A Day in the Life...

Instead of another adventure story or Saturday trip, I thought I’d share a little about the work I’ve been doing in Moshi. My days are spent at the Kilimanjaro Christian Medical Centre, one of 4 regional referral hospitals in Tanzania and the home of the Duke-KCMC collaboration. There are lots of studies going on in the Duke group – at least 12 – and all the major funders of HIV research are represented, from CHAVI (the international consortium working on an HIV vaccine) to the Elizabeth Glaser Pediatric AIDS Foundation and the NIH.

I’m working on two studies in particular, one in children and one in adults. In the pediatrics study we are trying to develop affordable predictors for when a child’s antiretroviral medications stop working and the virus begins to take over again. In the US, this so-called virologic failure is determined by a complicated (and expensive!) method that measures the number of virus particles in the bloodstream. Technology and resources are not to the point of being able to use that method widely in Africa, however. Virologic failure is a major problem here, because the longer patients are in failure, the more likely they will develop resistance and fail the only second line regimen currently available in Tanzania. Through this study we are hoping to find a combination of affordable lab tests that could be used to predict when patients begin to fail their regimens.

The second study I’m working on is called Coping, Health, and Treatment in Tanzania (CHAT) and is examining a lot of psychosocial factors that go into HIV care and prognosis. It’s a long-term study that will run over the next 5 years and involves multiple sites in addition to KCMC.

These days I spend most of my time in the KCMC family care clinic, where HIV+ parents and children come monthly for their HIV primary care. I help guide the patients and their families through the rather tedious process of being enrolled in the study, making sure they have met with the office staff, nurses, social worker, doctor, and lab technician. Afterwards I review the charts for past lab results and other necessary information. Now that I have finished Swahili School and my language skills are improving, I am hopeful that I will be begin to take an even more active role with the children and their parents during the enrollment process.

In the spring I will spend more time at the other sites for CHAT, including the mobile voluntary counseling and testing units that offer HIV testing in rural villages surrounding Moshi. I will also have the opportunity to help enroll patients in CHAT at Mawenzi Hospital, the public hospital in Moshi that lacks many of the resources found at KCMC.

Through these two studies I have been exposed to all aspects of HIV care, from the initial diagnosis to routine follow-up and end of life treatment. I have learned a lot about how the illness affects families here, both medically and socially. There is still significant stigma associated with HIV, but seeing the grace with which these families handle their situations has been inspiring.

Kiswahili School

“Habari za asubuhi?”
“Nzuri sana.”

“Umelalaje?”
“Salama.”

“Ulifanya nini jana?”
“Nilikwenda sokoni na nilinunua nanasi na maembe.”

For those not yet savvy in Swahili…. How are you this morning? Very well. How did you sleep? Peacefully. What did you do yesterday? I went to the market and bought a pineapple and mangos (Really, I did!).

This is a typical start to my day at Swahili School. We recap yesterday’s events over breakfast, then head to our first of eight hours of class. Grammar lessons, new vocabulary, lots of conversation, memory games, and a little singing – that is how we fill our time here! Sometimes we go on fieldtrips, such as our trip to the market yesterday to practice bargaining in Swahili. For less than two dollars I was able to buy about 10 mangoes, a pineapple, a pile of okra, a pile of garlic (yes, they really do sell things by the pile), 3 green peppers, a cucumber, and a bunch of sweet bananas. Others came back with all kinds of things – six feet of sugarcane, avocados the size of footballs.... you name it.

I have 9 classmates in this intensive three-week course. The students are a fascinating bunch, hailing from Germany, the Netherlands, Denmark, Sweden, New Zealand, France, and the US. What they are doing in Tanzania is equally interesting. They work for orphanages, embassies, and NGOs. A few teach, some work for the church, and others are engineers working with local organizations. The one thing we share in common is a strong desire to learn the language.

I came to language school because of a recognition during my first few days in Tanzania of how vital Kiswahili is to understanding Tanzanian culture. When I return to the hospital my goal is to speak only Kiswahili – the key to talking to patients and hearing their stories. After nearly two weeks of class, I am well on my way to being able to do exactly that. What I did not realize before I arrived is that I would learn just as much from my classmates and their experiences as I’m learning about Kiswahili. It has been a wonderful way to learn the language!

The day before our trip to the market, we practiced bargaining with some of the people who work at the school. Clearly it was a very serious endeavor!

My teacher, Mama Frida, and I after successfully
bargaining for the scarf.

Safari

Giraffes, zebras, baboons, warthogs… you see them in zoos and read books about them, but to see them in person – it was one of the coolest experiences I have ever had! A few weeks ago a group of us went to Arusha National Park, Tanzania’s smallest park and merely an hour from our house. We had been warned that the small park was no “true African safari.” Not true! Within 5 minutes of driving through the gates, we came across a group of zebra and a herd of cape buffalo. A few minutes later, when we had gotten out of the car to inspect a stream we were going to have to cross, a giraffe popped his head out of the trees, soon to be joined by two of his buddies. These scenes continued all day, including a huge flock of flamingos in a picturesque chain of lakes and wart hogs fighting next to a family of baboons. The animals even gave us a grand finale at the end. Before we left the park, we stopped to watch a herd of cape buffalo grazing. A few minutes later a bunch of zebra wandered up and joined the crowd, and then, slowly… one by one… giraffes slipped out from the behind the trees until there were over 20 of them in the clearing. Seeing all the animals together, with Mt. Meru in the background and the sun shining like a spotlight through the clouds, was an incredible scene!

Sarah and I in front of a literal menagerie of animals.
It felt like we had been dropped in the middle of the Lion King!

We spent a lot of time over the course of the day riding on the roof of the jeep, so of course we needed to pose for a photo up there.

Janet, Sarah, and I in front of the biggest fig tree I've ever seen.

The cape buffalo look friendly, don't they?

After watching the wart hogs fighting, I would not want to come
across one of these alone!

Our view at lunch included a beautiful lake with thousands
of flamingos... and a cow skull.

Not sure if this was a stand-off or making friends...

Did you know giraffe have blue tongues? That was a surprise to us.

Just a portion of the gorgeous scene at the end of the day. It was incredible!

TIA Moments

“This is Africa” or TIA moments are a daily occurrence here. The power goes out in the middle of cooking, a plumbing disaster turns your bedroom hallway into a lake, and getting an office key takes three trips to town and over a week because the key fundi’s are not exactly precise. Sometimes TIA moments border on the absurd, such as the day I went out for a run and was nearly run over by two cows being chased by the tails by a man in a pink ski cap. Sprinting cows aside, its about 80 degrees here on a cool day!

We had such a classic TIA moment on our first trip to Arusha that I was nearly laughing out loud. Shortly after we arrived, our taxi driver decided to take us to a place he described as a Masai free trade center. We thought it sounded interesting, but after battling traffic for nearly an hour to get there, Cultural Heritage didn’t exactly live up to his description. With giant plastic tusks marking the entrance and a 4 story tall Masai shield leaning against the building, it looked more like Disney meets Africa than anything else. To make matters worse, it was completely deserted. Our driver turned the car off and quickly jumped out to ask if they were open. When he returned, we discovered not only that they were closed but that we might in fact be staying for a while. The car had died, and getting it going again wasn’t looking promising. What I learned over the resulting few hours is that there is a miracle cure for all car problems in Africa…. water! After dismantling the passenger seat to get a closer look, our driver decided that the battery was the source of problem. We found a car fundi to help us – the African version of a mechanic – and he had just the ticket… pouring a liter of water onto the battery. It may sound shocking, but it worked like a charm! Before we knew it the car was up and going again, and we were on our way for an afternoon of exploring the city.

Searching for the problem...

Success! Brandi and Sarah celebrate the water miracle cure.

A Long Walk

Does Uru mnambe sound remote? I discovered on Saturday that it definitely is! Grant, a recent Duke grad who is spending a year in Moshi before medical school, invited us to join him and his friends on a hike to see waterfalls. Our destination, Uru mnambe, was absolutely breathtaking – a 120 meter tall waterfall high in the mountains, fed by Kilimanjaro. Getting there though…. that was another story! We had no idea the hike we were in for when we set off on Saturday morning. We started walking toward town, expecting to catch a dala dala on the way up the mountain. But much to our dismay, no dalas came! So we just kept walking… and walking… and walking up a mountain road for hours.

We passed countless rural villages on our uphill trek. The vegetation became more tropical as we gained altitude, until there were banana trees everywhere. Women passed us with bananas and vegetables on their heads, walking to market in Moshi to sell their goods. One woman actually had a chair on her head, which seemed completely bizarre until we later discovered that the town of Uru specializes in making furniture. Children ran out to the road to greet us, and despite quite a bit of staring everyone we passed was very friendly.

The last hour of our five-hour uphill climb was on a narrow dirt path, winding along a stream surrounded by hundreds of coffee plants. The view was spectacular, but with an impressive drop-off on the other side of the path we made sure to enjoy the scenery mainly during breaks!

Over twenty kilometers and an additional few thousand feet of elevation later, we finally reached our destination. We shared a lunch of peanut butter and honey sandwiches beneath a banana-thatched roof hut overlooking the waterfall, enjoying the view and appreciating the chance to rest. After our long trek, peanut butter and honey has never tasted so good.

We hiked fast on the way back to Uru, our tired legs more than enough motivation to catch the last dala down the mountain. This time luck was on our side, and we made the bus! Walking merely one way gave me an immense appreciation for the distance the women in these villages travel to go to market everyday. I cannot imagine doing that walk both morning and night, much less with a heavy load. Needless to say our Uru mnambe excursion was much more than a relaxed visit to a waterfall. It was quite an experience!

Hour 4, and we're still walking...

Getting closer... ever closer

Happy smiles after lunch!

Kilimanjaro Dirt Road Hash

Sunday was a first for me – I went on my first hash! Some of you - particularly my college roommate Laura - are hashing veterans, but this was the first time I’d actually experienced it for myself. A hash is kind of like a group run, but no one knows the trail beforehand. The group follows patches of flour set out on the ground the day before, and periodically there’s an X made out of flour indicating that the trail could be anywhere… so everyone fans out and searches until the lucky individual finds more flour and yells On on! Everyone then falls in line and the hash continues.

Hashes are known for being particularly adventurous, and this one did not disappoint. We ran through cornfields, crossed streams, and traversed many a dirt road. It was a great way to catch a glimpse of rural life in Moshi, and the scenery was beautiful, complete with blue sky and a spectacular view of Kili. I’m sure that the Tanzanians we passed along the way thought we were crazy, but they greeted us anyway and often pointed out the way. Barring a few areas where we are fairly certain chickens ate the flour, we managed to make it through the entire course and back to the host’s house for a giant feast of local fare. It was a great way to spend a Sunday afternoon!

Work, Home, and Play - Pictures from Moshi

With finding food still a daily challenge, over the weekend Sarah and I decided to treat ourselves to a night out. Logically, where else would we go in Northern Tanzania but the local Chinese restaurant? Yes, our first dinner out was at Panda Chinese, and it was delicious. We managed to find it on our own, which was quite a feat since there are no street signs here. It seemed abnormally quiet when we first arrived, but soon a giant green safari jeep pulled up and about 20 Japanese men rolled out. Needless to say the restaurant filled up pretty quickly.

Welcome to A5, our new home! We have the best house on the compound, but we may be a little biased. The garden in the back is fantastic. We can't eat the tomatoes fast enough, that's for sure.

Without internet at home or phones that call the US, we spend a lot of time reading in our living room in the evenings. The power goes out fairly often though, which makes for an interesting scramble to find flashlights and candles in the pitch black. Luckily there have been no major injuries from walking around in the dark!

I'm standing outside the front entrance of KCMC, the hospital where we work. Moshi has is very tropical - and its spring here - so flowers are everywhere.

This is the view from our office and also the area where ambulances deliver patients to Casuality (the Emergency Room). There are no sirens here, although they probably need them - the patients who come in by ambulance are very ill.