The Hoopers

Laura Hooper (our daughter-in-law) has spent the past three months working at a clinic in Tanzania. Listed below are several of her storing about life and work in this third world country.

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The past two weeks have been filled with some interesting public health projects. First, we met with the leaders of the squatter community living in the valley directly behind our houses. Due to the location, they are one of the target communities for our Health Center and we needed to assess the economic status, health concerns and services the clinic will need to offer. Even though we were in the heart of Dar es Salaam, it felt like we were revisiting some of the rural villages from a few weeks ago.

Taking the foot path that passes directly behind our yard, the Ziegler’s, Magi and I followed Ciprian, a clinical officer from the health center, into the winding alleys of this community. Even though there are permanent cement houses throughout the area, it is a squatter community because no one pays rent or is registered by the government as living on this Diocese-owned property. They have slowly taken over the existing structures and over time, formed a fully functioning community structure with leaders and shared resources, such as water. And just like the rural villages, this community has a completely unique personality.

At the first meeting we were joined by about 25 women and men—it started as a smaller group, but as people passed our meeting area, they got curious about the “wazungu” and filed in one after another. After the initial introductions, we asked them to meet during the week and identify the top health priorities for the community. Last week we were presented with a handwritten, prioritized list that included baby deliveries, mother and child heath services and the creation of a woman’s group—undoubtedly the women have a good amount of say in this community!

We continue to meet with them on a weekly basis and there is visible excitement at the prospect of improving the health of this population. Despite the fact that this is a “squatter” community, the leaders are some of the most organized and motivated individuals I have encountered thus far. The name of the area is Kisawani—in Kiswahili, it means “island.” While it is certainly an island of extreme poverty in an already poor district of Dar, it is also a place with unique determination to improve the health and lives of its people. The women, in particular, understand their importance in this process and by improving the education and health of their children, and assuming leadership roles, they are proactively creating change.

The other project on which I’ve been working is a deworming campaign at St. Augustine’s Primary school, adjacent to the Health Center. The Ziegler’s are starting a joint health education program, and I have taken over this particular item. It’s glamorous, I know.

Despite some of the more unsavory details (the stool samples for instance…) I am really excited about organizing the program. Worms are a major problem in most of the developing world, and especially in poor countries like Tanzania. They are most prevalent in school-age children and while normally not life-threatening, infections cause chronic health problems in children. These include anemia, malnutrition, and diminished cognitive development that usually results in noticeably lower test scores and attendance. The good news is that treatment is both inexpensive and extremely safe.

This past week I initiated the first part of the program with the assistance of the school’s headmaster. We organized a random screening of 20 children, spanning the six standards, and are awaiting the lab results. Children contract worms in a variety of ways—playing in the dirt, forgetting to wash their hands before eating, poor sanitation at home, or walking through schistosome-infested water. We anticipate a high infection rate given that many of these behaviors are observed daily, but we need to ascertain that at least 50% of the students are infected before treating the whole school.

I am currently working on a treatment schedule and drafting a letter to inform parents. Unfortunately, recent events in Dar have made this a real exercise in public health education for me. Just a week ago, one of the government schools treated children for worms without following simple protocols (like giving them food with the pills) and many of the students fainted and were taken to the hospital. The next day, this was the front page story of every newspaper—some were even (falsely) claiming that children had died! After a few days, the sensationalism and rumors had reached the point that many parents believed the deworming programs were a ruse and the pills were actually being administered to sterilize the children. Even some of the more reputable newspapers were reporting this and fueled the growing consensus that these programs were intended to control the growing population.

Enter my little proposal for a deworming program at the primary school. Impeccable timing.

Needless to say, this simple and straightforward project has turned into a full-blown parental education campaign. I am working on a letter that will be presented at the end-of-term parents meeting in a week and I am learning more about worms and treatment protocols than I ever cared to know! In all seriousness, I do hope this blows over quickly because these treatment programs really are safe and incredibly important for the millions of children suffering unnecessarily. But in the short term, I’m learning an awful lot about the importance of education and following protocols, especially when public perception (or misperception, as it were) has the power to destroy a program’s credibility. More to come….

On a side note, Magi and I took a Saturday vacation to an island just off the mainland of Dar. For $8 and a quick 25 minute boat ride, we were able to spend the whole day sunning and swimming in the Indian Ocean. Bongoyo Island is like a poor-man’s Zanzibar, with private thatched “bandas,” white-sand beaches, snorkeling and that spectacular aqua-green water. I ate freshly caught fish, sunned myself in the surf and actually swam laps in the Indian Ocean. After the dirt, poverty and crowding of Dar, this was a much needed and long-overdue break. And at that price, I’m already making plans for next weekend!

All my best from Tanzania (or the Land of Tan as it is often called, although after this weekend, perhaps the Land of Slightly Sunburned Pink…),

Laura

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This week I went up-country and into another world.

As part of the public health arm of the Zielger’s work here, we are conducting health assessments in 27 rural villages along the Tanzanian coast. This week I went with Magi and Uhuru, Dir. Of Dev., to 10 villages in three days.

We all piled into the 4 × 4 and within 30 minutes Dar was behind us and practically all traces of civilization had vanished. Outside of the cities, Africa gets rural—quickly. Since there are basically only a few paved roads that transverse the entire country (we’re talking like 5 or 6…) we were bumping along dirt roads almost immediately after leaving Dar. And perhaps I should qualify the term “road.” They are dirt (usually the deep red that is characteristic of the landscape here) that has been packed down, but with deep ruts that can span 5 to 6 feet due to the rains. Potholes of the most extreme variety. Since we had an experienced driver, we were getting up to 40 mph on some of these stretches. At this speed you quickly learn the best “riding” technique is to go completely limp and get tossed around like a wet noodle in the back seat. And so, with our heads bobbing and swaying along in perfect unison, we bumped our way into the countryside.

Since returning I have spent several days just processing everything that I saw. In many ways, this was like taking a trip back in time—and most certainly to another world. The poverty is crushing, pervasive and absolute. For me, the image that captures life in rural Africa is women carrying buckets of water on their heads. This single image is deceptively simple and genial--in fact, it is the figure of women walking, shouldering these heavy burdens, that most fully captures the poverty, the suffering and the culture of rural life.
Photo Credit: Magi Griffin

Driving into a village meant passing women and girls lining the road either on their way to the well or returning from it. These water sources can be 5-6 kilometers from the village and these women must make this journey twice a day. Often, this trip can take four hours round trip. Imagine walking 3 km in the morning, making the return trip with a full bucket of water, then, using that water to do the never-ending work of laundry, cooking, and cleaning, only to have to walk those same 6 km again in the evening—many times returning after dark. Really, try to imagine. I certainly couldn’t—even after making the trip myself (but only about half a km) to take these pictures of the women of Marui Mngwata (pron: Ma-roo-ee Mm-n-gwa-ta). Now, imagine that the water you’ve been collecting is visibly unclean and the cause of most of the village’s health problems—cholera, typhoid, diarrhea, amoebas. And this is if a village is fortunate enough to have a reliable water source—most we visited have insufficient, shallow wells that cannot provide even the unclean, unsafe water that is so essential. This is poverty of the most basic form.

The women are essential to this picture of village life. As Magi put it, they are the glue that holds these villages together. Their work is unceasing and relentless and this was abundantly clear when we would arrive in each village—the women are nowhere to be seen. We were warmly greeted by the leaders (all men) and would typically sit down to a village meeting surrounded by men and boys of all ages. Occasionally a few women would join us, but for the most part, they were figures in the background, quietly attending to the work that kept the village running. Even the young girls had a weariness and maturity in their faces that was incongruous on a body so small.

Although most villages were burdened with the same problems—lack of clean and safe water, too few teachers, insufficient healthcare (if any existed at all)—each village was unique. In many ways, they are like individual people, each with a complex and distinct personality. Kiwangwa (pron: Kee-won-gwa) was a village that made a deep impression on me. Its personality was a unique juxtaposition of poverty and hope. Kiwangwa is a village of 12,000 composed of 17 hamlets (imagine “mini-villages”). The pineapple, “nanasi,” is the village’s cash crop and there were mountains of the prickly fruit everywhere—on trucks, in the market, on the side of the road, and growing in a patchwork of fields. Kiwangwa also had a dispensary and this was simultaneously the site of the village’s greatest hope and most pressing need. A dispensary is essentially the bottom rung of the health care totem pole—local dispensary  health center  hospital. For a population over 10,000 people, a dispensary is just too small. But in Kiwangwa, it wasn’t the size that caught my attention, it was the number of staff—three: one clinical officer, one nurse, and one nurse assistant. For over 12,000 people. Unbelievable.

The clinical officer is a woman with unfathomable commitment and seemingly tireless energy. The dispensary’s hours are from 7:30am to 3:00pm, five days a week--in theory. In practice, the clinical officer confided that she stays past dark (i.e. past 6pm) almost every day and works seven days a week. She sees 45-50 patients a day with only one other nurse assisting. She delivers ~30 babies a month with no labor ward. She has been doing this for three years and quite simply, she is remarkable. Working with practically nothing, she runs her dispensary with competence, efficiency and order.

Photo Credit: Magi Griffin

Even in the midst of such paralyzing poverty and need, there are bright spots—Kiwangwa’s clinical officer is one of them. This village has a strong foundation to build on and it was easy to see the potential of this overrun dispensary. With solar panels there could be electricity. An ambulance they could transport patients to the hospital 100km away. And most of all, with additional staff they could begin to meet the overwhelming health needs of the community. But despite all these needs, the foundation is in place and that meant hope for this community. It is important to be reminded that there is hope for all of them.
Photo Credit: Magi Griffin

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I hope everyone had a wonderful Thanksgiving! It was about 90 degrees here, with a 1,000% humidity and as you might imagine, the thought of having the oven on for 6 hours was less than appealing—although the many chickens running around our yard were tempting. So, my favorite holiday passed without much fanfare, and instead of turkey and pumpkin pie, we had fruit salad and ice cream. But I was thinking of all of you and hoping you had a wonderful holiday with your families and friends.*

What this week lacked in good old American traditions, it made up for in some uniquely Tanzanian ones. On Wednesday night, I was invited, along with Magi, the Ziegler’s and another missionary, to the home of one of the Anglican priests. This was like no dinner party I had ever attended and the whole event was interesting from beginning to end. After braving the streets (and hundreds of pedestrians crowding the streets) after dark, we arrived at the host’s home. Like ours, it was a fairly rudimentary cement structure, but by Tanzanian standards it was quite nice.

After being greeted at the car and welcomed (“Karibuni sana”) by Jerome, our host, we filed into the house. Jerome chatted with us for about an hour and not once did we see his wife who was obviously in the kitchen cooking dinner. When she did emerge to begin setting the table, I noticed that there were only four place settings. Incidentally, there were four of us—the guests. Huh. Ushered to the table, we were invited to sit down and enjoy our meal. As in, our hosts would sit just a few feet away in the living room while we feasted on all the food she had been preparing.

Ok, time for a little explainer. In Tanzanian culture, it is not only a sign of great respect, but also considered a gift, to offer your home and food to your guests for their enjoyment. Jerome and his wife were so pleased to invite us into their home, spend hours preparing the meal, and then sit on the periphery to listen and ensure that we were having a good time.

And we did. After the first moment of awkwardly trying to insist that they join us, we politely thanked them and then sat down to dinner. The food was traditional Tanzanian with home-made potato fries, fried kingfish, curried peas, and fresh mango juice. This being a more sophisticated affair, we did not eat with our hands, but that is also a pretty standard occurrence when dining out here. (You would be amazed how quickly you can learn to eat curry with rice using only your right hand—and somewhat gracefully as well!) Dinner was delicious and even though I know it sounds completely awkward—it wasn’t. Since this was their home and their tradition they were obviously comfortable with the arrangement. And so why shouldn’t we feel the same way? As we laughed and had second and third helpings of everything, we showed our gratitude and they were pleased to have given us their home for the evening. And then, almost as soon as dinner was over, we were politely ushered out the door—with utmost practicality, there is no coffee or dessert and thus, no lingering after dinner. Short, sweet and to the point.

The second anecdote from this week was my adventure in getting clothes made. The fabric here is so beautiful and so cheap that it would be a mistake to leave without at least getting a few skirts. And so, I pulled together some fabric I had bought over the past weeks, made a few rough sketches, and headed over to the clinic to show some of the nurses. If I was going to visit the “fundi” (generic term for basically any type of workman—painter, bricklayer, electrician, or in this case, a tailor) I was going to need a translator. Case and point: Magi had taken some fabric and her sketch to another tailor earlier in the week and her skirt ended up with “ears” on either side of her hips—even for her, a slim woman, it was less than flattering. More “comic relief” you might say. And so, to avoid ending up with a pup tent instead of a skirt and shift dress, I brought friends—kiswahili speaking, friends.

Hilda, a nurse-midwife, and Mwanakombo, a nursing student, happily accompanied me as we trekked across the road from the clinic into the market streets of Buguruni. This first thing I remember about our excursion was having Mwanakombo grab my hand as we started to cross the street. At first I thought she was just being protective, but when we got to the other side and not only did our hands stay clasped, but Hilda grabbed my other hand, I remembered this was typically Tanzanian. It’s a real sign of friendship. You see men holding hands all the time (my favorite is when the policemen are walking down the street hand in hand…), but this was the first time it had happened to me. Incidentally, I think it is the nicest custom—so friendly and inclusive feeling, especially if you’re not used to it. And so, the three of us went to find fundi, holding hands the whole way.

The first fundi we visited clearly tried to take advantage of my being a “mzungu.” When he quoted $9 to make each piece, Hilda and Mwanakombo both looked like they had never heard anything so shocking in their life. They stalked out of the shop with me in tow. The next fundi was much more reasonable and after a little bartering, Hilda got him down to $7.50 to have two dresses and one skirt made—total. Unreal. Three days later (Hilda actually thought this was an inordinately long amount of time!) I had my new clothes. Pictures to follow, I promise!

Best wishes and I miss you all!

Laura