It is Harder to leave a"scrappy little junction town" than one might think. ( tears in eyes)
Kwaheri Tanzania!
Badi??????
Friday, February 27, 2009
Tuesday, February 24, 2009
Pancake Breakfasts
In writing report mode and got a bit carried away Sunday morning
A Plan to Think about Starting to make Pancakes for Breakfast
Ferbuary,22, 2009
1)Prayer
2) take attendance and identify the number of consumers of pancakes
3)Plan ETC ( estimated time of consumption)
4)Plane ENC ( estimated number of consumption)
5) Maple syrup 5.1 how to divvy it up, /pancake
/person
5.2 plan for leftover MS
6) cooking
7) table setting
8) eating
9) cleanup
10) debrief and problem solve for further pancake breakfasts
A Plan to Think about Starting to make Pancakes for Breakfast
Ferbuary,22, 2009
1)Prayer
2) take attendance and identify the number of consumers of pancakes
3)Plan ETC ( estimated time of consumption)
4)Plane ENC ( estimated number of consumption)
5) Maple syrup 5.1 how to divvy it up, /pancake
/person
5.2 plan for leftover MS
6) cooking
7) table setting
8) eating
9) cleanup
10) debrief and problem solve for further pancake breakfasts
Pancake Breakfasts
In writing report mode and got a bit carried away Sunday morning
A Plan to Think about Starting to make Pancakes for Breakfast
Ferbuary,22, 2009
1)Prayer
2) take attendance and identify the number of consumers of pancakes
3)Plan ETC ( estimated time of consumption)
4)Plane ENC ( estimated number of consumption)
5) Maple syrup 5.1 how to divvy it up, /pancake
/person
5.2 plan for leftover MS
6) cooking
7) table setting
8) eating
9) cleanup
10) debrief and problem solve for further pancake breakfasts
A Plan to Think about Starting to make Pancakes for Breakfast
Ferbuary,22, 2009
1)Prayer
2) take attendance and identify the number of consumers of pancakes
3)Plan ETC ( estimated time of consumption)
4)Plane ENC ( estimated number of consumption)
5) Maple syrup 5.1 how to divvy it up, /pancake
/person
5.2 plan for leftover MS
6) cooking
7) table setting
8) eating
9) cleanup
10) debrief and problem solve for further pancake breakfasts
Tuesday, February 17, 2009
Dinners in Muheza
Dinners
With less than 2 weeks to go ,
And most dinners consumed,
It felt like time to finish this series.
I will not tell you what I(we) miss( the list is not really that long)
Typical Tanzanian diiner items
Ugali ( a corn flour ball) very bland best enjoyed with anything with flavour
The more impoverished the local the less associated dishes
Meat with a saucy gravy tomatoey sometimes spicey( peppers) sauce is typical.
I have had it 3 times.
Boys stopped have school lunches because of it
Beans and rice.
Loads of beans options.
Best eaten with hot sauce.
Mchicha boiled/steamed and then fried bitter greens( generically spinach) usually with onions
The greens seem to be a variety of types depending on what is
available ..Paula was able to imitate the proper preparation and cooking better than I using the ‘Kazan’ technique of cooking bitter greens
cassava, grilled tough corn
meat dishes are either grilled meat ( beef or goat, chicken)
or meat in sauce beef, goat, chicken
being on the coast fish is plentiful
typically small fried bony fish about 3“ or a salted anchovie –like fish, bought dried in the market , served in toamoto sauce ( which I finally tasted last week)
but here on Sundays the fisher come to Muheza and we have fresh fish, steaks ( often called ‘tuna’) of all kinds,small to medium whole fish fried and twice large whole fish baked
but ingredients for musungu cooking musungu food in Tanzania are abundant
veggies – classic
carrots, cabbage, tomatoes, potatoes onions, garlic, peppers( green or hot)
occasional eggplant, zuchini, leeks
less classic or familiar
okra
eggplant- like yellow veggies
(eventually pictures will be added)
-pasta, cheese, tomato sauce ,meat sauce
-pizza veggie and meat ( bacon, mince)
-chapattis/paratha frozen or freshly made by juliette go with anything but we also make a taco like rollup with options of ground meat, cheese, onions, cucumbers, peppers, yogurt,
tomatoes
-frittata looking not much different than at home.
at home ( our Canadian home) we have stolen a recipe from Sally and Rose –‘Tuscan Chicken’
roasted splayed whole chicken on a bed of fennel, lemons, olives, garlic cloves, herbs
here we have ‘Muheza Chicken’ –same whole splayed chicken( a bit scrawnier and stringier), definitely free range, tender up well, in a similar roasting pot
on a bed of leeks or onions, green peppers, occasional other roast veggies, garlic cloves, limes, salt and pepper. Served with mashed potatoes made the way my dad taught me (warm the milk before adding)
at home ( that same Canadian place) often on Friday is nachos night at same sally and rose- previously mentioned- ‘s house ( is there another sally and rose really??)
No nachos here
But we have Chips and miyai( eggs) occasionally with sausages added
Chips made by street vendors , picked up at just the right time by Griffin ( and now Sy occesionally joins him) added to whipped egg as it fries
Sausages are lame packaged breakfast sausage( i do miss galloping goose sausages.. OK I said it)
Virtually all is 100 mile diet ( although condiments-hot sauce,pickle/chutney soya sauce , and our one true luxury olive oil do find there way to Tanzania and our table)
Salad is either tomato/cucumber/avocado( 10-20 cents each)
Or “Deb’s “ salad ( yes our dear friend deb lefrank) purple onion, mango( less than 10 cents each),lime and tomato… colourful and deelish
SO what is missing
You got it
Dessert, treats, postres, sweeties,kitindamlo
Fresh fruit ( often pineapple or banana -which I have eaten more of than in the last 10 years) can go only so far
We do miss sweets although cookies can be bought and a local dryish and less sweet cake is available and enjoyed - it ain’t Flan, chocolate mouse, chocolate anything
If Susan Griffith is reading this she might think about this as she hosts us in Cambridge in less than 2 weeks
No late night ice cream for me ( although last week while visiting friends in Arusha before our safari-lots of chicken, lots of rice- we were treated to PISTACHIO ICE CREAM…. MY FAVOURITE FLAVOUR)
Wine has been less than 5 glasses in 5.5 months although we did try a Tanzanian Rose ( once). Cold lagers work fine , the colder the better
Lots of water
And as I wrap up this final installment and we wrap up our final days here I will go have a small nip(60.2 % alcohol) of a’bunadh speyide single malt . brought by joel already a month ago.
cheers
With less than 2 weeks to go ,
And most dinners consumed,
It felt like time to finish this series.
I will not tell you what I(we) miss( the list is not really that long)
Typical Tanzanian diiner items
Ugali ( a corn flour ball) very bland best enjoyed with anything with flavour
The more impoverished the local the less associated dishes
Meat with a saucy gravy tomatoey sometimes spicey( peppers) sauce is typical.
I have had it 3 times.
Boys stopped have school lunches because of it
Beans and rice.
Loads of beans options.
Best eaten with hot sauce.
Mchicha boiled/steamed and then fried bitter greens( generically spinach) usually with onions
The greens seem to be a variety of types depending on what is
available ..Paula was able to imitate the proper preparation and cooking better than I using the ‘Kazan’ technique of cooking bitter greens
cassava, grilled tough corn
meat dishes are either grilled meat ( beef or goat, chicken)
or meat in sauce beef, goat, chicken
being on the coast fish is plentiful
typically small fried bony fish about 3“ or a salted anchovie –like fish, bought dried in the market , served in toamoto sauce ( which I finally tasted last week)
but here on Sundays the fisher come to Muheza and we have fresh fish, steaks ( often called ‘tuna’) of all kinds,small to medium whole fish fried and twice large whole fish baked
but ingredients for musungu cooking musungu food in Tanzania are abundant
veggies – classic
carrots, cabbage, tomatoes, potatoes onions, garlic, peppers( green or hot)
occasional eggplant, zuchini, leeks
less classic or familiar
okra
eggplant- like yellow veggies
(eventually pictures will be added)
-pasta, cheese, tomato sauce ,meat sauce
-pizza veggie and meat ( bacon, mince)
-chapattis/paratha frozen or freshly made by juliette go with anything but we also make a taco like rollup with options of ground meat, cheese, onions, cucumbers, peppers, yogurt,
tomatoes
-frittata looking not much different than at home.
at home ( our Canadian home) we have stolen a recipe from Sally and Rose –‘Tuscan Chicken’
roasted splayed whole chicken on a bed of fennel, lemons, olives, garlic cloves, herbs
here we have ‘Muheza Chicken’ –same whole splayed chicken( a bit scrawnier and stringier), definitely free range, tender up well, in a similar roasting pot
on a bed of leeks or onions, green peppers, occasional other roast veggies, garlic cloves, limes, salt and pepper. Served with mashed potatoes made the way my dad taught me (warm the milk before adding)
at home ( that same Canadian place) often on Friday is nachos night at same sally and rose- previously mentioned- ‘s house ( is there another sally and rose really??)
No nachos here
But we have Chips and miyai( eggs) occasionally with sausages added
Chips made by street vendors , picked up at just the right time by Griffin ( and now Sy occesionally joins him) added to whipped egg as it fries
Sausages are lame packaged breakfast sausage( i do miss galloping goose sausages.. OK I said it)
Virtually all is 100 mile diet ( although condiments-hot sauce,pickle/chutney soya sauce , and our one true luxury olive oil do find there way to Tanzania and our table)
Salad is either tomato/cucumber/avocado( 10-20 cents each)
Or “Deb’s “ salad ( yes our dear friend deb lefrank) purple onion, mango( less than 10 cents each),lime and tomato… colourful and deelish
SO what is missing
You got it
Dessert, treats, postres, sweeties,kitindamlo
Fresh fruit ( often pineapple or banana -which I have eaten more of than in the last 10 years) can go only so far
We do miss sweets although cookies can be bought and a local dryish and less sweet cake is available and enjoyed - it ain’t Flan, chocolate mouse, chocolate anything
If Susan Griffith is reading this she might think about this as she hosts us in Cambridge in less than 2 weeks
No late night ice cream for me ( although last week while visiting friends in Arusha before our safari-lots of chicken, lots of rice- we were treated to PISTACHIO ICE CREAM…. MY FAVOURITE FLAVOUR)
Wine has been less than 5 glasses in 5.5 months although we did try a Tanzanian Rose ( once). Cold lagers work fine , the colder the better
Lots of water
And as I wrap up this final installment and we wrap up our final days here I will go have a small nip(60.2 % alcohol) of a’bunadh speyide single malt . brought by joel already a month ago.
cheers
Living Deep and Wide
We are nearing the end and I haven’t blogged for a while. Hello out there ! Amazingly it feels like there is no time for reflecting in a blog!! How can that be, that we are so busy here even at altered African heat-pace ?
Lots to reflect upon. We had wonderful visitations by friends in January, first by Joel and Paula, overlapping by one night with my previous office partner Fiona Manning and friend Stephanie and their lovely 11 year old daughters. Joel and Paula made the epic journey for just 2 weeks with us, and they were wonderful to be with, such ardent explorers, keenly interested in anything and everything. Made us feel like we were living at the end of the anthropologic rainbow here in Muheza, and like our little family adventure was unparalleled. It was so nice to see Fiona, with whom I have shared so many clinical hours and reflect upon the medicine here with fresh eyes. Stephanie had lived near Mt Kilimanjaro with her family for almost a year, last year, and was now visiting her placement in follow-up and was a wealth of stories for comparing and contrasting our experiences.
Most recently we spent a week “on safari” which was other worldly. We had an amazing time !! We spent 3 full days in the Serengeti, then one each in Ngorongoro Crater and Lake Manyara. These are unbelievable places teeming with wildlife you can hardly imagine. I know I will both date myself and trigger childhood memories for many of you when I mention Mutual of Omaha’s Wild Kingdom on Sunday nights and say that it was surreal to actually see all of these great beasts in action and linger for long minutes and hours just watching. And these are not distant sightings !! We were metres away at times from 4 of the “big 5” (lion, water buffalo, leopard, rhino and elephant). It is like a giant (massive) reverse zoo, where we are the ones in the captivity of the car while the animals wander around us, seemingly quite oblivious to us (of course, simply desensitized to the thousands of vehicles who quietly watch them annually).
We were greeted by huge herds of migrating wildebeests and zebras (who travel together as one has good eyesight complimented by the amazing hearing of the other…have already forgotten which has which), and they were calving so saw lots of wee ones. Huge numbers into the tens of thousands and a real sense of a ‘migration’. Then it all unfolded over the days with multiple sightings of elephants, giraffes (my personal favorite!) tons of different gizelle/impala type creatures, water buffalo, cheetas with vultures post kill, lions (again lazy and satiated post grizzly wildebeest kill) , hippos and crocodiles in the wet pools, wart hogs, hyenas and jackals to name a few ! Ambrose became obsessed with the birds, and our guide Lawrence was highly knowledgeable and we identified over 100 of the 530 species that grace the park. They were the most beautiful colourful and curious of creatures, in all shapes and sizes of bodies, bills and feet. We will need to do a separate slide show just of our safari as it was truly an experience overflowing with the wonders of mother nature. The role and presence of the Massai also another interesting layer of local history and modern age lessons in traditional land use vs conservation (reminds me of first nation issues in Canada).
To think that we had contemplated not doing safari, as we were put off by the intensely unpleasant ‘vicious’ (as one medical student put it) aspects of the Safari business! Fortunately we were able to find a quite painless connection via the husband of a nurse at the hospital and we got a great price and wonderful guide and had the time of our lives. It was wonderful to see the kids so enthralled, especially Simon, who gleefully exclaimed “I could do this forever…”. This was why he came to Tanzania really, and now that the Safari is over he is quite ready to move on…
After Safari we returned to Muheza to no water and no power, and still find some North American ability in us to whine, and moan (it is 35 – 40 degrees after all) despite the fact that no-one in Muheza has water and everywhere we look, the industry of water transport and selling is milling about like activity in an ant hill. I find myself secretly thinking about a hot shower in Cambridge, and the temperature being cold enough to want one. I am also thinking about riding my bike with gears and silence (no clunks) without sweat pouring off and then dried in an uncomfortably itchy crust.
And so we are down to the last 2 weeks of work life here. We still have a few important teaching wrap-up sessions at Bombo, and the nursing school and in fact I am procrastinating on the final power point prep to write this blog ! Just before Safari, Ambrose and I shared the highlight of our time here when we funded a 2 day palliative care workshop (with some of the donor dollars from all of you!!) at Bombo Hospital. ‘So what ?’ you may say….BUT what is important is in the details. I had suggested we do an intro to Palliative Care lecture (thinking of an hour or 2) for the new satellite CTC clinics (the name given for clinics that care for people with HIV) that were opening in the Tanga region. Our little team took the idea and ran with it and before we knew it, it had become 2 days and 23 participants that included not only the new CTCs but also TAWG (Tanga Aids Working Group who do home based care), the Red Cross (home based care) and the head nurses from all the wards at Bombo Hospital. The best part was that several of the sessions (pain assessment, HIV related pain, and communicating bad news ) were delivered in Swahili by our new PC team at Bombo. This was so amazing, to see the confidence and passion that they brought to the teaching and how competently they had taken on the role of being leaders and educators in PC. This was a moment of great pride and satisfaction for Amb and I, and we now feel like a seed has been solidly planted. There is of course lots of next steps, we are discussing with them (more training needed for these leaders, money for a program, and staffing…etc) We will have our fundraising work cut out for us upon our return…However, this work becomes a joy, when we feel such affection for the individuals and have such a positive sense of their caring and their leadership skills.
Dr. Violet Bakari, the leader of the team, continues to reveal her powerful self to us in a quiet understated manner. Just yesterday, she had our family to her house for lunch and we were welcomed in a fully Tanzanian way, and had the opportunity to make a deeper connection and planning for the future. She shared with us her HIV + status (which had escaped our knowing over the last several months) and more about her health history and work accomplishments. She has worked closely with Dr. Mtatifiko over the last 3 years and has developed the Bombo CTC herself into the thriving functional arm of the hospital that it is. She only began her own ARV treatment in 2004 and was very sick prior to that, so this is really a remarkable accomplishment. She is now a picture of good health and is a success story of ARV accessibility. And now she quietly creates the palliative arm for the hospital, competently bringing the right folks together and building capacity in them. Gladly we will be able to work with her from afar over the next months and years as we look to the future.
Things at Teule, however, continue in a sea of politics and dysfunction. Amb has really given it the college try as they say, using his wonderful management and conflict resolution skills, that he brings from being Chief of Staff at SPH. But to date we have not shifted the milleu, and the 2 sides are deeply divided, and when we leave, so will leave the palliative care in the hospital. At Teule Hospitali we ended up doing precisely what we did not want to do, which was to provide direct service (some 80 plus consults between us) but not build capacity in Tanzanians. Those patients I am sure benefited from our presence here but sadly we will leave (unless some miracle happens in the last 2 weeks!!) without a lasting impact on program development. The reasons are complex and educative (of Tanzania, resource poor settings, of tribal traditions, of HIV/AIDS foreign aid sequelae, of religious leadership, of personality and leadership) but too long for a blog entry.
The whole thing of ARV (anti-retroviral) care in Tanzania is mind-boggling. These are complex treatments with side-effects, and need for absolute unwavering adherence to avoid viral resistance. The system of delivery is new since 2005 or so, constantly changing and expanding at an explosive rate to large numbers of people. However, the anthropology of its impact is not simple and completely different from the introduction of ARVs in a place like Canada. We met a young German MD at Bombo, whose partner is in fact a social anthropologist looking at peoples experience of ARVs both from clinician and patient/family perspectives, and I will be keen to stay in touch with them and learn more of this important research. In Canada, introducing treatments like active HIV care is difficult even when the health care delivery in general is advanced and layered and rich. Here, they are grappling with this complex beast when there is no reliable water, or power or basic medicines, shortage of health care professionals, and the majority by a long shot of the populous live in remote rural villages!
But most importantly I have realized, is that it is a completely different starting place in terms of the lay knowledge base around one’s body and health and disease. For example I saw a patient at Bombo who had advanced breast cancer. Her right breast was consumed by a large mass (peau d’orange for the medical folks) visible spread of the cancer along lymph nodes just under the skin one could see as a lumpy track heading for her arm pit, big lump under her right armpit, and swollen right arm, visible enlarged liver full of metastases. My point is that this cancer had been brewing for years unknown to her. She came to hospital because her right arm was swollen and painful. Think how quickly a typical woman in Canada would have been into her doc had she found a breast lump!! By contrast this woman, had no idea anything was wrong with her breast, and had never heard of cancer. This is a single story representative of a very common scenario. So in the HIV context we can not expect any knowledge base around the idea of germs, bacteria or viruses, let alone viral mutation, infections, or disease transmission. Of course this is changing especially now that treatment is available. Sadly, we are seeing a 2nd wave of deaths, because of course people feel well on ARVs and then think they don’t need them anymore, or side-effects (such as appetite stimulation in the context of not having enough food to eat) make it impossible to continue. All of this is a tall order for HIV educators and care providers, like Violet, and we are blown away by their adaptability, and resilience.
Bus crashes have been a terrible recent theme. Traffic/driving here is unbelievable scary. Speeding, reckless passing, poor vehicle conditions ( 5 gallon portable gas tank at our feet in the dala dala…) . By far and away the most risky thing we have done is to travel to Tanga twice a week and take the bus to Arusha for Safari….Terrible fatalities in the last month on our little stretch of highway, both speed related on the part of careless bus drivers, have resulted in dozens of fatalities. I will not miss this aspect at all. Always feels like a terrible leap of faith to get in a car/bus and go somewhere.
Anyways enough heavy stuff. Ambrose and I look at each other on a daily basis and marvel at the time we have shared here. For all the ups and downs, it has exceeded our wildest hopes as an experience for our family. We have been blessed with a safe and fascinating time here, and solid connections to individuals who have touched us and welcomed us despite our lousy Swahili acquisition, and odd Canadian way of being. I am cherishing the last few bike rides with the boys up to school, and my solo weekend rides through the sisal fields (now much more able to identify birds etc post safari). We are dividing up the last of the donor money between funding vulnerable children to school, provisions for palliative care, support for home based care, and a myriad of other little bits here and there. We feel honoured to have been trusted to share this money around, and grateful to have such concrete directly helpful spots to put it. We will prepare a report of all the homes it found.
It has been unbelievable to watch the boys develop and blossom and adapt. As my mother would have said, “my buttons are bursting with pride”. Each in their own way in their own time, they have come, and learned and shared of themselves. They zoom around Muheza on their bikes, competently exchanging the long multiple Swahili greetings, visiting the various fundi, bargaining at the market and generally taking it all in. Since returning to school in January, there is suddenly a young lad named Ally who rides with us to school, and a gaggle of boys have appeared at our house daily after school. Language still a barrier, but they have the commonness of curiosity in each other. I am so glad we persevered with Holy Family Primary School and didn’t bail to the International expat school in tanga.
And to watch my sweetie Ambrose dive into this time in Africa, has been an affirmation of love and wonder. As we all have seen him give, for this and that, and shared in his endless ability to just ‘get stuff done’ and find the time for everyone and everything, so he has given to Tanzania in the same Ambrose style. (Not that I don’t get very tired of being ‘Mrs. Dr. Ambrose’ and quietly accepting my less visible role….) But together we are a good team (it is the first time we have worked together so closely), and have had the gift of a similar way of seeing things, and endless discussions about life and death and HIV , foreign aid and Africa and human-ness and parenting. I will cherish these six months as a rich and wonderful journey. As one friend wrote in an email, a time of ‘living deep and wide’.
Lots to reflect upon. We had wonderful visitations by friends in January, first by Joel and Paula, overlapping by one night with my previous office partner Fiona Manning and friend Stephanie and their lovely 11 year old daughters. Joel and Paula made the epic journey for just 2 weeks with us, and they were wonderful to be with, such ardent explorers, keenly interested in anything and everything. Made us feel like we were living at the end of the anthropologic rainbow here in Muheza, and like our little family adventure was unparalleled. It was so nice to see Fiona, with whom I have shared so many clinical hours and reflect upon the medicine here with fresh eyes. Stephanie had lived near Mt Kilimanjaro with her family for almost a year, last year, and was now visiting her placement in follow-up and was a wealth of stories for comparing and contrasting our experiences.
Most recently we spent a week “on safari” which was other worldly. We had an amazing time !! We spent 3 full days in the Serengeti, then one each in Ngorongoro Crater and Lake Manyara. These are unbelievable places teeming with wildlife you can hardly imagine. I know I will both date myself and trigger childhood memories for many of you when I mention Mutual of Omaha’s Wild Kingdom on Sunday nights and say that it was surreal to actually see all of these great beasts in action and linger for long minutes and hours just watching. And these are not distant sightings !! We were metres away at times from 4 of the “big 5” (lion, water buffalo, leopard, rhino and elephant). It is like a giant (massive) reverse zoo, where we are the ones in the captivity of the car while the animals wander around us, seemingly quite oblivious to us (of course, simply desensitized to the thousands of vehicles who quietly watch them annually).
We were greeted by huge herds of migrating wildebeests and zebras (who travel together as one has good eyesight complimented by the amazing hearing of the other…have already forgotten which has which), and they were calving so saw lots of wee ones. Huge numbers into the tens of thousands and a real sense of a ‘migration’. Then it all unfolded over the days with multiple sightings of elephants, giraffes (my personal favorite!) tons of different gizelle/impala type creatures, water buffalo, cheetas with vultures post kill, lions (again lazy and satiated post grizzly wildebeest kill) , hippos and crocodiles in the wet pools, wart hogs, hyenas and jackals to name a few ! Ambrose became obsessed with the birds, and our guide Lawrence was highly knowledgeable and we identified over 100 of the 530 species that grace the park. They were the most beautiful colourful and curious of creatures, in all shapes and sizes of bodies, bills and feet. We will need to do a separate slide show just of our safari as it was truly an experience overflowing with the wonders of mother nature. The role and presence of the Massai also another interesting layer of local history and modern age lessons in traditional land use vs conservation (reminds me of first nation issues in Canada).
To think that we had contemplated not doing safari, as we were put off by the intensely unpleasant ‘vicious’ (as one medical student put it) aspects of the Safari business! Fortunately we were able to find a quite painless connection via the husband of a nurse at the hospital and we got a great price and wonderful guide and had the time of our lives. It was wonderful to see the kids so enthralled, especially Simon, who gleefully exclaimed “I could do this forever…”. This was why he came to Tanzania really, and now that the Safari is over he is quite ready to move on…
After Safari we returned to Muheza to no water and no power, and still find some North American ability in us to whine, and moan (it is 35 – 40 degrees after all) despite the fact that no-one in Muheza has water and everywhere we look, the industry of water transport and selling is milling about like activity in an ant hill. I find myself secretly thinking about a hot shower in Cambridge, and the temperature being cold enough to want one. I am also thinking about riding my bike with gears and silence (no clunks) without sweat pouring off and then dried in an uncomfortably itchy crust.
And so we are down to the last 2 weeks of work life here. We still have a few important teaching wrap-up sessions at Bombo, and the nursing school and in fact I am procrastinating on the final power point prep to write this blog ! Just before Safari, Ambrose and I shared the highlight of our time here when we funded a 2 day palliative care workshop (with some of the donor dollars from all of you!!) at Bombo Hospital. ‘So what ?’ you may say….BUT what is important is in the details. I had suggested we do an intro to Palliative Care lecture (thinking of an hour or 2) for the new satellite CTC clinics (the name given for clinics that care for people with HIV) that were opening in the Tanga region. Our little team took the idea and ran with it and before we knew it, it had become 2 days and 23 participants that included not only the new CTCs but also TAWG (Tanga Aids Working Group who do home based care), the Red Cross (home based care) and the head nurses from all the wards at Bombo Hospital. The best part was that several of the sessions (pain assessment, HIV related pain, and communicating bad news ) were delivered in Swahili by our new PC team at Bombo. This was so amazing, to see the confidence and passion that they brought to the teaching and how competently they had taken on the role of being leaders and educators in PC. This was a moment of great pride and satisfaction for Amb and I, and we now feel like a seed has been solidly planted. There is of course lots of next steps, we are discussing with them (more training needed for these leaders, money for a program, and staffing…etc) We will have our fundraising work cut out for us upon our return…However, this work becomes a joy, when we feel such affection for the individuals and have such a positive sense of their caring and their leadership skills.
Dr. Violet Bakari, the leader of the team, continues to reveal her powerful self to us in a quiet understated manner. Just yesterday, she had our family to her house for lunch and we were welcomed in a fully Tanzanian way, and had the opportunity to make a deeper connection and planning for the future. She shared with us her HIV + status (which had escaped our knowing over the last several months) and more about her health history and work accomplishments. She has worked closely with Dr. Mtatifiko over the last 3 years and has developed the Bombo CTC herself into the thriving functional arm of the hospital that it is. She only began her own ARV treatment in 2004 and was very sick prior to that, so this is really a remarkable accomplishment. She is now a picture of good health and is a success story of ARV accessibility. And now she quietly creates the palliative arm for the hospital, competently bringing the right folks together and building capacity in them. Gladly we will be able to work with her from afar over the next months and years as we look to the future.
Things at Teule, however, continue in a sea of politics and dysfunction. Amb has really given it the college try as they say, using his wonderful management and conflict resolution skills, that he brings from being Chief of Staff at SPH. But to date we have not shifted the milleu, and the 2 sides are deeply divided, and when we leave, so will leave the palliative care in the hospital. At Teule Hospitali we ended up doing precisely what we did not want to do, which was to provide direct service (some 80 plus consults between us) but not build capacity in Tanzanians. Those patients I am sure benefited from our presence here but sadly we will leave (unless some miracle happens in the last 2 weeks!!) without a lasting impact on program development. The reasons are complex and educative (of Tanzania, resource poor settings, of tribal traditions, of HIV/AIDS foreign aid sequelae, of religious leadership, of personality and leadership) but too long for a blog entry.
The whole thing of ARV (anti-retroviral) care in Tanzania is mind-boggling. These are complex treatments with side-effects, and need for absolute unwavering adherence to avoid viral resistance. The system of delivery is new since 2005 or so, constantly changing and expanding at an explosive rate to large numbers of people. However, the anthropology of its impact is not simple and completely different from the introduction of ARVs in a place like Canada. We met a young German MD at Bombo, whose partner is in fact a social anthropologist looking at peoples experience of ARVs both from clinician and patient/family perspectives, and I will be keen to stay in touch with them and learn more of this important research. In Canada, introducing treatments like active HIV care is difficult even when the health care delivery in general is advanced and layered and rich. Here, they are grappling with this complex beast when there is no reliable water, or power or basic medicines, shortage of health care professionals, and the majority by a long shot of the populous live in remote rural villages!
But most importantly I have realized, is that it is a completely different starting place in terms of the lay knowledge base around one’s body and health and disease. For example I saw a patient at Bombo who had advanced breast cancer. Her right breast was consumed by a large mass (peau d’orange for the medical folks) visible spread of the cancer along lymph nodes just under the skin one could see as a lumpy track heading for her arm pit, big lump under her right armpit, and swollen right arm, visible enlarged liver full of metastases. My point is that this cancer had been brewing for years unknown to her. She came to hospital because her right arm was swollen and painful. Think how quickly a typical woman in Canada would have been into her doc had she found a breast lump!! By contrast this woman, had no idea anything was wrong with her breast, and had never heard of cancer. This is a single story representative of a very common scenario. So in the HIV context we can not expect any knowledge base around the idea of germs, bacteria or viruses, let alone viral mutation, infections, or disease transmission. Of course this is changing especially now that treatment is available. Sadly, we are seeing a 2nd wave of deaths, because of course people feel well on ARVs and then think they don’t need them anymore, or side-effects (such as appetite stimulation in the context of not having enough food to eat) make it impossible to continue. All of this is a tall order for HIV educators and care providers, like Violet, and we are blown away by their adaptability, and resilience.
Bus crashes have been a terrible recent theme. Traffic/driving here is unbelievable scary. Speeding, reckless passing, poor vehicle conditions ( 5 gallon portable gas tank at our feet in the dala dala…) . By far and away the most risky thing we have done is to travel to Tanga twice a week and take the bus to Arusha for Safari….Terrible fatalities in the last month on our little stretch of highway, both speed related on the part of careless bus drivers, have resulted in dozens of fatalities. I will not miss this aspect at all. Always feels like a terrible leap of faith to get in a car/bus and go somewhere.
Anyways enough heavy stuff. Ambrose and I look at each other on a daily basis and marvel at the time we have shared here. For all the ups and downs, it has exceeded our wildest hopes as an experience for our family. We have been blessed with a safe and fascinating time here, and solid connections to individuals who have touched us and welcomed us despite our lousy Swahili acquisition, and odd Canadian way of being. I am cherishing the last few bike rides with the boys up to school, and my solo weekend rides through the sisal fields (now much more able to identify birds etc post safari). We are dividing up the last of the donor money between funding vulnerable children to school, provisions for palliative care, support for home based care, and a myriad of other little bits here and there. We feel honoured to have been trusted to share this money around, and grateful to have such concrete directly helpful spots to put it. We will prepare a report of all the homes it found.
It has been unbelievable to watch the boys develop and blossom and adapt. As my mother would have said, “my buttons are bursting with pride”. Each in their own way in their own time, they have come, and learned and shared of themselves. They zoom around Muheza on their bikes, competently exchanging the long multiple Swahili greetings, visiting the various fundi, bargaining at the market and generally taking it all in. Since returning to school in January, there is suddenly a young lad named Ally who rides with us to school, and a gaggle of boys have appeared at our house daily after school. Language still a barrier, but they have the commonness of curiosity in each other. I am so glad we persevered with Holy Family Primary School and didn’t bail to the International expat school in tanga.
And to watch my sweetie Ambrose dive into this time in Africa, has been an affirmation of love and wonder. As we all have seen him give, for this and that, and shared in his endless ability to just ‘get stuff done’ and find the time for everyone and everything, so he has given to Tanzania in the same Ambrose style. (Not that I don’t get very tired of being ‘Mrs. Dr. Ambrose’ and quietly accepting my less visible role….) But together we are a good team (it is the first time we have worked together so closely), and have had the gift of a similar way of seeing things, and endless discussions about life and death and HIV , foreign aid and Africa and human-ness and parenting. I will cherish these six months as a rich and wonderful journey. As one friend wrote in an email, a time of ‘living deep and wide’.
Quick Blog
2 weeks ago I was struggling with the idea of leaving
the safari trip took us away
made us tourists
and gave us time to talk about end game, goodbyes, final reports
add to that , upon our return in Muheza, no water and no electricity with high heat
and the thought of leaving seems easier and clearer
in actual fact leaving and a transition to a new part of this trip , will happen whether I am ready or not
the safari trip took us away
made us tourists
and gave us time to talk about end game, goodbyes, final reports
add to that , upon our return in Muheza, no water and no electricity with high heat
and the thought of leaving seems easier and clearer
in actual fact leaving and a transition to a new part of this trip , will happen whether I am ready or not
Saturday, February 7, 2009
departure looming
As departure looms
Roasted and Ground last kilo of coffee (sadly)
Turkish coffee not far off( not so sadly)
Wonder if I ill be able to get back into the routine
of morning showers for cleanliness
Instead of nightly showers to cool off
Roasted and Ground last kilo of coffee (sadly)
Turkish coffee not far off( not so sadly)
Wonder if I ill be able to get back into the routine
of morning showers for cleanliness
Instead of nightly showers to cool off
Tuesday, February 3, 2009
What will we miss?
What will we most miss?
The ants ( by the thousands)
The bats ( by the hundreds)
Or the gheckos (by the dozens)
What ya Think!!!
The ants ( by the thousands)
The bats ( by the hundreds)
Or the gheckos (by the dozens)
What ya Think!!!
Monday, February 2, 2009
A lovely day
Kid’s Club Goes to the YaCHt Club
YaCHt Club because Swahili is phonetic , all letters are pronounced( no silent ch). It was a non written language “ translated “ or transcribed into the English alphabet by Missionaries.
So today the Diana Center ( the palliative care center in Muheza ) took 91ish kids plus support staff to the YaCHt Club of Tanga for a semi annual outing.
All these kids are HIV Positive. They are a mix of ages from about 4 to 15, boys and girls.
Their health is variable
Coughs are common , some small for their age, some malnourished.
Many ,not all, are on ARVs( anti- retrovirals)
They come weekly to the center for health and social activities
Some are orphans( in Tanzania the loss of even one parent qualifies you for that title.)
The kids started assembling about 0800( 0200 swahili time)
Parents, family members or guardians dropping them off and those that lived in the ‘burbs ‘ of muheza were picked up.
Those with some sort of finery were wearing it, a number had good jeans, better shoes and dresses and some wore the best finery they had ,that was sadly less fine.
Simon recently ruptured his ear drum while swimming and snorkeling, came with us but could not indulge in water play, he is being a trooper with drops and pills for a klebsiella/pseudomonas infection in that ear( for you medical folk out there). Griff had gone in earlier with friends and their kids who are having sailing lessons and he sailed on his own in one of the dinghies, his first sailing experience and he enjoyed it.
We packed into 4 Dala dalas ( the local transport- Toyota panel van sized vehicles full of seats always overfilled and today was no exception.)
We headed off and not a kilometer out the small thin little boy next to me began too vomit, too soon for car-sickness, maybe excitement, or maybe an unwell lad. A plastic bag appeared and eventually a cloth and he fell asleep on my lap occasionally raising his head, looking for the bag and retching a bit more.
There was some bus singing( more on Leah’s dala dala) and then the YaCHt club was invaded.Many had not been on a Dala dala before but even more had not even seen the ocean.
So beach play-soccer balls, skipping ropes - sodas and samosa for morning snack and then a fairly unselfconscious change into swimwear , or not, for a play in the shallows. These kids are not swimmers. There was some concern that they may be drowners.
The next treat in a day full of treats was a boat ride around the bay in a sail boat owned by a displaced Zimbabwean musungu ( white guy) . Just motored but they loved it. Leah was asked if she could swim and when she answered in the affirmative she was invited on the ride in case of disaster( which would have been a terrible disaster) but all went without a hitch.
There was a 45 minute ( wasungu or Swahili time) period where lunch was not yet ready and the children were restless and the Diana staff who really came for a day at the YaCHt club themselves were enjoying their second or third beer,and kids starting wandering all over. There was a small hint of looming chaos and a ‘never invited back’ sort of scenario. But some of the non beer drinking staff made up games and songs and lunch was eventually served
Sodas again, rice, plantain stew, chicken, and stewed bitter greens called mcheecha. All deelish.
AND THEN
Ice cream and cookies!!
I had not seen tubs of ice cream since being here and there they were, vanilla AND chocolate .We did not give them a choice ( would they know what they were choosing between??). It was all consumed.
My little vomiting friend with the large sad eyes wanted dessert too but the coordinator thought better of it much to his sadness so I gave him 2 servings of cookies, small not too sweet, seemed reasonable. He was not happy about that but ate them without hesitation.
Clean up , pack up, final beers for some. Connecting lost swimsuits or finery with its proper owner and then up to the buses
On my way up I collected a plastic bag for my little friend assuming he would sit beside me . Besides the fact that I was assigned to a different vehicle I did see him on my way to the dala dala with a Bowl of CHOCOLATE ice cream. Hope his ride was uneventful.
All in all a heart warming experience in an already warm place.
27 days to go !!! AARRGGGHHHH
2310 hrs ( wasungu time) 31/1/09 and it is raining!! Always appreciated
goodnight
YaCHt Club because Swahili is phonetic , all letters are pronounced( no silent ch). It was a non written language “ translated “ or transcribed into the English alphabet by Missionaries.
So today the Diana Center ( the palliative care center in Muheza ) took 91ish kids plus support staff to the YaCHt Club of Tanga for a semi annual outing.
All these kids are HIV Positive. They are a mix of ages from about 4 to 15, boys and girls.
Their health is variable
Coughs are common , some small for their age, some malnourished.
Many ,not all, are on ARVs( anti- retrovirals)
They come weekly to the center for health and social activities
Some are orphans( in Tanzania the loss of even one parent qualifies you for that title.)
The kids started assembling about 0800( 0200 swahili time)
Parents, family members or guardians dropping them off and those that lived in the ‘burbs ‘ of muheza were picked up.
Those with some sort of finery were wearing it, a number had good jeans, better shoes and dresses and some wore the best finery they had ,that was sadly less fine.
Simon recently ruptured his ear drum while swimming and snorkeling, came with us but could not indulge in water play, he is being a trooper with drops and pills for a klebsiella/pseudomonas infection in that ear( for you medical folk out there). Griff had gone in earlier with friends and their kids who are having sailing lessons and he sailed on his own in one of the dinghies, his first sailing experience and he enjoyed it.
We packed into 4 Dala dalas ( the local transport- Toyota panel van sized vehicles full of seats always overfilled and today was no exception.)
We headed off and not a kilometer out the small thin little boy next to me began too vomit, too soon for car-sickness, maybe excitement, or maybe an unwell lad. A plastic bag appeared and eventually a cloth and he fell asleep on my lap occasionally raising his head, looking for the bag and retching a bit more.
There was some bus singing( more on Leah’s dala dala) and then the YaCHt club was invaded.Many had not been on a Dala dala before but even more had not even seen the ocean.
So beach play-soccer balls, skipping ropes - sodas and samosa for morning snack and then a fairly unselfconscious change into swimwear , or not, for a play in the shallows. These kids are not swimmers. There was some concern that they may be drowners.
The next treat in a day full of treats was a boat ride around the bay in a sail boat owned by a displaced Zimbabwean musungu ( white guy) . Just motored but they loved it. Leah was asked if she could swim and when she answered in the affirmative she was invited on the ride in case of disaster( which would have been a terrible disaster) but all went without a hitch.
There was a 45 minute ( wasungu or Swahili time) period where lunch was not yet ready and the children were restless and the Diana staff who really came for a day at the YaCHt club themselves were enjoying their second or third beer,and kids starting wandering all over. There was a small hint of looming chaos and a ‘never invited back’ sort of scenario. But some of the non beer drinking staff made up games and songs and lunch was eventually served
Sodas again, rice, plantain stew, chicken, and stewed bitter greens called mcheecha. All deelish.
AND THEN
Ice cream and cookies!!
I had not seen tubs of ice cream since being here and there they were, vanilla AND chocolate .We did not give them a choice ( would they know what they were choosing between??). It was all consumed.
My little vomiting friend with the large sad eyes wanted dessert too but the coordinator thought better of it much to his sadness so I gave him 2 servings of cookies, small not too sweet, seemed reasonable. He was not happy about that but ate them without hesitation.
Clean up , pack up, final beers for some. Connecting lost swimsuits or finery with its proper owner and then up to the buses
On my way up I collected a plastic bag for my little friend assuming he would sit beside me . Besides the fact that I was assigned to a different vehicle I did see him on my way to the dala dala with a Bowl of CHOCOLATE ice cream. Hope his ride was uneventful.
All in all a heart warming experience in an already warm place.
27 days to go !!! AARRGGGHHHH
2310 hrs ( wasungu time) 31/1/09 and it is raining!! Always appreciated
goodnight
Lunches in Muheza
Lunches in Muheza
Before I start I should let you know that I did get a few responses about the definition of Foodie and wether I am a member of such a club ( and even if I where the badge with honour.both e-mails and letter referred to official definitions and general habits. I enjoyed the correspondence and the comments gave me something to chew on.
Trying to avoid labels most of my life ( exept ,father, friend, doctor,husband…) I think my essys are more a way to share some of what we see here and maybe part of what we can slightly understand here so that you can get a feel or even a ‘taste ‘ of our time here. Consider it an anthropological assessment through the eyes and mouth of a person who can appreciate socity through it foods and…… no never mind let’s call it foods for thought,as best as I can see or taste them , no more no less from a person who rarely misses a meal or leaves food behind.
Lunch really has only one word- Juliette –
She is in charge of lunches at “hillview” from Monday to Friday ( except holidays and on the weekends we make do or eat leftovers from Juliettes weekday lunches.
There is little variety ( although some). Yet I ( for one O never tire of them
I think the general theme dates back to Richard and Karilyn( we see this now after spending 2 days with them and enjoying a delicious lumch of soup and bread.
So that is lunch soup and bread.
The variations include condiments and additons to the soup like cheese, yogurt, hotsauce and bread variations chapattis -2 types , classic bready greasy and a crepe-like batter with onions. MMMMM, and recently rose’s banana bread (now part of Juliette’s repetoire)
Although Juliette cleans and does our laundry ( irons too although not our socks, underwear and T-shirts anymore) lunch is something she insists on being involved with>
Leftovers from diner, +/- eggsalad , tunafish or peanut butter and jam sandwiches can be added to lunch but they are more common on weekends. By lunch time cold water is essential.
So the only other lunches of note , besides those when traveling to new destinations –all unique and none worth reporting- are our lunches in Tanga either on weekend errands and swim or our almost twice weekly visits for teaching and rounds.
The Food palace atsy Indian curries and western food, very slowly created , but tasty.
Mkonge hotel( site of rose’s last catan victory in Tanzania), overpriced remnant of colonial days, swimming pool, colour TV with soccer regularly available, good food just too much guilt associated.
Yacht club -ditto to Mkonge without TV or pool, ocean swim available.
But lately samosa to go from patwas diner with or without fruit juice or lassi.
Lunches are tasty , usually a chance to slow down and get out of the heat, nothing special but rarely disappointing.
Before I start I should let you know that I did get a few responses about the definition of Foodie and wether I am a member of such a club ( and even if I where the badge with honour.both e-mails and letter referred to official definitions and general habits. I enjoyed the correspondence and the comments gave me something to chew on.
Trying to avoid labels most of my life ( exept ,father, friend, doctor,husband…) I think my essys are more a way to share some of what we see here and maybe part of what we can slightly understand here so that you can get a feel or even a ‘taste ‘ of our time here. Consider it an anthropological assessment through the eyes and mouth of a person who can appreciate socity through it foods and…… no never mind let’s call it foods for thought,as best as I can see or taste them , no more no less from a person who rarely misses a meal or leaves food behind.
Lunch really has only one word- Juliette –
She is in charge of lunches at “hillview” from Monday to Friday ( except holidays and on the weekends we make do or eat leftovers from Juliettes weekday lunches.
There is little variety ( although some). Yet I ( for one O never tire of them
I think the general theme dates back to Richard and Karilyn( we see this now after spending 2 days with them and enjoying a delicious lumch of soup and bread.
So that is lunch soup and bread.
The variations include condiments and additons to the soup like cheese, yogurt, hotsauce and bread variations chapattis -2 types , classic bready greasy and a crepe-like batter with onions. MMMMM, and recently rose’s banana bread (now part of Juliette’s repetoire)
Although Juliette cleans and does our laundry ( irons too although not our socks, underwear and T-shirts anymore) lunch is something she insists on being involved with>
Leftovers from diner, +/- eggsalad , tunafish or peanut butter and jam sandwiches can be added to lunch but they are more common on weekends. By lunch time cold water is essential.
So the only other lunches of note , besides those when traveling to new destinations –all unique and none worth reporting- are our lunches in Tanga either on weekend errands and swim or our almost twice weekly visits for teaching and rounds.
The Food palace atsy Indian curries and western food, very slowly created , but tasty.
Mkonge hotel( site of rose’s last catan victory in Tanzania), overpriced remnant of colonial days, swimming pool, colour TV with soccer regularly available, good food just too much guilt associated.
Yacht club -ditto to Mkonge without TV or pool, ocean swim available.
But lately samosa to go from patwas diner with or without fruit juice or lassi.
Lunches are tasty , usually a chance to slow down and get out of the heat, nothing special but rarely disappointing.
Subscribe to:
Posts (Atom)