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