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?