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.

The First Week

Saturday, 06/21/14, 11:34 a.m.

Hamjambo, rafiki na wanafamilia! Hello, friends and family! I have finally settled in at the Ifakara Health Institute in the village of Ifakara, Tanzania, and have decided that the Internet is slow but reliable enough (knock on wood) to have a blog during my two months here. I hope you enjoy my thoughts and stories!

I’m out in the middle of nowhere for the summer because of an internship through the Harvard Global Health Institute, in which undergraduates get to assist professors who are involved in global health with their research abroad. I’m working under Dr. Wafaie Fawzi, who leads the global health department at the Harvard School of Public Health. The study is called the “Saving Brains” project, and is a partnership between HSPH and the Ifakara Health Institute (IHI). It’s an early cognitive development study prompted by the fact that lots of research and effort is put into reducing child mortality around the world, which is indeed an important pursuit, but there is little focus on how the child is doing if they are in fact alive. Presently, there aren’t good ways to measure a child’s skills and progress that don’t come from Western countries and are thus entirely bound to our culture. For example, the gold standard right now is the Bayley Scales of Infant Development, but it involves tasks for this study’s age range of 18 to 36 months like opening a doorknob or identifying a picture of a boy building a snowman. I would be comfortable betting that an toddler in Ifakara has had very little experience with either doorknobs or Jack Frost. The Saving Brains assessment is a modified version of the Bayley to include tasks such as making a pincer grip to pick up a rock and being able to say five words. The hope is that if Saving Brains is successful here in Tanzania in properly assessing child development and identifying needs and skills early on, this could become the new gold standard and be implemented around the world. 

So where does an undergrad with little to no experience in public health or developmental psychology fit into this? Actually, when you find out, please let me know because Harvard shipped me here by myself. Oh, you have experience in rural Kenya? And are learning Swahili? Okay, that’s good, said Dr. Fawzi’s post-doc, Chris, during my interview. And suddenly I had an award packet emblazoned with “Ifakara, Tanzania” on it in my lap and instructions that I was to be the only one from Harvard out there. Since then, I’ve been in touch with Dana, a post-doc from the Graduate School of Education who is working on Saving Brains, a few times because she has now been out here twice. She has given me tasks to do while I’m here, as well as lots of advice about Ifakara life ranging from the best time to go running (dawn) to that one place in town that sells Nutella (MinMarket). No one from the Harvard side of the partnership speaks more than a handful of words in Swahili, so I’ve been charged with the task of translating the nurses’ comments on the clinic visit forms, when the mamas bring in their toddlers to perform the Saving Brains scales. Dana suspects that there might be helpful information there to help improve the scales. No, this kid isn’t just sitting here crying because he has a developmental problem, he’s just a two-year-old with malaria. I would cry, too. Also, after observing both home visits, which occur before participants are invited to the clinic stage, and the clinic visits themselves, I am supposed to interview the supervisors and nurses about the Saving Brains questions. Are there any that consistently confuse the mamas? What examples do you usually use to help explain, so that they can be included for standardization? Are there specific words, originally written by American child psychologists, that don’t translate well in Swahili? (They’ve already found this for “easily distracted.”) This will help Dana and the rest of the team modify and improve the questions. 

As someone who expected to be doing grunt work, perhaps assuming such noble duties as filing paperwork and data entry which are suitable for my lowly standing, this is a pretty important job. I started with translating comments yesterday, and actually blew through a lot more than I expected because my reading skills are fairly good. However, the thought of interviewing the supervisors and nurses in Swahili is daunting. There aren’t too many people with which to practice conversation in Swahili back home, so I feel like a professional bowler with one super buff reading-and-writing arm and another dinky little speaking-and-listening one. I’ve been trying to practice as much as possible since arriving in Tanzania last Friday, but most conversations go like this:

“Hi! My name is Taylor. I study Swahili at university in America.”

“You know Swahili! Ulskdjflskdjf? Jlfksjflksjldkfjoifejwof! Osodiufweojfvlkdnwelkdjglkeruj.”

“I only speak a little, but I am trying to learn.”

“Sdlkjfgaldkgoiouwejglknhlweasdkjfalwkksljf19384444444akfldsjf&lsk##dfjkkkkkkkk.”

“Mmm.”

Luckily, some people take pity on me and speak slowly, and then I realize I can understand a lot more than I thought I did. People are actually pleasantly surprised that a mzungu is learning Swahili at all. I just hope that I can do more than politely smile by the time I have to conduct these interviews, so that I have something to show for my summer here and the hefty stipend I was given under the assumption that I’m some sort of Swahili whiz. At present, I am a fraud, but hopefully not for long. 

If right now you are wondering, But wait, Taylor! You said you arrived in Tanzania over a week ago, but just started work yesterday. What have you been doing, you bum? I would say that you need to close this window and go back to watching Orange is the New Black while eating peanut butter off a spoon. (At least, this is what I imagine the ideal summer is like when one does not spend them in East Africa.) But yes, you astute reader, I was supposed to spend my first four days in Dar es Salaam, the big coastal city with the airport, in order to adjust to the timezone and buy things I would need in Ifakara but cannot get here (i.e., Internet modem, cash, so much pasta sauce). Four days oozed into six when Chris, who is working in Dar right now, told me the Ifakara truck needed new insurance, the ATMs here were all out of cash, and a supervisor was deathly ill. Apparently, this kind of chaos is normal, but IHI needed a bit more time before sending someone to pick me up. I was kicked out of the researchers’ guest house in Dar after my four nights were up, and like the pitiful lost orphan I was, I went and stayed at the Mediterraneo, a beachside hotel for two nights. Hey, when lunch in Ifakara only costs a dollar or two, I have enough Global Health Institute money to watch the Indian Ocean twinkle while eating pretty darn good Italian food by the pool. A big part of me was anxious to get out here and actually start my internship, so while I enjoyed my time in paradise, I was relieved to get a call from Chris on Wednesday saying that the driver was on his way to Dar es Salaam and would take me the next morning. 

If you ever thought being on Harvard time (7 minutes past) was silly, Swahili time will make you pull your hair out. I sat at IHI’s Dar office for over two hours, halfheartedly waving the flies away who never gave up trying their luck to win my love. Finally, at 11 a.m., a blue pickup truck with a cracked windshield rumbled into the parking lot, was loaded up with lots of supplies to send out to Ifakara, and we were off. Luckily, along with the mostly silent driver I was accompanied by Geofrey, who is on the Tanzanian side of Saving Brains and is very friendly and good at English. For much of the trip I dozed in a dehydrated haze (Dana had told me the only bathroom option was the side of the road, and the driver usually doesn’t stop anyway), passing through sleepy villages of red clay dirt, green fields, and blue sky with lush, white clouds that seemed almost pregnant, despite the rainy season being recently over. I was able to keep my eyes peeled on our way through Mikumi National Park, where giraffes and zebras grazed fairly close to the road. Families of baboons sat on the road itself, daring you to bother them. I saw a baby clutching its mother’s chest, wondering what that godawful blue hippo-on-wheels was doing here. Signs every so often warned how many US dollars you’d have to pay if you hit certain animals, but the way they looked, with an awkwardly childlike painting of the animal and the penalty underneath, made it seem like that was the score if you hit one. Gotta catch ‘em all! 

After Mikumi, we were only about 45 km from Ifakara, but it took two more hours to get there because the tarmac ended and the dirt road was bumpy and pitted like the face of a really unfortunate teenager. It’s usually pretty bad there, but the rainy season just made it worse. I knew this would happen, I should have worn a sports bra today. Why didn’t I wear a sports bra? At 8 p.m., in the pitch dark so far away from any city lights, we arrived at the IHI compound. I have my own studio apartment--yes, my first apartment ever happens to be in Tanzania. And the first thing I did was to fix the toilet that didn’t flush, just like I always imagined for my first apartment. The stove didn’t get hot enough to boil water, even after two hours, but the kitchenette itself is fairly nice and I’ve got a big bed shrouded in a mosquito net that I imagine to be part of one of those princess canopy beds. Just call me the Princess of Parasites, I guess. Monarch of Malaria. Okay, I’ll stop now.

The World Cup games are shown in the bar here, and it’s been fun getting to know the other researchers. I’ve already been asked multiple times if I’m here for my master’s or Ph.D. On Monday, it’ll be back to work translating in the small Saving Brains office at my very own desk (a.k.a. half of the printer table that I seized). Until then, I’ll be hanging out, terrorizing the compound with this ukulele I brought with me, and probably trying unsuccessfully to understand this stove. Adult life!