Food Makes Me Happy

Mtoriro! I staple green here that Hasina grows in our back yard. She cooks it with onion, tomato and coconut milk....Delicious and Nutritious!

Whenever I’m feeling a little down and out, you know what I like to do? Talk about food….and eat if of course! So my apologies to those who are disinterested in dietary consumption, but food is where this blog post must start.

Seasonality has a whole new meaning for me after coming here. Here, you REALLY can’t get anything when it’s not in season, which adds a whole new exciting dynamic to the task of buying food. Word on the street is that mango season is a-comin’, but aside from the small green and very sour ones that Hasina uses for cooking fish, I still haven’t seen any. According to Shaaban there are at least 15 different varieties on the island, and man oh man I just can’t wait! I think late November and early December will really be their season.

Ok, you caught me, I didn't take this pic, but it's a great example of what jack fruit looks like inside.

Now jack fruit is popping up every now and then on roadside stands. These massively large and awkwardly shaped fruits are usually cut up and sold by the piece, and come to find out fenesi (jack fruit in Kiswahili) is Shaaban’s favorite. Because Hasina has a fenesi tree at her house, she’s shared a couple of pieces with us over the last couple of weeks and it is really amazing. Also, thanks to Shaaban, we learned that you can boil the large seeds, which are roundish and a little bit larger than a marble, and eat them. They have a meat similar to chestnuts and they are really, really tasty. Apparently little children LOVE them because they tend to make you fart a lot, and farting always makes for a good laugh.

Another fantastic thing that I’ve tried this days in juice made from tamarind and ginger. Aside from the fact that it is suppose to lower blood pressure, it’s freaking fantastic. It reminds me of my Kombucha drinking days, although the process of making it is very, very different.

But when things get really, really tough, I turn to dates. This little dried sugar-filled pockets of goodness are what keep me going. The last ones I bought are amazing, almost a caramel-like flavor. Although occasionally I have to shoo some little bugs out of my stash, apparently they like them just as much as I do, it’s well worth it.

Rooster among the banana trees. They definitely like crowing at ALL hours of the day and night.

Oh and I ever mentioned how ugly the chickens are here? Well, they are pretty darn ugly. Raising of chickens isn’t common at all here, and usually you just find them running around free. Often they are missing feathers and have 6-10 chicks running after them. Sorry for the vegetarians out there, but I have to say that the meat is really good though. It’s tough, probably due to their “free-range” lifestyles, but the flavor is really great. One good thing is that not a piece gets wasted, the head, free and all edible organs are consumed. Oh my goodness, speaking of free-range and chicken just walked into my office!

Ok, my urge to talk about food has past, and I thank you for your patience. As far as my work here, I have officially finished the observation time at the hospital. Which feels really great. Two full months of seeing the ins and out, the ups and downs, etc. Now I’m ready to write. I have to admit it’s a little difficult to know where to start, but I hope that what I present will start some discussion and be a good platform for this new management team that the hospital.

I also managed to visit the Pemba Island Museum this week, which is housed in an old fortress near the hospital. It’s simple, but full of information. It has one room about the archeological history of the island and the ancient communities that have been studied. There is a second room which talks about the maritime history and then a third room gives a time line of the post-revolutionary history, which began in 1964. The fortress was originally built by the Portuguese and then added onto during Arabian rule. Under this rule the fortress was actually used as a jail. Finally, the museum also has an exhibit of a “typical” Pemban home where common house hold tools and goods are on display.

random photo of millipedes that you find commonly here. Kinda creepy, but super cool!

Last week I finally began Kiswahili lessons with an older woman, Moza, who is also a primary school teacher. Although I had received many offers of free Kiswahili lessons in the past, they were usually by men who were looking for something in return, often marriage or sexual services, for there efforts. Although I am currently paying for the lessons, it is WELL worth it.

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Global Hand Washing Day in Kiuyu

Global Hand Washing Day (In Swahili)

On Saturday I had the opportunity to return to Kiuyu Village in Micheweni District to participate in the Global Hand Washing Day event that the Millennium Village Team was putting on in collaboration with local leaders.

I arrived in Kiuyu along with Ruwaila, Malim Omar and Ahazma (the MV team) at about 9:30am after stopping to pick up some soap for the event as well as some delicious savory fried dough balls that we ate along the way. Ahazma brought her whole family along too, including her two young boys, her nephew, her sister and her housekeeper….It was a full car.

Ruwaila had drawn up the poster for the event with basically depicts three characters in the form of drop of water, a bucket full of soapy water and a hand all linked together as if they were holding hands. The event was being held at the local secondary school, and after hanging the poster and getting all the children seated, we were ready to start.

Ruwaila Talking to the Students

The program began with a prayer, then an introduction by Ruwaila followed by a recitation by one of the boys talking about how important cleanliness is to the Islamic religion. Then, 5 boys came up from the audience to do a roll play emphasizing the importance of hand washing, especially after going to the bathroom and before eating. A couple other short speeches were given regarding (from what I understood from Ruwaila’s translations) the proper hand washing procedure, etc.

Boys Using Role Playing to Demonstrate Proper Hand Hygiene

A couple of really interesting facts that I found out through the discussion was that according to their religious beliefs, you’re not supposed to blow on food to cool it down because carbon dioxide can enter into the food and cause severe stomach infections…..this explains why when patients at the hospital eat their porridge in the morning to cool it down they pour it from one cup to another, back and forth, in order to bring down the temperature. Ruwaila also said that a long, long, long time ago, it was customary for an entire family to wash their hands in the same basin of water and then for the youngest member to drink the wash water. It was seen as some sort of fortifying medicine. It in some ways reminded me of the bleeding of patients in early western medicinal practices….a behaviour that probably caused the EXACT opposite of what it was intended to do.

On the way home, Aazma and Ruwaila spotted a banana salesman by the side of the road and asked the driver to pull over. Ahazma bought a gigantic bunch of plantains, which are usually cooked when ripe with coconut milk and cardamom. Ruwaila bought a gigantic bunch of small bananas which are just for eating and thanks to Ruwaila’s bargaining power we got some medium ripe ones (like the ones you find in the US) as a snack for the trip home. Man….I have to say these bananas taste NOTHING like those found in the US. Not only are the sweeter, but their flavor is also much more complex. Even the color of the fruit is diffrent. Instead of the white that we’re all used it, it’s a creamy yellow, almost custard color.

It was a great way to spend the morning and although I don’t know if I’ll make it back to Kiuyu during my time here in Pemba, I feel very fortunate to have had the opportunity to meet the community.

Everyone, I’d Like You to Meet Mariam

Mariam - the first birth I've ever seen!

I’ve been sitting here trying to figure out where to begin. A starting point for sharing my experiences of the week, but I can’t seem to find a good one. So I’ll start here: everyone, I’d like you to meet Mariam. Mariam was born on Tuesday, October 11th and she was the first live birth that I’ve ever seen. The mother, also named Mariam, was more than willing to let me take a picture of her newborn girl, all wrapped up in her colorful kanga beauty.

This week I was observing in the maternity ward, which includes the ward where all antenatal and postnatal patients are, as well as the birthing room, which consists of two rooms, one with two beds where mothers stay until they are ready to push and the other room with three birthing beds, which are often all full at once. I was brought to tears multiple times over the course of the week, sometimes out of the joy of seeing a new life enter into the world and sometimes out of sorrow and frustration, not all deliveries go well in the end.

Hospital Grounds

I never realized how romanticized pregnancy and birthing in the US is. From my cultural expectations, giving birth is suppose to be this painful but magical experience: the woman, with at least one family member by her side, screams and pushes until the baby pops out, then the doctor yells “It’s a boy (or girl)! and whisks it away to do preliminary health checks, and finally everyone is teary and congratulating the mom for all her hard work, etc, etc…..Here it’s a bit different. Sometimes you have one midwife attending three women that are delivering all at the same time and all in the same room. Let’s just say there is no time for individual attention. The women are strong, often silent and doing it all on their own. There is no one holding their hand, and just as the mothers are brave and courageous, these babies also seem to come into the world with that same bravery.

Pemba Scenary

I also learned some very practical skills this week, like how to check someone’s blood pressure and all about the three phases of labor. For being a female myself, I must confess that I was rather ignorant about the whole process before. In general, my work progresses and I plan to be done with my observational phase at the hospital in approximately two weeks…. I can’t believe I’ve been there for almost 2 months now.

It has been raining pretty consistently all week and as a result I’ve been making it to the hospital on foot because my bike without fenders mixed with a wet road leaves me incredibly dirty and wet by the time I arrive at my destination. While hitch hiking is fairly common on the island and I’ve been offered many rides in the past, my “don’t get in a car with strangers” mantra that I’ve repeated since I was small is too strong and I usually decline. This week, however, I must confess I threw that rule out the window.

One day when I was walking home under a heavy rain shower, Eddie, a tour guide for a local resort that I had met in town stopped and offered me a ride. I declined several times, but he insisted saying that my health was at stake, and so I hopped in. The craziest part was that he knew exactly where I lived…I guess that’s what happens when you live on a small island. On another day I manged to catch a ride home with Amur, a friend and neighbor, on his moped. In the nearly 3 years that I lived in Italy, I never managed to realize the dream of riding on the back of a Vespa, but just after two months in Pemba, my dream came true!

This weekend I plan to head back to Kiuyu again with the Millenium Village team as they  are putting on a program for International Hand Washing Day and I promised one of the elders of the village that I would come back to see them. Other than that, no plans for the weekend. I just want to relax, read and enjoy a good rain storm dryly from inside.

The Scent of Cloves

Mkoani Port, in the South

This week has been a little different than usual. I was fortunate enough to be able to go visit all the other hospitals on the Island in order to contextualize the work that I’m doing myself. The three major and two cottage hospitals have very little in common structurally as they were all build and remodeled at different times. One still uses a lot of the original infrastructure that was build in the 1920’s, so that was pretty cool to see. While there is little compare regarding the buildings, the challenges and problems that they face seem pretty consistent. All the touring left me rather exhausted, but it was a great opportunity to better understand the healthcare system of the island and how the hospital where I am everyday fits into it.

Baobab Tree - and this isn't even a big one!

Luckily to travel the Island I was accompanied by Nahya and one of the Foundation’s drivers, Abduli. Over two mornings we managed to cover the whole Island. First heading to the South to Mkoani and then the next day to the North to Wete and Micheweni. It’s clove harvesting season now and people dry the cloves that they collect by laying them out on mats near the roads. At almost every curve, the waft of clove scented air would enter the car. In theory this would be wonderful, but unfortunately due to the amount of curves and my tendency to get car sick in the back seat, I think I will forever associate the smell of cloves to a slight feeling a nausea.

Speaking of cloves, it’s interesting to know that cloves are one the the biggest money-makers for the Island and that the government is the sole buyer of the spice. As a result, clove smuggling is strictly forbidden. There are road blocks around the island where military personnel stop cars and do inspections to ensure that no cloves are being transported. They even have a special maritime squad that chases down boats that are trying to transport cloves to mainland.

Micheweni District - thatch roof houses are still pretty common across the island in the less urban areas

Another interesting, but much more unfortunate fact about cloves is that harvesting them is rather dangerous. The pickers climb the trees without ladders or any kind of safety equipment, and due to the structure of the tree, very tall with thin branches, accidents are rather common. At the hospital at least one or two individuals everyday are brought  in because they’ve fallen from a clove tree. Some are more fortunate than others, but it’s not uncommon for individuals to suffer spinal fractures and other injuries which leave them bed-ridden for months. For more severe patients, there is no neurosurgeon in Pemba, and so if a patient has the means, they must be transported to Unguja or Mainland for treatment.

Friday was also a great day because I got to take off my observation hat and actually get to work. The theater of the hospital was doing a complete reorganization in order to bring in the newly donated equipment and supplies that arrived from Italy. It felt great to use some elbow grease and help the team clean and organize. It’s refreshing to see an immediate result of your work, which I feel like I’ve been lacking lately.

Theater Team with 2 Visiting Italian Physicians

For the first time since my arrival we were without power for over 24 hours this week. The worse part was that it was just at our house. It seems that a coconut branch lying on our power line is making the power cut out sometimes. Living without power is kinda cool, but it definitely makes things a little more challenging. I honestly never thought a candle lite dinner could be so unromantic. I was actually expecting the power to go out more than it has been, so I feel pretty fortunate.

The good weather and gentle breeze are constant here. Even when it rains it’s pretty great. There has been a recent increase in mosquitoes, and I’ve got the bites to prove it, but nonetheless all is well. Weekend plans include reading, eating and a little work on the side…..I know, pretty exciting right? Word on the street is that mango season is just around the corner…..at least I have something to look forward to.

October Has Arrived

Pemba landscape coming home from work

For some reason since Chiara left, time feels like it is moving sooo slowly. It seems like the last days of September lasted for months. I’m not exactly sure why that is, but I think it has something to do with the fact that by mid-September I had convinced myself that the month was over…a rather stupid move on my part.

My daily routine remains pretty consistent: 6am wake-up, hospital by 7:30 am, PHL by 3pm, home by 6:30pm before it gets dark, shower, dinner, study/read and then bed at 9pm. I love my 9pm bedtime…and there is nobody here to make fun of me or try and convince me that something else would be WAY more fun. It’s a good thing that I’m getting more than 8 hours a night of sleep too, it really helps me get through the day.

Whether or not I sleep well is determined by the multiple muezzin in my neighborhood who sing at 3:30am and then again at 4:30….and every now and then at 5:00. If I don’t hear them at all, I know I’ve slept soundly; however, it isn’t uncommon for me to wake up at 3:30 and not be able to fall back asleep. It wouldn’t be so bad, except the muezzin that is right across the street is about a tone-def as my father….and if anyone has heard my father sing, they can understand how unlucky I am (just kidding Dad, I love your voice!).

Main road through Pemba - one of the three hills I have to climb on my bike to make it home

Two of my favorite interactions of the week include being called a “pagan” by one of the staff when I told them that I didn’t pray. Another gentleman asked if I might know a “white woman” that would be interested in marrying him since I had kindly declined his proposal. He then explained that marrying a woman of light skin tone is a kind of status symbol. I told him that unfortunately I did not, but that I would keep a look out for him. Although the marriage proposals are pretty consistent here in Pemba, both inside and outside the work context, luckily I carry a picture of Luke and me always, so even when they don’t believe that I have a boyfriend, I have physical proof, which usually convinces them.

Gift from Nahya. She said it makes me look "Very Beautiful"

I also received a very lovely gift this week (see picture). Nayha gave it to me because she said it would be much easier to use than wrapping my head every morning. I told her that I was very grateful for the gift and that I would definitely try to wear it. I did warn her though that since it’s black and polyester, it might be too hot for me, especially while riding my bike. Once I told her that if I get too hot, I start feeling sick, she was very understanding. I told her that I would definitely keep it for special occasions.

I spent a lot of time in the pharmacy this week. The staff was very patient with my incessant questioning and the huge language barrier since only one can speak relatively good English. Although at first I didn’t understand anything, everyday I was piecing together the puzzle as to how the pharmacy functions. In theory the system works great, but unfortunately in reality, the efficiency of the system has been greatly limited. I think the pharmacy is a really great example of how lack of management at all levels (ministerial, hospital and individual) creates gaps and limitation that in the end, impact the care and lives of patients the most.

In both the United States and Italy, it’s almost as if pharmacies grow on trees much like papayas do here. They are everywhere and each one has one, two, three or even more fully trained pharmacists. Here unfortunately, human resources are a bit more limited and although the hospital has several very competent pharmaceutical technicians with 30 or more years of experience, there is no pharmacist.

Road to my house

My weekend has been great so far. A lot of reading and soccer watching. In the Manchester United vs. Norwich game last night there was an epic triple header goal. It really made the entire match! Riccardo and I went to the market yesterday and for the first time I bought fish. The fisherman removed the scales and guts right in front of us, wrapped it in newspaper and for 4,000 shillings (about $3) we got a whole fish, head and all. I’m looking forward to cooking it tonight, although I wish my Nana was here to help us eat the head, I’m not sure if either of us will be able manage that.

Hokey Pokey Shower

Flower outside my house: Spring is here!

This morning I woke up, wrapped a blue, white and red kanga around my waste, slipped on a t-shirt and headed out the door with my keys, 600 shillings and a paper bag. I walked along the dirt road for about 1 minute until I came to the main paved street and took a right. After crossing and walking another 30 seconds I arrived at the bakery….I had a craving for fresh baked bread and butter for breakfast. They only make one item at this bakery, so choosing is never a problem. They produce personal sized loaves similar to french bread in the US. My 600 shillings was just enough for 3 of them….I always go with exact change because it is rare that the baker has the right amount to give me back. I headed home, made myself some tea and pulled the butter from the fridge to spread on my still warm mini-loaf.

Although dairy products aren’t used very much here, there is a small and growing market for

Bananas out my window

cow’s milk, yogurt and butter (probably mostly for wazungu like me who love their saturated fat). Shaaban told Chiara and I where to find it in Chake Market and we’ve been spreading it on just about everything ever since. It’s relatively expensive, 5000 shillings (about $3.50), for a half kilo of salted, creamy goodness, but it’s well worth it. It actually took Chiara and me about 3 tries to find the shop because it’s actually a cleaning supply store with a small hidden freezer inside where they keep the diary goods that the family produces on the side, but in the end we managed.

My search for some bread and butter comfort this morning comes after another week full of learning and topped with challenging moments. The biggest news of the week is that Chiara left. I am so happy that she made it back to Italy safe after a 4-month adventure here, but if I can be selfish for just one moment, I wish she could have stayed.

When I left Seattle, I promised myself that I wouldn’t live with multiple men ever again. Don’t get me wrong, living with all male roommates (up to 7 at one time) for many years was a great experience, and I loved every minute of it (almost), but I decided that in the future I would only live with one male, my partner, and that would be it. Life once again has tapped me on the shoulder to remind me “never say never.” Although now in Pemba I have two great male roommates, Shaaban and Riccardo, who is here doing researcher for his thesis, I am already missing the company and understanding of Chiara. Honestly though, I consider myself very lucky to have been able to pass these last two months with her.

Equipment from Cles

Also yesterday there was a celebration for the arrival of a shipment of equipment and supplies from the Municipality of Cles, Trento, Italy through the Cles – Chake Sistership program, which is facilitated through the Ivo de Carneri Foundation. A large part of the shipment was hospital equipment for Chake Hospital.

Dr. Sauda and Shaaban at the ceremony

When I got home, I chatted with Shaaban a bit and we discussed how good administration and management are critical in ensuring the efficient use of the newly arrived equipment and supplies. For example, you can have as many fully-functioning ultrasound machines as you like, but if you don’t have the gel needed to conduct the examination due to delays in the requisition process, they will be of no use. Shaaban is always great at listening and responding with a logical, experienced, and calm perceptive.

After our chat, it was time to shower up and then eat some dinner. Normally with the cold shower I approach it kind of like the hokey pokey….I put my left foot in, I pull my left foot out, I put my left foot in, etc. Eventually piece by piece I manage to get fully under the shower. But not yesterday…..I stepped in all at once and it felt great! I think I’ve gotten use to it and it was a great way to rinse away my grumpy mood.

Riccardo and I sat down to a dinner and I confessed to him that I could have really used an alcoholic beverage at the moment, but I contented myself with a dessert of dried dates and papaya. I don’t consider myself a big drinker, but even as I drifted to sleep last night I thought of me, Luke and a drink at Sun Liquor in Capitol Hill. There really is no substitute for a well made cocktail.

Dreams Can Say a Lot

Kangas out to dry

I don’t even know how many Saturdays I have been in Pemba now….maybe 4 or 5? Not quiet sure. Perhaps that is a good sign. A sign that I’m not counting the days and that time is flowing and passing with speed.

This week has gone relatively well. Speaking with the responsible for the female general ward of the Hospital, after the boat accident they saw an increase of mentally distressed patients, miscarriages and hypertension cases, but by the end of the week things seem to have returned to “normal.”

I finalized my questionnaires this week that I plan to use with all levels of personnel of the facility, and so far the interviews have been going well and people have been more than willing to take the time and answer my questions. I do have moments of desperation though, instances where I feel like a fat-ol’ fish out of water and that I should just step away and let go of my work. The language barrier continues to greatly impact my experience and at times the cultural differences between what I know and where I am seem almost too great to overcome.

Old PT building

Anytime I get frustrated or feel a bit lost at the Hospital the coping mechanisms that I have found are two: finding open water and buying food. One strategy that I’ve found is to go down to the old abandoned physiotherapy building (abandoned due to significant structural cracks) which looks out onto the channel between Pemba and Mainland. There is something really peaceful about the building now, with its roof stolen by thieves (because it was made of metal) and each room filled with branches and leaves and the occasional plant sprouting from cracks in the concrete walls. The second

View of channel from old PT building

option that I have found is to take a walk into the chaotic Chake Chake Market and buy food. This week I picked up dried dates, sweet potatoes, bufalo (a type of bread) and bilungi (a grapefruit-like citrus). These activities give me a break, a distraction from my sense of helplessness and allow me to move forward. I must admit that buying heavy things such as bilungi and sweet potatoes makes biking up the hill back home a little more challenging, but it is well worth it.

I think my dreams have been speaking to me. Last night of dreamed of steak, lots and lots of steak……perhaps it was influenced by some wonderful wedding dinner photos I saw recently (congrats Mike and Samantha!), but I think it might also have something to do with the fact that protein in my diet is present, but not nearly in the quantities that I am used to. I’m definitely not starving, but just adjusting to the environment. I also dreamed last night that it was Friday, and I was sooo ready for the weekend, but then someone informed me that it was actually only Tuesday……and I was so let down. I recognize that I am homesick and am looking forward to completing my time here….but perhaps I have a slight fear that time is actually moving backwards.

Old PT building

I am grateful for this opportunity, but I cannot deny my longing for the Pacific Northwest and all the lovely people it holds. Everyday I learn something new and every individual that I speak with gives me a different perspective and this encourages me to continue moving forward.

This weekend is quiet, no plans, just the wind blowing through the banana trees and into our house through our metal-mesh windows. The peace and quiet is something to be appreciated. I know I will miss it when it’s gone. Just like I know I will miss my breakfasts of tree-ripened bananas and dates with tea.