Tanzania photos, July-Sept 08, album #2

Click on the photos below to see a larger slideshow!

KA: Kitenge-holics Anonymous

Hi, my name is sophy, and i’m addicted to KITENGE!!!! Yeah!

[above: Rita, the amazing tailor-seamstress-textile-artist, and me - with the bags she made with my design sketches]

[above: Joelle sporting a hoodie made out of kitenge]

OUT with a BANG!

[above: mentoring Team TZ - Jenny, me, Guy]

My LAST week of fellowship and work in Tanzania is now OVER!

We came back to Moshi to do direct mentoring at the Mawenzi Hospital HIV clinic. Mawenzi is dreadfully representative of the broken health care system in Tanzania. It’s the regional referral hospital for all of Kilimanjaro, i.e. the northeast part of the entire country. The director of the HIV/AIDS clinic at Mawenzi Regional Referral Hospital is an eye doctor. EYE doctor. With no training in HIV/AIDS care and treatment. ‘Nuff said.

Needless to say, it was a busy week with many gaps to patch. Hopefully we did something good here. Hopefully the 18 year old young man with ataxia, fine motor weakness and loss of sensation in his right arm and leg will get better after empiric treatment for toxoplasmosis while we figure out how to get him a CT scan. Hopefully the 40 year old woman who can’t walk because she lost her position sense and has a horrible burning sensation in her legs up to her thighs won’t get worse since we switched her from stavudine to abacavir… and gave her some pain relief medications. Hopefully the 35 year old woman with rip-roaring cryptococcal meningitis will get the repeat lumbar punctures she needs to relieve the pressure in her cerebral spinal fluid and improve on high-dose fluconazole.

Fortunately, I was able to work with Imelda, a clinician who was eventually receptive and happy to learn. And the eye doctor, Dr. Temba, was eager to improve the quality of care at the clinic. Both are relatively new to the clinic. Mawenzi can only go up.

My very last day of fellowship… and training… was quite insane. As soon as I showed up, I got pulled into seeing two complicated, sick patients. They were too sick to defer evaluation, so the teaching session got delayed and delayed. I felt horrible about this but didn’t feel that I could do a half-arsed job seeing these patients. On top of that, in the process of seeing patients, I got short with Jenny and said something disrespectful to her – which (rightfully) upset her, upset me, then delayed things further and of course I felt bad again. It’s difficult to realize that I am exhibiting the behavior of nasty arrogant doctors. I felt terrible and spent some time apologizing and processing. I am unlearning the bad habits that have arisen from years of hierarchical abuse.

I recovered enough to work with Jenny and Guy to teach for a couple hours on six HIV antiretroviral cases. Most cases were based on patients I saw at Mawenzi that week. On the whole, it went well, and hopefully the 20 or so participants learned something in the process.

We ended with some chai and bites (snacks), lots of warm handshakes, and big hugs and appreciation from Imelda. Imelda did a great job discussing one of the cases with the group and demonstrating the peripheral neuropathy exam that I taught her earlier in the week. That was gratifying.

And then I had a cathartic cry, unleashing some of the pain of fellowship, university hierarchy, misogyny and racism. I was lucky to have Jenny and Guy there to listen through some of my processing.

Out with a bang – and a stream of tears.

Now that I’ve had my catharsis, I contemplate the prospect of not coming back to East Africa for a long, long time.

Tanzania photos, July 08, album 1

Please click on the above album to see the full-sized album and review the photos. Asante!

Moshi

[above: aerial view of Kilimanjaro at dawn]

Ahhh, back in Moshi, my home away from home. It’s funny how familiar everything feels, even though we stay in hotels. I stay at the familiar Bristol Cottages, where Mama Sakina and Mr. Aggarwal and the staff take good care of me. I also have my friends Mei and Joelle, transplants from Chengdu, China and Southern California (respectively) who always welcome me back. They speak Kiswahili and know the lay of the land. It is always good to have advice and guidance from two local strong, sassy and experienced women who are also living far away from their native homes.

Plus, Mei owns Panda Restaurant in Moshi and cooks us real home-style Chinese meals. She uses winter melon and greens from her own garden. And she makes amazing fresh tofu each day!!! How spoiled can you get: fresh tofu and Chinese greens in the mountains of Tanzania.

Joelle first landed in Moshi to teach at an NGO secondary school focused on providing education to the most vulnerable young people (often orphans). She’s now moved on to a women’s village health and empowerment project in Shimbwe, a mountain village near Moshi. I am hoping to link Joelle and the women in Shimbwe to a potential microfinancing project in which the women would make cool accessories out of Tanzanian fabric to be distributed by a San Francisco-based textile artist.

The training in Moshi went as well as a training goes. There were 15 relatively interested and engaged participants from the Kilimanjaro region – lots of rural mountainous villages. As usual, the participants were a mix of nurses, clinical officers and medical officers of highly variable experience, English proficiency and background knowledge on HIV care and treatment. There were no pharmacists this time, though there should be. Happily, as a group, they seemed to understand some key concepts (antiretrovirals, TB diagnosis and treatment, treatment failure, paediatric HIV issues…) and did remarkably better on their post-training exam than on their pre-training exam. I only hope that they are able to remember what they learned and take it back to the health centres in which they work. That’s what really counts.

Tanzania photos, album #3 of 3

This is my third and final Tanzania photo album. This album includes shots from Same, Huruma, Marangu, Keni health centre, Rombo district, Moshi, Stone Town and Prison Island Zanzibar. Click on this teeny slideshow to open a new window and see a bigger version of the photos (recommended). Enjoy!

i'm eating real chinese food in Tanzania!

above: Panda Chinese restaurant staff, Feng Yu (the owner) and me in Moshi

There are few things in life as lovely as eating freshly-made tofu, garden greens sauteed in garlic and good rice made by a new friend, who also happens to be a sassy, tough, adventurous Chinese-in-a-foreign country woman.

even the immigration officials have to harass me

Dudes, leave a girl alone! Sheesh.

Mr. Chukah A. Manyenga* was dressed in jeans and a t-shirt, holding a couple of Kilimanjaro postcards. He kept trying to stop me while I was running around Bristol Cottages (our Moshi hotel) trying to tie up loose ends before flying out to Zanzibar. Finally, he stood in front of me and wouldn’t let me pass. I looked at him, irritated, thinking that he was yet another fly-catcher trying to sell me something I don’t want. Moshi is full of these young unemployed and immensely annoying guys. Except he called me by my name. I didn’t really want to find out how he knew my name. Maybe a hotel staff person ratted me out.

“Sophia, I want to talk to you.”

“Please – I do not want to buy anything. I do not want to go on safari. Please let me go about my business,” I pushed past him to continue along my way.

“No, I’m not trying to sell anything. I’m an immigration official. I want to see your passport.”

I looked at him. Was he joking? No he wasn’t. I checked his identification and it looked reasonably legitimate (as legitimate as things look in Tanzania). Why was he chasing after me? Why did he know my name? Why do these annoying young men harass me every day? Why can’t I be treated like a normal human being? Ick, ick, and ick.

I allowed him to look at my passport, but I held on to it, knowing full well that he would more effectively try to bribe me if he took my passport away.

“Hey, hey, it’s OK. I just want to see it,” he said, condescendingly.

“You may look at my passport, but my passport is mine. You have no right to take it away. I don’t want trouble from you,” I stared at him.

Three of his buddies (a.k.a. immigration thugs who came to help extort money from us) came to surround me. Steve and Guy came too. He asked Guy for his passport too, but barely even looked at it.

The immigration officer tried to tell me that I had the wrong visa and that Guy and I had to go to his office for “further investigation.”

Steve said, “We are leaving. We have a flight to catch soon.”

Guy said, “Unless you’re going to arrest us, we are leaving.”

I told him very clearly that I was a professional consultant, that I had fully paid for a professional visa (I did and was very careful to do so), and then I showed him my UCSF physician’s identification badge. Being fully legitimate didn’t matter. They wanted a bribe. Then I pulled out my only weapon.

“I am a professional, a physician, here to assist as a consultant for the HIV care and treatment roll-out under the National AIDS Control Program. I have been hired to work under the Elisabeth Glazer Paediatric AIDS Foundation to help your country with your medical care. If you want to make trouble, you can first talk to our country director, who is a friend of the Kikwetes.” There. And all true. President Kikwete is the current president of Tanzania.

They stood back for a second. One of them mumbled something about me being a VIP, and that they should leave me alone. “OK, you can go.”

Feeling most unwelcome in this country, I dragged my luggage through Moshi with Guy and Steve to catch our van to the airport. It made me wonder, really, what am I doing here? Am I crazy to be so far from my home, from my family and friends? Can this place ever possibly feel like home to me?

Up to that point, I had been meditating on “Being Home” where-ever I was in the world. Now I’m not so sure that I can practice it.

*Yes, I checked his identification and wrote down his name before I allowed him to even look at my passport. Certified by Afisa Uhamaji on 31/5/2007. No details overlooked! And now anyone will know the name of the person who harassed and tried to detain us unfairly.

Tanzania photos, album #2

Check out my second batch of photos from Tanzania! (first batch is on my blog at the beginning of February) Click on the album here to get to a bigger online album to see the photos more clearly.

“You Japanese hate Black Man.”

It was innocent enough. I was walking along Nyerere Street in Moshi, on my way to pick up a tailored shirt that was being altered by a seamstress who set up her sewing machine on one of the side streets. I was almost there when I start to hear a familiar sound. An irritating, persistent voice.

“Hello, how are you? Come to my shop!”

“Hello, how are you? Come to my shop!”

“Hello, how are you? Come to my shop!”

“Hello, how are you? Come to my shop! Nice paintings.”

“Hello, how are you? Come to my shop!”

“Hello, how are you? Come to my shop!”

“Hapana, asante,” I replied, each time. No, thank you. It is almost a reflex now, since I get typically get bothered several times in a single walk down the street with similar phrases.

“Why not? Come to my shop!”

“Hapana, asante.”

“What are you looking for?”

I walk into a fabric store to try to get away from him.

“Want fabric? Come to my shop! I have nice fabric.”

I stop answering him and keep on walking to my destination.

“Where are you from?”

No answer. I keep walking.

“You must be Japanese. You Japanese hate Black Man.”

I looked right at him. He was a young black Tanzanian man with a shaved head, wearing an oversized Timberland shirt and jeans. I said, very sternly, “No, I am not Japanese. I do not hate Black men. Please leave me alone.”

“Yes! You are Japanese! You are Japanese!” he giggled, like he just discovered a new race. He tried to grab me.

I moved away quickly, into the shop associated with the seamstress I was looking for. He continued to harass me about going to his shop until one of the men from the shop managed to kick him out. Much to my sadness, the seamstress was out at lunch, so I had to come back in 15 minutes.

I made it to the corner of Nyerere Street when I heard that young man’s voice again from behind me.

“You, Japanese! You Japanese hate Black man!” He grabbed my arm, and I pulled away in a quick jerk.

“You Japanese MF!” he laughed and pointed at me.

That was the last straw. My seed of anger cracked open with a sprout. I turned around and noted that he was now surrounded by four of his hooligan friends, all staring at me, trying to look tough.

“Do NOT EVER say such a thing to anyone again! I will never go to your shop and buy anything, and I will make sure my friends will not go to your shop and buy anything.”

I turned again and walked into the street to cross it and get away from them. A speeding dala dala almost ran over me, but I sprinted across the street and made it in one piece.

A few minutes later, I told Steve what had happened. Thankfully, he walked back with me to pick up the shirt from the seamstress, just around the corner from that young man’s shop (or really, the shop he “represented”). It turned out that Steve knew the young men at the shop. I wanted to leave as soon as we had figured out that the shirt fit me OK.

“No, come with me,” Steve said. I hesitated. “Come!”

I walked over to the shop with him. The young man came up to us.

“Come to my shop!” he said, looking at both of us.

“I know her,” Steve said, pointing to me.

“You know her! She is the one I followed. You know her?!” the young man said, pointing at me, laughing.

“I know her. She’s a doctor. She told me what you said to her. You can’t say those things to her,” Steve said.

“You shouldn’t say those things to anyone,” I added.

“Oh sorry,” he said half-heartedly. “OK? Come buy at my shop!”

“No! I’m not buying anything at your shop!” Steve said, disgusted.

“Oh sorry,” the young man said again. “OK now? Come in and look at my shop! Just look!” he
attempted again.

I shook my head and walked away with Steve.