Love in a box of raisins

*Disclaimer-The opinions expressed below are mine and do not represent the USG.

It has been a while since I have done an update. Here is what I have been doing lately. We are still having major issues in Tanzania with the shortage of testing supplies. The primary issue is that there is insufficient funding on a national level to do the amount of testing and treatment that is required. Roughly 95% of all funds to purchase testing supplies are from foreign donations. We’ve projected to meet 2011-2012 testing targets; there will be about a $9 million gap between what has been promised and what is needed. The tough decision is the same as in the US, what gets cut? Do you stop testing pregnant mothers when you can prevent transmission to their babies? Do you stop testing blood donations? Do you stop testing teens and young adults? Tough choices as they all have consequences for public health and the fight against HIV.

Last week I went to the Mbeya Zone which is in the Southwestern part of Tanzania along the borders of Zambia and Malawi. I wanted to see the effects of the stock shortages on different levels (Zonal, Regional, District, Health Center, and Dispensaries). In this zone, Walter Reed (a DoD partner) funds the majority of supplies so there were no shortages. It was interesting seeing the different testing capabilities at the different levels. The zonal lab can do microbiology, HIV testing, PCR, and high level tests.

At each level below, you lose capabilities so that when you reach the bottom level (Dispensary), you can only do rapid testing and outpatient medical care (which includes child birth). All higher level tests are done by waiting for someone to come to your village, collect the sample, deliver it to the higher labs which perform the testing and send test results back along the same path. It sometimes takes 4-8 weeks to receive a test result. The dispensary I visited tests roughly 10 pregnant women a month for HIV. They get about 1-2 HIV positive women usually a month. They had never had an infant test positive until the day we arrived when they got the first result back after a 6 week wait. The nurse now has to go find the mother (who is already HIV positive) in the village and inform her that her new baby also has it. With the foreign support that Tanzania is getting in antiretroviral medicines, the infant now can expect to live about 20 years if they stay on the medicines. Most of the women contract HIV from their husbands. A lot of men in this area are farmers and truck drivers. Malawi has a high HIV rate and being so close to the border; the village men are exposed and transmit it back to their wives and occasionally infants. This area (Kyela) has around a 15% infection rate. The average in Tanzania is under 5%. There is also a stigma in this area about men coming in for testing so it’s usually only the women and kids that get tested.

On a side note, Kyela is where most of the rice in Tanzania is grown. They were harvesting it while I was there. Because it is straight from the fields, when you use Kyela rice, you have to wash it and pick through it as it often has rocks and dirt. But it is good and fresh rice. My hotel was on a coffee plantation and I got to see coffee beans growing on shrubs.

I also got to spend the night in Mikumi on the way back and saw more animals. The lodge was in the park and the windows were wide open only covered by a screen mesh. The park people said lions would probably come by around midnight. What!?!? I did awaken at 4 am to the sounds of animals snorting outside my window. I suspect they were cape buffalo or wharthogs.

One thing I like most about my job is the site visits. Most of the labs are located at PMTCT (Prevention of Mother to Child Transmission) Sites so I get to see lots of mothers and their babies. I have never seen so many exposed boobs in my life (focus on making eye contact). I introduced a group of mothers and their kids to Golden Grahams which were a hit. At the zonal hospital (where it got down to 55F at night), I noticed that a lot of babies were wearing knit caps. When I left Monroe, a woman in our church asked us to look for her mission opportunities for the children to do at our church. I thought if these hats were given for free to new mothers, it would be a good mission. I finally saw a woman coming close with her baby and called her over. Through my driver, I asked her where she got the hat for her baby. She said that she had bought it on the street. I thanked her and offered her a small box of raisins. She asked “how much do I give him?” Since I am white, she thought I must be a medical doctor and was prescribing these for her son. Having never seen raisins, I had to tell her what they were and that they were a gift for her and not her baby. She should not give them to her baby as he might choke. She then told my driver the following story:

“This morning I was across town and went to church. I converted and accepted Jesus as my savior. I came all the way across town to come to this hospital with my baby and no one said a word to me today until I got here. This man called me over, asked about me and gave me a gift. I believe that God wanted to show me that he cared about me and sent this man as his messenger. “

How do you respond to that? Here I was looking for mission opportunities and she was looking for a sign from God. We came across each other through different means. All over a box of Sunmaid raisins.

Mungu akubariki- “God bless you”

Madame Secretary Hillary Clinton

Hillary Clinton, yes, Secretary of State Clinton, recently made a visit to 4 African countries. Tanzania was one of them. During her visit here she made the rounds at a clinic and a power plant, and met with the President. Before leaving, she visited the US Embassy. All Embassy families were invited to attend. We immediately signed ourselves up!

At first, we were only given the date that she would be here. A couple of days beforehand, we received an email with specific instructions on our arrival time, etc. We were told that the Embassy doors would be opened from 1:30-2:30 to allow people inside. After that time, the Embassy would be on lock-down until she left the premises. We were warned to bring plenty of snacks and entertainment for the kids. As soon as we got to the Embassy (at 2:00) we were told that she was running behind schedule and it would be another couple of hours before she arrived. Thankfully, the Embassy opened up their café and pool area for the children to run around. Eventually we received word to head back inside. As we were looking for a place to stand, we were told that Madame Secretary was interested in seeing the families with children. We were quickly ushered to the front of the line. Since Sadie was missing her nap to be there, we were very nervous about how she would be. Despite a few little moments, she did really well.

Secretary Clinton arrived at the Embassy and gave about a 20 minute speech. After her speech, she came down to shake hands with everyone. We were a bit nervous, standing right there in the front. How are you supposed to act around the Secretary of State? These are not things that I learned in school. She came down the row of people, shaking hands and then it was our turn. She shook my hand, said that Sadie was very pretty, patted Cash’s head and then moved down to the next person. It was all very exciting to experience.

And then she was ushered out and on her way to another event. We are definitely filing that one in one of our top coolest experiences.

Mikumi

To thank Audra for all of her hard work we wanted to treat her (and ourselves) to a safari. With the Serengeti being a little far for a day trip, we started looking closer to home. Over and over we kept hearing “Mikumi”. Mikumi National Park is the 4^th largest park in Tanzania. And since it is only a 4 hour drive from Dar, it was a perfect choice for us.

Our driver, Frank, agreed to take us out there. We headed out early on Saturday morning. Traffic through Dar can be awful. Thankfully we went through at a good time with few stops. On the road to Mikumi we passed through several small villages. We noticed a lot of police presence in each of the towns. Frank explained to us that they will often pull people over and issue citations. Of course, you can avoid the traffic ticket if you just pay the officer directly. Frank was pulled over once for speeding. After a discussion with the policeman, he paid 10,000Tzsh (about $7US) instead of going through the hassle of the official ticket.

The drive to Mikumi was beautiful. As we left coastal Dar we noticed that we were entering a much more mountainous region (or “biiiig hill” as Sadie kept saying). We enjoyed getting a glimpse of the small villages with their mud brick homes and obviously simple life.

We arrived at Mikumi around 2:00pm. There is a highway that runs through the park. While on this road, on the way to the park entrance, we were immediately greeted by a family of baboons crossing the road. Soon after we saw elephant and giraffes. We were all surprised to see such large animals so close to the road.

At the park entrance, we paid our entrance fee and picked up our guide, who would be with us for the remainder of the day. We all stayed in the minivan with Frank driving and our guide instructing Frank which of the dirt roads he should take through the park. We were not disappointed with what we saw. Zebras, baboons, elephants, giraffe, impala and wildebeest all roaming freely.

As we drove through the park, our guide instructed Frank to make a quick turn toward a couple of vehicles stopped on the side of the road. As he suspected, they were looking at a lion. When we first pulled up we all stared into the tall grass, not seeing much of anything at all. After a little while, you could barely pick out the flicker of an ear. There were 2 lions fast asleep in the tall grass, not caring at all that we were about 15 feet away. We all agreed that had we been on foot, we would have all been eaten as we never would have seen them until it was too late.

Our next stop was at the hippo pool. As some of you know, hippos are a big favorite of Sadie’s….”Po” as she calls them. This is the only place in the park that you can get out of your car. I must admit that it was a bit intimidating to approach the shoreline as these huge beasts would rise out of the water to get some air before sinking back down again. Our guide explained that hippos come out of the water to feed at night. Although they are herbivores, they are very territorial and therefore dangerous to humans. During the heat of the day though, they are very lazy and will stay under the water to keep themselves cool.

The hippos also live a symbiotic life with the crocodiles. Fish feed on the hippos dung and become quite large and good meals for the crocs. The crocs in turn keep other animals from drinking all of the hippo’s pool water. We did not, however, see any crocs, although our guide assured us that they were there.

On our way out of the park we swung back by the lions. Sure enough they had moved out of their hiding spot. They were still fast asleep but we were able to get better pictures of them. Our guide explained that they were “honeymooning” and would probably not eat again for another 5 days.

On our way out of the park, we were stopped by this guy crossing the road. He stood for several minutes looking down at something in the grass. He would pick up his front foot and seemingly point his trunk. Our guide told us that he probably saw something that he didn’t like (snake???) and he wouldn’t move until it was gone. We were glad to just sit and watch him. Unfortunately a large truck was not as patient as we were. As he zoomed past us, the elephant decided it was time to continue on his way.

We had hoped to stay at a lodge inside the park. However they were booked for the night so we had to find other accommodations. Instead we went into Mikumi town and stayed at the Genesis House. It was simple, but nice. And they served dinner, which was most important since we were all starving by that point.

The next morning it was time to head back home. We took the same route back through the villages. At each village people sit on the roadside selling various items. We made a couple of stops to buy some baskets. We also made a stop for fresh fruits and veggies. We were very glad to have Frank with us as he did the negotiating for us. By the end of it all we walked away with 3 pineapples, a large bunch of bananas (still on the stalk!), 2 watermelons, 4 cucumbers, a 5 gallon bucket of potatoes, a 5 gallon bucket of tomatoes and ½ a bucket of onions for about $20US.

Mikumi was an amazing experience and one not soon forgotten.

Home Sweet Home

It’s been a while since we’ve posted anything and a lot has happened in the last few weeks. I will probably have to make several different posts to get things caught up.

One of our most exciting moments was when we finally moved in to our house!! We moved in on Thursday after 5 days in our temporary housing. The Embassy sent a huge canvas-topped military truck to move all of our things. The Embassy worker who came to get us smiled and said “I was told you have many suitcases; I should bring big truck”. Well, he was right about that. After a short drive up the peninsula, we were home.

We had seen pictures of the house, courtesy of our sponsor, Andrew. We were very pleased with what we saw in person. Our house is one of three in a compound. There is a 9 foot concrete fence around the entire property. We have 2 guards at the entrance at all times. Each of the 3 homes also has a 4 foot concrete fence around its property. We were very pleased to see that we have our own yard for the pups to run around in.

Our house is a 2-story house. When you walk in the front door, you step into the living room, which opens into the dining room. The stairs are to the right. Next to the stairs is a spare room (we are still debating whether that is going to be the “man room TV center” or the pretty guest bedroom). There is also a full bath underneath the stairs (yes, it’s quirky). To the right of the dining room is the kitchen. The kitchen is a very nice size with a large pantry (apparently a rarity here). We also have a large laundry room in the back of the house with plenty of storage shelves…and….most excitingly…a dishwasher!!! We were told there are no dishwashers here, so we didn’t even bring dish soap with us. I am most ecstatic to have a dishwasher as I do NOT like hand washing.

Upstairs we have 3 bedrooms (yeah, Cash finally has his own room!) and 2 full baths. The upstairs is also considered our safe area. Each Embassy home has an area that is enclosed with iron bars (windows and door). At the top of our stairs is a locking iron door. In the event of an emergency, we are to retreat to our safe area, lock ourselves in, and call the Embassy on our radio. Currently our biggest use of the iron door is to keep the dogs downstairs while we are sleeping at night.

The Embassy has fully furnished the house for us. We brought a few things (our bed, cribs, rocking chair) but otherwise we will us the lovely Embassy furniture. We are borrowing Embassy cribs for the kids until ours arrive. The Embassy also provides us with a “welcome kit” to use while awaiting our shipments. The welcome kit include: plates, bowls, silverware, cups, dishtowels, bath towels, a few pots and pans and a vacuum.

The house has also come with Peter. Peter is our gardener who was employed by the Embassy while our house was empty. Apparently his contract is for a month, so even though we are in the house now, Peter is here until mid-June. Peter is not that fastest worker in the world, but he works hard. He is here every day at 8:00am sweeping our porch and driveway. He has also trimmed all of bushes, cut the grass with a machete, weeded the flower beds and (constantly) waters the yard (even if it has just rained). We are working with him on the concept that rainy season means no need to water.

We received news that the car we ordered from Japan has been shipped. It’s currently aboard the Morning Menad. It is scheduled to arrive in Dar mid-June. After clearing customs and paperwork, we should have the car by early July. We are very eager to get our car. Although the Embassy provides a car to get Mike to and from work, we are relying on taxis for all other transportation. We have been lucky to have been introduced to Frank. Frank is a taxi driver who drives for a coworker of Mike’s. Frank has been very good to drive us around and give us really good rates (think $10US for about 3 hours of driving to 4 different destinations as I ran errands one day).

We have also learned the art of walking. Thankfully we are within walking distance of a grocery store and bakery (a French one at that). Walking to get groceries definitely adds a new twist to things. On one of my first outings I bought the 20lb bag of dog food, not really considering that I’d have to carry it home. Thankfully I had the stroller and was able to cram the bag in the bottom. However, it took up the whole space so I had to carry the rest of the shopping bags home.

Grocery shopping has been an interesting experience in and of itself. There is a rather large grocery store that we frequent called Shopper’s Plaza (or as Sadie likes to call it, Walmart). You can get most everything there, but it is at a price (think $7US for a box of Corn Flakes). They also do not have good quality meat, produce or bread there. For those things we have found specialty shops are the way to go. So we go to the butcher shop for our meat, Garden Market (a tiny little shop) for our fruits and veggies and Epi D’or, the French bakery, for our breads.

We had a new experience recently when we visited the fish market for the first time. There is a very large fish market in Dar with better prices, but a much longer drive. We chose to go to the one on the peninsula to check it out. It is an open air concrete building. As we stepped out of the car we were met by a dozen men each selling their catch of the day: red snapper, salmon, octopus, shrimp, crab, squid, flounder….just to name a few. Thankfully our driver went in with us to help negotiate. We walked away with 8 large salmon fillets, 6 red snapper fillets, 1 lb of jumbo shrimp, and 1 lb of calamari. I was very glad to have the men clean all of it for us.

On a sad note (for me at least), Audra is now on her way back home. We feel so very blessed to have had her with us for these first few weeks. She was an amazing help with the children, so patient as Sadie worked through her jet lag and general confusion related to this big change. We laughed that Audra was our guinea pig as we learned our way around our new town and new adventures. So for each of you who come to visit us later, you can thank Audra that your trip (hopefully) goes very smoothly. A million thank you’s Audra!!

Squeezing blood out of a Monroe boy

**Disclaimer..this blog is my opinion and in no way reflects the opions of the CDC or the US government.

On Friday May 13, I was asked by Dr. Elizabeth Marum (acting CDC Country director) if I would represent the CDC at the grand opening of a new blood collection clinic at a woman and children’s care and treatment center in Dar es Salaam. The Tanzanian National Blood Safety Program (NBSP) is supported by the CDC both through a technical standpoint and financially. As taxpayers, part of your tax money has gone to building this blood collection site in Tanzania which will provide much needed blood to women and children needing transfusions.

I was accompanied to the event by Regina who is a locally employed staff (LES) and Kate who works as the CDC public affairs person. I was so glad that Regina was there as the entire ceremony was in Swahili and the customs were a mystery to me. We began by sitting on a stage with all of the dignitaries (the director of the clinic, the director of the NBSP, city councilman, someone from the mayor’s office, etc..).

After a while, everyone stood up and started walking away. Regina said that I should follow as we would begin the festivities by marching as a group down the street back into the stage area. So I did and we did. We were led by a drum, a trombone, and a trumpet. We marched to the stage area and all of the school children marched in front of us waiving at us.

The official program began with introductions and then a hip hop dance group performed for the group. Kate had been out of town so did not get a chance to approve the rather questionable music and such. She had warned me that Tanzanians love dancing. They love to get the mzungu (white person) to get up and dance as well. No matter how badly you dance, you need to give it a shot so they can laugh and feel like you are part of it all. Luckily, they skipped me but Kate got a nice lap dance by the hip hop group. Can’t imagine that happening in the US.

After some traditional dancing, there were more speeches and then the opening of the clinic by the traditional cutting of the ribbon.

I was asked if I would like to give blood. When you donate blood in Tanzania, you are automatically checked for HIV, Hepatitis, etc.. like you are in the US to make sure your blood is safe. Many Tanzanians are afraid to donate blood because they are afraid to learn their HIV status. There is also a stigma associated with donating blood as many are afraid that they’ll catch HIV or other diseases from the needles used to donate. Giving blood in Tanzania is just as safe as it is in the US. Due to the scarcity of donors, Tanzania will bring school kids to these clinics to donate as they are not afraid of their HIV status. The limitation is that if you are under 17, you must have parental consent. I went ahead and donated a pint as it was good for locals to see that an educated mzungu would donate thus thinking it safe.

Overall it was a rewarding experience. Hope all are well.

Swahili lesson for today:
Damu = blood

Pictures

I had intended to include pictures with my posts but time got away from me and I didn't do it. Instead of plugging them into old posts, I'll just do a post of pictures. So here is a little photo journal of our last couple of weeks.

The Pack-out:

Heading to the airport:

Check out all that luggage!

Sadie sleeping on the plane to Amsterdam:

Cash's bassinet (yes, he's in there):

The rains in Africa (the view from our front windows):

Sadie's ready for the hotel pool:

Our visitor:

We found this guy in the grass in front of our apartment. At first I though it was an empty shell until I turned it over.

"Ok, done holding him!"