WellShare International

Village Orientations

2009-02-02T08:20:00.000-08:00

We are Sharon and Rick Slettehaugh, volunteering for two months with MIHV in Karatu, Tanzania with their Child Survival Project. Our perspectives may be different than many who volunteer here, as we are retired from the business and education fields, and don’t have public health or medical backgrounds.

We have been in about 40 countries, including several in the developing world. These include Laos, Cambodia, Borneo (Malaysia), Thailand, Brazil, Jamaica, Mexico, Dominica and Peru. We have seen life in small villages similar to those being served by MIHV, so we have some reference points.

We’ve only been here two weeks and have a lot to learn. Our intention is to make periodic entries to this blog as we gain more experience. We will describe what we hope to do here further down.

The goal of the project is to improve the health of infants and children under five and women of reproductive age in the Karatu district. So far, we are extremely impressed with the comprehensive, collaborative approach taken, working with the government and other groups. The staff is wonderful to work with, and the country director, Jolene Mullins, is a dynamic leader. From our perspective, they have made remarkable progress towards the project’s goals on a very limited budget.

Some of the statistics of what the people are facing here are on the MIHV website. Here is a little more information. By at least one measure, Tanzania is the fourth poorest country in the world. On the Human Development Index, they rank 164th out of 177 countries measured.

Being here has given us a much fuller understanding of the challenges faced. This last week has mostly been spent in two villages. In both cases staff was continuing to develop Survive and Thrive Groups, just one aspect of the effort here. These groups help unmarried mothers learn more about care for themselves and their children. These particular sessions are building on past training done by MIHV, including two days of additional work with traditional birth attendants (TBAs) and a third day with the TBAs and young mothers together.

The TBAs are truly remarkable women. To put this into perspective, we had to drive between 45 and 60 minutes to get to each village, which are only 20-23 miles away. The roads are unpaved, often rutted, rocky, very rough, and should only be driven with a decent size four-wheel drive vehicle. Ours is a 1995 Toyota Land Cruiser. When the rainy season comes, some villages become isolated as the roads are impassible.

The village homes are widely spread out among fields, and divided into sub-villages. In the second village we visited there was no electricity and we didn’t see a car or truck. Cell phones work everywhere, but to get anyplace, people generally walk or use a bike, the latter being beat-up versions of the old bikes we grew up on. Even with a mountain bike, the roads would be extremely challenging.

Although the Tanzanian government and MIHV are working hard to encourage women to get to clinics for deliveries, for many of them this is impossible. The reasons include the roads and available transportation, long and sometimes difficult distances to clinics, needing to plan ahead for the delivery and hoping the due date is accurate, along with the impossibility of leaving family behind.

The TBAs are not paid for their work, except if the delivering mother and family can afford to offer a chicken or other goods. Although TBAs are give safe delivery kits by the project, sometimes the TBA must buy supplies from her own funds. Some have even been known to take in a young mother and child if the woman is unmarried and the family is not able to care for her. As you might imagine, TBAs often have to go long distances, sometimes in the dark of night where wild animals could present a danger. Add to this that they teach women of all ages before and after delivery on health and safety issues. Their roles are definitely challenging.

Traditionally, TBAs’ knowledge was passed on from one woman to another within the family or village. It is obvious they are eager for the training they receive from MIHV, and happy they can bring more skills and tools to their work. Some have limited literacy or less than adequate Swahili, yet they show incredible motivation to learn.

A previous training from MIHV was on antenatal, delivery, neonatal and maternal care. The mortality rates for both are high, with a large percentage of them preventable. For children under five, 51% of deaths are from acute respiratory infections/pneumonia, 31% from malaria, and 3.6% from diarrheal disease. The education provided by the government, MIHV and other non-governmental organizations can eventually reduce the numbers dramatically.

MIHV wants to introduce a system for income generation in these groups. By doing so, the young mothers will be able to help support their families, hopefully help TBAs cover their costs, employ good health practices and encourage the mothers to stay in their villages rather than seek their fortune in Karatu town. The income generation part of the Survive and Thrive Groups is the focus of our time here.

Karatu is the gateway for Ngorongoro Crater, the Serengeti and other famous parks nearby, with an estimated 500,000 tourists each year. The town has only about 15-20,000 people, and most of the handicrafts sold in the tourist shops come from Kenya. The women of Karatu District produce traditional crafts, including baskets and bead work that can be sold to visiting tourists. The goal of MIHV is to develop skills in the groups to perfect the crafts, help the women start agricultural projects or small animal husbandry, provide the knowledge to manage these small businesses, and have the enterprises self-sustaining. Our hope is to contribute to that effort.

It is a privilege for us to be here with MIHV.

Kilimanjaro climb

2008-08-27T11:25:00.000-07:00

By Sarah Sevcik

Tanzania
August 18, 2008

For one week, Lizz and I decided to test our physical and mental stamina by climbing the tallest free-standing mountain in the world: Kilimanjaro. Kilimanjaro means “mountain ice��? or “bad mountain��?, depending on who you ask. Both meanings, in my mind, explain it well. Kilimanjaro is the tallest mountain in Africa and the tallest mountain one can climb without technical assistance (such as oxygen). We had an amazing time, and now that it’s done we are glad we did it. I have included some details of our trip below, but let me offer you a warning. If you would like to know only the good, esp. if you want to climb the mountain one day, read only the “good��? section. If you want to climb Kili some day but want to be given a reason not to, read the “bad��? and “ugly��?. If you want the whole experience, read it all.

The Good

Kili is beautiful. Breathtaking, in fact. There are five climate zones, so within six days you’ve climbed from a rainforest to a glacier. Amazing. The first zone, the Cultivation Zone, is the fertile land with a lot of agriculture (coffee, banana, mango, bean, corn, potatoes, cabbage, and tomatoes are grown here) and livestock. Next is the Montane Forest, which is the main water reservoir for the entire region. Here you find the most beautiful flowers, my favorite being the kilimanjari, a flower marked by reds, yellows, and oranges. In this rainforest area, you see layers and layers of vegetation, including Erica trees, moss, lichen, and ferns.Then on to the Heath/Moorland Zone, where we felt like we were trampling through a Lord of the Rings set. At this point we were above the clouds. The Moorland zone is full of Erica trees with bearded lichen, lots of grass and shrubs, and full of mist. From there you enter the Alpine Desert, where only a few insects, spiders and mice can survive. It’s essentially a desert made up of stones, and the UV radiation is very intense. Finally we reached the Ice Cap Zone, described as a “landscape bleak and offers no protection.��? Nothing can survive here. There are 15 names glaciers and the Reusch crater. In addition to enjoying many climate zones, we found beauty in the amazing sunsets and sunrises. Also, on the day of the Big Climb to the summit we walked through the night, led by the light of the moon, which made the snow and ice shimmer in the darkness. Our guide and his group were awesome. This was a camping trip I’ve never experienced, where others take care of everything for us. We never had to set up camp, or cook, or boil water, or carry anything but our daypack. Instead, we had a crew of 9 men taking care of the two of us: a guide, an assistant guide, a cook, a waiter/porter, and 5 other porters. It seemed strange at first, but by the end I can see why we needed so much help. We were served incredible meals. In the morning we received porridge, eggs, hotdogs, oranges, bananas, toast. We would eat popcorn, peanuts, and biscuits with tea during breaks. Lunches and dinners were anything from homemade vegetable stews and cream soups to curry chicken and beef with French fries. We ate fresh watermelon, mango, and papaya. The hiking routes were very crowded, as were the campsites (even to the point of ‘traffic jams’ when climbing). We enjoyed this, as there was such great diversity and comradely amongst the groups. We laughed and joked with everyone, and became known as the “MN girls��?. One man from South Africa wanted us to give him cupcake recipes every time we saw him. Eventually we wrote down a recipe, which included the steps of 1. Find a porter, and concluding with Warning: cupcake icing in high altitudes is not recommended. One funny/sad story: a flock of birds took off with a zip-lock baggie of a man’s medication and a search crew was sent out around camp to look for it.

The Bad

Nights were FREEZING. Our tent had ice all over it every morning, and getting out of the sleeping bag in the morning or the middle of the night to use the restroom was about the last thing you wanted to do. The temperature produced a continuous lack of sleep (at least for me). There is no shower or washing for 7 days. We stunk, which I suppose was fine because we all stunk together. But, being a contact wearer, it’s difficult to not contaminate your eyes and keep them from burning. Dirt is everywhere; under your nails, in your ears, caked to your feet. We didn’t know if we were getting tan or just loading up more dust on our bodies.Pit Toilets: Gross. I would much rather dig a hole than use the pit toilets. They were super smelly and often produced the gag-reflex. Most foreigners (including ourselves) were not always great at directing our excretions into the small holes, so the latrines were full of, well, you know. The worst were the pits on a slope, because the liquid and poop would pool in corners. Additionally, increasing altitude and eating different food caused many-a-person to have unusual bowel movements. Lizz got food poisoning at one point, which added to the fun. Enough about that.

And The Ugly

On Day 6 we were woken up at 11:30pm to start our midnight climb to Uhuru Peak, at 5895 meters. Probably due to both altitude sickness and not getting enough rest, I woke up with a headache. Boo. Not a good way to start a 9-hour hike. First of all, let me explain that at this elevation we were already seriously suffering from a lack of oxygen, and we had another 1,200 meters to climb. I popped a few Ibuprofen and altitude sickness pills and tried to get into a meditative rhythm. At the beginning of the hike, I said, “Asante Sana Kilimanjaro��?, or “Thank you Kili!��? Within a couple hours I started cursing the mountain, if not verbally, then internally. As Lizz says, this resulted in almost instantaneous karma. I kept feeling worse and worse. My headache was horrible, and I started to feel very dizzy. The rule was no stopping, because those who stop (other than to take a quick bathroom break) may not make it to the top. In fact, depending on the route, as many as 60% of the people who attempt Kili do not reach the top. Anyhow, back to the misery.Around 5am I took more meds and gave my day pack to the assistant guide. I tried to keep a rhythm with my two walking poles and prayed I would make it. I felt horrible. Imagine climbing for 9 hours in the night, temperatures below freezing, with little oxygen, only to know when you reach the top you have to turn around and hike another 6 hours back down the mountain. I tried to not think of this.Somehow, only God knows how, we made it to Stella Point at sunrise, and continued to Uhuru Peak by 7:30am. It was unbelievably gorgeous! I was feeling better by this point (thanks to many meds), at least enough to smile and be excited. Still, I was begging to start our way down the mountain. Indeed, it’s recommended to stay at the top for a maximum of 5 minutes. On the way down the mountain, I was nearly running. By the time we made it back to base camp, I felt like I was dying. I laid down and thought I had the flu—puking, dizzy, horrible headache and stomachache, etc. But, we couldn’t stay; after throwing up my lunch (of which I had no appetite for anyway) we had to continue hiking down for another 4 hours! It was miserable. I decided that day was like hell, and I would never again attempt a Kili climb. I was also wondering if it was worth it.
Now, with days between summiting day and today, I can say the hike was worth it. The climb was by far the most physically difficult thing I’ve ever done, and I was reminded that my body does not do well with altitude. (Indeed, I was sick for a day when I ran in Albuquerque!) Still, we made it, and we have many photos to share!

Sangoma Drama Troupe

2008-08-27T11:06:00.000-07:00

By Sarah Sevcik

Tanzania
August 7, 2008

Our most recent work for MIHV involves the making of a 30-minute video about Diarrheal disease entitled “Tatua Tatizo,��? or “Solve the Problem��?. What a blast! We hired local talent, the Sangoma Drama Troupe, to come up with a funny but educational way to explain how one contracts diarrheal disease, how to prevent it, and what to do if you get it. Sangoma came up with a wonderful story about two families, one of who does everything right (uses clean water when cooking and eating, washing after using the latrine, etc.) and another who does everything wrong (eating after cleaning the area where the cows rest, etc.) The “right��? family tries to help the “wrong��? family, but the “wrong��? family will not listen. Therefore, people get sick and need to visit the clinic. At the clinic, a doctor explains what they can do to help themselves in the future, including using clean water sources, when they need to wash their hands, and the importance of continuing to breastfeed a child even when the mother is ill.

Lizz and I were the Technical Advisors. In other words, we did the filming, editing, and video production. Despite my lack of experience in filming, the video turned out so well! We can’t wait to get it made into DVDs and share it with the community. Our hope is that the Dar Express will take it and show it on their buses. We’ll see. In any case, if anyone wants to check it out, I’ll bring a copy home.

The video wasn’t the end of our work with the Sangoma group. Yesterday we went to another rural village area for the once/month market day. After touring the rows of goods and eating a great meat meal on a stick (kind-of like the State Fair, eh?) we spent time watching the Sangoma group perform dramas and traditional dances. Much like the video we produced, the Sangoma group used drama to express a variety of messages. One song/dance included the chanting of “Malaria kills��?, followed by a drama explaining the need to use bed nets and receive treatment from clinic and hospitals. Another humorous drama showed a family in which the husband told the pregnant wife that she should get pregnant right away after delivery, and then again and again. The next family who came onto the scene then explained the concept and benefits of child spacing. The dramas were a HUGE hit! Well over 600 people were gathered around to watch!

Mr. Kombo preparing our lunch.

The Sangoma Drama Troupe doing their thing!

The crowd of market-goers watching Sangoma Drama Troupe

Our Excel trainings have become very popular around Karatu. After our initial Excel training with MIHV staff, we were asked to provide training for the staff of the NGO Canadian Physicians for Aid and Relief (CPAR) and the staff of a local clinic run by a muzugu cardiac anesthesiologist. We were even asked to give a personal tutorial for the District Medical Officer himself!
For the past few days, we have been without water at home. Why? The elephants. Apparently elephants tore up the ground up on the hill where the water pipes are located. Hence, broken pipes and no water. Even though going without showers and home cooking can be a bit frustrating, how often can you say the elephants got in the way?

For the next week, Lizz and I will be hiking the Machame Route on Mount Kilimanjaro. We know it will be difficult, but we hope to make it to the top and enjoy the adventurous journey. We start in a forest and end on a glacier—how poa (cool) is that?!

In the field, chiggers and all

2008-08-27T09:36:00.000-07:00

By Sarah Sevcik

Tanzania
August 2, 2008

The past couple of weeks have gone by so quickly. Lizz and I took a 5-day holiday from Karatu to visit the island of Zanzibar, via the Dar Express bus: a 13-hour bus ride from Karatu to Dar es Salaam. The last of the Temple med students were leaving Tanzania, and we wanted to tour another part of the country with them. Zanzibar proved to be a great mini-holiday: full of fresh seafood and fruit drinks, warm weather and beaches, and plenty of spices and kangas to buy in the market. Also, the trip gave us a chance to enjoy the beautiful Tanzanian scenery: rolling hills of corn, sunflowers, and sisel plants.

Upon returning to Karatu, we quickly re-packed for a three-day “out to the field��? excursion with a few MIHV staff: Honest, Harry, Eveline, and Veronica. We piled into a car and drove on some of the rockiest, most dust-filled roads I’ve ever seen; so bumpy that Veronica and Lizz took Dramamine to not be ill! Although my head hit the car window one too many times, I enjoyed the ride, as it showed me an even more rural part of Tanzania. Indeed, in some of the villages we visited, the children were so unfamiliar with muzungus (white people) they either became fascinated with our skin and hair (wanting to touch us) or would cry and run to their mothers for safety. :-)

I love to watch Eveline and Veronica work in communities; they have such a great spirit about them, and they immediately connect with the traditional birth attendants (TBA) we were there to see. We spent the days talking with the TBAs about their most recent experiences and problems, completing our conversations with an introduction to the new monitoring and evaluation tool: the pregnancy monitoring book. It was fascinating to learn about birthing issues in these villages. Many TBAs explained how difficult it is to travel long distances by foot, especially in the night, to reach the pregnant mother’s homes. Often, the TBAs desire for the women to travel to the TBA’s home, where they can rest and the TBAs are available when needed. Indeed, in the second village we visited, a TBA helped deliver a birth just hours before we arrived. After the TBA training we had a chance to greet the new mother and her first child, who were resting on the TBA’s bed.

TBAs, one with a prized certificate of her training as a TBA.

TBA at her home, where she helped with a birth just hours before this photo was taken.
Some of the TBAs and me.

Veronica became quite popular in the villages, as she is a nurse by training, and her skills were needed on various occasions. One such occasion was to dig a chigger out of my toe. It wasn’t until a big hole behind my nearing-the-falling-off-stage-toe-nail, as well as the production of an egg sack full of nearly a hundred eggs, was presented to me that I truly believed I had chiggers. What a bugger. Needless to say, I’m a bit more nervous about wearing my sandals around town; I might stick to my “rubbers��? from now on. Thankfully, Eveline said a prayer for my toes: “In the name of Jesus, may there be no more chiggers in Sarah’s feet.��? I hope her prayer is answered.

Other than having wonderful conversations and laughs with the staff, my favorite part of being on the field was meeting with a group of TBAs who ended the session by declaring their desire to sing for us. Their voices were beautiful, and my body started to groove with the sound. The oldest woman of the group, probably in her late 60s or early 70s, noticed my movement and came over to dance with me. Boy could she dance! She started moving her hips and sticking out her bottom and swaying her arms; I followed along. She removed a kanga from her head and put it around my waist so it would bounce around as I jumped. Almost everyone started dancing, and we continued to dance and sing for another 15 minutes or so, until it was time to go and there were a crowd of men standing outside the building, wondering what was going on. The older woman then told me (in Swahili, which was then translated for me) I was her daughter. So sweet!

We returned home to Karatu last night, and I was dropped over at Peter’s home to help him make a dinner for Jolene, Lizz, Peter and me. A couple weeks ago Peter and I took a long walk towards the Ngorongoro conservation area where we passed a woman’s home with many ducks walking around. At the time, Peter inquired about the ducks; what will she do with them? Well, one of those lovely ducks was sold to Peter this past week so that we could eat it. I was very excited to take part in this process: I had never before killed my own meat. Not that I did much last night, other than take a few photos, help stuff the bird in a bag, and pluck it’s feathers, but nevertheless, in the end we had a most delicious meal. By the way this was an indigenous, not exotic, duck. :-)

The "before" shot. Poor duck.

The "after" shot. Hmm Hmm good.

Church and Dala Dalas

2008-08-27T09:31:00.000-07:00

By Sarah Sevcik
Tanzania
July 21, 2008

Sunday morning I went to a Lutheran church on the edge of town, near the Secondary School where Peter lives. Thankfully, Peter joined me, and I was excited that he’d be able to translate for me. However, when we arrived at the church, we noticed the men were separated from the women and children. Shoot. Thankfully, I was warmly welcomed to sit by the women, and during the 2-hour service I was able to follow most of what was going on. Of course, I didn’t understand the words, but the structure of the service was familiar, with everything from the prayers and the sermon to the Lord’s Prayer and taking an offering. The music, sang by a young man’s choir, was my favorite part. I just closed my eyes and listened to the voices, understanding only the word “mungu��? (God) and the intense dedication of the singers.
At the end of the service, we walked outdoors, still singing, and gathered around in a half-circle. Then came the auction. Apparently, after the service, items are auctioned off in order to raise money for the church. On Sunday, three “original Bic��? pens were the prized items! The pastor started low and increased the price until someone said they were willing to buy the pen in honor of another. The third pen was bought for 500 shilling and given to Teacher Peter. :-)
After church Peter and I took 3.5 hour hike to the edge of the Ngorongoro Conservation area. We walked through fields of wheat and fields of sunflowers, eventually reaching a coffee plantation and then a field of tobacco. Everywhere we walked, the beauty was so great it nearly took my breath away. Then, it was time to come back home to greet a bunch of our friends who just finished climbing Kili. To get home, I needed to jump on a dala dala.

The public transportation system in Karatu is the dala dala. A dala dala is essentially a 15-passenger van. However, it isn’t full until stuffed with 30-35 people, a few of whom are hanging outside the open door. Thankfully, I have not needed to prove that my arm muscles are strong enough to handle such an outdoor ride, but that doesn’t mean I lack adventure inside the van. Indeed, when traveling back from church, I was nearly leaning my head in a man’s lap while arms and even legs were tangled all around me. Meanwhile, a standing woman dug her elbows into my neck and shoulders as her way of holding on. Actually, I didn’t mind—it felt a bit like getting a deep tissue massage!

Speaking of dala dalas, Peter and another Peace Corp member are using the dala dala scenario in writing a math textbook for the secondary schools. For example, one question might read, “You are trying to make money for your dala dala business. Each person pays 500 shillings to ride. You can put up to XXX kilos on the top of the dala before it is too heavy and falls over. If more than XXX people are in the dala, it will cause a riot. How many people and kilos do you need in your dala to make at least XXX shillings if the price of gas is XXX shillings and you travel 10 miles?��?

Diarrheal disease, chickens, and Excel training

2008-08-27T08:36:00.000-07:00

By Sarah Sevcik
Tanzania
July 18, 2008

One of the biggest childhood mortality causes in Tanzania is diarrheal disease. Therefore, we have decided to make a video (with a newly donated video camera—thank you!) emphasizing hand washing. A drama group will be working with us to create a story involving a demonstration of proper hand-washing (identifying a clean water source, using soap, etc.), the appropriate times to hand-wash (before preparing or eating meals, before feeding children, after defecation, etc.), and how to get appropriate treatment when diseased.

In order to prepare for the video, however, we want to help people come up with ways to identify clean water sources. Water here is super expensive—water costs more than tea, coffee, or soft drinks, and a small bottle cost about the same as ½ the price as a main meal. Therefore, we want to develop “water stations��? made of old plastic water bottles that are heated in the sun in order to kill bacteria and other organisms. We’ve been doing some research to figure out the safest way to do this, and so far we’ve gathered some positive notes. This week Lizz and I wrote letters to 5 major water companies used in Karatu to inquire about the type of plastic used to make their bottles. The last thing we want is to find out 20 years from now everyone has cancer from plastic. At this point, things are looking good to go, however!Capacity building: One of my goals for this summer is to help MIHV with community capacity-building activities, and today I had a chance to put my skills to use! The entire MIHV staff sat in on a 4-hour Excel training that Lizz and I put together, with a good break for lunch in the middle. We brought in every computer on site and walked everyone through our “Comprehensive Introduction to Excel��?, including the use of formulas and charts. Although many staff members had used Excel, they all agreed today’s training was by far the most useful training. One woman said she had taken four courses at the university and understood more today that she’ll actually be able to use than all of those classes combined. I had such a joy teaching; all my “students��? were completely engaged and grateful for the lesson. One way they showed their thanks was to all rub their hands together quickly while chanting “pasha��? (which means “warm up��?) and then clapping their hands together at the same time while shouting “choma!��? (which means “burn��?). In other words, they are giving me the “fire��? to do a good job. Check out the photos below of the training.

For lunch today we ate rice, beans, and chicken. Merci and Eveline (MIHV staff) then became my teacher by explaining to me the difference between the “indigenous��? chicken and the “exotic��?, or “modern��? chicken. As I learned, the indigenous chicken has culture and a history, as they live for about 2 years. It is a ‘true kuku’. These chicken are really independent. When they wake up in the morning they wander all day and find their own food and water. Around 6pm they come back home to sleep. They are disease-resistant chicken. Their eggs are yellow. When you eat them, you use your hands. Modern chicken, on the other hand, only lives a number of months. They are very dependent chicken who eat modern food, fed to them by humans. They need electricity in their very small house, where they are not free to wander. They need a lot of care, for if you let them wander on their own, they would probably eat bad things and die, or get diseases. They produce white eggs. When you eat these chicken, you have to use a fork.I’m wondering, can you tell which chicken comes from American farms?? Gosh, I just love how Merci and Eveline gave such a persona of these different chickens. I was roaring on the ground laughing when they told me this story. I have a new nickname: “Pabichi��? (pa-beech-i) which means “wet spot��? or “place of water��?. I was given this name because every day when I pour water from my 5 liter jug into my 500ml bottle I spill water on my floor into a wet spot. Lizz loves it. :-)

Karatu Secondary School

2008-08-27T08:25:00.000-07:00

By Sarah Sevcik
Tanzania
July 18, 2008

On Wednesday Andrea, Lena, Lizz and I visited Peter at Karatu Secondary School, where Peter teaches advanced math and physics to an all-male boarding school. Until recently, most Tanzanians did not make it this far in their education—most only finishing primary school, if that. Thankfully, more and more secondary schools are opening around the country and students are enrolling.We sat in on Peter’s physics course, watching 15 young men dressed in uniform, quietly and intensely listen to their teacher. I have to admit, the course was really hard; I was lost in the first five minutes. Peter says he has really great students, but unfortunately they really only care about what is going to be on the national exam and let go of anything else. At times, he’ll want to teach something interesting and with more activity, but the students first ask, “Will this be on the exam?��? It’s understandable, of course, because the exam is the only thing that really matters. Thinking about this, it helps me appreciate my education, which not only emphasized grades, but also creativity, the arts, and involvement in community and school activities.

Peter and some of his physics students.

After class we took a long walk through fields of wheat to visit coffee plantations and see wildlife and birds. It was truly like a piece of heaven; I love to be in nature and get away from the hustle and bustle of cars, commerce, and people. I included a photo of the area to show you just how wonderful it was!

A view of heaven.

Upon returning to Peter’s home, we spent a couple hours playing with the neighbor children, who were such a delight! They loved to count to three and have us spin them in circles (see photo), play tag, and practice making the sounds and movements of different animals, such as lions and elephants. Again, I'm reminded that people who have very little (materially) can find the greatest joy in the simplest of activities. I love it!

Lizz and the kids.

Peter and me with the neighbor kids.

On food:Meals in Karatu generally consist of rice and beans for every meal, and sometimes spicing it up with French fries, eggs, bananas, and roasti (beef stew you put on rice and beans). Although the food here tastes great, we have been trying to be creative in adding more vegetables and protein to our diets. Every day we go to the market to buy fresh produce—green beans, potatoes, carrots, eggplant, onions, garlic, tomatoes. We’ve cooked these in every way we can think—as stir-fry, as soup, as sauce. Regardless of what we do, it’s always amazingly fresh and tasty. Admittedly, there are certain foods I really miss, namely milk, cheese, and ice cream (i.e., dairy), but thus far we have been getting used to adding powdered milk to our filtered and boiled water to make tea. Yesterday, however, was a great treat. While visiting Peter, we made pumpkin bread with a fresh pumpkin from his garden, and then made alfredo sauce with real milk. When we asked Peter where he found milk, and he said, “Find a man with a cow and bring an empty water bottle.��? So, we had seriously fresh whole milk, and it was great! Peter doesn’t have an oven (who does?), so to bake bread we had to create an oven by using multiple layers of pots, the stove, and coals (see photo). This was all done in a room without electricity, so we cooked with flashlights.

The "oven" :-)

I have been working on an Excel tutorial, which will be taught on Friday during the lunch hour. We’ll be talking about everything from how to make borders, colors and fillings to making bar charts and using the “sum��? feature. I'll let you know how it goes!

Quick, Buy a Brick!

2008-08-26T10:03:00.000-07:00

By Sarah SevcikTanzania
Quick, Buy A Brick!

If you have been reading and enjoying learning about the work MIHV is doing in Tanzania, please considering buying a brick (with your choice of what it says!) for the Healthy Mothers, Healthy Babies center. Read on...

Support mothers and babies in Tanzania

Last fall, Minnesota International Health Volunteers launched a new child survival project in Tanzania that is working to improve the health of mothers and babies. We work with communities to ensure effective prevention, detection, and treatment of childhood diseases and proper maternal care during and after pregnancy.
Part of our Tanzania Child Survival Project is the development of Healthy Mothers, Healthy Babies centers where pregnant women and new mothers can go for confidential counseling and education on pregnancy, reproductive health, and raising healthy children. Each center will include a resource library, a garden cultivated to teach women about nutrition, and learning areas for children.
The Healthy Mothers, Healthy Babies Center is about to open! This is your chance to support this important community work before the grand opening in summer 2008. With a donation of $50, we will place your name or the name of your choice, an individual or a group, on a brick used to build a patio and walkway outside each Healthy Mothers, Healthy Babies Center. Children can learn and play while their mothers use the center’s services. All donations will directly support projects in the Tanzanian communities we serve. We are in need of 100 more bricks to complete the patio, so you don’t want to miss out!
With your donation, we will be able to continue the innovative work we do to improve the health of women, children, and communities in Tanzania and around the world. Thank you for your support!To buy a brick and support this important work, visit MIHV”s website at www.mihv.org and donate securely through Network for Good. With your online donation, please specify “Brick project” in the “Designation” field. In the “Dedication or Gift” field, enter the name you would like to appear on your brick.

You may also mail your donation, along with this form, to:
Minnesota International Health Volunteers122 West Franklin Avenue, Suite 510Minneapolis, MN 55404-2480 U.S.A.
If you have any questions, please call 612-871-3759 or email info@mihv.org.

Breast Feeding and TBAs

2008-08-26T08:45:00.000-07:00

By Sarah Sevcik Tanzania
10 July 2008

Today I went “into the field’ to participate in a Survive and Thrive Group meeting. Honest, our driver, took us to the town of Rhotia, where we first met with the Community Leader to introduce ourselves and accept his blessing. Then, in one of the community buildings most often used by military men, a group of 20 young village women gathered together with their notebooks and pens, eager to learn more about today’s topic: Breast feeding.

A photo of us sharing the road. We had to get out of our car and let our driver go into the field to let the people go by. It was fun!

Photo of Joyce teaching about breast feeding.

Although the session was conducted in Swahili, we were able to follow along decently well. The women learned about the benefits of breast feeding, when they should be breast feeding, and the importance of continuing to breast feed even when they (the mother) are ill (since antibodies get passed to the child). I became quickly entranced with one woman’s baby, who just as quickly became entranced with my jump drive/ carabineer device and decided to chew on it, throw it to the ground, and hit her mom with it. I tried to take the child into my arms so her mother had free hands to write the lesson, but she refused to leave her mother’s back or arms. That was, until we started playing “catch the jump drive” on the ground. :-)

The baby and me.

After the breast feeding lesson, the three Traditional Birth Attendants (TBA) in the room continued their lessons with the MIHV staff. Traditional birth attendants are a lot like midwifes; they are female community leaders who have been trained in helping village women deliver children. The pregnancy monitoring tool Lizz and I put together yesterday came into view, and Veronica and Eveline (MIHV staff members) walked the TBAs through the form, teaching them how to use the form and making sure any questions were answered. The women were very excited about this new tool, as it keeps all the needed information in one place and is easy to use. We were all pleased. :-)

Eveline and Veronica showing the TBAs the new monitoring and evaluation tool.

Mothers studying about breast feeding.

More studying.

I’m currently working on some capacity building initiatives, such as putting together an Excel tutorial for some of the MIHV staff, especially those who want to use Excel for accounting and budgeting purposes. Chloe (a Temple med student) is putting together a tutorial for STATA, a statistical software program. We hope to conduct some lessons in the next week or two.
Another thought:I’m reminded of things we take for granted in America. I had a conversation with Peter, a Peace Corp volunteer in Karatu, who mentioned that when we go into a store or a restaurant, we expect the things on the menu or shelves to be there. And we expect them to look the same, taste the same, smell the same as every other time before. (Think McDonalds.) Here, it’s different. You may go to a restaurant and ask for chicken, but they don’t have it. Rice and beans? Maybe not today. Last week when we went into the town of Arusha to buy bread, no one had bread to buy. Water and electricity are similar issues. Last week the power went out all over the country, so we just had to wait to begin work. In the past couple of days water has been low, so we have been cautious about taking showers or using water for other washing. Although I enjoy consistency and predictability, I also love to be challenged with this kind of flexibility and unpredictability, realizing how unrealistic my American “sure-thing” upbringing is for most of the world.

Curtains and Pregnancy Forms

2008-08-26T08:36:00.000-07:00

By Sarah Sevcik Tanzania
9 July 2008

This has been our first real week “on the job”, and it has been fun and interesting already. My first day involved putting up curtains in the new Healthy Mothers Healthy Babies (HMHB) center. HMHB is in the old office of the District Medical Officer (DMO) next to Karatu health center. The idea is to allow intense education on prenatal and antenatal care for women with high-risk pregnancies. There will be private counseling for women and their families, a nutritional area, growth monitoring, and access to the health center garden for education on healthy weaning foods and diet. The center isn’t quite finished, as it still needs furniture, toilets, and a brick walkway, but Jolene hopes it will be open before we leave. We didn’t have enough curtains to cover every window, so Lizz and I spent the rest of the morning walking around the village trying to find more identical fabrics. It didn’t work out so well, but we enjoyed the process of having village men assist us by running ahead into fabric shops explaining the colors and designs we needed.

Putting up curtains in the HMHB Center.

Today we spent the day putting together a pregnancy-monitoring tool for the Village Health Committees and Traditional Birth Attendants of eight villages in Karatu District. This consisted of revising and editing the final monitoring document and then using a ruler, pencil and scissors to cut poster-sized paper into legal size paper (which doesn’t exist here) to use for printing. Often there are no (or few) records of children born in the hospital, and certainly few (if any) records when children are born outside of a clinic (which is the case for the majority of families). The record-keeping document will be used to keep better track of pregnant women in the district and make sure they are receiving adequate care during and after pregnancy. Once we printed out such booklets for each village, Lizz and I took them to town to get bound. However, there were no legal-sized binding, so each cover didn’t quite reach far enough. No problem—we just added packaging tape to the edge to make it more laminated. :-)

Lizz and I with the monitory book.

I have recently started running, and I’m thankful for the chance to do so. I find that I see the most interesting things about a culture by running through new areas and keeping an eye out for the colors that make up people’s lives. Whenever I run, the adults walking by shout out, “Pole! [Po-lay!] Pole!” which means, “Sorry!” I smile back and say, “ham na sheeda” which means “no problem”. People feel sorry for me that I’m running, but I want to! The children, on the other hand, come squealing out of their homes and dash to catch up to me. They love to run beside me for a few hundred meters with amazing pace despite their lack of footwear.

Speaking of children, I have only seen joyful and excitable kids around Karatu. They are such an inspiration to me. I just love how little things impress the children. Today Lizz and I passed Theresa’s (our house and laundry cleaner) home and saw her children playing with a broken tennis ball. We asked to throw the ball with them and they jumped up and down with joy. We probably could have stayed there all day and they would have been happy. Last week we visited an orphanage, and all of the children there were full of laughter, smiling eyes, and a love of play. We played football (soccer), let the kids use our cameras to take hundreds of photos of themselves, and found it humorous that nearly all 30 children had bright and bold colored crocs on their feet. Perhaps a gift from the states?

Some cultural experiences:
*Americans eat food much sweeter than Tanzanian’s desire. When we were camping outside during a safari, we offered roasted marshmallows with melted chocolate to our drivers. They didn’t like it at all—much too sweet. Even Mark’s banana bread has been too sweet for many Tanzanians.
*Nearly every business, tourist attraction, hotel, school and public landmark here are advertised with Coca-Cola. No joke. I think Coke must have offered them free advertising posters or something. Even the police station states “Police Post” with the Coca-Cola sign attached.
*I bought some fabric to bring to the tailor to make cloth napkins. The man didn’t speak English, and I don’t speak Swahili, so it was difficult to get my idea across. “Napkin” certainly wasn’t a word that was getting us anywhere, so I ran down the street to get a paper napkin from a restaurant and ran back, where the man said, “tissue?” Yes, tissue! It worked. :-)

The view of a village watering hole from the Healthy Mothers Health Babies office.

Jambo from Karatu!

2008-07-11T01:35:00.000-07:00

Jambo! We are Lizz Hutchinson and Sarah Sevcik, the newest volunteers at MIHV’s Tanzania site. We are Masters of Public Health candidates in Community Health Education at the University of Minnesota and will be spending the next eight weeks or so helping with MIHV’s child survival project in Karatu, Tanzania.

Our first week here at the project has been great. By far, our favorite thing about Karatu (and Tanzania more generally) is the people; everyone had been so welcoming and friendly. Kiswahili is the primary language spoken by everyone, although many speak some English. As you walk around, shouts of Jambo or hello, come from adults and children.

A funny side note about MIHV—as you know, the name Minnesota International Health Volunteers is long, and not everyone speaks English, so everyone in Karatu calls the organization just ‘Minnesota’. This often leads to confusion when people ask us where in America we are from.

After putting up curtains for the new Healthy Mothers, Healthy Babies center and completing a pregnancy monitoring tool book used by traditional birth attendants, we starting to really get our feet wet in our projects. We are excited for what’s to come!
Please check back regularly for updates on our journey and experiences in Karatu and with the project.

Asante sana (Thank you very much),

Lizz Hutchinson and Sarah Sevcik

2008-05-20T00:22:00.000-07:00

2008-05-20T00:20:00.000-07:00

2008-05-20T00:18:00.000-07:00

2008-05-20T00:14:00.000-07:00

I leave Tanzania tomorrow afternoon. It's been a wonderful, life changing experience. Everyone I've worked with and everyone in town has welcomed me with open arms. Of course there have been a few difficulties and frustrations along the way, but I'm certain I would have had at least as many had I spent these nine months in the States.

Last week, I climbed Mt. Kilimanjaro it was unbelievable. It was so beautiful and such a great way to challenge your mind and body. I was very lucky and didn't suffer from altitude sickness at all, so I was able to summit and appreciate the beauty of Tanzania from an entirely new angle.

Some of my friends told me that they got the impression that I didn't enjoy my trip to Kilimanjaro from what I had written here previously, and I'd like to apologize for that. To say that my experience of Kilimanjaro and Tanzania in general was anything less than amazing would be a lie. My intent was to show both the good and the bad parts of the trip, but I don't think I did a good enough job writing about the good. Thank you for this wonderful opportunity.

The Marathon

2008-04-25T05:37:00.001-07:00

On Monday, I ran my first half-marathon. It was generally a positive experience, and I finished in 2:10, not too bad for my first one. However, it was also one of the most ridiculous experiences of my life. We enlisted the help of a local runner in recruiting participants. He recruited about 200 international elite runners. There were no other runners besides these runners, David (another volunteer) and myself. So my time, that I was pretty happy with, was about 30 minutes after the next closest woman, and I think about 25 minutes after David. Everyone was waiting on me to start the awards ceremony, so I had mixed emotions of embarrassment and pride as I crossed the finish line. These feelings were soon enhanced. It turned out that several of the women who ran the race didn't finish. This meant that I finished 20th (and last) amongst women. However, prizes were given to the top 20 men and women finishers, so I won 5,000 Tanzanian shillings (about $4) and had to go up on stage to claim the prize. The runners were generally very kind and congratulated me on finishing the race, and my prize. Some of my office colleagues made fun of me for finishing last. Katherine and Natalia took pictures of the race, so when I receive them I will post them here as well. I'm sure everyone can appreciate the humor of me lined up next to several Tanzanian Olympians. There have been a lot of other activities around Karatu that deserve comment as well. I'll write about them tonight and post soon.

2008-03-31T06:00:00.000-07:00

2008-03-31T05:53:00.000-07:00

2008-03-31T05:52:00.000-07:00

My family came to visit for a week and a half. The beginning of the trip was not too great as their flight was delayed, and the next day our trip to Lake Manyara turned into a bit of a debacle. However, after that our trip was great. We went to the Serengeti for two days. Unfortunately we weren’t near the migration, but the scale of Serengeti is still beautiful and awe inspiring. Then we went to Ngorongoro Crater. The highlight of the trip to the Crater was the cheetah sighting. I had been hoping to see it each time I went and it finally happened. They were up running around as well, so it was interesting to see how the wildebeests and zebras reacted even though the cheetahs obviously weren’t on the hunt.

The next day I introduced my family to Karatu. We met some of the people I work with, though many people were out in the field for trainings. My mom was very excited to meet my friends at the market, so that was our next trip. They had also been very excited to meet my family. In fact, they had been asking about my mom for at least a month. She made new friends by taking some great photos, and Karla made friends by passing out candy. Next we visited a local orphanage because some people I work with were going there donate an Easter meal and others were going to film a commercial. Everyone had a great time playing with the kids, and I think my family was struck by the kindness of the children. That evening, we enjoyed dinner and watched a drama troupe performance at Highview Hotel. It was similar to other drama troupe shows I’ve seen, but I was glad to share the experience with my family because I knew my mom would like it, though I’m not sure my uncle Mark appreciated the high pressure sales tactics of the performers after the show.

That Thursday we took it easy. We did some souvenir shopping, then I introduced everyone to ugali. Ugali is made from corn flour and its texture resembles very thick mashed potatoes. It’s not my favorite food, but it’s not bad, and I felt it was an important part of the Tanzanian experience.

The next day we woke up early to travel to Lake Eyasi. While there we were able to meet the Hadzabe people, a hunting and gathering tribe in that area. They were especially skilled at finding honey, and the honey they generously shared with us was delicious. Interestingly, one of the types of honey tasted like mango juice. Then we drove to Lake Eyasi to see it. I had been near the lake, but never on the shore. I was surprised at how low the lake was, even though rainy season has started. We then met the Tatoga people. They are pastoralists, similar to the Maasai, who graze cattle. This was probably my favorite part of the day because the women were preparing for a wedding and we joined in the singing and dancing.

The next day we relaxed around the house and Gibb’s Farm (a fancy hotel nearby) and played cards and scrabble, and on Sunday it was time to leave. We traveled to Moshi so we could see Mt. Kilimanjaro, then back to the airport for my family’s departure.

Since then we conducted a drug shopkeeper training. It went well, but it didn’t seem like it would initially. In retrospect planning the training for the day after a five day weekend was a mistake, but after everyone arrived and we adapted the training for the participants we weren’t expecting it went well. We reviewed information about history taking and danger signs, discussed childhood illness, STIs, family planning, and their role in educating the community.

Now I am preparing for MAISHA training next week. It will be a tight squeeze to get everything ready in time, but it seems that in Tanzania everything falls into place at the last minute. I continue to train for the half-marathon and I’m preparing to spend four weeks in Israel on my way home from Tanzania. I’ll return to Minneapolis on June 20 and start classes two days later.

2008-03-10T06:06:00.000-07:00

2008-03-10T05:38:00.000-07:00

2008-03-10T05:29:00.000-07:00

2008-03-09T23:08:00.003-07:00

2008-03-09T23:08:00.002-07:00

I haven’t written for a while, in no small part because other that work and training for the half-marathon not too much has happened. I finally got the results to our Secret Shopper Survey, and they were really good. In the fall 45% of drug shopkeepers would not sell partial doses to patients, now 90% of drug shopkeepers will not sell partial doses. (This is important for preventing antibiotic and anti-malarial resistance). More drug shopkeepers are referring people to the hospital or advising customers to go to the hospital if symptoms worsen and the percentage of secret shoppers who felt confident in the treatment they received increased as well.

Since then, I’ve been continuing to work on a new Drug Shopkeeper curriculum to continue to work on the weaker areas of “history-taking” and recognizing danger signs. I’ve also been working on a study protocol for some research about Rh incompatibility and finishing up some details about MAISHA training.

We found out last week that the President of Tanzania will be coming up to Karatu for our marathon and the opening of the Healthy Mother Healthy Baby Center. It will be an exciting and busy time for us and should bring a lot of positive attention to MIHV and malaria awareness in general.

2008-03-09T23:08:00.001-07:00

2008-03-09T23:08:00.000-07:00

2008-02-21T00:22:00.000-08:00

2008-02-21T00:17:00.000-08:00

2008-02-21T00:08:00.000-08:00

Our trip to the Serengeti was incredible. The beauty of the Serengeti was strangely familiar, as much of it was prairie land. Obviously, the zebras and giraffes weren’t part of our summer drives across Iowa, but anyone who has ever driven across Kansas or Nebraska knows that Serengeti, the Maasai word for “endless plain” isn’t too far off. Because of the size of the park it was more difficult to see animals up close than in Ngorongoro Crater, but it seemed more natural and thus more interesting.

We had the opportunity to stay in a tented camp out in the middle of the Serengeti. According to the national park rules, camps like this have to move every three months and ours had just moved two weeks ago, so we couldn’t have breakfast any earlier that 7:30 for fear that the animals would come.

As most of you know, President Bush came to Tanzania last week. It was interesting, because even though I’m in the country I heard most of the news of his trip from friends and family back in the states. He didn’t come to Karatu to see us but his visit did essentially shut down the town of Arusha, two hours away. Ken, another volunteer, was leaving to travel to Zanzibar that day. He had to walk about 2.5 miles with his luggage to get to the Arusha Airport because the one road to the airport was closed. The president did spend a lot of time focused on malaria projects, which is, of course, an important part of our project. I think some people around the office are hoping we can use that picture of him wrapped in the bed net to make a poster.

At work, I’ve been continuing to work on organizing the MAISHA training and I am eagerly awaiting the results of a Secret Shopper Survey we conducted last Saturday. The results of that survey will help us assess if the first Drug Shopkeeper training was successful and give us an idea of what we should focus on for the next round of training.

2008-02-10T21:56:00.000-08:00

Since I last wrote, the volunteer population in the Minnesota office has doubled. Ken, a fourth year medical student from Temple, and Katherine, a soon to be first year medical student, have arrived. Our trip to Serengeti was postponed until next weekend, so we’ve been keeping busy in other ways. I’ve been working on getting a couple research projects started regarding maternal alcohol and water quality, and I’ve been preparing for MAISHA training and a survey for drug shopkeepers that will help me design the next curriculum for shopkeepers who have already had one round of training.

Our trip to Ngorongoro was incredible. I was able to see lions and rhinos, which I hadn’t seen in my travels yet. In fact, the lions came as close as 10 feet from our vehicle. There were also a lot of baby zebra, lions, warthogs, and even baby rhino around. It was hard to shake the song “Circle of Life” out of my head.

The drama troupe that performs at the monthly market day had to conclude their performance early due to rain so the new volunteers missed it. Ken and Karen will leave before the next market day so we went to a local hotel where they perform on Saturday night. They performed a traditional dance from Zanzibar, Southern Tanzania, and did some acrobatics as well. At one point during the act one of the performers bends himself in various directions to fit through a narrow metal cylinder. I think it was pretty stressful for Katherine, who was quite concerned that he would get stuck.

Sunday morning two of the Peace Corps volunteers in the area came over for brunch. Veronica, the Maternal-Newborn Care assistant manager, is staying with us right now because her house isn’t quite ready yet. The chapati she makes is very crepe-like, so needless to say brunch was quite fancy and delicious.

I also found out this weekend that my mother, my sister, and my uncle will be coming to visit me in Tanzania in mid-March, so I’m quite excited about that.

This coming week, we’ll be conducting a secret shopper survey in the drug shops, heading to Rhotia, a nearby village, to do some clinical work and community observation, and President Bush is coming to Tanzania, so we are hoping he will visit us in Karatu on the way to the Crater.

Ngorongoro Crater

2008-02-07T02:16:00.000-08:00

2008-02-07T02:11:00.000-08:00

2008-01-28T00:15:00.000-08:00

2008-01-28T00:11:00.000-08:00

Back to Karatu

2008-01-28T00:06:00.000-08:00

After two days of travel, I arrived in Karatu Tuesday evening, and because all of the sleep I got was on planes, I don’t think I’ve ever been so tired in my life. The next day I took it easy, but did visit my friends in the office. I had almost forgotten how much fun everyone here is while I was gone.
On Thursday, it was back to work, and Friday, Karen, the other volunteer, conducted a planning workshop. It was really great. It can be difficult to track people down to make plans when they are out in the field, so it was wonderful to be able to sit down with everyone and make sure our plans all work together.
After work on Friday, I went out for a jog, and upon returning home my friend Margaret was at my house. She told me there was a man under a tree across the street that was quite sick. He had been throwing up for three days, and had walked from a town that is over six hours away by car without eating or drinking. He had been working in Serengeti, but got sick and was trying to return to his home near Mt. Kilimanjaro. Needless to say he was quite confused.
I made him some oral-rehydration solution. He was able to drink it, but soon vomited again, so we took him to the health center for some additional help. Because his pulse, blood pressure, and temperature were normal they asked him to come back the next day if he was still sick. There were some men in town who tried to help him find some food and a bed. My guess is that he had an electrolyte abnormality, and needed IV fluids, but I did not have access to the necessary lab tests or an IV, so I couldn’t do much more to help. Unfortunately, I don’t know what became of him.
This weekend, Karen, Veronica, and I went for a short hike to the Elephant Caves and a waterfall. We were a little disappointed that we didn’t seen any wild buffalo or elephants because we could tell they were nearby, but next weekend we will be going to Ngorongoro Crater, and the following weekend we will go to Serengeti, and we won’t have any difficulty spotting wildlife there.
MIHV is planning a half-marathon for malaria awareness on April 25. I am excited about this because, initially we had planned to organize a full marathon, which I had no intention of training for. Karatu is about a mile above sea level and the surrounding area is very hilly, not a good place for a first marathon, if I were interested in participating in a marathon in the first place. We changed the plan because many local marathoners are training for a marathon about one month after ours. They were interested in a training race, but running another marathon would have been too much. This works out great for me personally because I think a half marathon is something I can do, so I look forward to participating, even though I probably will be the last one to finish.
This week, a new volunteer, Ken, is arriving. He is a fourth year medical student from Temple University. We are planning to work in the clinics at some of the local health centers and do some community observation regarding water sources, latrine availability, standing water, cooking fires, etc. I will also be putting the finishing touches on our MAISHA training materials, for a training at the beginning of March and working with the District Pharmacist to plan the next round of Drug Shopkeeper trainings.

Nimefurahi kukujua (I am happy to know you)

2008-01-19T19:32:00.000-08:00

Hello, I am Amy Walsh. I am a fourth year medical student at the University of Minnesota. After going home for the holidays, I leave tomorrow to return to Karatu, Tanzania. I was in Karatu for four months this fall, and will spend four more months in Karatu before returning to my studies. So far my work has focused on designing a training for local drug shopkeepers to help them recognize emergencies and improve drug dispensing procedures and designing a training for local taxi drivers and long haul truckers to help them provide emergency transport and community health education (MIHV's MAISHA program).

A little about me, I grew up in Bettendorf, IA and studied Biology and Chemistry at the University of Missouri before medical school. I delayed my graduation from medical school to participate in MIHV's project in Tanzania, and after I complete school I plan to pursue a career in Emergency Medicine. I am hoping to integrate international medicine into my career, though as of yet I am unsure how I will do that. Outside of academics, some of my interests are ultimate frisbee and mountain biking, and I've been spending my off time in Karatu braving the dust in Karatu to go running and reading a lot of incredible books, next on the list is The Epic of Latin America.

I look forward to sharing my journey in Tanzania with you.

Zanzibar

2007-12-22T20:51:00.000-08:00

Unfortunately (due to malaria), I spent most of our trip to Njombe in the fetal position, but after a few days in southern Tanzania, Amy and I headed to Morogoro and then on to Dar and Zanzibar, where we would spend our last week before flying home for Christmas.

Onions for Sale

2007-12-16T20:48:00.000-08:00

Malaria is hell...

2007-12-14T20:41:00.000-08:00

But after 4 days and 48 pills (16 ibuprofen, 5 flagyl, 24 ALu, 3 Cipro) I'm happy and healthy again!

Heading South

2007-11-29T12:25:00.000-08:00

Tomorrow Amy and I are heading to Njombe, which is about 13 hours south of Karatu, where we'll visit a hospital that MIHV is considering partnering with to send medical volunteers to in the future. I'm really looking forward to seeing another part of Tanzania, and after a few days in Njombe, we'll head to Dar es Salaam, and then spend a few days in Zanzibar!

Where is the rain?

2007-11-29T03:11:00.001-08:00

The rainy season started in Uganda just before I left for Tanzania and a few weeks ago Karatu seemed to be following suit, but after a couple days of rain, the skies cleared.

The slightest breeze sends dust everywhere. Today, walking into town, the wind picked up and all the people in the street had to stop, shielding their eyes with their hands, hiding their faces under congas, as the road jumped up and around, into hair and noses and mouths.

It's the end of November and supposedly the middle of the short rainy season, but we seem to be missing a key ingredient...

Ngorongoro Crater

2007-11-27T04:22:00.000-08:00

This weekend, we visited Ngorongoro Crater, one of the most spectacular safari spots in all of Africa, that's just 15 minutes from MIHV's Karatu office. Ngorongoro is reputed to have the densest population of mammalian predators in all of Africa. Inside the crater, we drove past hyenas, herds of zebra and wildebesets, buffalo and elephants, a pride of lions and even a black rhinoceros! (In 1965, there were estimated to be about 108 black rhinos left in the world; in 1995, this had fallen to between 11 and 14).

Give Thanks

2007-11-25T22:57:00.000-08:00

If the only prayer you said in your life was “thank you,” that would suffice – Meister Eckhart

This was my first Thanksgiving away from home.

I was expecting it to be a difficult day, anticipating that most of the traditions that mark the holiday for me would be absent. There were different people around the table and different food on our plates, but I was surprised that it still felt like Thanksgiving.

Thanksgiving is a completely American tradition and some parts of the holiday were difficult to explain to my Tanzanian coworkers (Pilgrims? Cranberry sauce? Balloons of cartoon characters on 5th avenue?).

The important parts, however, translate. There was good food, good people and a day to appreciate the generosity I’ve received. Silent thanks for teachers who have inspired; for family who have loved selflessly and siblings who have always been my toughest critics and most loyal companions; for friends who have walked with me and strangers who have made the journey a little easier; and this year, most of all, for the many people who have welcomed me into their country, their homes and their lives.

Another deeply American tradition is expressing our gratitude by sharing what we have with others; sharing a meal, sharing our stories, sharing our wealth. Americans have a long tradition of giving and, looking at charitable giving as a percentage of a country’s GDP, Americans give over twice as much as any other country. In 2006, Americans contributed $295.02 billion and nearly 76% of this money came from individuals. (You can read more here).

According to a July 2007 study by the Charities Review Council, Minnesotans are especially likely to support charities, with more than three-fourths of Minnesotans giving to non-profit organizations (other than religious groups and colleges and universities).

Consider supporting MIHV. Your generosity makes a difference in the communities we serve.

$50 for a brick will help establish and support on-going activities at Health Mother/Healthy Babies Centers throughout the project area.

$80 will purchase a bicycle for use by a Village Health Worker in the provision of community based health education and identification and follow-up on pregnant women and sick children under 5.

$10 will purchase a delivery kit for project trained traditional birth attendants to provide safe deliveries of women in emergency situations and isolated areas while protecting the traditional birth attendant and mother from blood-borne diseases.

$500 will provide training to 20 traditional birth attendants in safe delivery, antenatal care, post partum care and referral services.

$3,000 will provide training at ward and village level for community-integrated management of childhood illnesses.

$100 will support performances in two communities by the project’s trained cultural troupe disseminating life saving information on malaria, diarrheal disease, MNC, pneumonia and child spacing.

$250 will support one year of meetings for a village level Survive and Thrive Group providing health information and capacity building training to young, unmarried, pregnant women.

For more information and to support MIHV, visit us online.

Sundays are for Scrabble

2007-11-21T00:03:00.000-08:00

On Sundays, Jolene, Amy and I try to find a place more beautiful than the week before to play our weekly scrabble game. In such a small town you’d think we’d be running out of places, but Karatu is a mighty beautiful small town.

Funerals

2007-11-20T20:45:00.000-08:00

In the last seven days, there have been two funerals.

A week ago, our District Medical Officer died and Saturday, one of the women on our staff lost her sister.

I can count the number of funerals I’ve been to in the last 18 years on one hand, so two in one week seems to me quite a lot.

At the last funeral I went to, the horses pulled my grandfather’s body across his farm, his home, to the grave and we followed, a trail of black. Here, as the doctor is carried across his farm, his home, to the grave, women in brightly colored congas follow: greens and yellows, red, lavender, white, patterned with flowers, chickens, the moon and stars.

For days before the funeral, the family holds all night vigil. Everyone goes. We sit for hours together, sometimes in silence, sometimes drinking tea and eating pilau, sometimes talking about Doctor, about work, but mostly silence.

The Burden

2007-11-19T14:01:00.000-08:00

Malaria Program Featured

2007-11-16T09:18:00.000-08:00

Check out the article on our new Malaria Communities Program, featured in the New Vision's Health section this Monday.

Duka La Dawa

2007-11-09T00:57:00.001-08:00

A child gets sick. Often, Tanzanian parents take the child to a traditional healer first. If, after a few days, the child is not better, they will then take their kid to a duka la dawa (drug shop), which has medications, but no one licensed or trained to prescribe them. The medication may not be the correct treatment for the illness or it may not be the right dosage. So, a few days later, if the child still is not better, the parents now take the child to the health facility (a facility where they could have gotten the correct medication, at the correct dosage, for free). The child is now very, very ill; and has been sick for several days. Sometimes, the health facility can help, but often the child is now too far gone. The child dies, and of course, “the health facility killed my child.”

This compounds the problem and only makes families less likely to seek out the formal health sector. Meanwhile, duka la dawas prosper. In Karatu alone – a town with a population of just 71,000 – there are 14 drug shops. In August and September, to assess the extent of the problem, MIHV trained “secret shoppers” to visit the shops with their sick child. Our “shoppers” found that while correct medications were usually prescribed (two-thirds of the time), they did not provide proper dosage and consistently gave partial dosages. For example, if a parent comes in with a feverish child, the drug shop keeper may tell them the child needs to take an anti-malarial -- the first line malaria treatment in Tanzania, ALu, is 24 pills -- if the parents have only, say, half of the cost of the drugs, the shop keeper will take the money and give the parent 12 pills.

Involving these informal links in the chain of health services is crucial. In October, MIHV held the first of several drug shop keeper trainings, where they discussed the importance of not giving partial dosages (in the short term, people don’t get better; in the long term, partial dosing leads to drug resistance) and if a family can’t afford the full amount, then refer them to a health facility where they can get the drugs for free.

Recently, Jolene, MIHV’s Tanzania Country Director, started feeling sick. We have a pile of partial dosages left over from the “secret shopper” assessment, so Jolene took part of the medication she needed and then sent someone to a duka la dawa to buy her the rest of the dosage.

The drug shop keeper refused to sell the man a partial dose.

Tembo

2007-11-08T09:11:00.000-08:00

We're Growing!

2007-10-31T05:07:00.000-07:00

Minnesota International Health Volunteers arrived in Karatu last January and as we approach our first anniversary, we’re growing. Our Tanzania Child Survival Project now has 18 full time staff.

Some of our incredible staff:

We’ve out grown our first office, and there’s a team hard at work on the new office!

The new space will have a training room, a resource library for the community and plenty of office space. Move in date is January 1st.

Statistics

2007-10-30T06:45:00.000-07:00

In sub-Saharan Africa, one child dies of malaria every thirty seconds.

I’m working on an article for an African newspaper about the U.S. President’s Malaria Initiative, which hopes to reduce malaria-related deaths by fifty percent. I was trying to make this statistic positive, to show what a difference programs funded by the initiative, like MIHV’s new Malaria Communities Project will make.

They will make a difference. And if they halve malaria deaths it will be huge.

But a child will still die of malaria every minute.

African Time

2007-10-28T00:09:00.000-07:00

Recently, I was having dinner in Nairobi with Father Joe and his friend Charles. We were discussing when we would leave the next morning.

Joe: Well we want to be there at ten, so we should leave at eight.
Charles: There’s no way it will take us two hours to get there!
Joe: But we need to leave time for the people we meet on the way.

Shades of Black

2007-10-27T07:57:00.000-07:00

“Those kids are sooo Ugandan” says Mercy, one of MIHV’s Tanzanian staff, looking over my shoulder as I sort through some photos on my computer.

“How can you tell?”

“Well, they’re darker. And look at those cheeks!”

Mercy’s skin is lighter, but not by much, and I’ve met Ugandans with surprisingly light skin.

“You can really tell if someone is Ugandan or Kenyan or Tanzanian just by looking at them?”

She nods. So I sift through my pictures, avoiding shots of women in traditional clothing, which would give away the region.

“Ugandan.”

“Kenyan.”

“Ugandan.”

“Tanzanian.”

“Ugandan.”

“Kenyan… oh no Ugandan. Definitely Ugandan.”

She’s right every time.

As I’m walking home later, I try to see the differences in the children I pass, but I can’t. As an outsider, there is so much that I just can’t see.

Karibu Karatu

2007-10-27T07:37:00.000-07:00

After almost two months in Uganda, working on MIHV’s Child Spacing Program and new Malaria initiative, I’ve moved to Karatu, Tanzania, a district in northern Tanzania that is home to MIHV’s Child Survival Project.

In Karatu, where 112 of every 1,000 children born die before their fifth birthday, MIHV's project is promoting maternal newborn care and child spacing and working to control malaria, diarrheal disease and acute respiratory infections. Over the next five years,the project will help over 100,000 people. The project reaches the community through groups like Survive and Thrive, a support group that enforces healthy behaviors for young single mothers and MAISHA (Men Active in Sustaining Health, MAISHA means "life" in Swahili). MAISHA works with taxi drivers in the region to convey health messengers to their passengers and trains the drivers to assist with emergency transport to clinics.

Karibu Tanzania!

Kitui

2007-10-27T03:31:00.000-07:00

Driving through southern Kenya, Uganda’s green expanse of banana trees and dark red soil is replaced by sparse fields, home to the occasional baobab tree, whose twisted arms reach up to the scorching sun. Here, the dirt is thirsty, khaki colored.

Kitui, is one of the most arid regions in Kenya. Locals told me it hasn’t rained since April. Some claimed that a few drops came down in July.

I was able to spend a week in Kenya, visiting a dear friend, Father Joe. We traveled from Nairobi, across Kenya, to his parish, and later to his childhood home in Mwingi, and to Tsavo, a huge wildlife reserve.

As we’re driving I ask Father Joe to stop, I need to stand on the ground, so I can understand what I’m seeing in a way that’s only possible when your feet are on the earth. “You are so lucky to live in this beautiful place” I say over and over. “It is very dry” he replies, over and over.

Some people say that beauty is painful. Though I suspect they’re more often talking about dieting or cosmetic surgery than the Chyulu Mountains, as I look out at those dry mountains, terraced by farmers in a feeble attempt to support their families, as we drive over bridges that cross dusty river beds, I see so much beauty; so much pain.

Lake Mburo

2007-10-25T09:08:00.000-07:00

I spent my last weekend in Uganda at Lake Mburo National Park… no lions, tigers or bears, but lots of impala, baboons and zebras!

I especially liked the zebras.

“…Zebras have a lot of stress because they have to flee from lions on a regular basis, but after the crisis they mostly just graze calmly. People, on the other hand, spend too much of their downtime worrying about the lions in their lives.” –NY Times

In the Southwest Journal

2007-10-24T22:35:00.000-07:00

A banana tree with a few stalks is stronger

On both sides of the road, going on forever it seems, are fields of banana trees. And as we drive to Nanseko, a village in rural Uganda, we avoid the deep ruts in the dirt road by swerving from one side and then to the other, veering so close that the long banana tree leaves brush the car's window.

Check out the full article on MIHV in Monday's Southwest Journal.

Rainy Season

2007-10-24T22:28:00.000-07:00

“It will rain every day now,” Robert tells me.

On Sunday, the rains came along with the wind, blowing the fronds off palm trees and uprooting a hibiscus plant in the yard.

The rainy season has started.

In Uganda there are two rainy seasons – a longer one, lasting from March through May, and a shorter one in October and November.

On Thursday, the rain started softly, the pregnant clouds just drip-dripping, but by the time we reached the bottom of Mbuya Hill, near the Kampala office, the rain was coming down hard. As we started up the hill the car lurched back and forth as Peter, the driver, tried to avoid the rivers of ochre mud rushing down the road. As the car rocked from one side, it jolted, stalled, stopped and then started again.A plastic rosary swung back and forth, looping around the rear-view mirror. As rain covered the windshield, the blue beads and tiny cross danced to Peter’s reggae music.

Religion seems to show up a lot here. Rainstorms. Supermarkets. Introductions.

When I first met Lilian, who I would room with for about three weeks, one of the first questions she asked me was “Are you a Christian?” A little confused, I nodded. She smiled, approvingly. I had just won some serious brownie points. “And what Church?” She was visibly disappointed when I said “Catholic.”

When I was later introduced to MIHV’s Mubende driver, Ronnie said, “This is Mwange. He’s a Muslim.”

The street merchants market light-up pictures of the Virgin Mary to the cars stopped in traffic. And Eid-ul-Fitr, the last Friday of Ramadan, is a national holiday.

Sunday morning, as I walked to church with Passy, a friend who I stayed with this past weekend, she explained, “Sometimes it’s hard to get people to go to church. They don’t know that they can do no work without God.”

The night before, I had fallen asleep to Passy’s children reciting their prayers, the Luganda words flowing together into a holy stream.

Unsure of my own faith, being surrounded by such certainty is at once comforting and disconcerting.

Now the beads stop swinging. The car has stopped. “It’s out of gas,” says Peter. We’re two houses away from the MIHV office, but it’s pouring. Peter turns off the engine and the reggae and we sit, quietly, trying to discern anything beyond the windshield. Peter puts the car in neutral, and we start to roll back down the hill.

“What are you doing!?”
“Oh, it will start if we go backwards,” explains Peter.

We roll down past the offices, the gated houses and near the bottom of the hill, Peter tries again. It doesn’t start. And now we’re at the bottom of the hill.

So I get out of the car and run. The water rushes down and over my ankles as I make my way through the henna colored dirt-rivers, up the hill.

Soaking, I run and run and laugh and laugh, because here I am in Uganda, crossing the red sea.

Lamadan

2007-10-08T15:09:00.000-07:00

For the last month, during Ramadan (which often becomes "Lamadan," because in African English "r" and "l" are pronounced the same, making my name often "Sal"), men in long white galabiyyas and hats and women in hijabs color the streets as they make their way to mosque.

Under a Mango Tree

2007-10-05T15:02:00.000-07:00

This is Sister. Her Christian name is Mary, but Sister is the name used for older Ugandan women who have earned great respect in their communities. Sister’s whole life radiates a deep reverence for the dignity and wellbeing of the people in her community

Sister’s father wanted her to be a teacher, but she insisted she wanted to be a nurse. Nursing doesn’t feel like work, she explained. Along a shelf in her home rests a piece of painted wood with the words carefully carved, “Do your work not for mere pay, but from a real desire to serve.” (1 Peter 5:2). After working for seven years as a bedside nurse, Sister went back to school to be a nurse trainer, fulfilling both her and her father’s dream in combining teaching and nursing.

Twelve years ago Sister was hired by MIHV. Although she has worked in several positions, today she is the Deputy Country Director and the Family Planning Coordinator. She’s a busy woman; she’s the leader of her church’s Christian Women’s Fellowship and a human rights activist, having trained several years ago as a paralegal, she works in outreach programs to spread awareness to rural Ugandans about their rights.

Sister raised three children of her own. She lost her oldest son, Andrew, to sickle cell anemia at seventeen. Her youngest daughter, Annette, graduated from Makerere University last weekend. Her older daughter, Esther, will give birth to Sister’s first grandchild any day.

Sister is not wealthy. “Sincerely,” she said, “I’ve had to take out bank loans to get by.” Yet she would never turn away someone in need. Norman, 6, and Shakira, 14, are only the most recent children to take up residence in Sister’s house. Over the past several years, Sister has taken in and covered the school fees of a number of her brother’s children, orphans and even the daughter of one of MIHV’s Ssembabule guards.

Like many of MHIV’s staff, Sister has deep roots in the community and is nourished by her faith. With roots and faith, MIHV’s passionate staff are deeply committed to the health and wellbeing of others. No one would dispute that Uganda is materially a poor country, and yet I have never received richer hospitality. “We don’t have a lot,” said Sister, “but what we have, we share.”

“With committed staff you can set up a clinic under a mango tree.” –Helen Epstein

Jesus, etc.

2007-10-03T11:54:00.000-07:00

Many Ugandan establishments endorse a higher power.

Organized by Collective Disorder

2007-10-03T07:54:00.000-07:00

In grade school, I went everywhere as one segment of a straight line of classmates, dutifully ducky-ing along behind my teachers. I remember one teacher would play a game with my class as we walked from the art room to the lunchroom or back to our classroom, surprising us by turning around from her position at the head of the line to inspect our line. We loved the game, and giggled as we carefully followed the child in front of us to ensure that all twenty-one of us stood neatly like dominos.

I don’t think Ugandan kids play that game.

Ugandans don’t order themselves like Americans. There are few zebra crossings (crosswalks) here and where there are, people don’t use them. Rather, people cross four lanes of traffic wherever they please. And when I say lanes, I really mean a road three cars wide, that has boda-bodas (taxi motorcycles) weaving in and out of the cars and matatus (mini-buses), because there are no lanes.

In churches, a collection basket isn’t passed around. Instead, there is one large basket at the front of the church and at a designated time in the service, everyone gets up and squeezes past the others to put their donation in. At communion, people don’t get up row by row or form a line. There is a holy free for all towards the priest and the little round wafers.

Last week, while I was in town, a man stole something, or at least that’s what someone said. In retribution for the theft, the shopkeeper threw a rock at him. Another man joined and then six more and soon there were thirty some people throwing rocks at one man as he ran away, stopping occasionally to deflect the rocks with a large stick.

One Month

2007-10-02T08:49:00.000-07:00

This is a letter I sent to many of my friends and family a few days ago. A few people suggested I post it as well.

Dear Friends,

Tomorrow I will have been in Uganda for a month.

Every morning I wake up at seven to gospel and/or Christian rock music (I am rooming with a Born-Again Christian who likes to start her day off with a healthy helping of Jesus). I spend most of my day traveling between villages visiting and interviewing people and in the evenings I write profiles and articles. I love the work I’m doing here and I feel like it’s been a very good “match” – I am getting so much out of living here and think in turn I’m also able to give a lot to MIHV in return.

I am deeply grateful to the people I meet everyday who welcome me into their homes and tell me their stories. I spend six or seven hours a day sitting with people and having conversations about their family, education, aspirations for their children, their sex lives, marriages and separations, religion, childhoods, reasons for using (or not using) contraception, and their goals for their communities.

Today Specioza, a 50-year-old woman, brought out a blue plastic photo album filled with photographs of her ten children. Another, Benedict, told me how while giving birth to her fifth child, labor was obstructed and her uterus ruptured. That child, who died in birth, would have been her first with her husband. As she told me her story, her husband picked up his three-year-old daughter from his second wife, who he married shortly after Benedict’s hysterectomy.

Sometimes it’s a bit strange, going up to strangers and asking them what type of contraceptives they use and why, how their religion affects their decisions, how being one of three wives affects them emotionally or their children financially. But when you get past the initial fear of asking such personal, at times painful, questions, you realize it is a glorious opportunity to be invited to ask these questions. It is an opportunity to begin to know a country, one woman, one family, one story at a time. Sometimes, when I’m walking along the little paths that weave past mud houses and through the fields of banana trees, I inhale Uganda and try to exhale gratitude.

I cried for the first time during an interview recently while talking to a 14-year-old girl named Fatumah. Fatumah’s parents separated when she was an infant and the family lost contact with the mother. Fatumah’s father raised her and her siblings. When Fatumah was 11 her father was diagnosed with AIDS. The girl’s older siblings had moved away and Fatumah became his full time care taker. He died a year ago.

School started for Ugandan children about two weeks ago and when I spoke with Fatumah, a few days before school would begin, I asked her what grade she was going into. She explained to me that she was kicked out of school last July because of overdue school fees (Uganda has universal primary education, but school fees for secondary schooling can be prohibitive, even for families where both parents are living). She plans to spend the fall working her family’s small farm to raise money so she can go back to school. When I asked Elijah, one of MIHV’s Ugandan staff if he thought she could feasibly do this, he said it was unlikely she would ever go back to school. “Other expenses will come up,” he explained. “Who will pay for the paraffin for the lamps?”

I asked Fatumah how much she owed the school. She owes 15,000 Ush for the construction of a new latrine, 5,000 Ush for lunch, 14,000 Ush for her uniform, 3,000 Ush in exam fees and 7,000 Ush for school supplies. When I realized 44,000 Ush (about $27) is keeping a 14-year-old from going to school, I started crying. I’m not sure if it’s a good idea to cry in the middle of an interview, but I’m pretty sure I wouldn’t be any good at this job if life here didn’t make me cry sometimes.

Take care,
Sarah

My Wednesday

2007-09-26T09:22:00.000-07:00

Today I woke up, made tea, helped distribute 30,000 condoms, spent 6 hours interviewing family planning community health workers (essentially peer counselors trained by MIHV), and spent another couple hours writing up the interviews and sending queries for MIHV.

Overall, a pretty normal day.

In the New Vision today

2007-09-24T01:49:00.000-07:00

It takes two to plan a family

MANY young Ugandan men know they do not like birth control, even if they do not know much about it. “Most men think family planning is harmful,” explained Kassim Balikyweunya, 17, from his spot cheering on the sidelines of the football match. “They think those hormones destroy a woman’s uterus.”

Balikyweunya was among the 250 people at Minnesota International Health Volunteers (MIHV)’s first “Family Planning Day” in Nanseko Village. He expressed a prevalent misunderstanding about the side effects of contraceptives.

The full article appeared in the New Vision today, Uganda's leading daily newspaper. You can view it online by clicking here

Emma

2007-09-17T04:15:00.000-07:00

“I’m surprised he’s not scared of you,” said Lilian. I have just picked up Emma (short for Emmanuel, a common name for Ugandan baby boys born on Christmas). His dark eyes gaze up at me, he pokes his tiny fingers at my pale face, then he sighs, sticks his thumb in his mouth and rests his head against my shoulder.

I think there is a joy in holding a baby, because you are holding close to you someone who knows a great secret.

As infants we know something that is lost when we no longer know what we know because it is what we feel, but because it is what everyone around us does. We do not learn language because we instinctively feel that the word “milk” means lunch or that “mzungu” means white person, outsider – we acquire language from others. But before language, there are some things that are not acquired, things that are imbedded deeply in our brains and heart and pancreas, and seem to be lost on everyone over the age of 18 months.

Where ever I go, people stare at me.

Not a surprised glance or a quick once over, a long, uncomfortable stare. Sometimes I meet their gaze, hold it, smile, all the while thinking, ‘Yes, I see, you’re looking at me, I’m white, but that’s enough now.’

Ugandans may be many things, but they are not mind readers. They just keep staring.

Every time I go to the latrine behind the Mubende office, a little girl calls “Mzuuuunnnnguuuuu, Mzuuuuunguuuuu,” drawing out the “ooooo” sounds. It’s been a week and she still feels the need to herald my presence. Yesterday, a man at the market, ten feet from me, barked, “Mzungu, Mzungu, Mzungu.” While running in Ssembabule, I looked to one side of the road, and there were a dozen people, adults who had been working, children who had been playing, all frozen, their eyes following me down the rutty road.

Emma’s mother is one of our puppeteers for Family Planning Days. As his mom rehearses, Emma and I walk around the event, stopping to watch the cattle being herded by, wandering over to a group of children laughing, past the women who stare.

Emma isn’t offended by my whiteness. For him, my hip is just a hip and my shoulder’s paleness does not merit an announcement. It’s just a shoulder, a good a place as any to rest his tired head.

Little People, Little Shadows

2007-09-14T08:46:00.000-07:00

Are we speaking the same language?

2007-09-13T23:28:00.000-07:00

I think Mwange (MIHV’s Mubende driver) and I are both speaking English, but sometimes it’s hard to tell.

Earlier today I called him and said he did not need to pick me up, I would walk. He arrived a few minutes later.

Then this afternoon, as we arrived at the apartment complex several of the staff live at, we had another meaningful conversation:

Sarah - “How long have you lived here?”

Mwange – “Oh he’s just opening the gate.”

(I look confused.)

Mwange - “Wait what were you asking?”

Sarah – “Oh, I wanted to know how.... long .... you .... have.... lived .... here?”

Mwange – “Ooooooh. About three hours.”

Family Planning Days

2007-09-12T13:31:00.000-07:00

Sunday, MIHV hosted the first of four “Family Planning Days”

After a rainy morning, we had a beautiful afternoon. Over 250 people attended, including many of MIHV’s target audience – teens and men. The idea for the “Days” is to bring in communities not served by other MIHV outreach programs and invite them to an event that is both fun and provides information on family planning.

The average Ugandan woman has 6.7 children, the highest fertility rate of any country in eastern and southern Africa. Although most Ugandans know about family planning (96.6% of all women and 98.1% of all men can name at least one method), usage of contraceptives is fairly low. Just 24% of women age 15-49 report using any method of family planning and when limited to modern methods, this number drops to 18% and further yet to 15% in rural areas.

The people gathered seemed to enjoy the afternoon; children danced to the drumming and songs and the crowd often erupted into laughter while they watched the drama show, which depicted a married couple struggling to handle their nine children.

I interviewed a lot of men in their late teens through early thirties. They had come to the event for many reasons – some just came to watch the football game, one was taking care of 13 children and knew he and his wife couldn’t afford another pregnancy, more often, they had heard a little bit about family planning, but had never used any form of contraception and came to learn more.

A small part of me doubted that one community event would change things. If 98% of men have heard of family planning and few are using contraception, how is one afternoon going to change their habits?

I was reminded, talking to one man, that the way we receive messages can make all the difference. Do, 25, is a farmer and father of two. He explained to me that he had never used birth control before, although he had heard messages about family planning on the radio. “I listened, but never really took any notice,” but he said, “now I see.”

A box with no hinges, key or lid, yet golden treasure inside is hid

2007-09-09T14:12:00.000-07:00

Yesterday, I wanted to take a photo of the Minnesota International Health Volunteers sign that sits at the beginning of the turn off to our Ssembabule office. As I walked down the muddy turn off, a woman was walking along the path with her goats. She did not speak any English, but seeing my camera, she began gesturing for me to cross the road with her and pointed to my camera and then to her three little boys standing in her yard across the street.

We cross the road and she eagerly lines the boys up. I motion for the boys to come towards me, into the sun light, and she hurries them along. I photograph her and her children and then thank them and leave.

Later, as I’m waiting at the office for the Family Planning Implementation Team meeting to start, I think about those little boys. I go to my room and take a handful of Starburst out of my duffel and I make my way back down the turn off and give the woman the little yellow, pink and orange candies. She smiles broadly and gives the sweets to her children.

Today, I am in my room working and Mabol, MIHV's cook, comes to my room. Mabol speaks a bit of English and I hear her say from the hallway, “Sarah”…”Madam for you.” There is a woman standing a few feet from the door, but I do not recognize her. I have met so many people in the last two days that I am confused. Is this a woman I met in the market? Was she at the meeting yesterday? I smile and nod to her and Mabol then explains, “She says you took her photograph.” Now I remember. The woman comes to the doorway and kneels down on the steps. She holds up three eggs to give me.

I ask if I can pay her for them. Mabol interprets and the woman shakes her head no. Really, I say, I would like to. I think about the children’s bare feet and dirty clothes.

“Gift” Mabol says. I nod.

The Hospital Bed

2007-09-06T13:22:00.000-07:00

I’m sitting in on the Family Planning Implementation Team’s quarterly meeting for Ssembabule District.

Noelina, who works in Ssembabule’s hospital, mentions that one of the surgical beds at the hospital is broken. The bed cannot be adjusted up and down, she explains, so tubal litigation and vasectomy operations cannot be performed. Men and women are turned away every day.

Around the table are MIHV staff, a representative of the Director of District Health Services and a Community Development officer who works for the Ministry of Gender, Labor and Social Development.

The hospital has a second, working, surgical bed in a different room, but they are unwilling to use it for these operations. Noelina explains the other room is reserved for emergencies.

The district claims they do not have the money for the bed and has asked MIHV to pay for the repairs. MIHV says they will not pay, knowing that in doing so they will not only pay for the bed, but open the door to funding requests every time something is broken.

The repairs would cost 80,000 shillings ($48).

Paige, MIHV’s Country Director, parts her lips. She seems weary, frustrated, but her voice stays calm. “This is now our third quarterly meeting where we’ve talked about the surgical bed needing to be fixed.”

$48 would give men and women in this district access to permanent forms of birth control.

$48 would mean fewer Ugandan children would grow up in families that cannot afford to care for them.

At the end of the meeting they have found no solution. They will meet again in December.

To the Field

2007-09-05T07:05:00.000-07:00

This morning I'm leaving for Ssembabule (red), one of MIHV's two Ugandan field sites. The drive from Kampala (blue) to Ssembabule will take about four hours.

Being in Kampala has been wonderful, I've gotten to meet Paige, MIHV's Uganda Country Director, who is incredible. I've wandered through the tombs of the ancient Buganda kings, met with editors at the local Ugandan papers, visited the Nommo National Art Gallery and feel somewhat adjusted to life here.

That said, I can't wait to get into the field. The work MIHV does really happens in the field. Throughout the month of September every Sunday MIHV will be hosting a Family Planning Day, a day designed to be fun for the community while also increasing awareness about reproductive health and MIHV's programs. These Sundays will target males and youth and aim to increase their involvement in family planning. The events will include a drama show, quizzes, a puppet show, a soccer match, and a film show.

Being in the field will give me the opportunity to meet MIHV's Ugandan staff (Paige is the only American working for MIHV's Ugandan programs) and Community Health Workers as well as the beneficiaries of MIHV's programs. I hope that being there, sitting and listening and sharing time and place, will allow me to start to tell their stories.

In the next few weeks I'll be at both the Ssembabule site and Mubende (yellow) site. Ssembabule doesn't have electricity or running water, let alone internet, so I may not be able to post until I get to Mubende.

I'll write soon. Take care.

Morning at the Market

2007-09-04T09:34:00.000-07:00

As I enter the market, women beckon me to their booths saying, “Madam, here” and “Sister, come.” Stalls overflow with pineapples, garlic cloves, rice, beans, peas, apples, zucchini, onions, dried vanilla, melons, peanuts and corn. I pause to negotiate the price of a bunch of bananas and then hurry past the stalls where meat hangs from the ceiling and hooves lay stacked on the counter.

I am the only muzungu meandering through the crowded aisles and people ask me my name, where I am from and why I am here (many ask if I am from Colorado or Texas, others assume I’m a journalist writing about CHOGM). Some, seeing my camera, cry, “Photo me! Photo me!” while others, mostly the older women, hide their faces.

Nawolovo

2007-09-03T07:43:00.000-07:00

The Kampala office has a resident chameleon

No matter where you go...

2007-09-03T05:43:00.000-07:00

Robert, the gardener at the Kampala office, is a Jehovah's Witness... they don't wear the suits here.

Waste Not

2007-09-01T16:29:00.000-07:00

A Kampala journalist named Michael Wakabi told me that Kampala has become ''a used culture.'' The cars are used -- they arrive from Japan with broken power windows and air-conditioners, so Ugandan drivers bake in the sun. Used furniture from Europe lines the streets in Kampala. The Ugandan Army occupies part of neighboring Congo with used tanks and aircraft from Ukraine.

(Packer, George. “How Susie Bayer’s T-Shirt Ended Up on Yusuf Mama’s Back” The New York Times. 3 March 2002.)

Check out the full article... it looks at the used clothing trade in Uganda: http://select.nytimes.com/search/restricted/article?res=F10D14FA3E5F0C728FDDAA0894DA404482

* * * * *

My Coke bottle’s label is worn away in some places. I’m out to dinner with Paige and Phil at the local pizza shop and my glance at the bottle has turned into a stare. The red is faded, but just slightly.

“Is this bottle used?”

“Yep,” Paige says, looking up from her salad, “Best recycling program in the world and nobody knows it’s happening. You actually have to pay more for the soda if you want to take the bottle with you.”

“There’s no broken glass in Kampala,” adds Phil. “Not when it’s worth something.”

* * * * *

Later, we stop by a going away party for one of the expats Paige and Phil know.

In one of those awkward, no-one-knows-anyone-in-this-group moments, a girl from Boston looks down at one of the Ugandans' sandals.

“Hey, nice Jesus sandals!”

Looking down, he laughs, “I made these”

"You made them?”

“Yes,” he shows us the sole of his shoe, “From old tires.”

From where he stands the sandals look black, albeit a bit plastic-y, but the bottom of the shoe reveals tire treads. The Americans launch into how ingenious the tire-shoes are. He shows us how he cut the tire and with four nails affixed the straps. The Ugandans laugh at our fascination.

“These shoes – lugabire – are all over. They sell them for 2,000 shillings ($1.18) in Kampala.”

“I love them!” the Boston girl exclaims, “What market did you say?”

The Ugandans laugh again.

“It won’t be 2,000 shillings for you – 50,000 ($30) maybe”

Americans buy clothes in disposable quantities -- $165 billion worth last year. Then […] we run out of storage space, or we put on weight, or we get tired of the way we look in them, and so we pack the clothes in garbage bags and lug them off to thrift shops.

The Monkey on the Roof

2007-08-30T06:03:00.000-07:00

This morning I woke up to the sound of monkeys dancing on the roof.

This tree is in Paige’s yard in Kampala.

Firsts

2007-08-28T13:50:00.000-07:00

“Would you like a hot towel, ma’am?”

I’m sitting in World Business Class (thanks to a frequent flier upgrade) for the first time ever and am being offered a hot towel before my dinner of goat’s cheese with peppers, beef tenderloins with a horseradish sauce, a cheese plate, and Ben & Jerry’s ice cream.

I am quite sure I do not belong here.

Thank God for the Indian businessman next to me, whose mime-like gestures helped me figure out how to use my button-adorned chair.

With attendants offering me bottled water and eyeshades and wine and fresh fruit and “raspberry vinaigrette or balsamic, dear?” and pillows and “anything else I can get for you, young lady?” I am stuck somewhere between very comfortable and horribly uncomfortable with my situation. I like my big chair and the little television that pops out of my arm rest, but I also feel like I do not deserve this seat. What about Helen, the elderly Danish woman I met waiting at the gate, who is wheelchair-bound? She certainly needs the attentive staff more than I do, and would probably appreciate the extra space more. Why should she sit in the back of the plane while I sit comfortably (or not) in C-06? The single, yet defining, separation, of course, is money. Pieces of paper – that we all agree – mean a minority of passengers get a substantially better lot than the majority on board.

I think that this feeling, this guilt, that I have money when others do not and that I have this not by any merit of my own, but by the luck of my birth – that I was born in a Minneapolis suburb rather than rural Uganda – is something that may haunt me over the next four months.

My name is Sarah Schewe. After being accepted to Dartmouth College last spring, I chose to defer my college matriculation for one year. This fall, I will be volunteering for MIHV in Uganda and Tanzania, where I will blog, write articles for MIHV’s website and other literature, and provide photographs for these publications.

Three flights and 24.5 hours after leaving Minneapolis, my flight arrives in Entebbe.

When I step off the plane, it’s only 8:15 pm, but the sky is dark, and the moon is full. A new cycle starts tomorrow. A beautiful, dark face catches my wide eyes and crinkles into a smile, saying “Welcome to Uganda.”