Sunday, August 17, 2008

a day in the life…

[above: HIV Care and Treatment Refresher Training participants, trainers and UCSF help-staff (i.e. the team i work with in Tanzania) in Shinyanga, picture taken on 15 August at the Ngoloko Hostel, Catholic Arch Diocese centre; this was a historic Refresher training because all of the direct trainers were Tanzanian and a majority of the training was conducted in Kiswahili! i served as the content coordinator and trainer of trainers.]

I have two radically different work schedules here in Tanzania. One is for trainings, and one is for mentoring of mentors out in the field. Each of these programs last one work week, so we tend to travel from place to place on Monday mornings, return to our favorite regional hangout on Friday afternoons, stay over the weekend, and leave again for the next destination the next Monday morning. That’s when I have a say in the travel schedule. When I don’t have a say, we often end up traveling over the weekend, so we end up not really having any days off. I count traveling as work. It’s more tiring than my work – and far more dangerous.

No matter where I am in Tanzania, I try to follow this routine:

5 am: occasionally get woken up by the morning call to prayer from the local mosque (this happens regularly in Moshi, Stone Town, and Bukombe)

7 am: wake up to my cell phone alarm for real; use the bathroom, wash up, and make the bed

7:05 am: sitting meditation (I have been meditating on the Visuddhimagga) followed by stretching exercises

7:45 am: get dressed and go to breakfast. When the breakfast is good (as it is at Bristol Cottages in Moshi and The Orion in Tabora), I can get a big bowl of fresh fruit, reasonably fresh bread (toasted), and eggs over easy. I bring my own loose tea in a tea strainer from home, and have a cup of jasmine green tea. When the breakfast is bad (as it is at The Karena Hotel, where I am staying now in Shinyanga), I bring one of my oatmeal packets and make myself some instant oatmeal to have along with my tea. I’ve also gotten into the habit of ordering my dinner at breakfast. It’s so nice to have it ready when I return so I don’t get hungry and annoyed waiting 1-2 hours for it to appear. (Yes, that’s typically how long it takes to get food after you order it here.) Plus, it reduces the stress on the chef and staff so that they don’t need to scramble to prepare food for the impatient wazungu. Afterwards I return to my room to brush and floss my teeth, get my backpack.

8:15 am: leave for work (in a small town, by foot; in large or further locations, by taxi or EGPAF vehicle)

8:30 am: work! Here’s where there’s some divergence-


are held in conference venues in the regional centers, such as Shinyanga (where I am now), Tabora, Moshi or Arusha. We live comfortably with access to most of the modern conveniences: electricity, plumbing, hot water for showers (except occasionally in Tabora), vegetables. Eating vegetarian is not very popular in the rural areas. When you eat out, you’re supposed to be eating meat!

Trainings generally following this schedule:

8:30 am: opening schmooze, energizer, wait for trainer to arrive

8:45 am: morning session

10:30 am: chai break (tea or coffee, stale bread, egg, fried thing)

11 am: continue morning session

1 pm: lunch

2 pm: afternoon session

4 pm: soda break (Coca-Cola monopoly sodas – coke, Fanta, Sprite, other junk I don’t drink)

4:15 pm: complete afternoon session

5-5:30 pm: finish the day, figure out how to get back to our hotel

6 pm: return to hotel, wash up

7 pm: dinner

Mentoring visits…

vary day-by-day and site-by-site. Some days we stay at the district hospital clinic and teach or mentor folks there. Some days we go to one of the lower level health facilities, which may take a few hours to get to on rough road, and ideally mentor the district mentors there. When we mentor mentors, it means that I am meta-mentoring. (Follow?) I am working with one of the clinicians from the district hospital who’s been managing HIV-infected folks for at least a year, observing her/him mentoring one of the inexperienced clinicians from the lower-level health facility. It can get quite difficult when something doesn’t happen quite right (i.e. something harmful to the patient is about to occur). I then have to respectfully discuss the issue with the district mentor, and suggest that s/he mentor and support the lower-level health facility clinician to correct the problem. It’s two steps removed from seeing the patient myself.

All of this happens in Kiswahili, so I need to derive quite a bit from body language and my limited command of Kiswahili. When something seems critical, and I don’t think I understand, I will ask the district mentor to interpret for me.

In an ideal mentoring visit, this is what the week looks like:

M- arrive around noon, meet and greet the District Medical Officer, schmooze, meet the Hospital in-charge person, and meet the HIV clinic in-charge person who usually gives us a tour of the clinic and the district hospital. In the afternoon, I teach some content (TB-HIV coinfection, IRIS, ART review, etc.)

T- district clinic mentoring

W- lower-level health facility mentoring of district mentors

Th – “

F- in the morning, district clinic mentoring and feedback meeting. Prolonged good-byes. In the afternoon, return to our weekend location.

In the evening, I have been eating dinner with my work colleagues. It’s usually a few hours long if I haven’t ordered at lunch time:

7 pm – order dinner, drink soda water or tonic water to bide my time and curb my hunger

8-9 pm – receive dinner and eat (typical meals for me: pilau rice with vegetables, white rice with beans and spinach, grilled fish in tomato stew with plain white rice and cabbage, palak paneer, dal fry)

10 pm – finish up dinner and conversation, return to room, shower if I haven’t already

10:30 pm – email using our super-cool USB sim-card modem which connects us to the satellite internet system via local cell phone carriers.

11 pm – stick in ear plugs, put down the mosquito net, take my malaria prophylaxis, sleep.

Lala salama! Enjoy your dreams.

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