saturdays are for trainings

Each Saturday, I have been working with the team from the Buguruni Anglican Health Clinic to conduct trainings on a variety of health topics. The recipients of these trainings are 45 health works associated with the Christian churches and Muslim mosques in the area. The health workers are charming, boisterous people who love to laugh as much as they love to learn. They are very engaged in this whole process, and are the root of our success. Their desire to help their community makes our team work harder and be more engaged with our work.

I merely observed the first few trainings, with either Mr. Mabula or Dr. Obondo whispering the English translation of the Swahili lesson in my ear. It was clear that the community was confused as to why I was there. At some points, my presence even became uncomfortable. This program is based on sustainability, and the community helping its most vulnerable. The first Saturday, the health workers were talking about how excited they were to work on a program with other Tanzanians, that was both by and for the community. One of the main points was how the community can help itself without help from mzungus (white people). I am the only non-Tanzanian on my team at this point. As I was sitting there, knowing little Swahili and less about Tanzanian culture, I seriously questioned my role in all of this.  But that is part of the joy and excitement. The whole goal of public health work, especially international public health work, is to engage and empower the locals. If we do our jobs, the community should have the tools it needs to create programs and carry out health plans without outsider help. While this interaction made me question my role, it also made me proud. I am fortunate to be a part of a team and working with a community that is dedicated to helping their own. I know that this project will continue on after I leave. I know that I am learning more than I could ever give. I’m learning about education, about leadership, and about Three cheers for sustainability.

The week before last, I was finally able to participate. Dr. Obondo worked as both my translator and my co-facilitator, and together we gave a lesson on HIV. What was originally supposed to be a 2.5-hour seminar on HIV and Tuberculosis ended up being completed dedicated to HIV. The health workers had good questions, and wanted to know more about the disease, which led to our change in plans. They were engaged, curious, and willing to ask uncomfortable questions to get answers.  Part of this program is eliminating stigma around uncomfortable topics, such as HIV, and it was wonderful to see health workers and church leaders open up about their questions and concerns. Their willingness to talk candidly about HIV, and ask questions about it, gives me hope that similar conversations will be occurring within the community. We have stressed their role in training others and spreading information, and I have faith that it is working. At the end of this training, the participants told us how much they enjoyed our lecture. The Chairman even asked if we could conduct the trainings twice a week, since everyone is learning a lot and eager to learn more (due to schedules, this unfortunately is not possible).

Last Saturday, Mr. Mabula, Mama Mhada and I presented on all aspects of the Ukombozi curriculum. I taught about STIs, building on the HIV training from the previous week. Dr. Obondo was once again a fabulous translator. Mama Mhada taught about drug abuse, and Mr. Mabula taught about violence. At the end of each one of our parts, we asked about the participant’s ideas for combatting each of these issues within our community. Gathering ideas from the participants is integral to our work. If the community does not believe that a certain method will work to reduce STIs, drug abuse, and violence, then we should not include it in our future trainings. If the community strongly believes that a method will work to reduce these issues, then it has to be included. We’re building a manual that is both scientific and practical, that can be used throughout Dar es Salaam, and maybe even throughout Tanzania.

I have finally felt like I am contributing to the trainings in the past two weeks. I recognize that other members of the team could just as easily do my work, especially since they are all trained and experienced health educators. But working with the community is something I love. I learned in Guatemala that I enjoy teaching people. I enjoy answering questions, approaching uncomfortable topics, and feeling as though people are walking away from our trainings with more knowledge. Saturday trainings have become my favorite part of the week. Working with the health workers is incredibly rewarding. The members of our team are smart, compassionate, and invested in making the community better. I am so proud of the progress we are making. There is no training today, but the participants have been instructed to take time to update their action plans and collect data on the number of widows and orphans in their neighborhoods. Next Saturday, we’ll be back at it once more.

 

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taking a stand

After over a week in the hospital, Faidha’s mother passed away Monday evening. Our team is devastated. Faidha is a source of great strength in our community, and she is a remarkable, warm-hearted woman. Our thoughts are with her family.

I went with the rest of the health clinic on Tuesday to watch Faidha’s mother’s body be transferred, and to see the funeral procession off on their journey. All of the men who were present lined up, and passed the coffin between them from the morgue to the car. Instead of having set pallbearers, every male is a pallbearer. It is a chance for everyone to say goodbye and show their support. Because of this tradition, the men and women are separated. I ended up on the men’s side, since I was talking to Dr. Obondo at the time. As I hurried over to the woman’s side, I let out a nervous laugh and an apologetic smile. I was darting from one side to the other, during a time of prayer. As I stood there, saying “pole” (sorry), one of the women kept looking at me quizzically. She then asked if I was afraid. When I asked for clarification, she said, “are you afraid of us?”. Faidha and her family are Muslim. I was the only woman there without a head scarf. My heart immediately sank.

Is this what it now means to be an American? We are perceived as being afraid to be surrounded by Muslims. To parts of the world, we no longer offer aid and friendship, but fear and hatred.

I woke up this morning to find out that Trump has once again tried to shift blame of the events in Charlottesville to the counter protesters. He denounced white supremacy groups too late, and now is taking steps to defend them. We have a President who is listening to white supremacists, who is tweeting images of violence, and purposefully creating hostile environments. It is not hard to say “Nazis are bad”. It is not hard to say “the KKK is bad”. It is hard to understand why the leader of our country is unable to take a firm stance on protecting all of our citizens.

With words of “fire and fury” and “many sides”, the American President is isolating us. We are being isolated from the rest of the world, and we are being isolated from each other. The compassion, understanding, and eloquence that symbolized the previous administration is being replaced by bullying, threats of violence and hot-tempered tweets. We are taking steps backwards—steps towards segregation, steps towards systematically tearing down people and cultures.

The United States is a nation of nations. We have most cultures, religions, and languages represented within our borders. Our diversity is our greatest strength. It has led to great ideas– advances in technology, literature, science, and the arts. It has led us to strive for the best, to want the best for our friends and family, and to create a better future for generations to come. Now, with the current political atmosphere, the current ideas on race, religion, gender, and nationality within our country, we are at risk of losing all of this. We must fight the ideas of “supremacy” (white, Christian, male, straight, or other). We must differentiate between free speech and hate speech. We must strive towards equity as well as equality.

If we want to make America “great again”, we need to remember what makes America “great” to begin with: diversity, opportunity, helping others, and leadership.

To my friends and colleagues of different nationalities, gender identities, cultures, and religions: I promise to do better. I promise to support you. I promise to show up. I promise to talk less and to listen more. We will drown out the messages of hate and intolerance with messages of love and acceptance.

Please call your Representatives and Senators. Make sure your voice is heard. Attend counter protests of these hateful events, which there will undoubtedly be more of. Have the hard conversations with friends and family. Talk about race, gender identity, and religion. Work to destroy stereotypes and promote understanding. Stand up for your friends, family, and even strangers. Stand up against hate and bullying. Stand up for what makes our country great. Also, remember that mid-term elections are coming. Register to vote, and don’t forget the events of the past week when elections come.

The only way we can move forward is together.

 

zanzibar

It’s a cold, rainy day here in Dar. The perfect kind of day for reflection, administrative duties, and updating blogs. I’m sitting here in Woodbury Cafe, eating a red velvet cupcake and dreaming of sunnier days. Mostly, dreaming of crystal clear water, traditional sailing boats, and sweet mango juice. It’s been over a month since my trip to Zanzibar. I’m finally getting around to posting pictures and a little bit of my trip. So, enjoy.

I spent the first weekend of July exploring the alleyways of Stone Town and the sandbars of the Indian Ocean. Zanzibar is a quick two hour ferry ride from Dar es Salaam, made even quicker by the company of new friends. My first night in Zanzibar was spent at an outdoor night market in the Forodhani gardens. This market only appears after dark, and works as a lovely gathering place for tourists and locals alike. You can pick out any food from the many stalls, and then find a perch on the sea wall or the edge of a fountain to enjoy your meal. I chose beef shawarma, grilled chicken, and a “Zanzibar dessert pizza” (phyla dough filled with Nutella). The leftovers all go to the neighborhood cats, who impatiently wait for their next meal of octopus, fish, or chicken.

The following morning was spent exploring the alleyways of Stone Town. The whole city is a maze of carved wooden doors, friendly shop vendors, and persistent taxi drivers. I wandered to the House of Wonders, by an old church, to Freddy Mercury’s House, and along the ocean before ending up at a friendly tourist agency, who organized a spice tour for me.

The spice tour took me inland, where I learned about the difference between ground cinnamon and cinnamon sticks (ground cinnamon is from the leaves, cinnamon sticks are from the bark), how nutmeg is grown, and what a vanilla bean looks like. I tried fresh fruit, and watched someone climb a tree to retrieve coconuts.

Once back in Stone Town, my afternoon was spent lounging on a rooftop with new friends and delicious pineapple and shrimp skewers.

The following day, I went out on a dhow, a traditional sailing boat. We spent the day sailing to a sand bar, snorkeling, eating mangoes and lobster, and taking so many pictures. My favorite part was this lagoon that was as clear as a swimming pool. The depth of the water there varies with the tide, and it is only accessible at high tide. The tranquility of being in this warm, secluded water resonated with me.

Then, it was up to Nungwi for a day of beach lounging and a full moon party. My hotel was home to fantastic mango and shrimp curry, an oceanfront pool, and a gorgeous canopy bed. It was incredible. I met up with friends from the dhow ride, and we did a sunset cruise.

My last day was spent laying on the beach, and rushing back to town to catch the ferry. Zanzibar is a truly magical mix of Arabic and African culture. It is a place trying to stay true to itself while managing an influx of tourism. It is a place with poverty inland, and resorts oceanfront. It is a place torn between a brutal history of slave trade, and peaceful ocean views. With three and a half weeks left in Tanzania (oh my gosh, can you believe it?), I’m still trying to find a way back.

 

a quick update

I’ve officially passed the half-way point for my time in Tanzania. It’s hard to believe that this part of my life is almost over, and yet it feels as though I have just begun. I’ve decided to take a more holistic approach to the rest of my time here, and learn as much as I can about the health system here and the culture instead of focusing solely on my work. In my time here, I have created and revised a manual on drug abuse, violence, and sexually transmitted disease prevention. I have helped improve the monitoring and evaluation of both the program and the clinic. I lectured 210 medical students on good communication, active listening, and goal setting. I am now working to create guidelines for patient centered care within the clinic. I have also spent a lot of time watching TV and reading. It’s been a good combination of work and relaxation, of activity and reflection. I’m learning about the kind of leader I want to be, the kind of organization I want to work for, and the kind of projects I want to be involved with. I am learning to value myself and that I do have skills and insight that I can bring to a team.

The work I have seen here has been inspiring. This team of two doctors, two nurses, and Mr. Mabula is doing great work. They are training community leaders on different health practices and creating plans with the community to help the vulnerable populations. This team knows what they are doing, and I am very impressed with the execution of it all. To be honest, they could be functioning quite well without me, which is great to see and gives me hope for the sustainability of the project.

One of the nurses, Faidha, is the most lovely person. She speaks very little English, and my Swahil is limited to basic greetings and ordering a taxi (however I did learn that “rafiki” means friend, and “hakuna matata” literally means no worries). We communicate mostly through laughter and hugs. Faidha has taken me under her wing, and let me go with her on home based care visits and to see non-governmental organizations. She’s one of those people who genuinely cares about everyone. I can tell from the way she greats people on the street, talks to patients, and plays with children while distributing blood pressure medication. It’s been great to learn from her.

I need to transfer photos from my camera to my computer, but here are some more snapshots from my phone.

independence

This is my third 4th of July in the past four years that has been spent outside of the country. This is the first time in those four years that the holiday has passed with no recognition of it. I’m not here working with an American institution, I’m here working with a Tanzanian health clinic. There’s no reason that they should recognize the 4th of July as anything but Tuesday.

Today I am celebrating our country by sitting in the lab at the health clinic and working on a manual for the upcoming trainings. I’m currently working on the chapters about sexually transmitted diseases and infections, so my morning has been spent looking up information on HIV, chlamydia, and gonorrhea. It’s very glamorous, I know. I did find that the local food stand sells chapatti for TSH200 (around $0.10), which is probably the highlight of my week. Chapatti is like a denser flour tortilla that is fried. It’s delicious, and a growing staple in my diet.  I may go visit community leaders with Mr. Mabula this afternoon, to drop of thank you letters for attending our meeting last Saturday. I signed 32 of them this morning. Here, in my current life, today is business as usual. There are no fireworks and no hot dogs (although there may still be country music later on… I’ll keep you posted).

I feel like I’ve spent a fair amount of time abroad, and I am starting to consider myself to be fairly well traveled. I still have much of the world to see, and many cultures to experience. I never want to stop travelling, because it expands my thinking. It makes me consider new perspectives, try new food, and get used to alternative forms of normal. Traveling the world also makes me consider what it means to be an American. The perception of the United States varies country to country. The reaction to me, as an American, varies as well.

There are some parts of the United States that I am incredibly grateful for. In times like these, it is easy to think about everything that we want to change. Believe me, I have a long list. Today, I thought I would take a minute and mention a just few of the reasons I appreciate the United States.

  1. The educational system. As a woman, I am grateful that my access to education was not limited because of my gender. Growing up in Washington, it was expected that I would attend school. Public school taught me critical thinking, independence, and team work.
  2. The natural beauty. The United States is a vast, beautiful place. There are corners filled with deserts, rainforests, glaciers, and everything in between. I’m glad I can travel the country and see a variety of climates, cultures, and wonders.
  3. Free speech. There is a difference between free speech and hate speech. Here, I’m focusing on free speech. The fact that we can question, criticize, and praise our government and superiors is wonderful. We do not have to worry about being arrested for saying the wrong thing. We can have open, intellectual debates with people who do not share our views.
  4. The right to vote. As someone who loves politics, I find this to be great. Not only can we vote, but we can participate in the political system as much. We can campaign, attend town hall meetings, call our representatives, and march in protests. If you haven’t done any of these things, you should. Let your voice be heard; it matters.
  5. Helping others. The clinic I’m working at is receiving ART for every HIV positive person that goes there. People with HIV can get free treatment that will extend their lives for years. This is made possible because of the CDC and PEPFAR; all the medication and testing supplies are donated by the US Government.
  6. A wide selection at the grocery stores. You can find Belgian chocolate, Argentine wine, and tikka masala sauce from India all at the same grocery store. Not only that, but you’ll have multiple choices of each. I can pick from 10 different types of macaroni and cheese, and I can’t even count the number of types of yogurt. This is amazing.
  7. Stephen Colbert and John Oliver. Thanks for keeping me informed and entertained (and yes, I know John Oliver is British).

I recognize that as a white American who grew up in the suburbs of Seattle, my list may vary from other people’s. We need to work together to make sure that every American has access to the same freedoms, services, and opportunities (keep calling your Senators and Representatives!). There’s a lot we can improve, like access to healthcare, reforming immigration laws, committing to clean energy and reduced carbon emissions, and dismantling institutionalized racism. But every once in a while, it’s nice to realize that our country does some great things, and has afforded us some great experiences.

 

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lessons in patience

When I was in Guatemala, I had to actively work on being patient. I had to tell myself to slow down, to breathe deeply, and let life happen at this slower pace. It leaves more room for appreciating the small things, more room for taking it all in, and more room for forming memories. It is an understanding that life is not as easy, and that there is so much to be done. Here in Tanzania, I am once again being flooded with these lessons.

On Saturday, I witnessed a training of over 20 community leaders on the program I will be helping to implement this summer. The training was completely in Swahili, the local language that I have yet to learn, so I certainly didn’t contribute much. I am working towards learning Swahili, but that is another story. The meeting was supposed to go from 8:15am to noon, and finally started at 9:30am. It still ended at noon, as a consideration to the participant’s time. Community leaders from the local government, the local churches, and the local mosques all slowly trickled in, and were greeted enthusiastically each time. I was impressed how many people showed up at all, considering 9am on a Saturday is not usually a popular work time. Mr. Mabula explained the program, which is designed to simultaneously help widows, orphans, and single mothers while teaching about and hopefully eliminating stigma of substance abuse, domestic violence, and HIV. My favorite part of the meeting was how it was opened with a Christian prayer, and closed with a Muslim prayer. It is both interesting and encouraging to see two dominate religions co-exist peacefully and with mutual respect. I was told the meeting was very successful, with all the community leaders vowing to support the program. If we had started on time, we would not have had an audience, let alone a successful meeting. Patience guaranteed the training’s success.

The biggest lesson in patience has been the traffic, which is as much a part of the culture as the chapatti bread (Tanzania’s gift to the world) or drinking chai. That’s what happens when you have a city of over 6 million people and a handful of highways. Buses weave in and out of the roads, preparing to abruptly stop for more passengers. Cars cut each other off. The tuk tuks and motorcycles roam between lanes, on the sidewalks, and anywhere else they can find space. People organize their work schedules, their outings with friends, and their meetings around the traffic. If you’re a local, you simply refer to it as “the jam”. This is the second post I’ve talked about the traffic in, so you know it is a big deal. I’m constantly impressed by the mass daily movement of people, and the impact that this movement has on everyone’s life.

Waiting here is normal. It’s not a bad thing (we certainly wait a lot in the States as well), it’s just how work happens. The meeting starts when everyone shows up. The lecture ends when the professor is done talking. Everything is more organic, and less structured. There is room for tangents, and comments, and questions about families before work begins. There’s not the same sense of urgency that we have in the States, which for me will lead to lower levels of stress and anxiety. I’m cultivating my patience once again, and am ready for it to continue to grow.

 

snapshots and snapchats

Valerie requested that I share some images from my first weeks here, so here they are! I have yet to bring my camera out, so these are mostly shot out of moving vehicles, and all shot on my iPhone 5c. I apologize for the poor quality and composition, but hopefully you’ll enjoy seeing a small bit of what I am seeing.