Notes from the Field 2009

By Robyn Browning

Before I left for Tanzania, I already knew that things rarely turn out the way that you plan them. It appears as that goes double for things in Africa. The few plans that I had for my time here didn't seem to materialize, and the project I came to work on turned out to be vastly different than I had imagined. But that is life.

My trip to Karatu fell through, which is pretty disappointing for me. However, it gave me an extra day of being on safari where we visited Tarangarie National Park, home to nearly 3,000 elephants and many other animals such as giraffe, lion, leopard, wildebeast, waterbuck, warthogs, tree pythons, zebra, baboons, ostrich, elant, mongoose (which I should get extra credit for spotting and correctly identifying), monkeys, impalas, and water buffalo. This was on Sunday, after we had spent the previous day at the Ngorogoro Crater where we saw many of the same animals, in addition to a black rhinoceros. hippos, pelicans, hyenas, flamingo, cheetah, and a good show of lions mating.

As for my project, I definitely learned a lot about public health issues in Tanzania and about appropriate technologies that are being developed and implemented to help improve public health. I was hoping to work on something that I would be able to see go into practice here, but it was just not possible within the time frame that I have had here. I would guess it's my background working in social services that compels me to want to dig it and help as many people as I can, but as we learn in public health, the first and most important step is to listen and develop relationships with the community. With only five weeks, that was a task that could not be accomplished. So I will take the lessons I have learned here and apply them to the rest of my coursework at the SPH. Perhaps I will be able to return again one day to work on the issues that I have discovered to be important and of great interest to me.

I will post photos when I return home to Minnesota at the end of the week.

Posted at 8:21 AM | Permalink | Comments (0)

By Robyn Browning

On Monday we visited a children's village called Food, Water, Shelter (FWS). It's a newer NGO which was started by five women from Australia about five years ago. You can read more about it at http://www.foodwatershelter.org.au/ It is still in the development phase, so the residents have not moved in yet, but the mamas have been selected and the hope is that they will move in with their children by the end of August. The mamas are women from the community who will live at FWS and raise a group of children from the Arusha area who are orphans. Each mama will have their own living space that they share with the children under their care so that attachment can be fostered and a parent-child relationship can be developed..

The most interesting part of FWS is that it has been developed to be eco-friendly and self-sustaining. They have nearly every eco-friendly technology I have seen so far at their site. We saw the rainwater collection system, the aquifer they are building, the organic garden they have planted (which they hope will eventually feed all 60 residents there), the tilapia pond they dug and now eat fish from, and the cows they have for their waste generation to use for bio-gas. We learned about the sanitation system they will be using for human waste. They will use urine as a nitrogen source to grow banana trees and will compost solid human waste to be used as fertilizer for the fruit they will grow. It was great to see so many self-sustaining systems being employed all in one place.

Yesterday we went to the new Arusha Lutheran Medical Center in town to meet with the woman in charge of the subsidized orthopedic surgery program that is operated out of the hospital. The woman in charge, Sarah Wallis, does outreach in communities where she finds children with physical disabilities. She meets with their families and tells them about the program at the hospital where the children can come and get operated on and then stay for the entire time of their recovery. The surgeries performed include cleft palate, club foot, and burn scars. Parents must pay 100,000 shillings for the surgery (approximately $90 USD) so that they have an investment in the medical care. Sarah is hoping to start another program that is focused on education about burns and includes the development of an acute burn unit at the medical center. She explained that she sees a lot of burn scars in the communities, mostly in the Masaii areas because the dwellings that the Masaii live in, called bomas, have a fire in the middle which can easily lead to children getting burned.

Tomorrow we leave for a weekend safari near the Serengeti. On Friday we will do a site visit at a community that will be installing a new water system for irrigation soon. The NGO Global Service Corps will be digging a hafir there so the engineers on our team are going to look at the site and give their input. We will then spend Saturday at the Ngorogoro Crater. On Sunday, I will leave the group and bus to Karatu where I will do site visits and be hosted by Minnesota International Health Volunteers. Monday I bus back to Arusha and then on Wednesday Kat and I will be busing back to Dar Es Salaam for our departing flight on Thursday.

I have finally arrived at the point in my field experience where my remaining days in-country are numbered and time is moving fast. There are still so many things that I want to do and see before I leave, so hopefully there will be time for the important things. I will hopefully be able to post again before I leave next week, but internet access will be limited. I plan to write some follow-up posts when I return home and have the ability to post pictures.

Posted at 3:14 AM | Permalink | Comments (0)

By Robyn Browning

As we wrap up our site visits to NGOs in the Arusha area, there has been much discussion within our team about NGOs in general. We have visited most of the NGOs in the region that focus on sustainable technology, from both the development side (those focused on research) and the implementation side (those selling the new technologies to communities). We also visited some NGOs focused on assisting specific populations such as disabled women and street children. Though it is not certain that all of these NGOs are meeting their goals, it is certain that there are a lot of them and still more are being formed. I have heard several people comment about the staggering number of NGOs in the area. With all of the organizations, why are things not improving as they should? The answer seems to be that NGOs are not working together and that sadly, NGOs are a major way to make money in TZ (and perhaps all over the world). It seems to be common that NGOs do not cooperate with one another. They do not know what other ones are doing and they are not interested in collaboration. This is most likely due to the competition for funds. And the funds seem to be going to those in charge-- specifically staff salaries. NGOs are getting the reputation of making money and not helping, at least here in Tanzania. One of my teammates recently made the comment that if NGOs really did what they set out to do, then they would cease to exist at some point. I had never thought of that before, but it makes sense. Some NGOs grow so big that they become mini-corporations. We visited Heifer International, a well-known pretty much world-wide NGO, and it was amazing to see all of the resources they had at their office (amazing Mac computers, video cameras, etc.). We set up an appointment to do a site visit with them, but the man never called us back and did not return our calls to confirm. We heard from a local that they were becoming less and less helpful to visitors who wished to speak with them. Perhaps becoming too big can more than a few negative outcomes.

So what is the answer? I remember while in Haiti hearing one of the volunteers I was with say that someone should really coordinate all of the aid coming into Haiti so that someone can know what issues are being addressed and what needs more attention (this was due to the multiple volunteer groups flying in and out with us on our flights). It is a good idea, but then wouldn't it become like having a second government almost? Things would get lost in all of the overhead and red tape. All of a sudden someone would have to in charge of coordinating all of those resources and all of those volunteers. Would this help or hurt? Would it be worth attempting?

On a separate note, I had the pleasure of attending a church service on Sunday morning. Yup, I was definitely the only white person in a church of maybe 500 or so people. There was a mass both before and after the service I attended. Getting in and out of church was quite an experience. Church-goers really want to get a seat so its a crazy mix of a swarm of people trying to get into church while the people done with mass struggle to find their way out of church. I don't think I've ever experienced a church scene like that in the states. The most interesting part was the huge painting on the wall of the church behind the crucifix. It covered the entire wall and was a scene where a river separated a lush, green space with animals from a dry and desolate space where people were dying and praying. (Due to the placement of a statute on the wall, it looked exactly like Jesus was riding the elephant in the painting-- it made me smile each time it caught my eye!) I asked my church companion, Joel, a student from the Univ. of Dar Es Salaam, what it meant and he informed me that it was a representation of Tanzania. He explained that animals have it good here because they have lots of land and open space while the people here toil and experience death at an alarming rate. A very powerful message to have on a church wall. One that certainly stuck with me, especially as we walked down the church steps, filled with people begging on both sides.

Tomorrow we are off to tour an orphanage outside of town. Everyone is excited to see their facility, one which was designed to be completely self-sustainable and have zero waste.

Posted at 8:43 AM | Permalink | Comments (1)

By Robyn Browning

The past couple of days have been busy here in Tanzania. This week we are continuing our site visits to NGOs in the Arusha area. Yesterday I tagged along with a different team than my own because I wanted to visit the NGO Arusha Disabled Women Group. We met with the leader of the group, Josephine, and a couple other members. The focus of the group is to help women with disabilities with employment so that they can earn a living and not have to to beg on the streets. Josephine's vision is to have all people with disabilities in the Arusha region to have the same level of employment as the able-bodied.

I asked a lot of questions and in return got a lot of unsettling answers. There is not a lot of help for persons with disabilities in Tanzania. There are no government programs and health care is supposed to be provided for free for this population, but according to the group leader, they are still required to pay for their health care services, often a small fee that they cannot pay. Largely unemployed, persons with disabilities end up begging on the streets. This vulnerable population is susceptible to physical and sexual abuse. We were told that women with disabilities in urban areas have drastically high rates of HIV. This is largely due to the prostitution that the women engage in in order to earn money. Women with disabilities often charge a lesser fee, which appears to contribute to the increased risk of contracting HIV.

Being a student of Public Health, I automatically thought that it would be beneficial to start a research study on this population to see if indeed the incidence of HIV is higher in women with disabilities. Perhaps this is the way that we are trained to think after reading study upon study while conducting research for class assignments. Although knowing more specifics about the transmission rates would be helpful and garner attention to the subject, it seems as though resources and energy would be better spent helping these women right now. The key to assisting this population in the long-run will be to help them secure economic stability (short-run being to get this population off of the streets). So we are hoping to perhaps focus some of our research efforts on coming up with a way for the women to become self-sufficient without having to turn to begging.

Before I close, I want to write a bit about mental health in Tanzania. When I asked the leader of the Arusha Disabled Women Group if they included women with mental health diagnosis, she said no because it is not considered a disability. After seeing the reaction on my face, the leader quickly changed her answer to being that they did not have the money to assist that population at this time. Mental health is certainly swept under the rug here. I recently learned that only 5.5% of the Tanzanian government budget is dedicated to health care. This does not include any funding for mental health care. That's right, a budget of $0 for mental health in the country, even though the WHO concluded in 2002 that 25% of the medical need in TZ is mental health. In a country with a total of 17 clinical psychologists and 12 psychiatrists (that's for the entire country of 35.5 million people), mental health services are deficient to say the least.

Posted at 8:09 AM | Permalink | Comments (1)

By Robyn Browning

Sometimes, you get more than you ever bargained for. Yesterday I thought we were headed out for what was going to be a nice trip to see a potters' colony in a small village east of Arusha. After a long daladala ride out of town, we walked up a hill to meet with the man in charge of the colony. He showed us his pottery making shop and then informed us that he would take us up to the top of the mountain so that we could see the place where he gets his clay from. Not prepared for a mountain hike, I hoped that he was joking. Oh, but he wasn't. So up and up we climbed to the top of a ridge on Mt. Meru. The path up to the village on top of the ridge was step, rocky, and very narrow in parts, definitely a "one at a time" sort of path. We were all out of breath and sweating, but the village children walking up with us were not at all phased by the trek. We ended up following up a couple of women from the village-- both carrying large buckets of water on their heads and both wearing plastic flip-flops. Our guide/local potter informed us that there was no clean water on the mountain, so the women would walk down each day and bring back up buckets of water for their families. An arduous task, especially one that would seem very dangerous during the rainy season when surely the path turned to mud.

Continue reading "On top of the mountain" »

Posted at 7:12 AM | Permalink | Comments (0)

By Robyn Browning

Today marks the end of my first full week in Arusha. It has been a week full of excitement and learning, as well as some frustration. Before I left for TZ, I informed those who asked me that the project I would be working on is a water and sanitation project. That is really only a portion of the project. Like I mentioned before, this is the first year in a three year project funded through the National Science Foundation. The first year of the project is dedicated to doing field research and forming relationships with NGOs in the area. The project aims to help further develop the sustainable and appropriate technology that is being produced here in Tanzania.

Part of the reason I applied to assist with the project is that I wanted to learn more about water and sanitation. I'm learning a lot about sustainable technology like solar energy, bio-fuel, and efficient cooking stoves. Since I'm not an engineer, a lot of the details are lost on me. The one thing I hear often is that there needs to be more evaluation of how these technologies improve the health of those who use them. Definitely a place where someone trained in public health could step in.

I want to leave you with some important things that I have learned this week, arranged in no particular order:

-Hydration is really important. Even if your water bottle is heavy and you have to carry it around all day, you still need to bring it with you and keep drinking water.

-Many of the NGOs we talked with this week agree with what is currently being said about aid to Africa: it simply doesn't work. It destroys the local economies and people do not respect things that are given to them for free.

-At the heart of many of the problems here is education (in addition to money). Children and adults are not being adequately educated. Those who advance in the education system end up going abroad to complete their studies and often do not return. Brain drain is a real threat to many communities here.

-If you ever find yourself in the position of being in a car that needs to drive through a river while dodging boulders, people, and donkey carts, the Toyota Grande (which I think is Camry in the U.S.) is your car. Perhaps I'll test this with my Corolla when I return to the U.S.

-Some people find their passion in life when they are young, some when they are older. I met a woman this week who informed me that she found her calling in life when she was 40. She will be receiving her PhD when she turns 51 in the next few months. She loves what she does (clinical psychology here in Arusha) and sounds like she wouldn't have it any other way.

Posted at 8:54 AM | Permalink | Comments (2)

By Robyn Browning

We arrived to Arusha on Saturday evening, after an 11 hour bus ride to get there (not the 9 hours I was told to expect). The bus was cramped and hot and the seats were hard as a rock. So needless to say, we were all happy to be done with the bus ride by the end of the day. We were transported to Peace House Africa Secondary School where we were shown the guest houses, our homes for the next several weeks. Peace House has a beautiful campus. With Mt. Meru in th background and nothing but rolling hills surrounding us, it is a very serene and relaxing place. The campus is surrounded by an electric fence and there are security guards present 24/7. We have been advised to not leave campus after dark, which is mostly because we are very close to Arusha, which is known for being the most dangerous city in TZ.

Monday was our first official day of starting our research (to this point we have been traveling and spending time at the University of Dar). We were assigned to teams for the first two weeks of our project. Each team consists of a Univ. of Dar student, a Michigan Tech student, and a Public Health student. We have 3 teams of 3 people each (minus one team with 2 Michigan Tech students instead of a Public Healther). My team consists of Jarod, a Geology Master's student from Michigan Tech and Divina, a graduate in food technology from the University of Dar. Our first task was to create a list of NGOs that we want to visit in the surrounding area. We have a list of 8 NGOs currently, which includes Heifer International, Tanzania Girl Guides (an organization devoted to enhancing the lives of women through technology), and the Global Service Corps, among others. Without an abundance of contact information for most of the organizations on our list, we headed into Arusha to try and find them on our own.

Jarod had contact information for a woman who works for an NGO near Arusha, affectionately known as Mama Africa. We met with Mama Africa at a coffeehouse where she told us about her organization. She explained in detail the safe water project her organization has undertaken, which uses sand to clean the water. Mama Africa's organization also focuses on HIV education. Her organization only promotes abstinence. Mama Africa said that giving condoms was like giving out a gun and then telling people not to use it. Deciding to avoid confrontation, I did not bring up the topic of the spread of HIV within marriage, largely due to infidelity when the men are away from their wives.

We will continue to visit organizations throughout the week in order to better understand the public health needs of Tanzania, as well as how appropriate technology can address those needs. For now, it is time for a dinner of ugali (still corn porridge) and beans.

Posted at 8:22 AM | Permalink | Comments (2)

Today is day 5 of my trip of 34 days to Tanzania. Kat and I arrived in Dar es Salaam on Tuesday morning after 30 hours of travel from Minneapolis to Chicago to London to Dar es Salaam. We were both warned that Heathrow would be a disaster, but actually our 6 hour layover there was quite pleasant. No problems and pretty luxury accommodations at the airport lounge. We skipped a trip into London due to our time constraint and the cost (not to mention my overpacking of my carry-on luggage).

After we arrived at the airport and paid our $100 for a visa, the professor in charge of the University of Dar es Salaam contingent met us outside of the aiport so that he could escort us to our hotel. The drive to the hotel was quite an event. We came upon traffic jam after traffic jam. There aren't a lot of rules of the road here, but everyone is very courteous and drivers really help each other out. With the windows down the entire time, it became very nauseating as the roads aren't in great condition and you can feel yourself breathing in the large particle matter from the surrounding vehicles. We eventually made it to the hotel safely, very grateful for our safe and rather crafty driver.

For me, I seem to be focused on comparing Tanzania to Haiti. So far, they look pretty similar. Lots of people walking on the side of the road, people working hard, small shacks piled up on top of each other, buses (called daladalas here) zooming about filled to the brim with people. However, Tanzania seems to be more developed than Haiti. We ate at a rather nice shopping mall the first night here, which was a little surprising to me. The mounds of trash burning on the side of the road are smaller here (piles here compared to mini mountains in Haiti). Also, so far no power outages and you can get the water to become mildly warm when bathing. On our outing last night I noticed an abundance of street lighting-- not something you would see in Haiti.

We just concluded our first official meeting with the professors and students from the University of Dar. At the end of the meeting, the professors selected the four students from Dar who will accompany us while we are in Arusha. We leave for Arusha on Saturday morning, a 9 hour bus ride. We hope to get settled into our guest house on the Peacehouse Africa campus on Sunday and then officially start our research on Monday.

Posted at 8:35 AM | Permalink | Comments (2)

During the week I spent in Haiti, we held four mobile clinics over four days. The first was held on the hospital grounds in Leogane, followed by three clinics at schools or churches. As the days progressed, we traveled farther and farther to get to our clinic locations, all of which were in rural locations. The main roads were paved, but once off the main road, it was one-lane dirt road, and for us, straight up a mountain. So there we were, all pilled into two trucks, in for one of the bumpiest (and sometimes scariest) rides we could imagine. (No guard rails, huge rocks in the road, mud and muck, and steep cliff on all sides). Luckily, by the end of the day at the clinics, we would all be so tired that the ride down the mountain was seen as nothing out of the ordinary.

The clinics operated by having each patient be given a paper with their basic information on it. Adults got their blood pressure taken, were weighed, given a chewable tablet for worms, and then were taken to the doctor. Children also got their arms measured for malnutrition. After they saw the doctor, they had to wait for their medications to be packaged by the pharmacy. The pharmacy was quite a sight--boxes of medication, bottles of liquids, and six volunteers running around trying to keep the process moving.

My job was to weigh the patients, measure the arms of children, and pass out the medication for worms. I learned two phrases in Creole for my medication task: "Medicine for parasites" and "Are you pregnant?" Women who are pregnant cannot take the worm medicine. Lucky for me, it was the job of the doctors to tell people that they would be excreting dead worms for the next week or so after chewing the pill. My task of passing out the worm medication was the most interesting for me. After getting many confused looks (imagine my horrible accent attempting to speak Creole!), I decided to point to my mouth when giving the medication in order to indicate that it must be eaten. This made people open their mouths, prompting me to stick the pill in their mouth myself. This gave me lots of insight into the poor oral health of the people of Haiti. None of the older patients over 60 seemed to have any teeth. Adults had a lot of missing teeth and what was left were mostly decayed and rotten. It made me glad to have the luxury of brushing my teeth with a toothbrush and toothpaste.

Here are some observations that our team observed during our clinics:

-There was more pregnancy in the urban areas.
-There was more scabies and malaria in the rural, mountainous regions (nearly every child I took an arm measurement from in the rural areas seemed to have scabies)
-Haitians don't seem to sweat, despite temps in the 90's and crazy humidity. I thought that they must just be adjusted to it, but Dr. Pizey pointed out that it's most likely because they do not drink much water.

Posted at 9:27 PM | Permalink | Comments (2)

I have returned from my week long trip to Haiti to assist with 4 medical clinics that occurred in and around Leogane. I plan to make a couple of entries this week to talk about my trip and explain what I did and what I observed. To start off, I want to share some basic information about Haiti (from the CIA World Factbook):
-population of 9 million
-slightly smaller than the size of Maryland
-poorest country in the Western Hemisphere with 80% of the pop. living under the poverty line
-per capita GDP is $1,300 (versus $47,000 per capita GDP in the U.S.)

The group I traveled with was comprised of 3 doctors and 8 other volunteers (including me) who committed to conducting 4 medical clinics during our trip. We arrived in Haiti a day late, as our first attempt fell short when our flight from Miami to Port Au Prince had to turn around and return to Miami. This happened after being in flight for 20 or so minutes due to "a mechanical failure," which, who doesn't want to hear that over the P.A. while over the Atlantic Ocean? We got there safely and proceeded to make the trip to Leogane. We drove though Port Au Prince, which was quite a ride. In Haiti, people drive with their horns. No rules to the road except for the biggest and fastest vehicle gets its way. I had to occupy myself by looking out the window and not watch the weaving through traffic that our driver was doing. We drove through Port Au Prince, which can easily be described as crowded and dirty. There are people everywhere and so is the garbage. Garbage collection is intermittent and so most garbage gets tossed pretty much anywhere. There are hills of garbage on the side of the road, often smoldering quite heavily, as there is nothing else to do except burn it. Houses are on top of each other and often include an incomplete second level, as unfinished houses do not get taxed. The water in the open sewers/ravines is dirty and filled with trash, which seems to really please the pigs that you can see tied up in them. Port Au Prince is a city enveloped in public health concerns.

We arrived in Leogane in the afternoon and then prepared for our first mobile clinic the next day. We would be conducting it at the grounds of the St. Croix Hospital in Leogane. The hospital is vacant as there are no doctors to staff it and no electricity, as a few months ago its main generator broke and there is no money to repair it. This means the only hospital in the region is in Port Au Prince, about an hour's drive away. I will soon find out that this will be true for the villages in the mountains that we will visit for the next few days.

Here's a picture of the ambulance at the hospital.

Posted at 11:05 PM | Permalink | Comments (1)

This past weekend I met with the team I am going with to Haiti in order to have what we called a "packing party." Everyone brought two large suitcases so that we could fill them with the medications we are taking for the mobile clinics we will be conducting while we are there for one week. We filled each bag with 50 pounds of various medications and medical supplies. My bags are packed with prenatal vitamins and children's chewable vitamins. Our goal is to distribute 6 months worth of vitamins to all children and pregnant and nursing mothers who visit the clinic.

We leave Saturday morning for our week of service. I heard from one of the other volunteers that she met Paul Farmer at the airport in Port Au Prince the last time she was there, so I am going to keep my fingers crossed that I might be so lucky!

Posted at 10:14 PM | Permalink | Comments (0)

Hello!
As I write this, I am working on a list of things I still need to buy for my two trips abroad this summer. I leave for Haiti in two weeks in order to spend a week assisting with mobile clinics near Leogane, Haiti. I will be traveling with a small group of volunteers from St. John’s Episcopal Church in Minneapolis. I am lucky enough to have a co-worker who is friends with the organizer of the trip who is a family practitioner. My role will be to assist in the “pharmacy” as well as help take vital stats and do some crowd control. I was told that when we arrive to the clinic sites each morning we are expected to see a line of 100 or so people waiting to be seen that day. Most of the medications we will be dispensing will be brought with us, meaning that I will be taking two large suitcases full of vitamins, antibiotics, and various other essential medications. I am looking forward to getting to experience how health care is delivered in Haiti while getting to learn more about its rich culture from the patients we will be seeing.

After my week in Haiti, I will be leaving for my field experience in Tanzania for my MPH in Community Health Education. I am a part-time student in the program, and I just completed my second year of taking classes. One of my interests is safe water and sanitation, which I will be assisting on a collaborative project near Arusha, Tanzania. The project is headed by Dr. Kurt Paterson of Michigan Technological University. Another student from the School of Public Health, Katarina Grande, and I will be going with a team of engineers from Michigan Tech. It will be the first year of a 3 year project, which will address safe water, sanitation, air pollution, and malaria. The first year is the planning year, where we will conduct a community needs assessment. We will be working with a group of students from the University of Dar es Salaam in Tanzania, and we are being hosted by a great organization that is based out of Eden Prairie-- Peace House Africa. Peace House Africa is an organization dedicated to creating a brighter future for Africa’s orphans, vulnerable children and their communities through nurturing care, dynamic education, technology research and business development. I encourage you to check out their website:

http://www.peacehousefoundation.org/

I’m looking forward to writing about my experiences this summer. Hopefully I will have internet access that will allow me to post stories and observations, as well as some great pictures.

Now back to my list of things I need to take along!

Posted at 2:59 PM | Permalink | Comments (0)