Notes from the Field 2008

Hello everyone!

This will be my last post on the SPH blog site. I’m sad to see it come to an end! I just wanted to let you know a little bit of what happened at the end of our trip, and then update you on what I’m up to now.

So, we talked all about the Feria de las Flores and our visit to the cookie factory. In our last week or so of field experience, we were able to attend a colloquium on nutrition and new studies that are coming out. There were some interesting ones, like using yogurt as probiotics (like antibiotics, but they treat different things) and adding avocado to your diet to give you a better cholesterol ratio. Pretty neat. There aren’t a whole lot of studies done on obesity in Colombia, but I finally heard a presentation on one and it was great! As you can kind of make out in the blurry slide below, it is a rising problem in Colombia (the rate of overweight in adults in 2005 was more than 45%, up from 20% in 1980 – but to give a perspective, in the US it is about 65%).

Obesity: a problem of Public Health

We also were able to visit the secretary of public health for the neighboring little town of Rio Negro, and got lots of insights into the public health issues that face them. Apparently they have seen a great rise in suicide attempts recently, and they are now working to figure out what is going on.

Me and Yomaira, the secretary of public health for the city of Rio Negro

We also tried to capture on film just exactly what it is that Nutritional Epidemiologists do, so Noel and I headed over to the local fruit market to get some photos of nutrition in action.

At the very end of our time, we took a trip Medellin to the coastal city of Cartagena (it is on the Caribbean Sea . . . you can see it on the map below). Noel thought I should see it before we left, and he was right!

We spent a day in the old city of Cartagena and then took a boat ride over to a beautiful beach where we spent two days. It was my first experience sleeping in a hammock, and I have to say, it worked better than I had thought!

In case you’ve ever wondered what a mosquito net looks like over a hammock, well, here is one way they are used:

Cartagena used to get attacked by pirates, so they built a wall around the old city.

Noel and me posing with the Colombian flag and the new city of Cartagena in the background.

Now, the fun is over and real life is back. I only had a couple of days when we got back to the states to recollect my life and get back to the grind. I started medical school this week, and I am wiped out! I need more time to sleep! The end of our trip was exhausting, and I didn’t get caught up before school started again. Needless to say, I’m looking forward to the Labor Day weekend.

* * * * * * * * * * * * * *

Thanks for all of your attention and support as we’ve had this really cool field experience in Colombia. A few closing remarks:

-Just for the record, it was far safer than anyone ever made it seem before we went, and well worth the time and money.

-Support Sergio Fajardo in the upcoming 2010 Colombian election for president (he was the amazing mayor of Medellin)!

-Try to visit if you ever have a chance! Colombia is a beautiful and safe country with beautiful and friendly people.

Adios,
Maureen

Posted at 12:26 AM
Permalink | Comments (0)

States, Here I come!

My time in Zambia ends in less than 24 hours. My last week has been a whirlwind, trying to answers last minute questions, trying to say goodbye to everyone, and trying to wrap my mind around the fact that I am actually leaving. There are a few events that have occurred in my Week 5 and I would like to share them with you.

MY CROC BURGER EXTRAVAGANZA

Okay, so as soon as I read about crocodile burger at this reptile park, I knew it was destiny! Well, I just like to experience new things. So, Jason, Amanda and I headed to Kalimba Reptile Park where we saw these giant crocodiles, baby crocs, turtles, and snakes. I ate a croc burger, held a snake, put a turtle on my head, and had a python around my neck! We ended up running into Elizabeth (even across the ocean I still think it’s a small world!). Pictures are below.

MY MWEMBEZHI ANTENATAL PROGRAM VISIT

On Tuesday mornings, the Mwembezhi Rural Health Centre has a program for newly pregnant women. I was able to observe this program implementation this past week. Eight women showed up around 08:00hrs. Since they have come in to receive prenatal care, they fill out an Ante-Natal Card, which they will always bring to appointments. This card includes their logistics (name, age, weight, etc), obstetric history, records each ante-natal visit, and delivery information. After registration, there are specific steps in the program which are as follows:

1. HIV/AIDS education: HIV/AIDS education is given to all the women. Two leaders discuss the importance of HIV testing for pregnant women and safe motherhood. They urge the women to get tested so they can administer the proper precaution medicine during delivery. They also talk about family planning and breast-feeding.
2. Vitals: Women visit the nurse to have blood pressure tested
3. HIV Counseling: If the woman decides to have an HIV test (when I was there, 5/8 had testing done), she has her labs taken and will receive counseling. All five women who were tested were negative! I was jumping for joy =)
4. Exam: The nurse palpates the woman’s stomach to feel the baby (I did this and felt a baby’s head!). She then proceeds to listen to the heartbeat. However, in this rural clinic there is no ultrasound. Instead (bear with me- I don’t know how to describe it) it seems like this situation: You are one side of a wall and a conversation is occurring on the other side. Because you are being nosy, you attempt to listen with a cup (plastic? Paper? Styrofoam?) at your ear. However, when listening to the bellies, I was not using a cup; it was more like two ends of a trumpet put together- one circle at each end, connected by a skinny tube. Only about 6 inch long and smaller circumferences. I heard a baby’s heart beat with this thing!
5. Meds: These women get 4 types of pills while they are here at the first visit. The first, Fanlar, is an anti-malarial tablet. The second is Mebendozole which is a deworming tablet for the mother. The last two are folate and iron. Each woman gets thirty to sixty tablets (1 for each day) until they come back for a follow-up visit.

What I am looking forward to in the States:

My family and friends. I am used to talking to them every day and since I have been here, I feel out of the loop!!! My nieces and nephew (I missed Sam’s first walk by himself!), the late night phone call from my father, the heart-to-hearts with my mom, cribbage and cookouts, the Gpa update, homework sessions, Loring Park old school movies, happy hours, SPH potlucks, girls’ movie nights. My grade school chicas. I MISS EVERYBODY! xoxo

My second semester. In my first blog I said how happy I am to be in my program (Maternal and Child Health, concentrating in Health Disparities). And being here in Africa has reaffirmed my passion for community health, especially children’s. This semester the two courses I am looking forward to taking are Building Communities: Increasing the Health, Refugee Health, and Child and Adolescent Nutrition. I love school!

My apartment. And all of its vines covering the windows. And my clean fridge and new curtains (thanks Lloyd and Imee!).

Honestly, I am dying to have a McDonald’s sausage/egg biscuit breakfast. Especially the hashbrown. I know, public health, but what can I say?

What I am dreading missing in Zambia:

The children: their curled eyelashes, the strong hugs, the arms reaching out, the smiles, the singing, the 2.3 kg Baby Deborah, 4 year old Jennifer…

Everyday talks: I have been blessed to have such a great mentor here, Jason, who has taught me more than I ever thought possible in five weeks. Guiding me, providing answers to my questions, and questioning my thoughts, I could not have asked for a better field experience preceptor.

My walks from the bus stop: Whenever I took the bus and walked home (or walked anywhere), I would say hello and every person would say, “Hello, fine, and how are you?�? Everyone is so nice!

The food: Loved the Indian and Ethiopian food here. And of course, the nshima. Although, I do not think I could eat it every day! Zambia has gotten me back on track with my veggies and fruits because they are so cheap here!

The minibus boys: So once in awhile they can be pretty annoying when they rush to you, grabbing your arm or yelling “Where to, Madam?�? “Chelston? Avondale?�? BUT they do want me to ride their bus and rarely did they try to rip me off =)

The not-so-fast paced lifestyle: I am used to always going, going, going… but here, people are late. People are carefree. People are “whatever�?. In the states, not so much.

My Zambian family: Jason, Amanda, Dee, Dave, the HAC (Kent, Tom, and Dave), and the Alabama girls (Sullivan and Audrey) … thanks for everything. =)

Posted at 07:12 PM
Permalink | Comments (3)

A good friend of mine sent me an email wondering about the prevention of HIV/AIDS here in Zambia. And I apologize because in all my stories I have not been clear as to what prevention is here. I have discussed some programs for orphans and AIDS victims, both care and treatment. After receiving this email, I freaked out- realizing that I only had one more week to view prevention programs. After discussing my fear and concern with Jason, I realized that the prevention had been right in front of my eyes in many of the programs. I wanted to share with you these prevention strategies.

IN THE CHURCH…
Zambia is a country where the pastors are the community leaders. Through church services and programs, education about HIV/AIDS can be taught and prevention programs can be implemented. Pastors may speak the Lord’s Word to encourage good decision-making. For instance, adultery is common here, becoming an easy means of spreading HIV. Therefore, sermons on the wrongs of committing adultery may be delivered. Providing programs to church members is also a means of prevention. During my congregation visits with the Humanitarian Aid Committee, I witnessed a literacy circle (which also incorporated tailoring clothes and blankets), a youth tailoring project, and chicken rearing. Providing opportunities for community members enhances their knowledge and brings joy and hope to their lives. Together they can earn an income, whether it is for themselves or for AIDS widows and orphans, and strengthen the community. These projects also get youth involved in something other than sex and alcohol.

Literacy Circle in Session (the dirt ground is the chalkboard)

Youth Tailoring Group

IN THE CLINICS…
Posters are hung on walls and on doors in clinics. At a clinic called Mwembezhi there are many posters reminding patients/caregivers of the importance of ART adherence and the use of malaria nets. One poster geared towards the youth was about the importance of abstaining from sex. These posters from this clinic are listed below.

Malaria Prevention

ARV Adherence

Virgin Pride Poster

In this same clinic, during the antenatal program, educators provide testimonies and facts to new mothers about mother-to-child transmission. I also visited Macha Clinic to find out about prevention programs. The medical director informed me that it was a private clinic and there were no programs available, however HIV testing can be done for 5,000 kwacha ($1.50). In 2006, there had been a large push by the Zambian government to accelerate prevention. The Ministry of Health declared June 20 as the National Voluntary Counseling and Testing Day in Zambia. Roughly fifty people per month come to Macha Clinic for an HIV test. And finally, at a program called Tiny Tim and Friends, there is a women’s group that meets weekly to discuss HIV/AIDS. One major topic is s the importance of Preventing Mother-to-Child Transmission (PMTCT).

IN THE COMMUNITY…
Throughout Lusaka I see people wearing t-shirts with the AIDS ribbon logo. I see the giant walls that surround peoples’ property painted with the names of organizations willing to fight HIV/AIDS. Red ribbons appear on these walls and on billboards. As mentioned earlier, projects keep community members busy and close-knit. In that same morning, where I was freaking out about not “seeing� prevention, Jason pointed out a large sign painted on a wall, encouraging youth to join football (soccer).

Prevention in Soccer

In addition, the next day, I asked a few teenagers about school and community programs that discussed HIV/AIDS and other STIs. I was told about a youth program in the community of Kalingalinga, This program was help from 1500-1700 hours every Tuesday at the Man Jerad Education Centre. Trusted adults (usually teachers) would come in and teach about HIV/AIDS, other STIs, malaria, and cholera. They learn to prevent HIV/AIDS and other STIs by abstaining from sex or by using condoms if they chose to have sex. These condoms are available at the center. To prevent malaria, they are encouraged to buy mosquito nets (available for 15,000 kwacha or roughly US$4). All three of these boys told me they used nets at home. One boy stated that he loved to play soccer and sing, and the Jerad Education Centre gave him a place to express these likes. Again, keeping youth away from sex and alcohol.

Prevention occurs at every level- the newborns, the youth, and the adults. It is important to realize that prevention comes in many different shapes and forms. A variety of methods are needed to reach a large number of people. Many of the grassroot organizations seem to have an effect on the communities’ awareness and involvement in the fight against HIV/AIDS.

Hope this helps clarify prevention here in Zambia a little bit!

Much love,
Debby

Posted at 08:08 PM
Permalink | Comments (3)

… with Africa! And my life here. My week 4 was quite the adventurous trip. I decided to fly to Malawi last Friday (Aug 15). And since I am back, safe and sound, I can tell all of you I made the trip by myself (with the help of a few saints I met along the way). It was so wonderful. I enjoyed every second- yes, even when I was frustrated with the poor transportation system, deep down I was beyond happy. I will go over the highlights, and I hope you find them as wonderful as I do.

I left Friday afternoon from Lusaka airport. They have one departure gate (actually it is a waiting room). I was so confused because there are no signs about which flights would be boarding. I listened closely as I did not want to miss the boarding bus call. I was to sit in seat 1C, which is the very front, facing the back of the plane, allowing me to see everyone (weird!). Because I was not use to this, I thought “there must be some mistake!� and I moved to 10C. Wrong. I got kicked back up to the front, but back in row 10, I met a very helpful man who was also flying to the same place as me: Blantyre (in southern Malawi), so I was grateful I had been mistaken. He helped me with my bags, got me through customs with ease (although it is never very difficult here), and gave me a ride to my home for the next couple days. Blantyre is surrounded by three mountains and my new home had a beautiful view of one of them. I had originally planned on climbing, but I was not prepared (I didn’t even have hiking shoes), so I decided to head to a tea estate instead!

During the last half hour of my drive to Satemwa Estates, I was surrounded by fields of green. The massive amount of tea plants made it seem as if I was in Emerald City. Upon arrival, I received a brief history of tea and learned that there is over 1000 acres of tea plants on this one estate. I also learned the ins and outs of the process of making tea. I will give the steps below with some pictures, but if you really want to learn more about this, I can give a very detailed explanation (but will save it for a one-on-one basis).

Satemwa Estates Tea Factory, specializing in tasty tea!

1. Withering Trough (14-18hrs)- put the leaves in this trough to reduce moisture content. When you pick the leaves, you assume they are at 100% moisture. This needs to be reduced to 72%.
2. Cutting Machine (“Rolling Room�)- temperature over 30deg C, machine smashes leaves into tiny pieces, giving a product which they call: Dhool

Cutting Machine

3. Oxidization Process- reduce temperature and applying oxygen through tiny ducts. This turns the leaves from green to copper in color.
4. Dryers- to reduce the moisture content raise the temperature to 125-130deg C to stop the oxidizing process, and then drop the temp to 70-72deg C. A fluidization process takes place now, where a “force� (air from steam from a boiler) moves the leaves to a sorting machine.
5. Sorting Machine- separates the stalks and veins (fiber) from the leaves. YOU NOW HAVE BLACK TEA! You could purchase it at this point if desired.
6. Grader- A machine moves the black tea over a mesh screen. It separates the tea into three types: brokens (bold, large), fannings (leaf, medium), and dusts (powder, small).

The Grader

7. Package the tea!

During the wet season, there are more than 1,000 pickers in the field and they yield over 100’s of tons each day. I was happy to learn that to become a picker, you must be 18 years old. So no child labor. I hope he was telling the truth. I was able to taste-test about twenty teas (balck, green, white, oolong, and puu).

Taste Testing many kinds of teas

On Sunday I was able to catch a ride up north to Cape McClear, which sits on Lake Malawi (500km of clear blue water and sandy beaches). I ended up riding four hours in the back of a truck. There was no top, so I had the perfect view of my surroundings, including palm trees, huts, and Mozambique’s mountain range. I was in heaven. And I could not decide which hurt more: my bottom being bruised by the bed of the truck and the potholes in the road, my bottom when I jumped off a forty-foot cliff in Ecuador (nearly breaking my tailbone), or my cheeks from smiling so much. By the time I arrived at the lodge, my face was filthy and sunburned (except where my sunglasses had been- very attractive) and my hair was so knotted I thought I was going to have to chop it off. But a nice shower did the trick.

My ride to Cape McClear

In Cape McClear I sat on the beach gazing at the clear endless lake, conversed with the village children, observed a futbol match, watched the sunset (probably the most brilliant neon orange and pink sun I have seen setting), and learned about Malawian life. I took a boat to a nearby island (Thumbi Island West) with one of my local friends. We went snorkeling (the fish are tropical looking with neon blues, greens, yellows). I ate fish, rice, and vegetables, which had been cooked over an open fire.

The Beautiful Scenery

Getting ready to jump in and snorkel!

My delicious meal

The No Toilet sign on the island- pretty graphic!

I never wanted to leave Lake Malawi. I had been enjoying all the locals’ company. Everyone was so friendly. I watched a boy catch three small fish at the same time with just fishing line (they do not use poles). I chatted with a woman who was always washing dishes and clothes in the lake (but the lake still manages to stay clean and clear!). I listened to a boy’s love for school, but his need for a notebook and a pen. We danced at a local restaurant/bar, which seemed to be the popular hang out. I played pool with much smaller pool balls than those in America. I ate chips (French fries) and salad for breakfast. I woke up early to listen to the children getting ready for school near the lake. I knew after only two days that I wanted to return. In just two days, I learned about their families, their successes, their failures. I learned about their poverty, their illnesses, their hope for a brighter future. In just two days, I realized I wanted to be a part of that hope.

Boy Fishing

Many use the water for washing themselves, clothes, and dishes

Boys enjoying the canoes and water

My travels home were exciting and exhausting. It took me eight hours in the back of a pick-up truck to get from Cape MacClear to Salima. I was not even half way home to Zambia. I sat in this truck with about ten other passengers, three goats, and two spare tires. We ran out of gas once and the engine seemed to stall/die about ten times. Very eventful! I was happy to make it to a hostel. The next day (Wed Aug 20) I tried to make it home. (I really dislike traveling back home after an extremely great trip and the ride home seems to take FOREVER- which I should not have been surprised!) My first two bus trips went well and I thought I was making good time. I shared a minibus with a duck and a half-bus with a little chicken that basically sat on my lap. I crossed the border thinking I was home free! But I missed the last bus traveling from Chipata to Lusaka. By the time I made it back on Thursday mid-day, I was so grateful to see the gates to my Zambian home. Although, I am also grateful to have experienced the real traveling life in Africa and I met such amazing people on my way back through the two countries.

Wouldn't you be in love too?

Posted at 05:28 PM
Permalink | Comments (2)

(My Week 3)

A fellow SPHer came to visit me! Elizabeth, who is staying in a village about an hour north of Lusaka, stayed with me for two days. First, I took her to Ambuya, where we read “Peter Pan� (with a translator) to the children and taught them “Jesus Loves the Little Children.� Both were a success! It was great sharing my experience with someone from back home. During the afternoon, we walked all over downtown Lusaka and the surrounding areas. We walked for miles just exploring the city. The main road, Cairo Rd. reminds me of an American city street- busy with people, many shops, post office, large bus stations, tall buildings. We went to the Town Centre Market on Cha Cha Cha Road. At this market, there are just rows of narrow walkways, lined with stalls selling tapes, DVDs, clothes. We wanted to eat a traditional meal, so we found a food stall that served nshima. For about 13,000 kwatcha ($4.00US), I ate a chicken leg, a whole fish, mealie meal, and veggies. The men eating next to us were having a giant t-bone steak. And even with something like this, it must be eaten as finger food. And they do not like to use napkins either! We headed to the National Museum to learn more about Zambian’s rich history, culture, and art. They have beautiful paintings and an extremely detailed explanation of Zambia’s gain of independence.

Elizabeth and I in Zambia together!

Elizabeth picking out her piece of chicken

My whole fish and veggies- YUM!

On Saturday (Aug 9) I rode on a minibus to Elizabeth’s village. She thought that Lusaka life was way too busy- two hours to travel by minibus, getting hassled on the street, etc compared to her village life. Some major differences between our Zambian homes: Elizabeth’s is rural, the electricity goes out everyday (sometimes twice!), they just got hot water, they do laundry by hand, Mine is urban (although it takes me 45 minutes via minibus to get downtown), electricity has only gone out only once while I have been here, hot showers, washer and dryer. I live rather unrealistic compared to how many Zambians live. At her village, I saw three-day old kittens, heard the children praising the Lord, and ate lots of spaghetti and Elizabeth’s and Kate’s famous scones. =)

My projects are going well. The week of Aug 10-14 was my last week of working with the children at Ambuya. Because they had already took their end of term exams, I spent time doing activities with them. We continued learning “Jesus Loves the Little Children� and each day I would read another story. One lesson was on the world. We went over the seven continents, four oceans, and even colored a map of the world! By the end of the week, they mastered the song. Every morning, as I entered the schoolyard, the children would come running and yelling “Anti! Anti!� (Children here call women caretakers “Anti� and men caretakers “Uncle�). And then even without me telling them, they start singing the song. Their favorite line is “Red, Yellow, Black, and White.� I think it because they can bolt out the colors. They are just awesome.

They love wearing my sunglasses!

At the House of Moses, I was there when two little babies were brought in. They were less than two weeks old, had both been independently abandoned at the University Teaching Hospital, and were in need of names. With one being a girl, I immediately said, “Debby!� The coordinator’s daughter was Debby as well, so she immediately approved and the little girl was named Deborah. I was overjoyed. I just know she will be placed with a wonderful loving family and grow up to be strong, courageous, and compassionate. I know all of these children will. Please keep them in your thoughts and prayers. And to all those who have asked me to give many hugs to all the children, I have. Countless hugs and kisses. I will miss all of them greatly when I leave. Each and every child I have met, held, smiled at, has touched my heart in such a special way.

Posted at 05:08 PM
Permalink | Comments (4)

The name of this entry comes from a message we heard on KISS FM, a local radio station, ‘the best day of the year is Friday’. After our experience climbing Mt. Kilimanjaro, I completely agree.

We left Karatu by bus for the town of Moshi, which is located on the base of Mt. Kilimanjaro. After staying a night in the swanky Springlands Hotel and meeting with our guide, Saidi, we left early the next morning to begin the climb. The first day we hiked through rainforest and our campsite was located just below the cloud line. Each day consisted of between 4-9 hours of hiking, on trails of dirt, mud, and/or rock. We hiked through various climate zones, ending at base camp that was over 10,000 feet above sea level. Each night was spent camping in a tent, where a cook prepared delicious meals for us.

On our climb, our guide, Saidi, an assistant guide, a cook, a waiter/porter, and 5 additional porters accompanied us. The porters were one of the truly amazing parts of this experience. Each porter carried up to 15 kg of supplies, such as tents, gear, water, and food. What is amazing is that all of this was carried on their heads throughout the week-long walk! We, on the other hand, were just carrying our daypacks with water and snacks, and were walking very closely and often struggling uphill.

On Midnight on Wednesday we left base camp and began to summit. After a long 6 hours of uphill climbing by the light of the full moon (and a metor shower!) we arrived at Stella Point. A mere 1 hour later we had reached Uhuru Peak, the summit of Mt. Kilimanjaro as the sun was rising! It was truly an amazing experience with beautiful views of glacier and rock landscapes. Of course, we stopped for the necessary photo at the peak as well! The climb back down the mountain we completed in a day and a half, which was a huge challenge for my knees! We returned to the Springlands Hotel in Moshi on Friday, for a relaxing swim in the pool and sleep in a bed with a mattress!

After returning from Moshi/Mt. Kilimanjaro, our time in Karatu went by quickly. We had about 5 days, in which to finish up our projects at MIHV, visit the Ngorongoro Crater a mere 20K from Karatu, and say goodbyes to everyone. We were able to finish with the Tatua Tatizo Diarrheal Disease video, and burn many copies onto DVD, and also help with some brainstorming for an upcoming MIHV fundraiser. Monday, we also had a visit from Diana Harvey and Dr. Bill Toscano from the U of MN SPH who are in Tanzania for a week or so. Tuesday, we spent the afternoon with the District Medical Officer and his wife touring the Ngorongoro Crater and Conservation Area, seeing lions, hippos, zebras, and all sorts of other wildlife.

It’s now Thursday morning, and we leave Karatu in about 30 minutes. We are headed to Arusha, to have lunch and do some last minute souvenir shopping before heading to the Kilimanjaro airport for the flight home. My 8 weeks here in Tanzania have passed so quickly, I cannot believe that we are already leaving. I have learned so much about public health, the culture, and have made connections and friendships with so many great people, it is difficult to leave. I look forward to the opportunity to stay connected to Jolene, the MIHV project, and all the other people who have made my trip so memorable and I hope to return to Tanzania sometime in the future.

Asante sana for following my adventures, and feel free to contact me if you’d ever like to see photos!

At the top of Uhuru Peak!

A lion at Ngorongoro Crater, very close to the vehicle!

Posted at 07:28 AM
Permalink | Comments (1)

Well, here we are, not too far from being done with our field experience. The past week and a half has been CRAZY, and I got used to the feeling of exhaustion again, which comes in sweeps. At first it was all so much to take in, then I think we acclimated, but the Feria de las Flores has been more than my senses could handle. Below I have posted some of the pictures that Noel was talking about earlier, from the Desfile de las Silleteros, or the flower parade.

The other REALLY COOL thing that I want to talk about a little bit is our trip to the cookie factory! We were able to visit Galletas Noel, the company that will be manufacturing the fortified cookie. (I should mention that Noel is the company sponsoring the study – how funny since Noel’s name is also Noel. Apparently it is not a common name here, so every time Noel introduced himself to someone at the factory, they would do a double take, like they couldn’t believe it.) We went on Monday to have a meeting with the nutritionist there, Isabel, and she told us the background of the study and then discussed the progress with the study coordinator from the University. On Tuesday we returned for our very own private tour of the whole cookie factory! It was one of the coolest things I have seen so far in Medellín.

We got to see the warehouses of raw ingredients, then all of the huge mixers, the hot room where all of the dough rises for 12-24 hours in huge vats, then the conveyor belts of dough . . . oh the conveyor belts of dough!! They were one of my favorite parts. They roll out the dough, and it goes through many turns of huge rolling pins, then it gets layered on top of itself in 5 layers (so it is more crunchy and crispy after it’s cooked). The 5 layers are then rolled together again, cut or pressed into the different cookie shapes, and then they pass through a long long oven, which takes anywhere from 3-5 minutes depending on the cookie. Then they come out and pass upstairs on another conveyor belt, to a cooler floor where they will be packaged. Then comes the quality control and packaging. It all happens so fast on the conveyor belts and there are just cookies going around everywhere. It was a delight for my senses!! An avid baker and cookie-holic myself, I really really enjoyed our day at the factory. Unfortunately, we weren’t allowed to take any pictures inside the factory portion, but here are some pictures of us outside:

Me, in front of “Mundo Noel� (Noel World)

Noel and me with our guide, the nutritionist Isabel, in our going-into-the-factory garb.

Posted at 02:45 PM
Permalink | Comments (0)

I must say this experience has been very fulfilling and interesting. This last week at the WHO has been busy. It is time to finally put things together and round up everything I have been working on for the whole internship period. For this final week we put together a final list of experts for the 2008 Expert consultation on Waist circumference and Waist-to- Hip ratio. It was great to observe that this list was exhaustive, covering experts from the entire WHO region- America, Africa, Eastern Mediterranean, Western Pacific, European and South East Asia. In addition, the WHO BMI database has been updated with all the new studies and WHO STEPS (STEPwise approach to Surveillance) studies

I must warn you that this STEPS is very different from what we know in the US as the STEPS study. STEPS -WHO is a simple, standardized method for collecting, analysing and disseminating data in WHO member countries. By using the same standardized questions and protocols, all countries can use STEPS information not only for monitoring within-country trends, but also for making comparisons across countries. The approach encourages the collection of small amounts of useful information on a regular and continuing basis.

I was so happy to be allowed to view a photo shoot of WHO babies (and Assistant Director General for Food Safety) who were being breastfed! It was organized by the department of Food safety. It was such a lovely sight- with babies representing every continent! I bet these babies will grow up to be open to diversity and better tolerate people from other cultures because they get the exposure at such a tender age (2weeks to 10months)!! All the babies wore nice little shirts that said "mummy’s milk is the best!" in all the 6 WHO official languages. (I personally know 2 of these babies and their mums who work for the Nutrition department (from the Philippines and USA)

After my internship contract was finally over, my sister and my cousin flew over to see the beautiful city of Geneva. We went for a tour ride through Geneva and a cruise! This was a lot of fun. It was my first cruise in a big boat!! Although the free drinks they offered us disappointed us, we still had a lot of fun.

In all, I think this experience has been enriching both educationally and otherwise. I had the opportunity of meeting some great people and had a first-hand experience working in an organization I have admired since childhood. Pardon me if this statement is a bit exaggerated, but I think I have just been given the chance to live the dream of every Ghanaian child, born and raised in Ghana with an interest in the biological sciences- TO VISIT THE WHO!
Thanks to everyone who made this possible. I am truly grateful.
I couldn’t have asked for a better summer!!

Posted at 04:03 AM
Permalink | Comments (0)

August 18, 2008

For one week, Lizz and I decided to test our physical and mental stamina by climbing the tallest free-standing mountain in the world: Kilimanjaro. Kilimanjaro means “mountain ice� or “bad mountain�, depending on who you ask. Both meanings, in my mind, explain it well. Kilimanjaro is the tallest mountain in Africa and the tallest mountain one can climb without technical assistance (such as oxygen). We had an amazing time, and now that it’s done we are glad we did it. I have included some details of our trip below, but let me offer you a warning. If you would like to know only the good, esp. if you want to climb the mountain one day, read only the “good� section. If you want to climb Kili some day but want to be given a reason not to, read the “bad� and “ugly�. If you want the whole experience, read it all.

The Good
Kili is beautiful. Breathtaking, in fact. There are five climate zones, so within six days you’ve climbed from a rainforest to a glacier. Amazing. The first zone, the Cultivation Zone, is the fertile land with a lot of agriculture (coffee, banana, mango, bean, corn, potatoes, cabbage, and tomatoes are grown here) and livestock. Next is the Montane Forest, which is the main water reservoir for the entire region. Here you find the most beautiful flowers, my favorite being the kilimanjari, a flower marked by reds, yellows, and oranges. In this rainforest area, you see layers and layers of vegetation, including Erica trees, moss, lichen, and ferns.
Then on to the Heath/Moorland Zone, where we felt like we were trampling through a Lord of the Rings set. At this point we were above the clouds. The Moorland zone is full of Erica trees with bearded lichen, lots of grass and shrubs, and full of mist.
From there you enter the Alpine Desert, where only a few insects, spiders and mice can survive. It’s essentially a desert made up of stones, and the UV radiation is very intense.
Finally we reached the Ice Cap Zone, described as a “landscape bleak and offers no protection.� Nothing can survive here. There are 15 names glaciers and the Reusch crater.
In addition to enjoying many climate zones, we found beauty in the amazing sunsets and sunrises. Also, on the day of the Big Climb to the summit we walked through the night, led by the light of the moon, which made the snow and ice shimmer in the darkness.
Our guide and his group were awesome. This was a camping trip I’ve never experienced, where others take care of everything for us. We never had to set up camp, or cook, or boil water, or carry anything but our daypack. Instead, we had a crew of 9 men taking care of the two of us: a guide, an assistant guide, a cook, a waiter/porter, and 5 other porters. It seemed strange at first, but by the end I can see why we needed so much help.
We were served incredible meals. In the morning we received porridge, eggs, hotdogs, oranges, bananas, toast. We would eat popcorn, peanuts, and biscuits with tea during breaks. Lunches and dinners were anything from homemade vegetable stews and cream soups to curry chicken and beef with French fries. We ate fresh watermelon, mango, and papaya.
The hiking routes were very crowded, as were the campsites (even to the point of ‘traffic jams’ when climbing). We enjoyed this, as there was such great diversity and comradely amongst the groups. We laughed and joked with everyone, and became known as the “MN girls�. One man from South Africa wanted us to give him cupcake recipes every time we saw him. Eventually we wrote down a recipe, which included the steps of 1. Find a porter, and concluding with Warning: cupcake icing in high altitudes is not recommended.
One funny/sad story: a flock of birds took off with a zip-lock baggie of a man’s medication and a search crew was sent out around camp to look for it.

The Bad
Nights were FREEZING. Our tent had ice all over it every morning, and getting out of the sleeping bag in the morning or the middle of the night to use the restroom was about the last thing you wanted to do. The temperature produced a continuous lack of sleep (at least for me).
There is no shower or washing for 7 days. We stunk, which I suppose was fine because we all stunk together. But, being a contact wearer, it’s difficult to not contaminate your eyes and keep them from burning. Dirt is everywhere; under your nails, in your ears, caked to your feet. We didn’t know if we were getting tan or just loading up more dust on our bodies.
Pit Toilets: Gross. I would much rather dig a hole than use the pit toilets. They were super smelly and often produced the gag-reflex. Most foreigners (including ourselves) were not always great at directing our excretions into the small holes, so the latrines were full of, well, you know. The worst were the pits on a slope, because the liquid and poop would pool in corners. Additionally, increasing altitude and eating different food caused many-a-person to have unusual bowel movements. Lizz got food poisoning at one point, which added to the fun. Enough about that.

And The Ugly
On Day 6 we were woken up at 11:30pm to start our midnight climb to Uhuru Peak, at 5895 meters. Probably due to both altitude sickness and not getting enough rest, I woke up with a headache. Boo. Not a good way to start a 9-hour hike. First of all, let me explain that at this elevation we were already seriously suffering from a lack of oxygen, and we had another 1,200 meters to climb. I popped a few Ibuprofen and altitude sickness pills and tried to get into a meditative rhythm.
At the beginning of the hike, I said, “Asante Sana Kilimanjaro�, or “Thank you Kili!� Within a couple hours I started cursing the mountain, if not verbally, then internally. As Lizz says, this resulted in almost instantaneous karma. I kept feeling worse and worse. My headache was horrible, and I started to feel very dizzy. The rule was no stopping, because those who stop (other than to take a quick bathroom break) may not make it to the top. In fact, depending on the route, as many as 60% of the people who attempt Kili do not reach the top. Anyhow, back to the misery.
Around 5am I took more meds and gave my day pack to the assistant guide. I tried to keep a rhythm with my two walking poles and prayed I would make it. I felt horrible. Imagine climbing for 9 hours in the night, temperatures below freezing, with little oxygen, only to know when you reach the top you have to turn around and hike another 6 hours back down the mountain. I tried to not think of this.
Somehow, only God knows how, we made it to Stella Point at sunrise, and continued to Uhuru Peak by 7:30am. It was unbelievably gorgeous! I was feeling better by this point (thanks to many meds), at least enough to smile and be excited. Still, I was begging to start our way down the mountain. Indeed, it’s recommended to stay at the top for a maximum of 5 minutes. On the way down the mountain, I was nearly running. By the time we made it back to base camp, I felt like I was dying. I laid down and thought I had the flu—puking, dizzy, horrible headache and stomachache, etc. But, we couldn’t stay; after throwing up my lunch (of which I had no appetite for anyway) we had to continue hiking down for another 4 hours! It was miserable. I decided that day was like hell, and I would never again attempt a Kili climb. I was also wondering if it was worth it.

Now, with days between summiting day and today, I can say the hike was worth it. The climb was by far the most physically difficult thing I’ve ever done, and I was reminded that my body does not do well with altitude. (Indeed, I was sick for a day when I ran in Albuquerque!) Still, we made it, and we have many photos to share!

Posted at 02:14 PM
Permalink | Comments (0)

Well, with just under a week left in Kisumu I’m starting to think about what loose ends I have to wrap up. I would be dreaming if I thought I could touch all the things I have left on my to-do list so I’m thinking realistically and coming to terms with the fact that there will be things left undone. But that gives me reason to come back! Which I’m definitely thinking about doing already, before I’ve even left.
So, what have I been doing the past 2 months? I haven’t gone into very many details in my blog mostly because there are so many other exciting things to share and work just seems to fall to the bottom of my list after surviving white-water rafting, a short-course of ciprofloxacin, and slaughtering goats (more on that later).

The UMN project in Kisumu mostly needed my help sifting through data and filling gaps. Occasionally data collection on mosquito densities and rainfall was lapsing and papers are starting to depend on this data being much more accurate. I spent the majority of June shuffling through paper forms (all of which are scanned into the computer for data entry), re-organizing filing systems, finding duplicate entomology records, and then shuttling dubious forms back-and-forth from the field for correction. The problems seem to be resolved now, for the most part – the rainfall conundrum still eludes me. But I’ve gained a newfound respect for good organizational skills and file cabinets!

My preceptor and I have also discovered the necessity for naming files. My supervisor at the U is good about insisting on proper filing syntax, but this teaching has failed to be instilled In Kenya so we end up with 4 files named “filterpaper samples round 4�. Bit by bit, though, things seem to be getting better, at least for the time being.

I have also been trying to finish several manuscripts on the analysis that I have been doing both here and at home. The task is daunting, but do-able. I’m resigning myself to weekends spent at the pool with my pseudo-working laptop writing feverishly (well, it’s more like writing and then DELETING feverishly, but you get the point). I had been good at setting deadlines like, the intros will be done on Saturday, and then I’ve been even better about missing them. Somehow the Kenyan mentality of “slower is always better� has permeated my existence.

My preceptor (who moved to Kenya not two weeks before I arrived) has also started to live the “Kenyan� way. We tend to roll into work at a leisurely 10am most mornings. We take a long lunch, enjoying the company at the canteen (and counting buggy beans) and the wonderful fresh air.

Another example of the “Kenyan� way: Fridays are known here as “Member’s Day� – officially meaning that members of the various supper clubs around town leave work around 4pm to gather for drinks and then a lavish dinner. Unofficially, this means that everyone – member or not – tends to start packing up their things by 3pm and then trickle out of the office so the boss-man doesn’t notice. In fact, the CDC shuttle (notorious for it’s 7:30am to 5:30pm work day) even observes this leaving at 4:30pm on Fridays, if not 4:15pm if the riders are ready.

But seriously, we have been working very hard the past few weeks and I think the “accomplishment� list is a few lines longer than the final “to-do� list, which is gratifying. I’ve learned so much about the practicalities of doing epi research. Like, when it rains in Africa you better not expect anyone in the field to get anything done…because there is absolutely no way that the roads are passable. Or that explaining a procedure or a method once is never enough…concepts take time to grasp and we should all be patient enough to ensure everyone knows what they are doing. And another, never assume anyone knows exactly what they should be doing or knows exactly what is going on. These issues are as much cultural as they are human…so expect them everywhere.

Posted at 08:08 AM
Permalink | Comments (0)

Before coming to Tamil Nadu I had researched about HIV/AIDS in India, giving me what I hoped would be a proper public health perspective and enough to prepare me for the start of my project. Tamil Nadu is one of the six high prevalence states of HIV in India, and numbers are higher in regions close to major highways and among vulnerable groups such as sex workers, intravenous drug users, prostitutes and lorry (truck) drivers. With Oddanchatram being the “Vegetable City�? of Tamil Nadu located near major highways and railways and filled with migrant workers, truck drivers and vegetable buyers and sellers, it is obvious why HIV is on the rise in this area. CFH diagnoses an average of 30 patients a month with the virus, representing only a portion of persons who are actually affected with the virus.

The more I had researched about HIV in South India, the idea of focusing specifically on women became clear. Women are now also considered to be at higher risk for the virus in this area, who mostly contract HIV through heterosexual contact from their spouse. Very rare is it that women contract the virus outside of marriage. With disparities in education, economic status and decision making power, women seem to have little defense over HIV, This is the basis for developing our project with the community outreach team.

The women we spoke with had a pretty high general awareness about HIV. However, still one-third thought that you can contract HIV through sharing utensils or water vessels with an HIV affected person, and that staying away from someone was an effective method from preventing transmission. Although most women said they would be willing to take a free HIV test, one-fourth said they would not. Reasons for those who were not willing was because they didn’t feel like they have any symptoms, or that people would think that they were a bad person. About half the women said that if they wanted their husbands to wear a condom, they would be able to ask them to wear one. Some women said they had no reason to want their husbands to wear one because they were respectable men. Others said that their husband would fight with them or think they were doubting them. In addition to getting insight from the women, each was given education/counseling by our health workers. We ended with 103 interviews.

Last Saturday, during my final meeting with the community health outreach team, we spent a good portion of the meeting discussing the findings of our project. Though nervous about how the meeting would turn out, the feedback from the group made my whole experience worthwhile. A few of the doctors gave some helpful criticism about the study and the community health workers talked about how the project helped them to be more involved and skilled in HIV prevention strategies. Discussion led to new ideas for dramas that can be created for promoting HIV prevention… lightbulbs seemed to be going off and I didn’t have to know perfect Tamil to understand that. Most importantly, it all felt like a group effort.

Yet apart from the research, the deepest impressions of my internship come from the women I have made close relationships with along the way. In particular, one friend of mine invited me to her home just before I left from the hospital. We had talked frequently about me coming, though we finally just decided to make it happen. She herself is closely affected by HIV/AIDS and is struggling to make ends meet for her and her family.

When I arrived at her home, my friend had prepared a feast of lemon rice, egg, fruit, cookies, cakes and biscuits. The food she had bought probably cost her three or four days worth of wages she makes as a domestic “servant.�? Half of her village came to visit this strange looking foreigner, and my friend was constantly offering me more food and drinks and trying to make me feel comfortable. Knowing how much she had spent on my visit was heartbreaking for me, yet I knew that not receiving it graciously would be even more heartbreaking for her. Finally, she reached into her cabinet and gave me one of her nicest saris, a beautiful pink sari with beautiful embroidery on it. She had never even worn it, yet insisted that I have it.

During my first blog entry, I talked about expectations for my internship in India. As I have just left my placement in Oddanchatram and am writing this as my final blog entry, I thought it fitting to reflect upon expectations for my public health service. Working with a top-rate hospital that gives excellent services with little resources, my public health experience has definitely met expectations.

Though I had come to leave some small impact on the women in South India, experiences like the visit to my friends’ house has left me overwhelmed with humility. As public health workers, we intend to improve the lives of others through education, economic, medical, and social service support. Yet through my experiences, I always learn so much more from the communities I work with…about perseverance, caring for others, and the beauties of the human spirit. For this reason, I have to thank the true educators of my internship for making my experience far exceed expectations.

Posted at 09:54 AM
Permalink | Comments (0)

So today my preceptor, friends, and I stretched our epi muscles at the canteen. The canteen is right in the middle of country club-esque CDC campus and is likely the cheapest place in Kisumu to find some grub. And grubs we have found!

About 3 weeks ago I discovered a bean with holes. Not ever seeing this before I inquired of my veteran friends. "It's a bug, just pick it out" A what! A bug in my bean? Ok, so my friend took her spoon and proceeded to smash the bean until she found the little black devil. Since then I've become only slightly OCD about checking my daily bowl of beans. At times I've had a killing, nearly 20 beans deserted from my plate for fear of bugs.

I guess I've related this story to several of the students here, much to their chagrin. So, today I was informing my preceptor of the buggy bean syndrome. Sure enough, he had quite a few. So, we decided to test our "eye-ball" evaluations. We took several of what we thought were positives for buggy-ness...100% bugged (true-positives)! Next we took what we thought were some negatives...100% non-bugged (true-negatives). Finally came the true test: the indeterminate. My eye said "bug!" but 3 of 4 felt otherwise. Low and behold we found a bug! I forgot to count our trials before the plates were cleared but my eye was truly 100% specific & 100% sensitive, not too shabby.

It's at this point that I hang my head in shame...I have officially become an epi nerd:) But at least I'm bug-free!

Posted at 12:23 PM
Permalink | Comments (0)

Hello again all of you fantastic blog readers. I come bearing stories about my adventures this past week.

We left Lusaka at 6:30am Saturday morning (Aug 4). Our first destination was Chipata. From the time we left Lusaka to the time we arrived, we had been on the road and in the jeep for nearly eleven hours. And this was no easy task as we were riding sideways and driving on the bumpiest roads ever! Along the way, we stopped at St. Barnabas church in Misolo, where two boreholes had been placed. Here I had my first real Zambian meal!! The women of the village made nshima for us. This meal consists of cooked ground up maize (aka Mealie Meal), veggies (usually cabbage, spinach, and tomatoes). You use your right hand to roll the maize into a ball, scoop the veggies with it, pop it into your mouth, and walah, you have tried nshima. It was very delicious, although very messy!

Me helping the women stir the Mealie Meal!

For the first time in Africa, I saw children with extended stomachs. Their eyes were yellow and their tummies stuck out of their shirts. Seeing this right in front of my eyes broke my heart. Just like many things here. It is/has been an emotional roller coaster. Its mountains and valleys, highs and lows. I see beauty everywhere- in the people, in the land. But I also see severe poverty and sickness. My mind has a difficult time grasping the world over here and my heart has a difficult time coping with the sights before me.

Hardworking women

Malnourished child

Beauty of Africa: the Baobob Tree, the "Tree of Life"

Children praising God after church

For the past two weeks, I have realized that the Zambian women are the hardest working people. I have been watching women and children carry so much on their backs, on their heads, and in their hands. One girl who was about seven was carrying a baby on her back and two large buckets of water. Many times this is what the scene looks like- women hard at work (cooking, sweeping, carrying necessities) and the majority of adult men are off at the bars or just sitting around town. Alcohol is a major problem in Zambia- in both the urban and rural areas. When the HAC team, Jason, and I were at one church, I decided to walk around the village. Of course, I had my own little tour guides- about twenty of the village children- so I saw every house, every garden, every person. Then I saw the strangest contraption. The two men managing it told me it makes a special liquor that will “get you very very drunk.� Later I learned from Jason that the type of liquor they were making Kachasu, which happens to be illegal here. One investigation of this homemade liquor found traces of bleach, formaldehyde, and battery acid. No wonder it's illegal.

The crazy contraption, The mixture boils in the pot on the right. The steam comes up into the tire and creates a new liquid, which then gets drained into the bottle on the left.

Me with baby in village (and the baby just happened to be peeing on me- look at my pants!)

After a night’s stay in Chipata, we left for Mwufe, where the South Luangwa National Park resides and where we camped at Croc Valley. I was feeling adventurous (and cheap) so I stayed in a tent with the wandering elephants and hippos. I had pitched my tent under a grass veranda, as the owner told me this would be safer than in the open. I woke up in the middle of the night to the sound of breaking branches and loud munching. I peeked out my tent and sure enough I had an elephant coming straight for our camp area! And when he was coming towards the tree that my tent was under, I must admit, my heart began beating faster and my eyes were wide open! He was about ten feet away from me and he tore down a large branch from the tree above me. And then along comes a hippo on the other side of my tent. Needless to say, I did not sleep much this first night. But it was worth it. Those staying in actual rooms were definitely missing out! The next day, our safaris began. We did both a morning and an evening one. Both were amazing. I saw impalas, pukus, crocs, warthogs, lions, zebras, giraffes, a hyena, storks, water and bush bucks, cape buffaloes, hippos, fish eagle (Zambia’s national bird), baboons, a genet, a cavit, porcupines, and two lionesses! It was awesome. I was just amazed by everything around me: The zebra baby nursing from its mother, the towering necks of the giraffes, the destructive nature of the elephants (they must have killed at least half the trees in this park), the albino baboon riding on his mother’s back, hippos playing in the water, the proud strut of the lions.

Zebra mom and baby

A family of elephants

My projects here in Zambia are going very well. I have spent much time visiting the HAC’s (Dave, Tom, and Kent) project sites. Not only do I see this committee’s projects, but I also get a chance to visit many villages. I have seen roughly eight different villages throughout the Eastern and Southern Provinces. Many of the villagers are welcoming. The children are slightly timid at first (especially the infants), but if you pull out your camera, they will instantly love you! They love it when you take their picture and love it even more when you show them the digital screen. It was a blessing that the HAC was here at the same time I was. I have learned so much about missionary work. I see the HAC working in two ways. First, they spread the Word of God when community and congregation members are involved with one of their projects, whether it be using the borehole, coming together to sew, or raising chickens to support widows and orphans. Second, they show the love of Jesus through their compassion to improve the health and well being of congregations and communities.

I have been going to Ambuja Day Care Centre to work with the children there. In my last blog, I was unsure about the details of this program and so I want to share with you more about this Centre. Ambuya (which means “Grandparent�) is a program that began in 2002 and is for orphans who are HIV+. Many times, when the parents die of AIDS or other diseases, the grandmother becomes the new caretaker, hence the name Ambuya. As mentioned before, these children come every day to the Centre to receive schooling, health care, and food. In addition, the Centre works with guardians of the children. They are taught about the care these children need, the stigma of HIV/AIDS and the importance of ARV drug adherence. The children here have hearts so full of love and joy and eyes so full with hope, which are reasons why I love working with children. Even though they struggle with HIV and the loss of their parents, they are still upbeat and optimistic. Often times we can forget that children can be our role models too.

The children at Ambuya and I

Other notes (the Good, the Bad, and the Ugly):

A movie here costs 12,000 Kwatcha, which is about $3.50. Large popcorn and a soda costs roughly $4 at the show.

The two hardest things to find in Zambia: 1) a cup of coffee and 2) a usable bathroom (seriously, the “latrine� did not even have a hole! Only a dirt floor and a very, very shallow trough were present).

There is so much litter here. Attempts have been made to spread awareness about keeping Zambia clean, but the message is not very well accepted.

Attempt to stop the littering

....

Much love,
Debby

Posted at 07:48 PM
Permalink | Comments (9)

As time winds down on our field experience, the city of Medellin is winding up with the Feria de Las Flores (Festival of Flowers). With Colombia being the second largest exporter of flowers in the world, next to Holland, and Colombians being keen on maximizing their celebrations, we knew this 10-day festival of flowers would be extravagant.

Activities with the Faculty of Public Health kept us busy up until Thursday, which was Colombian festivo (holiday) in honor of the Battle of Boyacá in which Simon Bolivar liberated Gran Colombia (now Venezuela, Colombia and Ecuador) from the Spanish Monarchy. More importantly for Medellin, and for us, Thursday marked the Desfile de Silleteros (Parade of Flower Vendors).

The sun-soaked afternoon must’ve reached 95 degrees as the crowds moved like water into every inch of movable space. Fortunately for me, standing a good foot and a half over all Colombians, attaining a buena vista wasn’t too difficult. For Mo: not a chance. That was until I heaved her on my shoulders to serve as the photographer for the day!

The silleteros come from Santa Elena, a pueblo situated high in the Andes near to Medellin. The night before they prepare their silletas (flower displays) as onlookers admire drinking canelazo (warm fermented sugar cane drink) and singing Colombian anthems. The silletas come in all shapes, sizes and designs and are judged by a panel before entering the parade. Carrying the silletas, from Santa Elena to Medellin for the parade, appears to be the most physically demanding part of the processional as old women, as a matter of pride, take it upon themselves to carry silletas which weigh up to 200 pounds on their backs!

As no one seemed to return to work following the fanatical festivo on Thursday, Friday allowed us to see another marvel of the Feria de Las Flores; the International Orchid Exhibit at the Botanic Gardens of Medellin.

With three mountain ranges, a Pacific and Caribbean Coast, deserts, and a portion of the Amazon river basin, Colombia features a variety of climates and environments ideal for orchid plants. In fact Colombia is home to 3000 species of orchids, and has arguably (see Ecuador) the largest variety of orchids in the world!

As we entered the botanic garden we were impressed by its sheer floral capacity and the long lines of orchideologist waiting for their own intimate experiences with the esteemed flowers. Phylum by phylum Mo and I were introduced to some of the exquisite hieroglyphs of nature. Even photos can hardly do justice to the beauty that Mother Nature showed us Friday afternoon.

Unfortunately, the floral lavishness of the ‘Feria’ has a flip-side. Colombia is the main supplier of flowers to the United States accounting for more than one out of every two store-bought flowers. In Colombia the flower market offers hope; however working conditions are less than ideal. Nearly 80% of the flower workers are women, and they make less per day than what four carnations cost in Cub Foods. The Colombian Ministry of Health states that floriculture has the highest rate of workplace ailment due to the demands of the trade. Dole corporation, which owns the largest share of the Colombian flower market, demands its workers to strip, cut, and pack 350 flowers per hour. Unemployment (rate over 40%) and the high number of displaced persons (due to armed conflict) suit the flower producing companies because many people will accept work under anomalous conditions since they desperately need income.

It will be interesting to see what the imminent Free Trade Agreement will mean for the Colombian flower industry. Obviously a FTA presents an opportunity to maintain preferential tariffs for Colombian flowers, but it does not address the poor working conditions or agrochemical pollution and toxicity that are linked to floriculture.

Nonetheless, knowledge of the poignant floriculture working conditions has made me appreciate the seamlessly endless supply of flowers flooding Medellin in these beautiful days of Fería de Las Flores.

Posted at 07:06 PM
Permalink | Comments (1)

5 August 2008

Monday was a busy day for us at the MIHV office. In the morning, we worked with some of the initial data that is being collected in the field by the TBAs with the pregnancy monitoring tool books we assembled. Jolene, MIHV’s country director, was interested in having graphical representations of some of the data, including mothers’ age at delivery, sex of infant, and morbidity and mortality data for both mother and child. We worked with Eveline, MIHV’s Monitoring and Evaluation Coordinator, to put this information into an easier format and then create a series of pie charts and graphs that will be used for reporting purposes.

Mid-morning, we left MIHV’s office and headed to a medical clinic in Karatu. A former American physician (cardiologist/anesthesiologist), who came to Tanzania, climbed Mt. Kilimanjaro, and then had a revelation that he was meant to work in Tanzania, runs the clinic. On Tuesday morning, we gave another Excel training to staff. Our other motive for visiting the clinic was getting Sarah’s rash checked out, which turned out to be bedbugs, picked up while in the field last week. While at the clinic, I also assisted the head nurse with creating an Excel form that is used for monitoring the inventory of the pharmacy, as well as a form that the clinic will use as an itemized receipt given to patients for services rendered.

We spent the rest of the day with the Karatu Sangoma Drama Troupe, a group of about 10 local men and women actors. MIHV has worked with this group in the past creating skits about breastfeeding and child spacing. For the current project, the group had been tasked with developing a 15-20 minute skit about clean water, hand washing, and diarrheal disease. Today was the dress rehearsal and the filming of the drama. The storyline includes two families, one that washes their hands at appropriate times and the other family that do not. Of course, the result is a mother and baby who are terribly sick with diarrhea and receive education and information from the other family and the local doctor. Although all the lines are spoken in Swahili, the skit is truly hilarious! The actors are fantastic, especially the “sick� family. We will spend much of the rest of the week editing the footage and putting the video together.

Wednesday and Thursday of this week are both market days, in Karatu and another town. We will be accompanying MIHV staff and the drama troupe to market each afternoon, when they will provide community health education through skits, songs, and other forms of entertainment. I am looking forward to visiting these markets, not only to see MIHV’s work, but also to continue my hunt for some more beautiful khanga and kitenge fabrics!

Friday is the national holiday of Nane Nane (Eighth day of the Eighth month), or Peasants’ Day. Sarah and I will celebrate this long weekend riding a bus to the town of Moshi, about 5 hours away. Saturday morning we leave Moshi to begin our 7-day climb of Mt. Kilimanjaro!! This mountain is not only the tallest in Africa, but also one of the tallest in the world that can be climbed without requiring oxygen. Part of the reason for us spending a week doing the climb (some tours do it in 4-5 days) is to increase our odds of making it to the top, since altitude sickness is a big problem if you ascend to quickly. From what we have heard from prior climbers on the Machame route and with our guides, each day is different, with beautiful scenery and climatic zones, beginning with rainforest and ending at glacial snow. The major effort comes in the numerous hours (6-16!) of hiking each day, including going back down the mountain! While I have never attempted a climb like this before, I am a bit nervous, but also excited for the challenge and the opportunity to push myself physically. Stay tuned for what I’m sure will be incredible stories and photos!

Sangoma Drama Troupe of Karatu during rehearsal

Actress and her baby

Posted at 05:45 PM
Permalink | Comments (0)