple septuagenarian friends. I know your 21st birthday is a big milestone, but think about it--which is more worthy of celebration?) I spent the morning reading by the pool and swimming, there was impromptu Frisbee-ing in the afternoon, and as I walked through Lisa’s door for Argentine tango that evening, I was surprised by music, a “Happy 21st Birthday!” banner, a bottle of sparkling grape juice, and a packaged heart-shaped pound cake from the SimbaOil gas station (the only baked good in town). As I blew out the single hefty candle forcefully inserted into the heart, I thought about how grateful I was to be welcomed so warmly here. 

The joint birthday party the night before for two expats who work for a water sanitation company in town did not end up making any mention of me, but I really didn’t care at all because everyone I knew was there and having a good time. In a backyard, people danced to the thumping Tanzanian hip-hop music, a genre known as Bongo Flava for Dar es Salaam’s nickname “Bongo,” or brain. (They say you have to use your brain to get by in Dar.) I told a woman there in Swahili that I couldn’t dance because I don’t have a butt, and she might have gotten a hernia from laughing as if it were the funniest thing she’d ever heard. Well, I try. There was roasted goat, a common spiced rice dish called pilau, local Tanzanian beers like Kilimanjaro and Serengeti, and mouth-watering maandazi, which I would say are like doughnuts but are probably more phylogenetically similar to crack. Candles stuck in the necks of liquor bottles flickered and winked as laughter wafted out over the fence into the cool night air. All in all, birthday celebrations this weekend were a success. The next morning, thinking I was being nice, I brought the extra cake to the office and first offered some to my coworker, Khamis. He then politely declined and said he was fasting for Ramadan. You jerk, you even knew it was Ramadan! Didn’t you learn anything while fasting in Mombasa last summer? Waving cake of all things at somebody in the middle of the day is about the worst thing you can do. Later in the day, though, he shyly asked me if he could bring the rest home to his family for after they broke fast. Of course, the answer was a resounding YES, so I’m happy to report that Allah and I are on good terms again.  

On the work side of things, I’ve been following supervisors out on home visits this week both so that I am familiar with the study’s field work and so I am prepared for my upcoming interviews with the supervisors about the “Saving Brains” questions themselves. It’s been really fascinating to go out into the surrounding villages to do this; this week has made the neighborhood around IHI feel like a bustling metropolis. A supervisor, who has researched the location of each house and has drawn up a map to get there since house numbers aren’t a thing, leads on his pikipiki (motorbike) as the study driver, Bangaseka, Geofrey, and I follow in the ubiquitous blue pickup. Along the way, we often stop to ask people where to go next, and sometimes someone even joins me in the backseat of the pickup to give directions. The truck, by sheer force of will alone, somehow makes it through small, bumpy footpaths between the banana trees. We eventually pull up to small houses made of bricks cemented together with mud and roofed by thatched palm fronds to find out whether we can conduct the interview. More often than not, the mother has either permanently moved away since her information was collected for the original Vitamin A study a couple years ago, or she is out in the shamba (farmland) because it is harvest season now. 

When we do get lucky, the mama invites us to sit on stools outside under a shady tree (people rarely go inside during the day) while hordes of curious children and neighbors scrutinize us from farther away. Often chickens will peck around us, or a mangy dog will doze nearby, its ears lazily flicking flies away. The supervisor introduces us and explains why we have come, reading through the entire lengthy, but thorough, consent form, since some of the mamas cannot read. At least for all the interviews at which I’ve been, the mamas have always consented to have information about their child go towards improving understanding of early development and interventions that may be beneficial--the goals of Saving Brains. The supervisor then takes out their tablet (provided by the study to save loads of paper) and goes through a battery of 70 questions related to cognitive, motor, and socioemotional skills with the mama while Geofrey and I look on to note hesitations or any other signs of confusion or lying. In theory, there should be no right or wrong answers to these questions, but some of them are certainly very loaded, such as “Does your child hit, bite, or kick other children or adults?” Who wants to readily admit that? However, the supervisor is prompted to stress that children have different personalities and develop at different rates, and that that’s completely alright. 

Sometimes the toddler, whose ears must burn quite a bit, pays us no heed and plays nearby with a piece of trash, and at other times they can’t get enough mama-cuddling. I’m always reminded of college guys whenever I’m around these toddlers--for a long time, you aren’t quite sure whether they like you or not, then they have a lot of feelings about everything all of a sudden, and then, without warning, pass out. I’ve also had to get used to casual breastfeeding during the interview. It’s natural, it’s nothing I haven’t seen before, and it’s an integral part of raising a baby! My male coworkers hardly bat an eye. Why, as an American of pretty WASP-y upbringing, do I try so hard to look anywhere else? What’s wrong with me? I think this is a question much of America is still trying to figure out. At the end of the interview, the supervisor brings out a portable scale and instrument for measuring height, and takes measurements of both mama and baby.  The child then gets their head circumference measured, and they’re usually writhing so hard in protest it looks like some sort of rodeo stunt. The mama is invited to the clinic for an appointment the next week in which a nurse will do the Saving Brains-modified Bayley Scales with the child, and she is given money for transportation there. We pack up, say many thank you’s and good-bye’s, and set off for the next house in a cloud of dust. 

Dr. Masanja, a bespectacled older man who is the P.I. for the study from IHI (with Dr. Fawzi as the P.I. from Harvard), is usually located at the Dar office, but is visiting Ifakara this week. He is also using the data pool from the original Vitamin A study for a maternal mortality study for the WHO. Apparently, data about pregnancy outcomes from these mothers are missing, even though in many cases it’s clear what the outcome was because, duh, the mother and child are now involved in Saving Brains so they must be alive. Unless I completely misinterpreted this study and we’re helping zombies by saving braaaaaains. I actually got to help Dr. Masanja by creating questionnaire forms in Swahili (!) so that they can go back and find the missing outcomes for 3,000 mothers. Geofrey is not optimistic about this, which I understand after seeing how hard it’s been for us to locate them, but apparently Dr. Masanja will have some issues with the WHO if he doesn’t produce results. I’m hoping Saving Brains, which also has been presented to the WHO, will have some important findings! 

Other office duties have included sorting and stamping forms, a la that grouchy secretary monster from Monster’s, Inc., and coding the data from the translations I’ve made. Not the fancy computer-programming kind, but just turning qualitative data into something quantitative so that it can be analyzed by Dana, Dr. Fawzi, and others. I feel like I’m getting a really good view of what research in the field of public health is like, which is exactly what I wanted from this internship. I’m also hanging out with some pretty cool people, especially those under the age of 3. On the flipside, I’m also getting some time alone to be self-sufficient and just relax, which is very welcome after a bit of a roller-coaster spring semester. I highly recommend rural Tanzania for anyone who desperately needs time to just sit and stare for awhile.

Oh, speaking of those who are good at sitting and staring, the frog in my shower drain? Yeah, he’s totally a regular now. Strange choice of real estate, but hey, who am I to judge?

Lists

Wednesday, 06/25/14, 8:25 p.m.

Tomorrow marks the beginning of the third week of my trip! I can’t believe it has already been that long; time seems to be slipping through my fingers like sand. I’m powering through my work, though, having already caught up to the present with translating clinic visit forms and the child trauma and disability notes from the home visit forms. That’s 584 forms in 4 workdays, but, I mean, who’s counting. (I am.) Since I’ve been so engrossed in Excel lately, and because my last entry was a bit windbaggy (I had to cover a whole week!), I thought I would share some lists today. The items are not ordered in order of importance, because I am from Santa Monica and I was taught that ranking makes people/list items feel bad about themselves and acquire severe self-esteem issues.

THINGS I HAVE LEARNED THUS FAR:

-I understand the layout of the area, both inside and outside of the compound. Finally! On Sunday, I took it upon myself to wander around so that I would not only be able to find useful shops, the good road for running, and the produce market, but also so I could simply find the Saving Brains office by myself on Monday morning. The Ifakara Health Institute shares the compound with SolidarMed, a Swiss organization, the Tanzania Training Center for International Health, which trains local students to become doctors and researchers, and the St. Francis Hospital, which, along with IHI, was started by the Swiss in the 1950s. So basically, the Swiss have the biggest stake here and it was really funny when they lost 2-6 to France last week. I ventured outside the gates, and after a substantial amount of wandering in what I eventually found out was a relatively small area, I finally understood my new neighborhood. And bought veggies and milk in the market, using only Swahili! 

-As far as I know, I am the youngest person doing research here. I’m sure there are students younger than me at TTCIH, and some of the girls who work in the guest house kitchen can’t be a day over 14, but as far as IHI goes I’m about 10 years everybody’s junior. I’ve been the youngest before, like in my volunteer programs in South Africa and Vietnam, but I never really noticed because everyone had relatively little experience in the job and was interested in socializing with each other. Here, people have fancy degrees and lots of work to do. I’m absolutely happy to be helping out as an intern, though, and enjoy the part I play in this study. Luckily for me (and maybe not so much for him), Geofrey is stuck with me all day. And there’s a British woman here who works for a water sanitation company and it’s her birthday this weekend, too, so I’ve been roped into the party as well! 

-Related: I apparently look like I could be a doctor, because I was asked this today by a man who was also walking to IHI. 

-On my third trip to East Africa, I have finally mastered the art of using the choo (local toilet, just a hole in the ground surrounded by a bit of ceramic), without accidentally peeing a little on my feet. Success! I have a Western-style toilet in my apartment, but the one nearest the office is a choo and it's quite the quad workout. Yeah, it actually is, so you can stop laughing now, male readers.

-Sports are fun!! I have officially become an adult, not with a bat mitzvah as I’d always hoped, but by participating in an after-work sports team. Every Wednesday at 5:30, people go to the church community center’s soccer field and play Ultimate Frisbee. Today was my first day and my team won 9-3, and I made the catch that scored for 4 or 5 of those points. If you know me well enough to be reading this right now you are surprised. I just considered it a great excuse to wear a backwards baseball hat, which is a fashion statement of mine that only emerges in the recesses of Africa or the AD, but I am redundant. 

-People in Tanzania really like Celine Dion. Go figure.

-I’m acquiring new Swahili vocabulary, but most are gleaned from the study and are very specific to this topic. Even so, I will now be using mtundu (naughty), degedege (convulsions), and kuzubaa (verb for the “lights are on, but nobody’s home” look) in regular conversation. 

-I can do the Argentine tango! Or, at least, I am in the process of learning it. Lisa, who is from Louisiana and is here because her husband is doing research at IHI, gives two-hour lessons every Sunday evening in her living room. And to think I didn’t realize I’d need my ballroom heels for my trip to rural Tanzania! The group was about half-and-half Western and local researchers, and was just a really fun way to while away some time after sundown, when it’s hard to do much of anything. It made me nostalgic about the ballroom team a little, but I was glad just to be learning and spending time with people outside the office. 

-Efficiency is not a super high priority here, and I’m learning to be patient and easy-going about it. Anyone in Collegium who has seen my rabid eyes on concert day knows this is a big feat. I’d have that Sanders timetable down to the half-minute if I could. Supervisors are suddenly out for two weeks, there’s somehow no tap water in my apartment in the early morning or at night, mothers don’t show up for clinic visits, but it’s okay. The work will get done, and the local staff will wonder why there always seems to be a vein throbbing in the forehead of whomever visits from Harvard.

THINGS I HAVE YET TO LEARN:

-How to use the choo 100% splash-free. Yeah, I totally lied before.

-I really need to make a habit out of using the respectful greeting for elders. If someone is obviously older than you, you must say Shikamoo, which doesn’t have a direct translation but is a sign of humility. The elder responds with Marahaba, which essentially amounts to an acknowledgement of your respect. Then you can launch into how-are-you’s and be on your merry way. I blurt out the informal Mambo! almost all of the time, and while I can get away with it for appearing like an uninformed mzungu, it’s like throwing out a Sup, bruh to your grandmother and that’s not okay. In related news, the kids on the street who aren’t shrieking MZUNGU!!!! at me often use Shikamoo, and that makes me feel like I’ve unlocked some big life achievement. 

-I don’t know which side of the road to run on! That’s right, I have successfully completed two days of waking up to run a few miles at 6:30 a.m. The sky is just starting to lighten, but the sun doesn’t actually rise until I’m out on the road, and it’s glorious. Ifakara is just beginning to wake up, with market stands setting out their wares and children walking or biking to school. (I even caught up with and passed a school bus on the bumpy dirt road yesterday! I sincerely hope there were children inside to witness this fantastic feat of athleticism.) However, I was always taught that while you bike with traffic, you run against it, so that you can see who’s coming. This strategy led to me dodging quite a few confused men on bicycles and pikipikis (motorbikes), although on the other side I did have a minibus or two come up behind me honking. I will figure this out as I do it more (yes, I do know that you drive on the left here, thank you), and hopefully by then the novelty of this crazy white chick exercising will also wear off and people will stop calling after me. I’m going to run so often, I’ll have to use the Swahili hu- tense, which is used to describe actions you perform regularly. Ohhhhhh, snap. Unlike cynical Mombasa, though, it’s all good-natured. I’m not so much a disdainful potential-pocket-to-pick but an organ grinder’s monkey who has been taught a few adorable tricks. Look at her, she actually answered in correct Swahili! And that precious little hat. Give her a coin, or maybe a peanut!

-I really need to bring my FOP headlamp with me to these locations. Didn’t I learn about real, bona fide darkness from Wema, out in rural Kenya? Holding the flashlight in my mouth while I try to do something is a little silly. I found out Ifakara didn’t even start to get electricity until the 1990’s, which, I immediately thought, coincided nicely with the rise of Tamagotchi.

-Why do mosquitos like my ankles so much?? They go for them even with a hefty helping of 30% DEET. There’s, like, not even good blood flow there. Assholes.

And finally...

ANIMALS I HAVE SEEN (yes, of course this is included):

-The animals in Mikumi National Park that I saw on my drive over here, which I realize is a repeat from the last entry, but come on. Giraffes and zebras next to the road.

-This goes back to my time in Dar es Salaam, but the Harvard project there is at Muhimbili University, which is the only real medical school of note in Tanzania. I got to visit one day with Chris to see the study about vitamin D and HIV/AIDS going on now. Outside the labor ward of the teaching hospital, they dump all the placentas which are then eaten by stray cats. I kid you not. They do not bury them or anything, but instead have probably created some sort of mutant breed of what are affectionately known as the Placenta Cats. I’m already considering sending the idea to Stan Lee at Marvel, so back off. 

-There’s a bird here with a very distinctive, rhythmic call that I first heard every morning in Cape Town. Then, they followed me to Wema and to here, too! I’ve never seen one, though, and it’s killing me. CS50 folks: can someone make a Shazam-like app, but for bird calls? Actually, better not, because that’s the only thing I’d have on my phone and I’d start to lose friends.

-I saw a praying mantis eating another praying mantis the other day. Something tells me Daddy didn’t fare so well. Marge, where’s Norm? I thought you were both coming over tonight. And ya got a little antenna in your teeth, still twitchin’.

-On Monday morning when I was taking my bucket shower (chuckling at all the haircut naysayers, because it is excellent for this situation) in the tub, I noticed a pair of eyes peering up at me from my shower drain. Not with a particularly lecherous expression, but just a froggy one. Somehow, there was a frog living in the pipe and he had come up to check me out/survive the flood. We stared each other down for the rest of the shower, with me both hoping he would and would not jump out and be my friend.

-Later that day, a huge spider (as large or larger than my fist--I didn’t want to get closer to check) sat in repose on the wall of my tub. Okay, fine, no showers until you say so.

-Later still, no sign of frog or spider but there was a lizard high up near the ceiling. I’m pretty sure at least one of these last three characters ate the other, if not in some sort of combination. 

-Nature isn’t all red in tooth and nail, though, because baby goats exist. They are so cute. The little bleats and their knobby knees. Please love me, baby goats.

I realize that this didn’t end up being too much shorter, so I think I’d better sign off here. Also, I can’t top baby goats.