Epilepsy

Habari za siku nyingi? It's been a while since I've posted anything. I have been approached by a researcher from CDC Atlanta about collaborating with the Ministry of Health in Tanzania and a group of researchers from the Universtiy of Innsbrook and Dr. Louis Jilek-Aall in studying an emerging phenomenon called "Nodding Disease". Nodding Disease is characterized as such as children often lose muscle tone in their necks when presented with either a plate of food, drink of cold water, or a bath in cold water. It is equivalent to having an epileptic seizure. As it is usually triggered by eating, a lot of these children are malnurished or even die young as they do not get a chance to eat before the seizure "nodding" is triggered. CDC has studied this already in Uganda and Southern Sudan as they are recent occurrences. Interestingly, in Tanzania, there has been one woman (Dr. Lousi Jilek-Aall) who has been following cases since the 1960s. For those who find interest in inspirational people, she is one. In Tanzania, epilepsy is often believed to be caused by "bad spirits". People who are affected often get no treatment and even get shunned from a community as they believe them to be afflicted by evil spirits. Dr. Jilek-Aall began the only epilepsy clinic in Tanzania in 1960 to educate the locals and to treat those affected by epilepsy. 50 years later, the clinic is still operational and she is still strongly supporting it and gathering financial and technical support for it at the age of 70 something years old. All of this is pending us getting in touch with everyone and setting up potential studies but it is exciting. If you want to learn more, here is a link: http://mahenge.wordpress.com/about/mahenge-epilepsy-clinic/

There is also a youtube video of it: http://www.youtube.com/watch?v=1szyYVuduu4

Spring update

We have now been in Tanzania for 5 months now. In some ways it seems unbelievable that 5 months has already passed. In other ways, it feels like we’ve been here much longer. We have settled into a nice routine and things are going very well.

We braved the winter here and Spring is now upon us. We have noticed a change in the weather these last few weeks. It is getting warmer during the day and the rains have started again. This is the beginning of the "light rain" season.

One of the unexpected joys of this foreign service life is meeting many new people from all different walks of life. Being thrown into this unusual circumstance of living abroad, you bond very quickly with people. I feel fortunate to have met several stay-at-home moms and we now get together quite often for baby playgroups. I have been very surprised how many families with young children are living here. It’s fun to see Sadie learning to play with other children and hearing her talks about all of her friends.

On the flip side though, we are also saying good-bye to people. Foreign posts are just not long-term assignments, so there is a constant turnover of personnel. CDC has a program that allows its US employees to take a 3 month assignment oversees as part of a fellowship. Through this program we were blessed to meet Umed, Keysha, Debbie and Joe. We enjoyed having them over for dinners at our house. Keysha and Debbie were even gracious enough to babysit one night and allow Mike and me to have a date night. Sadie fell in love with them all. Each has now returned to their families in the states and we miss them.

One of our challenges in living here has been finding a church home. We have visited a few places but have yet to settle in to one. Each has its pros and cons. The first church we visited was the church of Christ. The congregation meets at the Russian Cultural Center in town. The service is conducted in Swahili and then translated into English. The congregation is very small. There were about 20 people when we attended.

Most recently we have been going to the Dar Christian Fellowship which meets at Cocoa Beach (yes, in a little grass hut right on the beach). It is amazingly peaceful and serene to watch the waves roll in during services. I would say there are about 50 people who attend DCF. The entire service is in English. Interestingly, at the last service a roll was taken to see how many different countries were represented. The final tally was 18. There is something really awe inspiring about worshiping with people from 18 different countries. Different languages, different ethnicities, different cultures…but all worshiping the same God.

One of our biggest hang ups at each location is no nursery for the kids. Having put Sadie in the nursery at home by 6 weeks of age, we have never had to sit through a worship service with our kids. I don’t know how people do it on a regular basis. At any given time, one of us is up walking around with Sadie, trying to keep her entertained…and quiet.

We have (finally) hired someone to help out with our house. That whole process became more difficult than I had imagined it would be. The first person we hired, Mary, was wonderful. She had worked for ex-pats before and she knew just what to do. She spoke great English, needed very little instruction and was great with the kids. After 2 weeks, she left us for a full-time position (we only had her part-time). Because she felt bad leaving us though, she sent Rosie. Although Rosie was very nice, she spoke almost no English, which really made giving instructions very difficult. After a week, we knew Rosie was not a good fit for our family.

One evening Mike was out talking to our guards and Albert (see previous post) mentioned the he had not seen anyone coming to our house lately. Mike confirmed that we were indeed without help. Albert offered that his sister, Eda was available. After meeting with her, we decided to give her a shot. Eda has never worked in an ex-pat house before. On her first day here I could see her eyes glazing over when I showed her various appliances. She had never seen a vacuum, a washing machine or a dryer before. I figured I would have to train someone to do things the way I wanted them done. I had not, however, anticipated starting from scratch on how to turn on a washing machine.

Eda has now been with us for about 3 months and things have greatly improved. What I love most about her is how great she is with the kids (and I think that’s something you can’t teach someone). She especially loves Cash. I have found him several times sitting in the laundry basket watching Eda fold clothes. Or she’ll tie him to her back while she cleans.

Mike has begun taking Swahili lessons at the Embassy. He goes to class twice a week and is really learning a lot (I think so at least). In the evenings, Sadie loves to run around the complex and go talk to the guards. Mike also takes that time to practice his Swahili with them. Before Albert had to leave, he was like a pea in a pod with our other guard, Jeff. Albert and Jeff mentioned to Mike one night that they wanted to improve their English. So we provided them with some of Sadie’s books to read.

Mike also decided that he wanted to introduce them to American movies. One night he took our portable DVD player along with 3 DVD’s to the building where they sit at night. Albert and Jeff both got very excited when they saw the movie Gone In 60 Seconds and both were saying “yes, Nicolas Cage”! Who knew that he was so popular in Tanzania.

House is slowly coming together. After my sewing machine arrived, I was able to alter some curtains to make them a little more personalized for our bedrooms. We have also been hanging pictures on the walls and settling on final furniture placements. After everything is done, I promise to take pictures of the house and post them.

The kids are growing and thriving. As I mentioned, Sadie is making lots of new friends. She is growing into such a little girl. She loves all things pink. Her language really exploded after we arrived and she is now able to make whole sentences. She can be a little bossy with her brother at times. Her time these days is taken up with the care of her 5 baby dolls. She spends hours sometimes in her room changing their diapers, dressing them, putting them down for naps, feeding them. It’s really quite funny to watch. Of course, I haven’t been able to get any of that on video because she stops as soon as she sees me.

Cash is moving all over the place. He can crawl at a lightening pace and is cruising down the furniture. He loves to eat and now weighs the same as his sister (both are 24 lbs). He loves Sadie. She makes him laugh and he especially enjoys when she brings him toys. His favorite toys are balls and anything musical. When he hears a beat he immediately starts bouncing and rocking to the rhythm.

We are looking at our calendar now and thinking about when we’ll be coming back home for a visit. Right now it looks like it may be sometime in March or April. We will certainly keep everyone updated on potential travel plans. We look forward to catching up with all of our family and friends when we return.

Farewell Albert

Mike and I have said many times that the most boring job in the whole world must be a guard at our house. We have 2 guards at a time who sit on 12 hour shifts....and just sit....and wait....for nothing. They open the gates for our car when we come and go. They turn on our outdoor security lights at dusk and turn them off again at dawn. And that's about it.

The Embassy policy is to rotate guards among all of the houses on a regular basis. However, there are about 3 guards who remain at our complex (our neighbor works for the Embassy security office, so she can pull some strings).

One of those guards is Albert. Albert was one of the first guards we met when we arrived. We soon learned that he has been working at our complex for 2 years now. Albert is young, early 20's I would guess. He is soft spoken and respectful. And he loves Sadie! One of Sadie's favorite games is to run around the corner and "talk" to the guards. Albert lights up when he sees her coming. He will sit with her and ask her to name him different colors ("what color is the table", "what color is my shirt"). He calls her 'da-da', which is Swahili for 'sister'.

We brought a new swingset with us in our sea shipment. When it arrived Albert and his sidekick, Jeff, were the ones who put it together for us.

One afternoon I looked outside and saw Albert painting. It brought tears to my eyes watching him. Mike and I went out to admire his work. We found out that he was taking art classes. There was something about learning that that really struck me. I enjoy talking to our guards and meeting them, but I had never really considered what their lives were like outside of our complex. I had certainly not thought about their hobbies. And here Albert was, with very simple paint and brush, making this beautiful creation on a piece of wood. Mike and I wanted to do something for him, so we went inside and found a set of watercolor pencils (practically unused from a whimsical "I'm going to learn to draw" moment). We presented it to Albert as a gift. Immediately we saw the emotion sweep across his face. He was so grateful, he was practically speechless. He quietly whispered "thank you" over and over again as he stared at his new pencils.

Last week, Albert knocked on our door. He was wearing street clothes, so immediately we knew something was up. He explained to us that he was going to be leaving, returning to his home in Malawi. We learned that his parents have already passed away and he has only his uncle still alive. His uncle is very sick and Albert is leaving to go care for him. He told us that now that he is a man, he must do this for his uncle. He wanted to tell us himself that he was leaving.

Mike and I were both surprised and humbled. Back home, if a family member is sick, you send flowers, you send a card, you call, you check on them, you visit. But most people wouldn't quit their job, leave school, leave their house and friends and move back to take care of that family member. Africans have a much different sense of family than we Americans do.

We will miss Albert very much. We hope to see him again one day.

Tragedy and commonality

So by now, most of you have heard about the tragic event in Tanzania where a ferry going between the island of Zanzibar and Pemba capsized killing over 200 people. Most of the victims were small children who were heading back for the start of school. In a country such as Tanzania, almost 11% of children under 5 will die before the age of 5. The children that have died on the ferry incident had past that window. When you combine it with a small community such as Pemba, then you not only lost kids in one family, but you lost their cousins so multiple relatives were affected. The ferry accident was caused by the ferry boat being very much overloaded. Between the rice, vehicles, flour, household goods, and over 1000 people on a boat designed to carry only 500 tops. Combine that with choppy water and winds, the boat capsized at 3 am. In the US, we have a tendency to be quick to rush with our prejudices and think “that’s Africa”. But in a sense, it’s most of the world. Even though the fares on these ferries are very small (about $1), in terms of third world salaries it is a significant amount. Crowding 20 people on a 12 passenger van is not uncommon. Putting 100 people on a 40 passenger bus happens all the time. 1000 people on a 500 person ferry are commonplace. Economies of scale are the only way they can make it. Unfortunately, it often leads to tragedy. Ferry accidents happen all around the world every year. We just seldom hear about them in the US. Attached is a photo of a similar ferry as to the one that sunk from our trip to Zanzibar.


I was talking with a colleague from USAID today who commented, “I’ve worked in several places but I have not been around as much death as I have here in Tanzania.” Within 2 months, one of her colleagues at USAID lost his wife as she was giving birth to their first child. The ferry accident has cost over 200 lives. One or two others in the Embassy have died in the past month with heart attacks. The deaths we are seeing are common place in third world countries. It really does open your eyes to the blessings that we have in the US. Healthcare is exceptional. In the US, there is always, in the back of your mind, the thought that something could happen. Here, it is expected that something WILL happen. Your joy of bringing in a baby is tempered by the worry that you may lose the mother. In Tanzania, 454 out of 100,000 births, the mother will lose her life. Combine that with the 11% child under 5 mortality rate, then you see the greater risk of either losing the mother or the child before the age of 5 is quite high.

"When any calamity has been suffered, the first thing to be remembered is how much has been escaped."

Samuel Johnson (1709-1784) British author.

The easy thing to do is to write off Africa as being corrupt, backwards, and primitive. In the US, all we see are National Geographic specials of naked Africans sitting in the mud houses. We are actually in a major city with successful businesses, doctors, and such. My opinions of Africa have totally changed and it’s given me a thirst to see more of the world. I was speaking with a Tanzanian colleague. He asked me what I expected from Africa. I told him I expected primitive people and lots of animals because that’s what we saw in the US on TV. He said that when he was in the UK, he saw programs on Africa and that’s what they showed as well. He thought to himself, “Where are they in Africa? I have not seen these places.” I challenge everyone to learn more about the cultures and places around the world then what you see on TV. The world is so much more than that.

In the end, life is no different in Tanzania than it is in the US. People want good health, steady work, and peaceful communities. We’re not so different after all.

In the Carpenter's Hands

This week has been very busy for us as our household goods finally arrived!! On Tuesday morning the shipping container arrived on a huge trailer. So huge, in fact, that it could not fit into our complex.

After verifying that the seal number on the container matched the number on our records, the container was opened and the unloading process began.

We were very blessed that our friend Vanessa and her daughter Saskia were able to come and play with the kids while Mike and I assisted the delivery guys. Saskia is 4 months old and I think Cash has a little crush on her.

While the boxes were coming in the house, Sadie kept running around yelling "toys, toys". The best toy of all that arrived....her pink Barbie Jeep. Sadie couldn't even wait for it to be unwrapped before she hopped in.

Sadie also enjoyed assisting with the unpacking process.

And 2 days later.....our car was released from the Embassy!! So here it is, what you've all been waiting for....green flames and all....our new Toyota Prado (AKA Land Cruiser).

When our stuff arrived, it was in huge wooden crates inside the container. As the crates were being torn opened, the movers would toss the wood aside. One of our favorite guards, Meck, approached me and asked if he could keep the wood. I told him he could. What did he want it for anyway, it was full of nails, split in some places and just not good quality wood. Back home we wouldn't have given a 2nd thought to piling all of that wood at the street for the trash truck to come and collect it.

Meck spent the next days painstakingly hammering out each nail, stacking the large pieces of plywood and separating the smaller 2x4's and 4x4's into piles. My curiosity got the best of me and I finally asked him what was he going to do with all of that wood. Meck's face lit up with pride. As he placed his hand on his chest he told me, "I have a house, it is my house." He was beaming. He then said, "But I have no roof on my house. With this wood I am going to put a roof on my house." I was instantly humbled. Here I was looking at this used plywood and what I saw was trash. When Meck looked at it, he saw hope and his future.

Later in the day, Meck presented us with a very special gift. He had used the wood and nails to make a garage for Sadie's car. Even though we offered, he would not accept any money for his labor. He simply told us, "it was my pleasure".

Daily life with the Dillon's

May ended with Audra heading back home. It was such a blessing to have her here as we learned the ropes and tried to settle in to our new life. I was very grateful to have her company each day. She was a huge help with the children, keeping the house cleaned, helping at meal times and just my general sanity. I can not imagine how newcomers make it without help. Thank you Audra!

As part of our move we were allowed to bring some of our personal belongings with us. We were allotted 3 shipments: a small amount by air, the bulk of our household goods by sea and a consumables shipment (grocery items that are either not available or very expensive here). We were told different stories about when each of these would arrive. The Embassy officially said that our air and consumables shipments would take 2-4 weeks. The shipping company told us it would be there within a few days of our arrival, and might even beat us here. Much to our dismay, the Embassy was right. Although we packed a lot in our 12 suitcases, we were counting on having our air shipment sooner than later. Paperwork, customs forms, the Embassy, the shipping company, the delivery guys…all had to get on the same page. After hearing 6 different delivery days, our stuff finally arrived. We were all so excited. It was like Christmas in June. We received 38 boxes full of food, Sadie and Cash’s toys, towels, sheets, toiletries, etc. Sadie went crazy opening everything up. I’m not sure if she was more excited about the toys or the food. Every food box we would open she would say “I want that! I want that!”. Mike and I wanted it too. Over the next couple of days we enjoyed Pop Tarts, Kraft Mac & Cheese, chocolate chips, chocolate syrup (for chocolate milk), Lucky Charms, and Pam cooking spray (who knew!).

After it was all unpacked and put away, we were left with quite a mess of boxes and paper. What better use for shipping boxes than to make a house :)

We are still waiting on our sea shipment and the arrival of our car. Our car was ordered from Japan (online…a very strange process). We recently received notice that both are Dar. Our sea shipment is still at the port and will be released to the same delivery company that brought our air shipment. We are hopeful they will call us any day now with news that they are on the way to our house. As for the car, it has been released to the Embassy. We are waiting for the Embassy to register the car and put Diplomatic tags on it. After we have received our local driver’s licenses (a process we have started but not completed), we will be able to bring the car home.

We’ve now been in our house for 2 months. We are starting to settle into a routine, which is nice. Since our car isn’t here yet, Mike is still relying on the Embassy motorpool to get him to work each day. He usually gets picked up around 7:30am, though some mornings it’s been closer to 9:00am. He gets home around 5:00-5:30pm. On Friday’s the Embassy closes early, around 11:00am, so it’s a short day of work for everyone. I’m enjoying my time with the kids. Sadie has developed quite an imagination and it’s fun to watch her play. Cash is rolling over and growing so quickly. He’s starting eating solid foods, which is always an adventure.

We have hired some local household help. Peter is our gardener. He was hired by the Embassy to take care of our yard before we moved in. He is an amazingly hard worker and we quickly let him know that we wanted him to continue to work for us. We have a new appreciation for our American yard tools after watching Peter cut grass with a machete, trim hedges by hand and sweep the driveway with an old broom. We have also begun having Peter help us with other things, such as refilling our Cokes. All sodas are in glass bottles here. Once they are empty, you take them to the duka (a roadside stand) and exchange the empty bottles for full ones. Mike quickly found out how challenging that can be when he walked to the duka down the street and then had to carry back 24 full glass soda bottles.

We are still looking for help inside the house. We hired a housekeeper to come 2 ½ days a week. After 2 though she was offered full-time work by another family and she took it. So we’re back to square one and looking again. The whole notion of having household help is very foreign to me. It was hard for me to accept it at first, even though it is quite the norm here. Part of me feels like I am perfectly able to take care of my house on my own. But I will admit that I enjoyed the extra time that I had to play with my kids, spend with my husband and update this blog!

Exploring Dar, or at least our little peninsula, has been fun for us. As many of you know, we like to eat out…a lot. We have been pleased to find numerous good restaurants in our area. Some of our favorite dinners are at Zuane’s (an Italian restaurant with delicious wood-fired pizzas), Addis is Dar (Ethiopian food), Coral Beach (yummy seafood), George & Dragon (an Irish pub with real American-style hamburgers) and Thai Village. Our Saturday morning favorite is Epi D’or. It’s a very cute French bakery and restaurant within walking distance of our house. They have a little playground in the back too that Sadie loves. We’ve spent each Saturday morning there enjoying cappuccinos, chocolate crepes, waffles and croissants.

Hopefully after we have our car, we’ll be able to take more outings around town and post some more pictures.

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”