Pictures!

Kigoma

Gombe

Arusha/Zanzibar

Dar, Arusha, and Zanzibar

We flew from Kigoma to Dar es Salaam, and checked into EconoLodge. After being in the quiet town of Kigoma for two months, the activity of Dar was a little crazy. I wasn’t quite used to so many cars and people in close quarters! We met up with Molly and Terry, and went out to dinner at Addis in Dar, an Ethiopian restaurant. The food was amazing – and it was nice to sit outside and not get eaten alive by mosquitoes! After a hot shower and a good meal, it felt like I was slowly returning to the real world.

The next day we flew to Arusha, and then the following day went on a one-day safari to Arusha National Park. The morning was great – we went on a walking safari and got very close to a lot of giraffes. We also saw a lot of zebras and wart hogs. The afternoon was a little boring – a lot of driving around and looking at scenery (which was beautiful), but no animals. We found out too late that Arusha doesn’t have any of the big game animas like lions, cheetahs, and elephants. So we were a little disappointed.

The next day we flew to Zanzibar, and we spent a night in Stonetown. The main part of the city is a labyrinth of old white washed buildings. It’s pretty, but very touristy, which I wasn’t really used to. We had dinner at Fondori Gardens – a park where locals set up stands and sell an incredible variety of seafood. Octopus, lobster, squid, several varieties of fish, prawns, and even some meat are grilled. You just point and they serve it up. We ate way too much, but it was cheap and very delicious, especially when washed down with cane juice.

The next morning we took a dala dala up to Kendwa, a beach town on the north coast of Zanzibar. Immediately upon arrival we had a one hour massage, which felt amazing. We spent the next three days lounging on the beach and eating great seafood. One day we did a discover scuba course and dive, where I saw beautiful coral and many different schools of fish. And on our last day we treated ourselves to full body scrubs and massages (very indulgent, but also very cheap), and I think the Kigoma dirt finally got scrubbed off of me.

One more night in Stonetown, a flight to Dar, and one more night in Dar, and then we were on our way home. Our flights were uneventful, and I got home safely on August 7th. Since I’ve arrived home, I’ve been enjoying hot showers (since I can count the number of them I had all summer on one hand), good food, reading Harry Potter, and cherishing all the comforts of living here. I do miss Kigoma and my life there a bit, but right now I’m really enjoying being back.

Checking Out

We paid for our plane tickets today, so it’s official: we’re leaving Kigoma on Saturday. I’m very excited to leave, but a little sad too. Kigoma is a very special place; a small town in a beautiful location. Even though I’m very ready to leave, I’ll always have a soft spot for this place.

We’ve packed up the boxes of questionnaires and handed them off to Dr. Godfrey, finalized the budget, are close to having a clean data set, and will (hopefully) have all the transcriptions in our hands tomorrow. We’re done! It’s a very good feeling, and we feel proud of the work we have done. I’m looking forward to seeing what happens with all the quantitative and qualitative data we have collected.

Our last few days here aren’t that exciting. Tying up loose ends, saying goodbyes. We took Anton (director of Jane Goodall Institute) out to dinner last night, and true to form Gibbs took two and a half hours to get our food on the table after we’d ordered it. We don’t get annoyed at it; it wouldn’t be dinner if you didn’t have to wait a few hours (it’s part of the entertainment here; what else would you do with your evenings?). We had good company: we were joined by the newly arrived conservation specialist for JGI Kigoma and the director of a research program for undergraduates (all sorts of water, fish, and snail projects) who’s been arranging groups of students to come over for research experience for the last ten years. She knows a lot of great facts about the lake, and is an all-around nice person too.

I had my last run in Kigoma, which made me a little sad. There’s great running here, although I won’t miss the dust and exhaust fumes from the cars. Today was our last day, and it was blistering hot; really uncomfortable. I spent the morning at Baby Come & Call and taking pictures of Kigoma. We went up to Hilltop for a lunch of grilled cheese (one of the best things I’ve tasted in a while), and tonight we’re having dinner at Gibbs. Ending our stay in Kigoma the same way we started it. And like that first day, we’re still waiting for our food.

So, we’re flying out of Kigoma tomorrow (Saturday) morning. We fly to Dar for one night, where we have plans to go to an Ethiopian restaurant with Molly and Terry, who are arriving back from Zanzibar that day. The next day we fly to Arusha, and on Monday we’re doing a one-day Safari to Arusha National Park. Tuesday we fly to Zanzibar, where we’ll stay until Sunday. We fly back to Dar on Sunday (fingers crossed the flight doesn’t get canceled!), and then back to SF on Monday. So, this will be my last blog entry until I get back to the US, when I’ll let you know how my travels went.

Almost Done

We’re down to our last few days in Kigoma – thank goodness! The project wrapped up really well. We ended up with 930 completed questionnaires – about double our target so we’re really happy. All the data has been entered, just has to be cleaned up a bit. We need to prepare the boxes of surveys to be shipped back to the States, but that should b finished tomorrow afternoon. During the last two weeks of data collection, we also conducted almost thirty in-depth interviews with mothers, TBAs, and nurse/midwives at the hospital. Last week we held five focus groups with community leaders, TBAs, and health workers. They went really well, and we have almost ten hours of recording from them. What we’re waiting for now is to have all the audio transcribed into Swahili before we leave, so it can be translated into English when we get back to Berkeley. So, needless to say, we’ve been busy busy the last few weeks. But now there’s only a few days left, and we’re itching to go. We really could finish what we need to do in less than a day, but we have to wait for all the transcription. It’s dragging on, and it doesn’t look like we’ll get to leave until the end of the week. It’ll leave us with about a week to travel, and we’re hoping to go to Arusha for a one-day safari and then on to Zanzibar for a few days on the beach. And then, two weeks from today, I’ll be on my way home. It’s hard to believe that the summer is almost over; it’s gone by really fast. I’m happy to be coming home, and I’m really ready to leave Kigoma. With only one restaurant left that hasn’t made us sick, and nothing to do but sit in our room at night, we’re really ready to leave!

7/18: And then there were two...

As July continues to pass by at the pace of a runaway train, things are beginning to wrap themselves up here. Molly and Betsy finished their project on the 10th, and we had a farewell dinner at Gibbs with Dr. Godfrey and the supervisor from their team, Mr. Caliste. It was an enjoyable evening, and it was just unbelievable that they were actually done (which meant we were approaching being done). They did a random sample of 30 houses in 50 villages, ending up with a response rate of 91% and interviewing 1200 women – pretty impressive. I’m really excited to see what their data looks like. It was great having two fellow students working on a similar project to share this experience with, and I’m sure we’ll be in contact in the future (maybe do another study, perhaps? Although I think hiring interns to do data entry is a fabulous idea).

We spent Betsy’s last few days fabric shopping (our favorite pastime, fabric is cheap but it’s adding up in both weight and cost!), and eating at our “favorite places” (aka the only three places in town we can eat). And then on the 12th Betsy left.

I guess her leaving marked the beginning of the end, because a week later Terry and Molly left for Zanzibar. On their last day, Terry and I went for our final run together. We logged 83 minutes, going a little more than 9 miles by our estimate. We ran from AquaLodge through Kigoma, around to the lake and across the bridge to Kibirizi, and then followed the road out of Kibirizi for another half hour. Around the spot we turned around, we were rewarded with an amazing view – a distance shot of Kigoma and the lake. We were surrounded by grass fields and a few mud houses, and groves of palm trees spread out below us and into town. It was one of those “woah, I’m in Africa” moments. I’m kind of used to being here at this point, it all feels kind of normal. But then sometimes it hits me where I am and what I’m doing, and it just feels really unbelievable. We came back from our run feeling pumped and excited, and starving.

All four of us were invited to Caliste’s (Molly and Betsy’s supervisor) house for dinner that evening. He lives in a really nice house – actually the first real house I’ve been in other than mud huts – in what feels like a suburb of Kigoma (we called it Kigoma’s Agrestic – I’ve gotten everyone hooked on Weeds). His wife is beautiful and very hospitable, and cooked us an amazing dinner of noodles, coconut curry vegetables (the first time we’ve had veggies we’ve seen in the markets – okra, eggplant, and peppers!), beans, chicken, rice, ugali, and chipati. For dessert there was perfectly ripe papaya and bananas. It was a feast, and the most delicious meal we’ve had in Tanzania. We’ve really been missing out – the food in the restaurants doesn’t compare. It felt really nice after a month and a half of living in hotels and eating in restaurants to be in someone’s home and have a home-cooked meal, and hang out with a family. Caliste’s triplets (two boys and a girl, almost ten) had arrived the previous day from boarding school, so we got to meet them, which was a treat.

It was really sad saying goodbye to Molly, Terry, and Betsy. It doesn’t feel real that they are all gone. It’s quiet just the two of us, and we miss having other people to share our time and meals with (dinner seriously is the main source of entertainment. Since it takes at least an hour at Gibbs to get your food after you’ve ordered, it takes most of the evening to have dinner – thank goodness or else we’d be really bored!). So now it’s just the two of us, counting the days until we can leave Kigoma and do a little traveling before we come home.

7/15: Observation

I spent today shadowing a nurse-midwife in the maternity ward of Maweni hospital – an incredible experience.

The maternity ward is set up like a shotgun house – each room leads directly to the next, going straight back (so if you fired a shotgun, the bullet would travel through each room). The first room you enter into is the recovery/ward room. 18 saggy old metal beds line the walls. Today every bed was full – women sleeping with a baby wrapped in bright kangas like a present at the foot of the bed or next to them, awake mothers breast feeding, and then the recovering women – laying on their side staring into space, recovering from a c-section or suffering from malaria, the drained and exhausted women recovering from PPH, and the vacant expressions of the women (around 3) where the brightly colored packages were conspicuously absent. Around 12 visiting hours began, and the ward turned into a zoo. Each woman had an average of four women visitors, each carrying kangas, tea, and porridge to fortify the new mothers. They held the baby, bugged the nurses, fed the women, and provided support. It seemed like a very necessary part of postpartum care for these women. A few men came, hanging back and maybe holding the baby. It was obvious that this was women’s territory. When the visiting hour was over, the mass of people went outside to wait for the next visiting time, which explains why there are always groups of ladies with thermoses and kangas sitting in the (open air) corridor outside of the maternity ward.

The next room is the nurses station. It, like the ward, had chipping cream and sea foam painted concrete walls, a concrete floor, a single fluorescent bulb, and a rusty metal fan. It’s a busy room, with people (not just nurses, but patients too since it connects all the rooms of the ward) coming and going. They don’t have a stapler, so they use medical tape to hold patient’s papers together (I’m giving them one when I go to observe again next Monday).

The room beyond that is the delivery room. It has four metal beds with plastic pads on them. When women deliver they put a plastic sheet down, which they reuse wash between patients. There’s also a rusty little box on wheels that they use to hold the babies after delivery. There’s only room for one, so if more than one newborn is present the others have to lay on the weighing table next to wrappers and instruments. Beyond the delivery room is the ANC room, where women who have begun labor but aren’t ready to deliver wait until they were ready. The ward was so crowded when I was there that the overflow stayed in this room.

So today there were over 26 patients – 18 in the ward, 4 in the ANC room who had already delivered, and a few that showed up to deliver. There were five deliveries during the 8 hours I was there (all but 1 were delivered in the last two hours). There was one nurse/midwife and one public health nurse on duty.

I spent a lot of the day alternating between being really bored and being incredibly overwhelmed. When I first arrived, a woman was going in for a c-section. They invited me into the theater, but I declined – didn’t feel quite ready for that. I went back to the delivery room and watched women labor for the next few hours, taking breaks to watch the nurse give transfusions and injections. I saw several vaginal exams – one of them I was instructed to step back during the middle of it, and a few seconds later her water broke flooding the table and the floor. Later I was standing just observing the room, when I got pushed out of the way. I looked back, and a couple feet from where I was standing, a head was emerging. I saw the baby be born, and then the n/midwife took the baby and started cleaning it. She ignored the mom, and when I looked back over my shoulder, I saw another head appearing – twins! I tapped the nurse on the shoulder, and she went back over to deliver the other twin. They had no idea that there were two babies there – no ultrasounds here and archaic methods of listening to heartbeats, so usually twins are a surprise here. The second twin was much smaller, and had to be put on oxygen. Meanwhile, the on-call doctor for the hospital (the one) examined a woman that had been laboring for over 24 hours. He said that the heartbeat on the baby was beginning to change, and he needed to perform a c-section. So I attended a cesarean. They put me in scrubs (not sure if they were clean or not, there was a bit of scurrying to find them) and wrapped my face in gauze (no extra masks). The doctor had me stand two feet from his side, and I watched the procedure. I won’t gross you out with the details, but it was really interesting. The baby had gone into distress, and it’s head was about a foot long from being stuck in the birth canal for so long. They spent ten minutes resuscitating the infant, and thankfully he was fine.

After that, I was done – a long day! It made me realize I definitely don’t want to be a doctor (all that sewing looked really monotonous), and maybe don’t really want to be a nurse either (the operation didn’t bother me, but drawing blood and tying the umbilical cord did). I think I do really want to be a doula, because all I wanted to do during the hours I spent with laboring women (4 at once at one point) was support them and rub their back and help reduce their pain. It was an incredible day, and I’m fortunate enough to be going back for another observation with one of our interviewers who is also a nurse-midwife at the hospital next week.

What amazed me a lot was how self-sufficient the mother's were. There was definitely no coddling involved - in fact the nurse slapped a laboring woman on the but a few times to get her to move. Among the women's belongings were thermoses of tea, and in between contractions they would pour themselves a cup. The woman who had twins barely made a peep during delivery, and showed no surprise when she delivered twins. In fact, she never spoke to the nurses. After delivering the placenta and getting cleaned up, she wrapped herself in a kanga and, without a work, walked into the ward. She looked utterly exhausted, and never asked about her babies. Her mother came in later to retrieve them and take them back to the ward.

7/11: Evil Eyes

Yesterday was another great day in the field. I conducted two in-depth interviews with mothers that had PPH and were treated with miso. Both were great respondents, and we spent about an hour with each woman (and I took about three pages of notes on each!). I give my interviewer a list of prompt questions, and then she conducts the interview in Swahili. This part takes about 20 to 30 minutes, depending on how much of a talker the woman is. Then I have my interviewer review what was said during the interview, and I ask questions about her responses or think of other questions. I had great conversations with both mothers about miso and TBAs, what the problems were and how we could make things better. The women had great suggestions, such as having the community pool together for the TBAs to have a cell phone so she can be reached for emergencies.

I sat and talked with my interviewer for a while after we finished the interviews. There was a woman we really wanted to interview, but we were unable to reach her. I guess when she completed the questionnaire she spoke with this interviewer for a long time afterwards, and her story is great. Even the TBA was disappointed that we weren’t able to get her for in-depth interviews because she has a lot to say. This woman lived in a remote village off of the lake (probably one of the villages I saw on the way to Gombe, where there is only boat access). In her village, at least 5 women die per month due to PPH. She heard from a relative that there was a TBA in this village who had a drug to treat PPH, and so she traveled all the way here to give birth with her. When she heard that there were people coming to the villages to ask women who had had PPH and taken miso questions, she traveled back to the village just to be interviewed, which is when she met my interviewer. She stayed for a week just to be here for the questionnaire administration, and during that time 3 women died in childbirth.

The TBA and her assistant walked us back to the main road when we were done. They asked me questions about where I came from, and had heard of San Francisco before. I asked if they wanted to see pictures, and pulled some out (I always carry some with me, people love them!). I said I had a picture of my house in SF, and my interviewer asked if I had built it myself. I said no, and that I rent, but that didn’t really translate. When I showed them pictures of my roommates, they started pointing very excitedly at Pearl. I said no, that’s not me, I’m on the right. But they kept pointing, and finally my interviewer asked me why her eyes were red. I explained that when people have blue eyes, often the camera makes their eyes look red. She said “oh, ok” and explained that they had all thought that she was evil or possessed, and they were all really worried. They asked to keep one of the pictures to remember me, and they definitely did not want the one with Pearl in it, they took one of my family at Elise’s graduation instead.