June 26th and 27th - Relaxing on our last weekend in Dar

Pictures
1, 2 - More pictures from the deck of our apartment in the early morning.
3 - A boy that I was writing messages back and forth to in the sand at
CoCo Beach

In this post: Bus station, wood carver's market and connections

This weekend was a nice chance to slow down the pace and relax a
little during our last weekend in Dar. First though, we had to make
our way out to Ubungu bus terminal to buy tickets on a bus to get us
to Ifakara next weekend. We were warned to ask the taxi driver to come
into the station with us and help us negotiate a price on the tickets,
which we did and were thankful for. Even before we pulled into the
gates of the station, we had guys coming up to our cab trying to find
out where we were going. There are many touts (guys working on
commission who try to bring you to their company) and when we pulled
in, it was quite a sight to see 7 or 8 guys run up to the cab all
asking us where we were going. Additionally, the terminal is so busy
that one has to worry about pick pockets and we were carrying a good
amount of cash, so it was an exciting outing. The rest of the day was
spent organizing future travel plans and cleaning clothing.

Today after breakfast we took a trip to the Mwenge Woodcarver's
market, a pretty amazing place about half hour away, with less of the
pressure and aggressiveness of the city and quality carvings. You can
even watch the artists as they carve their intricate sculptures, a
nice assurance that what you're buying is in fact original and not
imported from China. We then spent the afternoon at CoCo beach, a long
white beach with beautiful turquoise water where many local Dar-ians
spend their Sundays. We spent time swimming with some kids and playing
in the waves. It was nice to see many of the kids having fun, although
we certainly drew a lot of attention. It's an odd feeling and one
can't help but feel self-conscious standing out as much as we do.

One of the best moments was a simple exchange on the beach with a
teenage boy who was probably 16-18. He sat next for a few minutes and
then eventually wrote "how are you?" in the sand. I wrote "nzuri sana"
back and he smiled. He then wrote that he was deaf and we continued
writing back and forth for a few minutes. His english was very good
and we had a good time connecting. We then started playing
tic-tac-toe… we had to show him once so he got it, but then he beat me
three times in a row. It was a very personal and meaningful
connection, full of smiles and laughter. Another great day!

Pics of Dar

Pics from the drive

1 - Representative shot of the road in the community.

2 - random man biking along the road, some of the houses in the background. 

3 & 4 - typical sights around town. 

June 24th - The Real Dar Es Salaam

Today at Pasada, we spent the day with the Home Based Care team, who regularly drive out to people's homes when they do not have the ability or health to travel to one of the clinics. We piled into the back of a Land Rover and drove about 40 minutes to see our first patient. This was the first time that we had really driven off-road and the first time seeing the 'typical' Tanzanian community.

I don't want to call it squalor, because the people deserve more respect than that word expresses, but these communities are collections of dusty and tired shacks built with concrete  or brick if the family was lucky or mud with scrap-metal roofs if they were less so. The roads are pitted and would probably be impassable in anything other than dirt bikes or trucks. Shops hawking wares lined many of the narrow roads, with bunches of bananas, oranges and papaya on display next to khangas and seemstresses: the colours of each seeming to compete for our attention as we drove by. We got many stares driving through these neighbourhoods, and many children, as soon as they saw us, would immediately scream "Mzungu" and run towards us excitedly, braking off from whatever game they were playing. The kids were typically dressed in dirty old clothes that were probably second hand from Europe or North America in the 80s or 90s, but many of the adults are dressed smartly, in khangas (colourful fabric that can be used as a skirt or shawl) or dress pants and button-up shirts.  

Despite their conditions, every family who we called in on were incredibly gracious and seemed proud to have us in their home. They greeted us all with a warm "Karibu sana" and went to great lengths to make sure we were seated comfortably, even if it meant sitting on the floor while we took their chair (it felt a little awkward). They seemed interested and understanding of what we were doing there and comfortable enough to allow the medical assistant who was with us to translate their health histories for us. We saw AIDS patients with opportunistic infections, space occupying lesions in their brains, neuropathies and even called in a one person's home to find that he had passed away one month previous. It was tough to see. Many of these people would never progress to their stage if in Canada, but the lack of resources here is a death sentence to many victims of the virus.

I don't think I could ask for a better exposure to Tanzanian life in one day and I'm sorry that I cannot fully express the reality here in words or pictures. I had my camera and snapped some photos from the window of the car, but I felt wrong bringing it out on the street, as if I were a tourist. We got to see some beautiful countryside though, and I've tried to include some representative shots

June 21-23rd - Pasada: Tusaideane (We help eachother)

In this post: PASADA, Football

             We've had a pretty good string of beautiful (and hot!) days in Dar in the past week. We took a teksi (some Swahili words are loaned from English, with an i on the end) to PASADA for 8:00 on Monday morning after a hurried breakfast of papaya slices, toast and coffee provided by the hotel (you can pay 1000 tanzanian shillings for 2 eggs (about 70 cents CAN)). Pastoral Activities and Services for people with AIDS, Dar es salaam Archdiocese (PASADA), is an NGO founded in Tanzania 15 years ago that treats people with HIV / AIDS. They are currently treating 48000 patients in various capacities, supported mostly by the PEPFAR fund (a decent funding program that came out of Bush's government… who knew?) and some other organizations, including the Stephen Lewis foundation. We spent Monday morning touring their main facility and meeting the executive director and some of the physicians. They have a great facility in the city and numerous satellite facilities to allow easier access for those living rurally.

In my opinion, the most unique aspect of PASADA seems to be the continuity and comprehensivity (I just made that up) of the care they provide. Clients can walk in off the street, be referred by a physician or by the various clinics or hospitals in the area.  Once a patient is registered with a positive HIV test, they are followed closely by the various care providers on staff at PASADA. In addition to a staff of 5 or 6 physicians, PASADA employs nurses, nutritionists, counsellors, pharmacists, lab technicians, psychologists, specialists in PMTCT (prevention of mother to child transmission) and numerous support staff and volunteers. As such, patients of PASADA typically receive significantly better care at PASADA than they would at a government hospital, giving PASADA the designation of center of excellence for HIV/AIDS care.

 In addition, many children are registered at PASADA, including almost 1000 with HIV. Some of these kids have parents or grandparents caring for them while some are orphans. Whatever the case, PASADA provides them with the care they need and the social, mental and physical support required for them to grow up as they should.

Tuesday was a day entirely about the children at PASADA. It was called "Shiny Day" and it was held in a large hanger on an army base just outside the national football stadium. It is a once-a-year event and they obviously put a lot of effort into the day. We were all surprised when we showed up to see the pretty swanky decorations for the day and the breakfast laid out for us. Basically the day consisted of performances by the children of PASADA, such as dancing, singing, tribal drumming, rapping, fashion showing, art displaying etc., a small sample of which I've tried to convey in pictures. The kids were adorable and pretty excited to have us around and dancing with them during the two big dance parties throughout the day. Priceless.

On Wednesday we spent some time observing the day-to-day at PASADA. We spent the morning in the lab there, learning how to test for CD4 levels, do CBC counts, test blood samples for HIV and how to identify tuberculosis under the microscope. It was great to see these processes, although I don't have much clinical laboratory experience to compare it to in Canada. However, given the differences in resources between our countries (such as access to an un-interupted supply of electricity), some of the tests we use and take for granted are unobtainable in Tanzania.

            Our afternoon was spent sitting in with two physicians as they met with patients. The experience was good because there were many learning opportunities throughout the day, many of which one just doesn't see very often in Canada; opportunistic infections are very common, as is malnutrition. I was surprised by the selection of anti-retrovirals that they have available to them: I think that I had a preconceived notion that North America would have a vastly larger ARV arsenal than what would be available to Tanzanians. This is not the case for first line treatments, although their second line treatments are limited and once the second line has failed, the patient has essentially been sentenced to death. Apparently this is all in jeopardy now though, because USAID, the major supplier of PASADA's funding, may begin forcing the purchase of US-made drugs, which can be up to 100 times the price of the generic versions that come from India (with the same efficacy, no doubt). It almost seems unthinkable to me that a government could attach such restrictions to "Aid". It's not aid if it's all going back into your own pockets… Obviously the number of people that PASADA could help would be decimated by such a decision. A major meeting to decide this fate is set for tomorrow.

 

            Football: It's been great having the football playing while we've been over here, although I have to say that I thought it would be bigger than it has been. I would blame that partially on the lack of Tanzanian representation and partially on the performance of the African nations in this world cup to date (some of the guys we've talked to have been pretty disgusted thus far!). Things perked up a bit last night when S. Africa won though, and we've walked by a couple bars that have been lively during the games. Jeff and I usually catch the late games at night in the lobby of our hotel, although we might go watch the match on a big projection screen at the slipway on Friday. (2$ beer gets you admission.)

June 21-23 Pictures

Hey guys, 

here are some pics from the past few days. Movies really do the performances justice, but they are too big for these internet connections. 

Cheers,

1- Dala Dala, the local buses, packed at all times.

2- Dr. Frank, medical director of Pasada, giving a speech on Shiny Day

3- Playing around with colour accent during the first dance party.

4- Group of kids and the heads / originators of Pasada

5- Kids having fun for pictures

6- Kids singing about Pasada and Tanzania. They had a great time. 

June 19th -

Pictures: Shots of the bay from the slipway market at sunset

In this post: Willies (intrigued?), Slipway

Today was a slowish day in Dar. Interesting to see how
"quiet" the streets were today compared to the rest of the week,
although these streets quiet are about as busy as Spring Garden Rd on
a Saturday. Woke up to see a group of about 50 children of all ages
jogging in time and singing down the street, with a couple kids out in
front with flags, stopping traffic. I have no idea what the
significance was, but it gave me the willies… Lord of the Flies or
City of God willies. Those are bad willies… I've reached my quota of
the word "willies" for the year, sorry.

Spent some time trying to sort out the blog as well and had to use a
full hour to work it out. Seems like I've figured out something that
will work to post pictures, although I can't format them as I'd like
to. Thanks for all the encouraging comments about the blog. I've
enjoyed updating it.

Most of our day was spent at Slipway, which is a permanent market for
Mzungus, with extra stalls of all sorts of goodies for the traveller
looking for trinkets. We had a great time sitting in the café,
drinking some cold Kilimanjaro brand beer and soaking in the sun. We
had dinner as the sun set across the bay in a beautiful restaurant
with an amazing view. It feels great to have had these few days to
start settling into the city before our program starts tomorrow.

We will be meeting representatives from the two groups we'll be
working with in Dar Es Salaam: Pasada and Muhimbili Hospital. Pasada
is a non-governmental org. that works with patients with HIV/AIDS in
the region and helps them deal with the disease. Prevention of
mother-to-child transmission is a big focus, but also trying to figure
out ways to treat all the sequelae of AIDS with limited resources. It
should be an eye-opening experience and we're all looking forward to
seeing what is in store for us. Stay tuned. Muhimbili is the major
national hospital and is associated with the university and med
school. We'll be split into nursing and medicine and I will be with
the departments of Surgery and Internal Medicine while I'm here, but I
don't start there until next week.

Pictures to Catch you up

So the Pictures are still a headache... the HTML won't let me easily imbed picutres into the post, so here are a select few of the pictures so far. pictures in the streets is not recommended, so very few of those.
 #1 - Me in the airport in the exciting few minutes before our first flight. I look cool.

#2 - pic of the deserts of Egypt as we flew over.

#3 - self explanatory

#4 - View from our hotel window on the first morning.

#5 - twister touching down while we wer on the boat!!! 

#6 - Performers of the traditional dance and drum

#7 - Meredith and Erin standing out front of the Econolodge.
 

June 19th - No Rain: Dry Season

 

That was what our cab driver backhandedly told us a couple days ago when we asked about the forecast for rain. Two days of rain later and the streets are now mud puddles. It hasn't really deterred us from exploring though, and we had another decent day today.

In this post: Safari, Orphans and Monkeys… Oh my.

We spent some time today organizing a safari that will start in July. We've shopped around a bit and three of us have decided to go for a camping safari of Lake Manyara, the Serenghetti and Ngorogoro Crater. 4 days, 3 nights under the stars of the African savannah. Can't wait. If I don't see lions eating an elephant I will be sorely disappointed. Hippos eating Cheetah would also suffice.

We also wanted to try to book some flights for our time after the program (more on the structure of the program in following posts), so we walked to the airline office, but being a Saturday, they had already closed for the day. We grabbed some lunch and decided to head to the Botanical Gardens, which were nearby. On the way, a guy named Marvin came up to the group as we were walking and started smooth-talking me. I'd heard this schpeel before… he is an artist, an artist who loves to help people with his art. He was trained in Bagamoyo (which makes him localish, but just far enough away to discourage travellers from coming to his office?) and has an all-new style of painting which he invented himself. He would be honoured if we "just looked" at some of his art. He also supports orphans with the money he makes from these paintings. Orphans are relying on him (In Bagamoyo… not here in Dar). I'm cynical because another guy told me the exact same story two days earlier and I gave him the benefit of the doubt. I hate being cynical and I hate that meetings like this are tainting my view of the people who approach me on the street. I'll have to fight in the next days to ward off this cynicism, to be replaced with healthy scepticism?

We ended up in the Botanical Gardens after Jeff and Lauren low-balled the guy's price big time and bought a couple of paintings pretty cheap. He didn't seem too happy. The gardens were nice despite it being the "Dry Season"; there were a wide variety tropical plants and trees and some Peacocks scattered throughout the park. And then… outta nowhere, a male monkey the size of a large house cat comes streaking across the grass towards Erin M, totally aggressive and looking like it was going to jump up on her! Luckily a firefighter was hanging around and shooed the thing away. Turns out that there was a whole troop of monkeys there… These were the famous blue-balled monkeys… I have no idea what their real name is. Got lots of pictures of them once they settled down and started doing normal monkey stuff. I think they just got excited because we were a new colour of hairless, upright ape.

 

In this post: Boys v. girls, Traditional dancing

I apologize for the lack of pictures… my time on the internet is limited and the website is giving me a bit of grief, but I'll try figure it out by Sunday.

Had a great day today. Managed to get out for a half hour run with Jeff in the morning to start things off. We got a lot of interested looks and one or two people calling out to us, but pretty uneventful otherwise. The girls also ran this morning and the difference is apparently night and day. Alone, the girls get a lot of attention from men, although for the most part, it is simply "Habari za asubuhi" (how's the morning?) or Hujambo ('Sup?).

The rest of the day was fairly chill: we just wandered around, soaking in the city and its people. We found an awesome spot for lunch, with incredible traditional Tanzanian fare for cheap. I had ndizi bugota nyama, which means bananas with meat, in the style of the region where it came from, Bugota. The bananas were plantains, and had the flavour and consistency of potatoes (weird), but the dish was hearty and delicious. All the food here has been fantastic.

One of the highlights of the day was getting to see Susan for a little while via Skype, which put some bounce back in my step and made me realize how much I'd love to be sharing this experience with her. The internet is sketchy here, and unreliable, so it cut us off a few times and then blocked us altogether, but it was great to connect to home.

In the evening we went to an amazing singing and dancing performance at a cultural center nearby. In the lonely planet it says they do the show every Friday, but they seemed surprised to have us there, but more than willing to put the show on. Turns out that it was a private show just for us: incredible. They performed 6 or 7 traditional songs from different regions in Tanzania, complete with tribal drumming, singing and women ululating. Then there was the dancing, which was ridiculous and had us all staring somewhat embarrassingly at the women moving their hips in ways that seemed anatomically infeasible. I have no concept of the musculature required to make hips pop and lock like they do; I have a theory that their sacro-iliac joints are in fact ball-in-socket joints. At the end of the performance, they got us all up on stage to try the dancing ourselves: Epic. I'll see if I can post the video.

An amazing Day in Dar

In this post: First day impressions; Bongoyo island

It turns out that Dar is a beautiful city in the daylight, though perhaps not in the traditional North American sense. It has a certain appeal that I find incredibly intriguing. Many of its buildings look run-down, with dirty walls and flaking paint. Every available piece of useable space on, in or around a building seems like it is being used to sell something. But buildings do not a city make, and its really the people that make this a special experience. The hustle and bustle of people going about their business is impressive. I would liken it to the busy 5 minutes between classes on a university campus, or Walmart on Boxing day (yeah, I know, I judge myself too). The difference is that this mix of humanity is not limited by class times or door-crashers. Oh, and the endless stream of fuming, noisy cars, trucks and heavily laden motorbikes make crossing the street a precarious game of Frogger. Gotta keep the head on a swivel walking around this city.

The people seem friendly, and I haven’t gotten as many out-right stares as I expected, but almost everyone on the street seems to have something to sell you, so we get a lot of attention for just being Mzungu (Swahili for “European”, or “white”). Some are pretty persistent in approaching you and trying to use small talk and a few jokes before pulling out paintings or leading you into their shop. All fairly harmless as long as you politely make it clear that you aren’t interested in the pink or the green loufa they’re hawking (perhaps the weirdest thing I saw today). There are also those unlucky few who have to resort to begging: men with amputated legs or crippled from polio, walking on their hands to knock on a taxi window for spare change. The disparity is great, but the city is vibrant and energetic.

You’ll be happy to learn that call to prayer didn’t actually blare through our windows today, which was particularly fortunate because I was sleeping like a baby after all that travel. I nixed (sp?) the jogging idea after having glanced out our 5th floor hotel room to be confronted with all of the above. Perhaps another day once I am more familiar with the city. Plus, the potholes in the sidewalks alone are enough to make a stoic runner think twice (we have a couple of those in the group: they still ran though). Our morning was spent sorting out some logistics (friendly tip: don’t travel to Africa with chips in your debit or credit cards… it’s proving a bit of a headache to access money) and then we travelled to Bongoyo Island for the afternoon, which is about 7 km north of the city by boat. Gorgeous beach, beautiful warm water and plenty of wildlife around for me to play with. The snorkelling wasn’t amazing though: only a single stand of brain coral with a dozen or so fish. Lunch there consisted of a whole BBQ’d fish, which was very tasty and I had fun playing with the skeletons afterwards (and maybe during). The weather was beautiful all day, despite seeing a little twister a couple kilometres away that was clearly whipping up the water where it touched down.

All in all, an amazing first day in Dar!

It’s supposed to rain for the rest of the weekend, so I might have time to sort out the pictures of some of the things I’ve been talking in the blog.

Tutaonana baadaye!

We're in Dar!!!

I’m lying in my little bed in the Econolodge in the middle of downtown Dar Es Salaam, a sprawling city of 3 million or so. We arrived safe and sound and with all luggage accounted for about an hour after the sunset, so despite having spent 6 waking hours in the city, I still don’t really have a feel for it. I can’t wait though. I’ve got a taste and I think I’m going to love it.
The flight from Zurich was long, but good. The newer airplane they had us in was considerably better than the first and I managed to catch a few winks, pretzeled as I was in my seat. It was an incredible feeling watching the little airplane animation as we crossed over the Mediteranean and over African soil for the first time. Looking down over vast stretches of dunes was amazing.
Arriving in Dar was smooth. No problems, no delays, no issues getting to the hotel, which at night feels as if it’s in a sketchy neighbourhood, but I remember feeling the same way when we’ve landed at night at the various all inclusives down south. I’m sure the light of day will correct at least some of this first impressions.
Something that’s struck me so far has been the number of people out and about, hanging out on steps of buildings, sitting and chatting in small groups or hawking bunches of bananas. People are everywhere. This will likely be one of the biggest cultural differences to get used to.
Alright, must get to bed… people are planning on jogging in the morning and I have not yet ruled out this possibility. We’ll see how I’m feeling when the call to prayer wakes me up in 3 and a half hours…

Culture Shock

I had my first real taste of culture shock today, and it was … shocking. After a 7 hour flight from Montreal to Zurich in the Swiss-made sardine can of an airplane (apparently they are as efficient in their air travel as they are in time-piece and utility knife construction), we landed in Zurich for a couple hour stop over. I wanted to use the internet to send a quick email, but… the keyboard had a totally different layout! The Y and the Z were in opposite places!!!! (Please note the gravity of this finding by the number of exclamation marks, the key for which, coincidentally, was also located on opposite side of the keyboard). It really makes you think

Once I picked my jaw up off the floor, I managed to scrape together the will to carry on and I wrote that email. I wrote it good. I’m a survivor and I received cultural training prior to my departure, so I escaped mentally unscathed. Just.

Less facetious posts to follow once I’ve got some sleep.

Summer elective in Tanzania and Rwanda.

I'm leaving for Tanzania tomorrow morning: unreal.

It's a thirty hour trip that will take me through Montreal, Zurich and Nairobi, but don't worry, I've been practicing my isometrics and have hired a small man to massage my calves on the plane to keep the DVTs from clogging my lungs.

This trip is a life-long dream for me, inspired by the stories told to me by my father, who traveled from London to Cape Town by land Rover when he was in his twenties; by David Attenborough and the BBC, who have given me impossibly high expectations for wildlife encounters; and by my wife, who spent a summer in Africa 4 years ago and whose stories and support I have treasured since.

The gist of the trip is that we'll be spending 2 weeks in Dar Es Salaam, the coastal cultural capital of Tanzania, two weeks in Ifakara, a smaller, rural city, and a week in Rwanda. We'll be working in and with local hospitals, med schools and NGOs to get a feel for the Tanzanian health care system. I'm expecting that much of the time will be spent in shock or awe of who different their system is from our own in Canada, but I can't wait to get in there and experience it. At the end of all that, I'll be taking some time for safari and R&R on Zanzibar.

If any of this sounds vaguely interesting, follow along and I'll try to keep regular updates on my progress, with photos or videos to give you a sense of life in East Africa.

This picture is of the group that I'll be travelling with (2 med students and 5 nursing students), along with our Swahili language teacher, Said and his wife, child and friend.

Asante sana na nitakusema baadaye!