July 7, 2009
One of the first lessons we learned while staying in Tanzania was surviving with simplicity. You do not need to use the standard 35 liters a day of water consumed by an average American… you cope with maybe 3 to 5. This means turning off the tap when shampooing your hair, brushing your teeth, and soaping your body. This means not flushing the toilet as often and scooping out a limited amount of water to wash your dishes. Here, we do not shower everyday. Nor do we send our clothes for laundering after wearing them only once.
Another thing to be conserved is energy. We can never be sure that there will be a steady flow of electricity when we plug our devices into the outlets. Therefore, one should never be caught without a reliable flashlight or a candlestick and some matches. There is not enough electricity to support multiple appliances: the sound system cannot operate in conjunction with the TV. Turning on our laptops dims our ceiling light.
Only after deprivation of modern-day equipment do you realize how many hours you expend daily on watching TV, surfing the internet or listening to music. After finishing work at the dispensary, we often have nothing to occupy ourselves with and must come up with things to do. We play with the children of our homestay parents and those of their relatives’. They are ingeniously creative at entertaining themselves without Wii video games, computers, or sophisticated toys. We saw cars made from water bottles, a game involving just a wheel and a stick, and “hacky sack” made of a ball of grass. In the past two weeks, Sanaa and I have rediscovered the joys of jump roping, playing with cards, bouncing rubber balls, and dancing to the radio. We also took walks around the village, learned to peel potatoes using a plain knife, and rolled dough for making chapatti. Instead of iced coffee or smoothies, soda in a glass bottle became a rare sugary treat to savor under the afternoon sun.
Living simply brings people together. Hordes of children of different ages can be seen playing together in the fields. Without complex machinery, chores are completed under the collaboration of many hands. But this also means the work is difficult and time-consuming. Washing clothes, cooking, and cleaning can take hours.
Yet for many of those living with less, they embrace their life and its challenges. A bumper sticker I saw on the window of a truck summarizes their perspective: “Yesu Atosha.” Jesus Enough.
Saturday, July 25, 2009
Yaoli: The River that Flows in All of Us
July 4, 2009
A heartbeat occurs about once every 0.625 seconds. The myogenic signal starts at the sinoatrial node and blood rushes into all four chambers. Tiny electrical signals, dictated by the opening of millions of molecular voltage gates, travel to the atrial-ventricular node via the Bundle of His. The movement of sodium ions is ultimately translated to a powerful flood of calcium. The ventricles contract, pumping blood to the lungs and the artery highways leading to the rest of the body. In the meantime, just as oxygenated “red” blood leaves the heart, deoxygenated “blue” blood returns and fills the upper atrial chambers.
Laden with oxygen saturated hemoglobin molecules, our erythrocytes travel inside muscular vessels which diverge to smaller and smaller streets. The map of a human body is remarkably complex: more highways than any nation, more alleyways than any city. Yet each cell navigates through the maze with ease… just routine. It happens every 0.625 seconds after all.
Finally arriving at its destination, the oxygenated blood wash over the tissues, bathing the cells in much-needed nourishment and hydration. With oxygen, our body can transform glucose, amino acids, and fats into energy… energy to power our legs, maintain our body temperature, even digest our next meal.
Our blood is our lifeline and the staff at Mwika Uuwo dispensary is its most competent plumbers. Blood pressure check, blood smear, hemoglobin count, ELISA for HIV, fast blood sugar level… these are tests the doctors rely on daily to infer their diagnosis. In addition to providing reliable diagnostic information, the circulatory system is utilized to rapidly deliver remedies throughout the body. Patients coming in with acute malaria or typhoid infections may receive antibiotics through an IV. Elderly patients suffering from dehydration or low circulatory electrolytes immediately receive saline drips to stabilize their blood pressures. In fact, almost all patients in the wards can be seen with a scalp vein or cannula affixed to the back of their hand or forearm.
The nurses diligently monitor the fluid level of the drip bags and change them every 6-8 hours. They ensure that the fluid is dripping steadily through the giving set and into the vein… 42 drops every minute, in fact. For the elderly, receiving an IV drip can be a difficult process. Forcing fluid through veins with poor circulation can be excruciatingly painful and result in edema at the infusion site. Many patients are frightened by the severe swelling and complain to the hospital staff. Clots are another obstacle. They can stop the infusion of fluid entirely and therefore require another needle insertion at a new site.
Blood’s dangerousness rivals its merit. Two of the most deadly diseases in Tanzania – malaria and HIV – travel via blood. The first lesson we learned while shadowing Dr. Raymond was not how to care for patients or treat diseases, but how to protect ourselves. “Any bodily fluid… especially blood, is a very dangerous thing. If you get infected, how can you continue to care for others? You must always wear gloves. After using a needle on another, you must be very careful to dispose of it. If you administer HIV tests, you need to observe the patient first. See if he or she is stable, calm, ready. You need to protect yourself at all times.” This couldn’t be truer. At our dispensary, staff is overworked and in short supply. It operates 24/7 on two doctors and only a handful of nurses. Stanley, the laboratory technician, multitasks between performing diagnostics, giving injections, and filing paperwork. Nurse Flora executes the duties of a pharmacist, accountant and secretary. She keeps records of the drug stocks, files the insurance claim forms, and dispenses the medication. They only get one day off a week and cannot afford to be sick. But of course, in a country as poverty-stricken as Tanzania, no one can.
A heartbeat occurs about once every 0.625 seconds. The myogenic signal starts at the sinoatrial node and blood rushes into all four chambers. Tiny electrical signals, dictated by the opening of millions of molecular voltage gates, travel to the atrial-ventricular node via the Bundle of His. The movement of sodium ions is ultimately translated to a powerful flood of calcium. The ventricles contract, pumping blood to the lungs and the artery highways leading to the rest of the body. In the meantime, just as oxygenated “red” blood leaves the heart, deoxygenated “blue” blood returns and fills the upper atrial chambers.
Laden with oxygen saturated hemoglobin molecules, our erythrocytes travel inside muscular vessels which diverge to smaller and smaller streets. The map of a human body is remarkably complex: more highways than any nation, more alleyways than any city. Yet each cell navigates through the maze with ease… just routine. It happens every 0.625 seconds after all.
Finally arriving at its destination, the oxygenated blood wash over the tissues, bathing the cells in much-needed nourishment and hydration. With oxygen, our body can transform glucose, amino acids, and fats into energy… energy to power our legs, maintain our body temperature, even digest our next meal.
Our blood is our lifeline and the staff at Mwika Uuwo dispensary is its most competent plumbers. Blood pressure check, blood smear, hemoglobin count, ELISA for HIV, fast blood sugar level… these are tests the doctors rely on daily to infer their diagnosis. In addition to providing reliable diagnostic information, the circulatory system is utilized to rapidly deliver remedies throughout the body. Patients coming in with acute malaria or typhoid infections may receive antibiotics through an IV. Elderly patients suffering from dehydration or low circulatory electrolytes immediately receive saline drips to stabilize their blood pressures. In fact, almost all patients in the wards can be seen with a scalp vein or cannula affixed to the back of their hand or forearm.
The nurses diligently monitor the fluid level of the drip bags and change them every 6-8 hours. They ensure that the fluid is dripping steadily through the giving set and into the vein… 42 drops every minute, in fact. For the elderly, receiving an IV drip can be a difficult process. Forcing fluid through veins with poor circulation can be excruciatingly painful and result in edema at the infusion site. Many patients are frightened by the severe swelling and complain to the hospital staff. Clots are another obstacle. They can stop the infusion of fluid entirely and therefore require another needle insertion at a new site.
Blood’s dangerousness rivals its merit. Two of the most deadly diseases in Tanzania – malaria and HIV – travel via blood. The first lesson we learned while shadowing Dr. Raymond was not how to care for patients or treat diseases, but how to protect ourselves. “Any bodily fluid… especially blood, is a very dangerous thing. If you get infected, how can you continue to care for others? You must always wear gloves. After using a needle on another, you must be very careful to dispose of it. If you administer HIV tests, you need to observe the patient first. See if he or she is stable, calm, ready. You need to protect yourself at all times.” This couldn’t be truer. At our dispensary, staff is overworked and in short supply. It operates 24/7 on two doctors and only a handful of nurses. Stanley, the laboratory technician, multitasks between performing diagnostics, giving injections, and filing paperwork. Nurse Flora executes the duties of a pharmacist, accountant and secretary. She keeps records of the drug stocks, files the insurance claim forms, and dispenses the medication. They only get one day off a week and cannot afford to be sick. But of course, in a country as poverty-stricken as Tanzania, no one can.
Tuesday, July 7, 2009
Yaoli: A Stroll Around the Shamba
July 1, 2009
During the brief window straddling day and night, Gilbert took us on a tour of his farm. We have stayed at his house for more than a week now, but have never ventured into his fields. Meandering through the banana trees, coffee bushes, and rows of beans and maize, you can make many insightful observations revealing broader facets of Tanzanian life. Keenly perceptive and engaging, Gilbert has the uncanny ability of understanding how society and people function, even in environments vastly different from his own. During the trip, I witnessed his natural talent for tour-guiding and story telling.
Never sparing a moment to rest, he had just spent the afternoon planning an addition to the chicken coop. On top of wild chickens, his shamba also boasts three goats (which he breeds to sell the young), seven pigs, and a bull (for harvesting manure to fertilize the crops). We strolled past the animal pens to survey the land. He points out the branches laden with still-green coffee fruit. Once red, the fruits are harvested and crushed to yield crude coffee beans. The beans are dried outside in the shade, then sold to commercial companies capable of roasting and refining. Farmers here in Tanzania sell their beans at less than $1.50 for a kilogram. In contrast, even the cheapest instant coffee will run you more than 7x that. “So we are very stupid, selling it so cheaply.” This is the plight of commodity exporters worldwide: poor countries such as Tanzania sell cash crops or natural resources at bargain prices to companies which turn the raw material to expensive end products.
Walking further, we passed by dark rich upturned soil fertile for planting. Rain here in Mwika Uuwo is thankfully frequent and the land is abundant in vegetation. Labor is all manual. Farmers carve out the steep hills of the Kilimanjaro region by hand; powering large-scale equipment is impossible. Logs from fallen trees are sawed by the power of man, not electricity. Tanzanians take their children’s education seriously – their country has one of the highest literary rates in Africa. However, the large labor demand also meant that a child’s primary priority is not education but doing their share of the chores. Firewood for cooking must be gathered, grass to feed the cows must be cut (very difficult, as the blades are short) and water must be lugged in buckets from pipes far away.
Wearing flats unfit for the precipitous dirt trail, I struggled to stay on my feet. Gilbert paused to show us the flat, long leaves of a plant on the side of the road. “This plant has special meaning to my ancestors, the Chaga people. It is used in ancient times to mark one’s territories.” We learned that you can also tie the leaves in knots to signify “no trespassing”. A gesture of peace, one can tear a piece of leaf and give it to someone in order to resolve a conflict. It is now prized as a robust and handsome houseplant, too. The national boundaries here were not drawn by Africans, but arbitrarily by European powers during the “scramble for Africa”. Thus, signs of Tanzania’s multi-tribal, multi-language culture can be found everywhere.
In many of the neighboring shambas, we could see children kicking around a makeshift soccer ball or old women sitting and chatting outside on the porch. But one plot of land did not possess the rich foliage typical of the others. Instead, the ground was a carpet of yellowing and desiccated patches. “Many young people nowadays go to the city, where they think life is better. They leave and there is no one to take care of the land.”
As the sky deepens from azure to a rich navy, we stepped down the trodden path slowly towards home. The view was breathtakingly beautiful, staggered mountain peaks peeking from a hazy grayish mist. The hills were blanketed by lush emerald canopies, not the glittering lights of civilization. The only sign of mankind was the twin cellular communication towers flickering softly in the distance.
During the brief window straddling day and night, Gilbert took us on a tour of his farm. We have stayed at his house for more than a week now, but have never ventured into his fields. Meandering through the banana trees, coffee bushes, and rows of beans and maize, you can make many insightful observations revealing broader facets of Tanzanian life. Keenly perceptive and engaging, Gilbert has the uncanny ability of understanding how society and people function, even in environments vastly different from his own. During the trip, I witnessed his natural talent for tour-guiding and story telling.
Never sparing a moment to rest, he had just spent the afternoon planning an addition to the chicken coop. On top of wild chickens, his shamba also boasts three goats (which he breeds to sell the young), seven pigs, and a bull (for harvesting manure to fertilize the crops). We strolled past the animal pens to survey the land. He points out the branches laden with still-green coffee fruit. Once red, the fruits are harvested and crushed to yield crude coffee beans. The beans are dried outside in the shade, then sold to commercial companies capable of roasting and refining. Farmers here in Tanzania sell their beans at less than $1.50 for a kilogram. In contrast, even the cheapest instant coffee will run you more than 7x that. “So we are very stupid, selling it so cheaply.” This is the plight of commodity exporters worldwide: poor countries such as Tanzania sell cash crops or natural resources at bargain prices to companies which turn the raw material to expensive end products.
Walking further, we passed by dark rich upturned soil fertile for planting. Rain here in Mwika Uuwo is thankfully frequent and the land is abundant in vegetation. Labor is all manual. Farmers carve out the steep hills of the Kilimanjaro region by hand; powering large-scale equipment is impossible. Logs from fallen trees are sawed by the power of man, not electricity. Tanzanians take their children’s education seriously – their country has one of the highest literary rates in Africa. However, the large labor demand also meant that a child’s primary priority is not education but doing their share of the chores. Firewood for cooking must be gathered, grass to feed the cows must be cut (very difficult, as the blades are short) and water must be lugged in buckets from pipes far away.
Wearing flats unfit for the precipitous dirt trail, I struggled to stay on my feet. Gilbert paused to show us the flat, long leaves of a plant on the side of the road. “This plant has special meaning to my ancestors, the Chaga people. It is used in ancient times to mark one’s territories.” We learned that you can also tie the leaves in knots to signify “no trespassing”. A gesture of peace, one can tear a piece of leaf and give it to someone in order to resolve a conflict. It is now prized as a robust and handsome houseplant, too. The national boundaries here were not drawn by Africans, but arbitrarily by European powers during the “scramble for Africa”. Thus, signs of Tanzania’s multi-tribal, multi-language culture can be found everywhere.
In many of the neighboring shambas, we could see children kicking around a makeshift soccer ball or old women sitting and chatting outside on the porch. But one plot of land did not possess the rich foliage typical of the others. Instead, the ground was a carpet of yellowing and desiccated patches. “Many young people nowadays go to the city, where they think life is better. They leave and there is no one to take care of the land.”
As the sky deepens from azure to a rich navy, we stepped down the trodden path slowly towards home. The view was breathtakingly beautiful, staggered mountain peaks peeking from a hazy grayish mist. The hills were blanketed by lush emerald canopies, not the glittering lights of civilization. The only sign of mankind was the twin cellular communication towers flickering softly in the distance.
Yaoli: 10 Meters Between Life and Death
July 3, 2009
If you ever come to visit the Uuwo Dispensary, you’ll notice that behind the main two-story building, there is a little dirt path that leads to a smaller shack. Most days it sits abandoned and empty. Perhaps a warehouse for tools, you think.
On certain days however, the little shed fills with people and life. More villagers crowd outside its tiny porch than in the whole dispensary. And then you learn that the hut have a name – “mochwari”. Inside, a tomb-like silvery fridge protects the bodies in its frozen dark abyss. Another room showcases a metallic table and cabinets laden with strange and foreign tools. The “Maponyesho” (master of the mortuary) aka Robertson is a friendly energetic man. Thin as a rail but tough like a well-drawn wire coil, he can be seen working on the gardens, helping the nurses wash the bedsheets and blankets, or doing handyman work on days when the mochwari is vacant. But today Robertson is nowhere to be seen in the dispensary. Instead, he has more important work at hand.
Meanwhile, the midwives of the mother and child clinic upstairs at the dispensary are also busily scurrying about. On a different metallic table, a young mother is in the turmoil of labor. She lies struggling on her side; her hands clutch the steel bed-frame in pain. We were following Dr. Raymond on his usual morning rounds downstairs when he was called to assist. The fetus initially was not crowning. Even after midwife Mary managed to rotate the fetus into place, the uterine contractions were still futile – the head was too large. Dr. Raymond assessed the situation rapidly, then reaches for a nearby thermos from which he pours out a molten black liquid. “Black tea, to increase the contractions.” The mother receives the cup with trembling hands and takes a few sips before collapsing again in pain. She alternates between gasps for breath, groans of pain, and prayer.
The contractions are increasingly stronger now and the doctor and midwife doubles their efforts, offering more sips of tea and kneading her swollen belly. They position the mother on her back, bending her knees up towards the ceiling. Her fingers grip her ankles until they were nearly ashen. Mary tug at the vaginal wall and I feel a shiver race down my spine. The head seems impossibly big compared to the already extended aperture. They cannot afford to wait much longer; the fetus’ life is in graver danger with each passing second. During a particularly strong contraction, Mary seizes her opportunity. Her gloved fingers grasp onto the dark matt of hair tenaciously and she pulls with all her strength. The baby’s head pops out and the rest of the body follows, sliding like butter through the vaginal canal and out into the real world. “Asante asante Jesus,” the mother cries in relief.
The baby girl is silent for the first few seconds – perhaps to catch her breath or maybe to recover from the shock of being immersed in a new environment. Does her skin sense the cool air of the delivery room? Does her ears detect new and foreign sounds? Mary wipes the newborn with a washcloth and the baby gives a resounding cry, sealing her assimilation to mankind. We welcome her warmly, enveloping her in a colorful khanga, the first of many that she will wear in her lifetime.
If you ever come to visit the Uuwo Dispensary, you’ll notice that behind the main two-story building, there is a little dirt path that leads to a smaller shack. Most days it sits abandoned and empty. Perhaps a warehouse for tools, you think.
On certain days however, the little shed fills with people and life. More villagers crowd outside its tiny porch than in the whole dispensary. And then you learn that the hut have a name – “mochwari”. Inside, a tomb-like silvery fridge protects the bodies in its frozen dark abyss. Another room showcases a metallic table and cabinets laden with strange and foreign tools. The “Maponyesho” (master of the mortuary) aka Robertson is a friendly energetic man. Thin as a rail but tough like a well-drawn wire coil, he can be seen working on the gardens, helping the nurses wash the bedsheets and blankets, or doing handyman work on days when the mochwari is vacant. But today Robertson is nowhere to be seen in the dispensary. Instead, he has more important work at hand.
Meanwhile, the midwives of the mother and child clinic upstairs at the dispensary are also busily scurrying about. On a different metallic table, a young mother is in the turmoil of labor. She lies struggling on her side; her hands clutch the steel bed-frame in pain. We were following Dr. Raymond on his usual morning rounds downstairs when he was called to assist. The fetus initially was not crowning. Even after midwife Mary managed to rotate the fetus into place, the uterine contractions were still futile – the head was too large. Dr. Raymond assessed the situation rapidly, then reaches for a nearby thermos from which he pours out a molten black liquid. “Black tea, to increase the contractions.” The mother receives the cup with trembling hands and takes a few sips before collapsing again in pain. She alternates between gasps for breath, groans of pain, and prayer.
The contractions are increasingly stronger now and the doctor and midwife doubles their efforts, offering more sips of tea and kneading her swollen belly. They position the mother on her back, bending her knees up towards the ceiling. Her fingers grip her ankles until they were nearly ashen. Mary tug at the vaginal wall and I feel a shiver race down my spine. The head seems impossibly big compared to the already extended aperture. They cannot afford to wait much longer; the fetus’ life is in graver danger with each passing second. During a particularly strong contraction, Mary seizes her opportunity. Her gloved fingers grasp onto the dark matt of hair tenaciously and she pulls with all her strength. The baby’s head pops out and the rest of the body follows, sliding like butter through the vaginal canal and out into the real world. “Asante asante Jesus,” the mother cries in relief.
The baby girl is silent for the first few seconds – perhaps to catch her breath or maybe to recover from the shock of being immersed in a new environment. Does her skin sense the cool air of the delivery room? Does her ears detect new and foreign sounds? Mary wipes the newborn with a washcloth and the baby gives a resounding cry, sealing her assimilation to mankind. We welcome her warmly, enveloping her in a colorful khanga, the first of many that she will wear in her lifetime.
Yaoli: We Are All One God
June 30, 2009
Here as in the States, getting to know someone begins with the gathering of some basic information: first name, last name, ethnicity, age, hometown… However, another common inquiry for Tanzanians not found at home is religious affiliation. Founded on the bedrock of liberty, justice and the pursuit of happiness, America have had an distrust of religious institutions for centuries. Waves of immigrants, starting with the Puritans, journeyed to the New World to escape the snarls of persecution. They vow to separate religion and state. Rhode Island became a model state for tolerance of all beliefs.
But rather than complete acceptance, modern America has chosen the path of avoidance. Although we haven’t gone as far as the French to ban all discussion of religion in the educational system, our culture nevertheless shrouds religion in a veil of silence. One’s religious affiliation is not something shared along with one’s name. Extremist groups such as polygamist Mormons, Al-Qaeda Muslims and fanatic evangelical Christians give religion a reputation of being conservative, orthodox, and discriminatory.
While some stereotypes against Christianity are indeed unfair, I cannot deny that Christians can be prejudiced. How can I treat other religions equally when my church tells me Jesus Christ is the absolute savior and that accepting him is the only path to heaven? The perspective is resolute and rigid… no room for compromise or discussion. You either believe in Him or you don’t.
So imagine my surprise when I was asked over and over again “what religion?” “what denomination?” And Sanaa? “Ah, Muslim, yes, we are all one God.” They accept it with such ease, they talk about it so openly. They tell me, “we do not want strife. There are more than 120 tribal groups in Tanzania. We cannot afford to fight. So we say, we are all brothers.” We eat lunch daily at the Parish and we all take turns praying, in English, Swahili, and Arabic. People here are far more devoted to their faith than Americans: they go to service every Sunday, make tides to their local church, send their children to confirmation school… Yet paradoxically, they are also some of the most tolerant people I have ever met.
Here as in the States, getting to know someone begins with the gathering of some basic information: first name, last name, ethnicity, age, hometown… However, another common inquiry for Tanzanians not found at home is religious affiliation. Founded on the bedrock of liberty, justice and the pursuit of happiness, America have had an distrust of religious institutions for centuries. Waves of immigrants, starting with the Puritans, journeyed to the New World to escape the snarls of persecution. They vow to separate religion and state. Rhode Island became a model state for tolerance of all beliefs.
But rather than complete acceptance, modern America has chosen the path of avoidance. Although we haven’t gone as far as the French to ban all discussion of religion in the educational system, our culture nevertheless shrouds religion in a veil of silence. One’s religious affiliation is not something shared along with one’s name. Extremist groups such as polygamist Mormons, Al-Qaeda Muslims and fanatic evangelical Christians give religion a reputation of being conservative, orthodox, and discriminatory.
While some stereotypes against Christianity are indeed unfair, I cannot deny that Christians can be prejudiced. How can I treat other religions equally when my church tells me Jesus Christ is the absolute savior and that accepting him is the only path to heaven? The perspective is resolute and rigid… no room for compromise or discussion. You either believe in Him or you don’t.
So imagine my surprise when I was asked over and over again “what religion?” “what denomination?” And Sanaa? “Ah, Muslim, yes, we are all one God.” They accept it with such ease, they talk about it so openly. They tell me, “we do not want strife. There are more than 120 tribal groups in Tanzania. We cannot afford to fight. So we say, we are all brothers.” We eat lunch daily at the Parish and we all take turns praying, in English, Swahili, and Arabic. People here are far more devoted to their faith than Americans: they go to service every Sunday, make tides to their local church, send their children to confirmation school… Yet paradoxically, they are also some of the most tolerant people I have ever met.
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