Notes from the Field 2008

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)

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)

Monday was the official commemoration of the first year of MIHV’s Child Survival Project in Karatu. One year ago, a large celebration took place at MIHV’s Karatu office as the project was launched. There is even an official plaque on the outside of the building! The celebration included homemade cake that was thoroughly enjoyed by MIHV staff, as well as an in-depth discussion about healthcare in Tazania. Sarah and I spent the day on the long 13.5 hour bus ride back from Dar, so missed the festivities and discussion…but Jolene was kind enough to fill us in and even saved us some cake!

We spent today (Tuesday) doing another half-day training on Excel basics for staff from another Karatu non-profit organization, CPAR, based out of Canada. Six of their staff and one of MIHV’s staff who was unable to attend our prior training were in attendance. I’m learning how important capacity building work such as this is, especially since so few people have ever had experience/access to working with software such as Excel.

Tomorrow we head out to the field to Mongola, a village about 2.5 hours away from Karatu, where MIHV is doing work. Sarah and I will be traveling with Veronica, Eveline, Joyce, and Honest, all MIHV staff as we spend the next 3 days in this area. I am looking forward to visiting other field sites, especially those that so remotely located, and meeting more traditional birth attendants. I also am anticipating an exciting drive in the car, discussing the MAISHA project as well as listening to KISS FM, a fantastic radio station.

Today Sarah and I started getting serious about our training for climbing Mt. Kilmanjaro. We went for a run today after work, and I ran for over 30 minutes, which is quite impressive as I’m not really a runner and we are still somewhat adjusting to the altitude. We begin our climb in less than 2 weeks!

Posted at 05:35 PM | Permalink | Comments (0)

22 July 2008

As I mentioned in an earlier blog entry, Survive and Thrive Groups are a unique MIHV public health intervention where groups of women meet regularly for support and educational training sessions. Each Survive & Thrive Group is made up of between 12-20 women who are at the highest risk for poor health outcomes including being single parents, infected with HIV/AIDS, etc. Educational topics include breastfeeding, child spacing, antenatal care, and pre-natal care. Thus far, I have had the opportunity to visit 3 different villages where Survive & Thrive Groups have been started and observe a training session. What I find fascinating is the similarities and differences between the groups from different areas. Overall, most of the women are younger than me, live in rural areas, are shy at first, and are incredibly smart, asking great questions and remembering information learned from one monthly session to another.

Photo of a Survive & Thrive Group Training

Survive & Thrive Groups also have an income generation component, where the women are trained in using a sewing machine and are creating items such as ladies tops and bags to be sold at area gift shops/tourist ‘curio’ shops. A tailor visits each village with MIHV staff to train the women in basic sewing skills. Upfront costs of the fabric, khangas and kitenges, and the sewing machines are built into the amount charged for each item, and so women who participate receive a portion of income from each item sold. I spent part of the week assisting MIHV staff with this project, editing invoices, creating tags that are attached to the items with a ribbon explaining the significance of the items, and trying on and modeling the shirts. :D

Another project Sarah and I will be assisting with during our time in Karatu is filming and editing a health-education video. Merci, one of MIHV’s project staff, has been working with a local drama group on developing short dramas about a variety of health topics. Compelling story lines are key to the success of these dramas, so the scripts often include significant character development and complex topics. The drama group has been working with MIHV staff in developing the scripts, which focus on a number of topics including child spacing, malaria, and control of diarrheal disease. Over the coming weeks, we will be filming the drama troupe and then editing the footage into a 15-20 minute film. After completion, this video will be widely distributed throughout the district as well as shown publicly in a number of venues including on the Dar Express, a bus line that connects much of Tanzania.

Posted at 11:39 AM | Permalink | Comments (0)

One of the primary project objectives is to decrease the number of children with diarrheal diseases in Karatu district. In a 2007 survey conducted by MIHV, a total of almost 30% of children were reported to have had diarrhea within the past two weeks. Obviously, both prevention and treatment are important for control of diarrheal diseases (CDD).

Appropriate hand washing practices are a critical preventative measure and the MIHV Child Survival project focuses on helping caregivers recognize the link between household hygiene practices and diarrheal diseases. The three main messages being used are:

1. Wash hands with soap at appropriate place/times.
2. Get appropriate treatment and maintain proper nutrition.
3. Use clean water and safe storage.

However, there are many issues surrounding knowledge and practice of hand washing. Education on proper hand washing technique is important, including length of washing, using soap and a clean water source, and when it is necessary to hand wash (before food preparation, before feeding children, after defecation). Additionally, issues of access to soap and/or clean water are also major barriers to proper hand washing, regardless of the amount of education or intention one has to wash their hands.

One of the projects we will be working on during our time here is doing some research into using solar treatment for water purification and decontamination. Basically, the idea is to reuse existing 5L water bottles (which are plentiful throughout Tanzania as there is no recycling) and make them into containers that can be clean water sources and handwashing stations. To do this, a reused bottle is filled with water, the container capped, and then the filled bottle is set outside in the sun for 5-6 hours. The solar rays provide radiation that raises water temperature, destroying bacteria and viruses that may be in the water.

This method can be used not only for treatment of contaminated water, but also for the transportation and final consumption, since permanent use of the plastic bottles avoids the risk of recontamination when transferring water from one container to another. Solar disinfection of water has been used successfully in countries including Mexico, Columbia, and Thailand.

Our initial work on this project has begun by sending letters to the five major bottlers of water in Tanzania inquiring about the type of plastic used in their production of plastic bottles. We want to be sure before embarking on a pilot of this project in Karatu, that the plastic used in the bottles do not have any carcinogens that may be a problem when the plastic is heated by the sun. We have also researched similar projects done elsewhere in the world, and read a variety of articles on low-cost technologies for water purification.

I am very excited by the prospect of the success of this project, particularly because of the feasibility of simple technology that can create clean water sources for so many. I am hopeful that we will get timely responses from the water companies so we can proceed in developing this project through creation of handwashing stations and also creating some educational materials for the Karatu community so they can begin utilizing this technology and having access to clean water.

Posted at 09:50 AM | Permalink | Comments (0)

1 – Number of elephants it takes to scare Chloe to tears
2 – Khangas you SHOULD get when you buy cloth, even if you are a tourist…
23 – Baboons crossing the only paved road at one time in Northern Tanzania
3 – Types of bananas so far discovered
99 – Bricks for Healthy Mother Healthy Babies Centers that still need to be sold
1.5 – Hours to heat up water for a tepid 10 minute shower at our house
8 – Length (in feet) of the python road kill
5 – Years MIHV’s project will work in Karatu district on child survival
13,000 – Shillings we were quoted to buy a 4-meter piece of cloth for curtains
4,000 – Shillings it cost Tina, a MIHV staff, to buy the exact same piece of cloth
1 – One too many squat toilets
6 – Times the gecko has been in our bathroom
6000 – Approximate distance (in feet) above sea level of Karatu town
5 – Minutes in length of the handwashing video we are creating with MIHV
40 – Orphans at Shalom Orphanage who could have infected us with Mumps
4 – LOST episodes watched without getting hooked
14 – Large holes in the bed net covered with duct tape
3 – Women who have come to our yard and sold us woven grass baskets
8 – Number of women we still want to buy baskets from
15,000 – Ants marching in our kitchen from the door to the garbage can
6 – Loaves of banana bread we baked in one day
7 – Days it takes to climb Mt. Kilimanjaro
4 – Times we lost power in one day
12 –Temple Medical Students we have spent time with
10,000 – Points to win Farkel (the best game ever!)
65 – Malaria meds to take during our trip
2000 – Price in Shillings for a Coke and a plate of rice, beans, spinach, and beef
Infinity – Times each day a child asks us for a pen, money or candy
34 – Tanzanians (plus Lizz & Sarah) who fit into a Dalla Dalla to make it ‘full’
99,999 – Thanks to ‘Mama Minnesota’ for her gracious hosting and love

________________________________
2 – Weeks we have spent in Tanzania!

Posted at 02:37 PM | Permalink | Comments (1)

Part of MIHV’s Tanzania Child Survival Project is the development of Healthy Mothers, Healthy Babies centers where pregnant women and new mothers can go for confidential counseling and education on pregnancy, reproductive health, and raising healthy children. Each center will include a resource library, a garden cultivated to teach women about nutrition, and learning areas for children.

The Healthy Mothers, Healthy Babies Center in Karatu is about to open! Sarah and I spent Tuesday hanging curtains and the rest of this week the floors are getting finished. We also were able to bring some new toys from Minnesota that will be a fun addition for the children who come to the center.

We wanted to give you the opportunity to help support this important community project before the grand opening in Summer 2008 while we are here. With a donation of $50, your name or the name of your choice will be placed on a brick used to build a patio and walkway outside the Healthy Mothers, Healthy Babies Center in Karatu. Children can learn and play while their mothers use the center’s services. All donations will directly support projects in the Tanzanian communities served by MIHV. We are in need of 100 more bricks to complete the patio and help fund the center, so you don’t want to miss out!

To buy a brick and support this important work, visit MIHV�s website at www.mihv.org and donate securely through Network for Good. With your online donation, please specify “Brick project� in the “Designation� field. In the “Dedication or Gift� field, enter the name you would like to appear on your brick.

You may also mail your donation, along with the attached form Download file

to:

Minnesota International Health Volunteers
122 West Franklin Avenue, Suite 510
Minneapolis, MN 55404-2480 U.S.A.

Ansante Sana! (Thank you!)

Posted at 12:35 PM | Permalink | Comments (1)

10 July 2008

The first major monitoring and evaluation project that we worked on this week was revising and assembling a pregnancy monitoring booklet to be used at the community level by Village Health Committees and Traditional Birth Attendants to track prenatal care and pregnancy outcomes of women. In collaboration with district health officials and community leaders, MIHV staff created this tool that will be used for data gathering, monitoring and evaluation. In the weeks before we arrived in Karatu, a draft of the worksheet was pilot tested. This week, we made revisions, designed a cover page, and assembled eight booklets to be used in different communities.

These booklets are important, as they will function as the primary record-keeping document about pregnancy and childbirth outcomes in each community. At the present, there are very limited records of this kind being kept, especially for the majority of women who give birth at home instead of at a hospital or clinic. Thus, the information collected with this tool will be useful, not only to monitor and evaluate MIHV’s Child Survivial Project, but also for district health officials in their tracking and reporting.

One of MIHV’s unique public health interventions in Tanzania is the Survive & Thrive Group, groups of women who live in the same area who meet regularly for support and educational training sessions. Each Survive & Thrive Group is made up of 20 or so women who are at the highest risk for poor health outcomes before and after pregnancy, including women who are single parents, infected with HIV/AIDS, or who have other health issues. Educational topics include breastfeeding, child spacing, antenatal care, and pre-natal care. Survive & Thrive Groups have an income generation component, where the women will be sewing items such as clothing and purses to be sold at area gift shops.
MIHV staff lead group training sessions with support in each community provided by Traditional Birth Attendants (TBAs).

Today, we were able to see the pregnancy monitoring booklets in action when we visited the village of Rhotia, a smaller area outside of Karatu town. We observed a one-hour Survive & Thrive Group educational session on breastfeeding (completely in Swahili), and the subsequent training of four of the TBAs who serve the women of this area. The pregnancy monitoring booklets were introduced to the TBAs and were very well received. The TBAs commented on fact that this was a much simpler tool to record information compared to the five pages that they had previously been asked to complete. They also appreciated the combination of text and images used for each indicator. I am hoping to return to Rhotia next month with MIHV staff to observe another educational session and also to meet again with the TBAs about their first month using the new pregnancy-monitoring booklet.

Sarah and I with the complete pregnancy monitoring booklets

Veronica and Eveline (MIHV Staff) training the TBAs.

Posted at 09:16 AM | Permalink | Comments (0)

My first week on the MIHV project was spent becoming more familiar with the DIP or Detailed Implementation Plan. This long document is the complete work plan for all activities over five years. Included are a logic model/framework, description of activities, and timeline for the project. Specific interventions were organized using the social ecological model as a behavior change strategy, using levels of individual, family, and community, which mutually reinforce approaches used to promote and sustain changes in health behavior. Kudos to CHE first-year coursework for exposing me to these things so I knew what I was looking at!

Monday was also a national holiday, Saba Saba (Seven Seven) for the seventh day of the seventh month (July). To celebrate, MIHV like most organizations and offices was closed for the day. Coincidently, the seventh of every month is also market day in Karatu, where hundreds of vendors set up shop, selling everything from cloth to chickens, and flip flops to Fanta soda. We spent a few hours in the afternoon visiting the market and doing some shopping.

This past week, in addition to reading the DIP, I have been exploring Karatu town. I have visited Karatu Lutheran Hospital, a local orphanage, and the post-office, as well as numerous restaurants, markets, and shops. I am looking forward to the coming week, as I can begin to get more involved in project activities now that I have become familiar with the area, the people, and how the project benefits the community.

Posted at 11:21 AM | Permalink | Comments (0)

Habari Azabuhi! (Good morning!)

It is my third day in Tanzania and already feels as though I am settling in. Let me introduce you to the area and the actors who are part of my journey so far.

Karatu is a town located in the Karatu district located in the Arusha region of northern Tanzania. You may try to locate this on a map, but typically the closest thing you can find is the Ngorongoro Crater, which is about a 30-minute drive from the town of Karatu. The Karatu district is primarily rural and has about 41,300 households in 45 villages. Guidebooks describe the town of Karatu as “shabby� and “dusty� of which only the latter is true. A main paved road runs through the center of Karatu lined by numerous shops, restaurants and motels. All other roads and paths are unpaved, and the dry, red, iron-filled soil gets on everyone and everything. Otherwise, the area is beautiful, with many shades of green as plants and vegetation are everywhere. Sunflowers, coffee, and corn are planted in many fields and there are incredible views of the mountains in every direction. Karatu has a market located about 5 minutes down hill from the house I’m staying, which has a delicious assortment of fresh fruit, vegetables, and grains. Yesterday we did some shopping, and for less than $2 USD, bought 3 potatoes, 3 tomatoes, 3 green bell peppers, 2 mangos, 3 carrots, 4 onions, and garlic.

By far, my favorite thing about Karatu (and Tanzania more generally) is the people; everyone had been so welcoming and friendly. Kiswahili is the primary language spoken by everyone, although many speak some English. As you walk around, shouts of Jambo or hello, come from adults and children.

There are many other people who have already made this a great trip:

• Sarah Sevcik, a fellow U of MN SPH student who is also in Karatu doing her field experience with MIHV, who is a great housemate and travel buddy.
• Jolene Mullins, MIHV’s Country Director who runs the project, generously offers her home, food, advice, and so much more to volunteers and guests.
• MIHV staff, which welcomed us onto the project and share cultural tips and Swahili language practice.
• Temple University Medical Students, 12 of who are in Karatu for a month with MIHV and at the hospital, who share meals and weekend trips with us.

This weekend I look forward to a trip visiting Tarengarie Wildlife Park and camping at Lake Manyara National Park. Monday is a Tanzanian holiday, Saba Saba (or Seven Seven) for 7th day of the 7th month (July).

Happy (American) Independence Day!

Posted at 10:10 AM | Permalink | Comments (1)

Jambo! My name is Lizz Hutchinson. I am a MPH candidate in Community Health Education and will be spending the next eight weeks or so in Tanzania, helping with a child survival project in the rural town of Karatu.

The non-profit organization that runs this project is Minnesota International Health Volunteers (MIHV), headquartered in Minneapolis has international programs currently in East Africa in Tanzania and Uganda. You can learn more general information about the organization and their work on their website (www.mihv.org). I also have received support for this experience from the Walter H. Judd Fellowship at the University of Minnesota.

I am really excited to begin work on this program, not only because of my connection to MIHV (full disclosure: I worked for the organization for 2.5 years), but also because the focus of this program is to improve the health of children under five and child-bearing women, on topics such as maternal newborn care, family planning, malaria, diarrheal diseases, and acute respiratory infections. You may be surprised to learn that more than half of Tanzania’s population is children! Sadly, of every 1,000 children born, 118 die before they reach the age of five and more mothers’ die of pregnancy-related causes in Tanzania than in the vast majority of other countries in the world. For the sake of comparison, the rate in the United States is 8 children per 1,000.

Despite these grim realities, there are programs such as MIHV Child Survival Project, which are using innovative, community-based strategies to improve the health and overall quality of life of individuals and communities.

I begin my journey in just a few days, headed from the Twin Cities via Amsterdam to Kilimanjaro, Tanzania. Please check back regularly for updates on my journey and experiences in Karatu.

Posted at 05:18 AM | Permalink | Comments (3)