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!