Ramadan

On the day before the fête for the end of Ramadan, it was as if it were Christmas Eve since everyone seemed focused on food and planning for the festivities. I saw two cows standing in the backyard of the office in the morning and learned later that they had been slaughtered for the celebration, and everyone was more concerned with getting their share of the meat than scheduling meetings. Made for an interesting first day for yours truly.

It was a special treat to be invited to celebrate Eid ul-Fitr at the home of a friend of a new acquaintance, where everyone put on their best and gathered to break the fast. We drove to the outskirts of Bamako, where the density of people decreases, the traffic diffuses a little, and the hillsides are green this time of year (at the end of the rainy season). We sat inside a large living room and ate beet, carrot, cucumber, and tomato salad, couscous cooked with golden raisins, and lamb in a spicy red sauce.

Once the sun sank to a point where there was shade on the roof deck, we went outside to relax and digest … and to make room for more lamb. We sat on pillows and mattresses on the ground, in a circle, and ate with our hands. We finished with a sour milk which is basically like yogurt with lots of sugar added. As the stars came out, we headed back to the center of town. On the way home, I thought about how challenging it is to articulate some of the images of Africa. As we approached a stoplight, I noticed that both the red and green lights were lit. Stop? Go?

Bamako, Mali

It’s hard to believe that I’ve been in four African countries in a little more than one week. The capital of Mali is sprawling and full of people, cars, and pollution. It’s gritty but it seems like a place that grows on people, as many of expats that I’ve met seem to love it. Frankly, I’m waiting for that to happen, as it wasn’t love at first sight, but I’m enjoying the fact that it’s an adventure. The road system (or lack of?) has, surprisingly, been one of the biggest adjustments for me. There are approximately 5 unpaved roads for every paved road here and I have yet to deduce any “rules of the road.” Distances between regions are large. I asked my colleague here how far away is Dogon Country, and she responded, “oh, it’s close, like 8 hours.” Close? 8 hours? We laughed together about her well-adjusted perspective of time and the distances in Africa.

There’s activity everywhere in Bamako. The main roads are paved but lanes don’t really exist. The dirt sidewalks are a rusty, burnt orange color and the smaller roads that weave throughout neighborhoods are deep red in color and are muddy, with huge puddles, following the thunderstorms that roll in around 5 or 6 most evenings. Motorbikes carrying dad, mom, baby on back of mom and two children - one in front of dad and one sandwiched between mom and dad - go flying down the roads and no one wears a helmet, and the minibus passengers don't even bother to shut the sliding door (if one actually exists).

Farming and fishing (along the Niger River) are main livelihoods (80% agriculture) and the main exports are cotton and gold. The main crops are millet, rice, corn, peanuts, and vegetables. Cattle, sheep, and goats are seen almost as frequently in fields as they are along the roads in the city center. I followed 3 goats down the road from the office, and had heart palpitations when the baby thought about venturing into the dizzying traffic for one rather ill-timed moment (fortunately, it did not). Along with pollution, overgrazing and deforestation are major environmental issues.

In both Mali and Senegal, I’ve observed more people wearing traditional dress than what I saw in Tanzania, even people wearing modern styles. I met a woman on the plane from Nairobi to Dakar wearing a gorgeous traditional-style dress made of black and gold fabric, with a matching scarf covering her head. She showed me photos of her daughters and told me that she works for the Global Fund in the Gambia. I sat next to two adorable Malian girls on the plane from Dakar to Bamako who giggled at my terrible French, but seemed amused by my attempts to chat with them. When we arrived and were in baggage claim, the older sister (age 12) grabbed my hand and took me over to meet her mother, a tall, statuesque woman in a beautiful ensemble (scarf matched the fabric and print of her dress, wearing lots of gold jewelry) clutching a cell phone and a Blackberry with her nicely manicured hands. She gave me her phone number and I felt grateful for her generosity in welcoming me to Mali.

Dakar, Senegal

Dakar is beautiful and lively. It feels like there is water everywhere, since the city sprawls out on a peninsula (almost) and about ¾ of the area is surrounded by the Atlantic Ocean. The houses are square, colorful, and people tend to dress more traditionally, but the roads are largely unpaved except for the main stretch of highway which was built for a large celebratory Muslim conference last year. However, many buildings appear half-finished in the construction process and it appears that money ran out to finish the projects or materials weren’t available since they lack windows, doors, and a coat of paint.

I have an internship with an NGO (non-governmental organization), and am preparing for field work in Mali with a nutrition survey team (of about 20 people). We’ll interview health care providers and caregivers in villages about screening children for malnutrition. I’ll be helping with an evaluation to see if health and nutrition services are actually reaching these rural populations.

My first day involved broken French, some English, and charades. I haven’t really spoken French since I lived in Paris in college and although it requires an extraordinary amount of effort to communicate throughout a full day, I’m actually surprised by the vocabulary and phrases that have been unearthed from somewhere in my memory. It felt like a little respite to eat dinner that night with a dozen-plus expat women living in Dakar and working in the foreign aid arena, where I could be lazy and speak English.

Nairobi, Kenya

I left Dar es Salaam for Nairobi, the first leg of a long flight across the African continent, where I had an overnight layover. I was delighted to meet up with a familiar face from public health school, especially after taking a taxi ride from the airport where the driver asked me to help him get to America. Apparently it’s common for foreigners to be asked for such help, or asked outright for money. It took me aback initially but I recalled others talking about how frequently it happens and managed to change the subject.

Rob and his roommate, Obi, greeted me at a hotel just down the street from their house where the taxi dropped me off, and then treated me to dinner at Rob’s favorite Ethiopian restaurant in Nairobi. Rob’s a brave soul to drive there.

Rob and Obi were wonderful hosts and it was fun to hear about their research in HIV and malaria, respectively. Hopefully I will have the chance to return and visit with enough time to go camping with them in Kenya!

Roll with it

I've been learning that things often don't work as one might expect. Jessica offered priceless advice during a moment (okay, a day or two) of frustration as I came to realize that things often take longer than anticipated or don’t happen as planned, often without explanation: "If you can't change it, roll with it." I now repeat that to myself on a daily basis. Purchasing a ticket to fly from east to west Africa was no small feat. In the western world, we're accustomed to using credit cards and the internet to buy tickets. In Africa, some tickets can only be paid for in cash, in person, and involve separate trips to the offices. Or, one might go into the office only to find that "the flight does not go that day." Really? It was posted online and the agent on the phone booked my reservation that day. "It doesn't go that day." Ah. Well, so it goes.

Another lesson that I learned early on was to schedule no more than one appointment per day. If you are ambitious enough to try to fit in two meetings, one is likely to take long enough that you just can't make it to the other one.

It was with great reluctance then, that I attempted several things in one day: picking up that plane ticket in town, meeting with the director of a humanitarian organization for an informational interview, and heading to the airport in time to check in for a flight. I couldn’t believe it when I accomplished 3 for 3! That's the trick: be pleasantly surprised when things run smoothly, and roll with it when things divert from that imaginary plan.

Despite the pleasant surprise and other adventures ahead, there were tears when I said 'bye to Jess. The uncertainty of everything was sinking in and I felt like I was taking a huge leap of faith. Yet, I still trusted my gut feeling - the feeling that this jaunt across the continent was indeed a good idea.

Site visit

At the conference, Jess introduced to me to everyone under the sun and made it all seem effortless, but it meant so much to me. One of the highlights was visiting a site where several malaria clinical trials are underway. Jess connected me with the director, who enthusiastically fielded all of my questions about how one sets up a demographic and health surveillance site, finds participants, and runs clinical trials. The research site supports routine healthcare delivery so that patients in the communities benefit directly from the research.

We drove to the site, toured the hospital, pediatric clinic, and the data center (overlooking the Indian Ocean). The women at the clinic said that they had seen 90 children the previous day and the primary reasons for admission to the pediatric ward are pneumonia and malaria. I was told that Ifakara, the region where the centers are based (south of Dar), boasts the record of the most mosquitoes in the world, with over 3,000 mosquitoes counted in one night in one house!

In Bagamoyo, I observed lunch being served (ugali and beans) in the pediatric ward, and learned that tube feedings are often made of watered-down ugali with beans and fortified cereals. Although they currently focus on malaria, they plan to expand research in tuberculosis, HIV, upper respiratory diseases, and non-communicable diseases (there’s an epidemiological transition occurring in developing countries with increasing rates of diabetes, cancers, hypertension, and respiratory illnesses). By using the capacity and expertise that they’ve established in malaria, they can address other issues and respond to the health needs of Tanzania.

Karibu, Jess!

I’ve dreamed of coming to Africa for a long time. I spent much of the summer looking for work abroad and this trip started to take shape when, one evening in Seattle, Jessica said, “Come with me to the conference in Tanzania!” Although my first 36 hours had gone smoothly, I felt more relaxed in the company of a good friend and was so happy to meet up with her on my second day.

Friends of hers took us out on a boat to one of the small islands off the coast of Dar for the day, where went swimming, collected shells, and ate fish and chips for lunch. A dip in the ocean felt like a relaxing bath - the water was clear and warm, and the waves gently rolled to shore. Later on in the day we visited a craft market, called the Slipway, and then enjoyed a delicious meal of beef Bourgogne, fresh green salad, and sweet pineapple slices.

Tanzania

The sun is blinding and the heat hits like a wall, and it's only 7 am. Van waving Tanzanian flag on the dashboard is driving very fast down street towards city center, hits stop-and-go traffic. Men ride bicycles along side of road with a dozen crates of eggs stacked on the rear rack. People weave in and out of “lanes” and honk their horns. Said van drives over potholes 5 feet wide and a foot deep, dodges bicyclists and pedestrians, and navigates around 4 rows of cars on a road that was clearly built to accommodate only 2 lanes of traffic. But the more the merrier, right?



Welcome to Africa.

The trip to Dar es Salaam, Tanzania took 2 full days, including two overnight flights from Seattle and London. It was thoroughly exhausting, but I’d been too excited to finally land in Africa that I think I ran on adrenaline all day. I've been dreaming of this for a long time.

Dar is amazing. The name means "haven of peace" and along the coast (away from the downtown traffic), it's precisely that. The Indian Ocean hugs the eastern coast of Tanzania and the water is an unbelievable mix of sea green, turquoise, and deep blue. Graceful dhows sail off the coast. The sand is white and dotted with exotic shells that have washed up on shore. Along the dusty unpaved roads, palm trees and bougainvillea frame the landscape and the climate is tropical.

People seem so friendly and welcoming (“Karibu!”), always greeting each other with “Jambo!” (hello!) and asking about your health and your family. Younger people say, “Mambo!” (hey, how's it going?) and respond, “Poa” (it’s cool). Spoken Kiswahili sounds melodic as every letter is pronounced. Dar, yeah, poa.