Saturday, August 7, 2010

sorrow is universal

day 3 with the maasai

here’s a funny maasai story for you (ironic way to start a blog with such a contrasting title, I know). in their culture they are very decorated people. you can usually recognize maasai, even if they’re dressed normally, because they have gauged ear lobes and big hoes in the helix and concha of the ear, and they hang elaborately beaded earrings in them. it is huge jewelry and looks almost painful they’re so heavy, dangling from ear to ear. not to mention the beaded jewelry around their wrists, ankles, necks and waist, even as children. they are so decorated and they never take it off, not even to sleep! can you say uncomfortable? well I was standing with a group of the women and children in the cow boma one evening, and we have a serious language barrier because none of them speak even a little english, but I talk to them nonetheless, and they talk back to me in maasai, and no one really knows what’s going on, but we hang out just the same. well they were looking at all of my earrings, and one of the little girls was counting them, and when she finished with what is ‘eight’ in maasai I said, ‘wait, one more!’ and quickly lifted my shirt so that they got a brief glimps of my simple belly button piercing. you would have thought I showed them that I have no belly button at all. the entire group gasped and covered their mouths and just about fell over with shock. I was tremendously entertained. these people, so weighed down with huge and intricately made jewelry, were absolutely appalled that I had a tiny piercing in my belly button. just another cultural difference… we’re all human beings, but at the same time, so incredibly different. I find it very fascinating.

our third day with the maasai I was up before the sun to the sound of the rooster crowing. I left amy asleep in the room and ventured out on own, my headlamp in hand but off so as to draw less attention to myself. it’s amazing how comfortable I feel walking around alone here. I thought kurt and dr.lace were already headed toward the boma to help with milking, so I went off after them. the shadows of the livestock against the dim morning sky played games with my eyes and I thought they were people at first, or more like ghosts, until I got close enough to make out the distinctive shape and color of donkeys, grazing quietly on this cool morning. I passed between them and they ignored me. I looked for the familiar huts, ones I recognized from walking around the days prior, I had an idea of where I wanted to go, though I wasn’t sure at which boma I find them. as I approached, I made out the giant silhouette of dr.lace, followed closely by the much shorter kurt. the morning was starting to get noisier as the animals got lively, but the sun had not yet risen and it was still quite dark. dr. lace and kurt were walking away from the boma and I cut across the rocks and made to intercept them. as I walked I started to notice a high pitched wailing noise, louder than the animals stirring all around me. I thought at first it might be some morning ritual dance with singing or chanting, but with each step it became louder and soon I was aware that it was a very sad noise. I strained my ears… crying? yes, definitely, that is the sound of agony, despair, grief. I came around the corner of a hut where kurt and dr. lace had stopped. there were several women up against the mud siding, they were wailing their high pitched cry and the children around them looked distraught, unsure of the situation. it was clear that something bad had happened, and soon we were informed that one of their people had died in the night.

the men approached the mourning women and started yelling at them and beating them with their sticks. the women dispersed and we were led by one of the men to a small hut nearby. it was still dark but I could make out dr. lace’s plaid pajama bottoms that fell like high-waters well above his teva sandals. he went in the hut to check the body, we waited outside. when he confirmed the death we headed back to the house to get gladness, we needed a translator. as the sun came up we gathered with gladness and the men around that same hut and deciphered the story. apparently he was a young man, early twenties, who suffered from epilepsy. it appeared he had a seizure in the night and was discovered in the early morning, stiff and cold. they think maybe the noise from the campaign, the motorbikes and crowds of people, had set off an episode. there was some confusion about weather his wife had been with him, and there was talk of maybe another man in the hut as well, but no one wanted to disclose the exact circumstances around the death and who found the body. the maasai people do not like dead bodies. usually, when a person dies, they take the body out into the bush and leave it. if you are eaten by the animals within three days you were a good person, if you are not eaten, you were a bad person. that’s pretty much the extent of it. better hope that the day you die the animals are hungry, right?

after dealing with all of that in the early morning we went back for breakfast then headed to the clinic as usual. there were fewer patients than the day before because everyone was mourning. the village sort of shut down because of the death. we still saw many of the same cases: symptoms from the smoky huts and malnourished children. we ran out of the vitamin drink as well as almost used all of the mebendazole. still the mandatory tea break, and when it got slow in the afternoon we stepped outside to play with the children. we had nothing to give them except masks, which we joked they could seriously use when they’re in the huts. we also blew up our purple gloves and gave them out as balloons. they were a hit! and there was a paper airplane making competition… but despite standing out front of the clinic as a mzungu beacon to draw attention to the clinic, by the afternoon our patients were all on their way to the funeral, so we ended early and went to change.

because of this tragic death we had the opportunity to witness what few wzungus have ever gotten to see. we were definitely the first white people to get to attend a funeral in this particular village, and it was a privilege to see the ritual. here’s how it went… paulo was his name, and his mother, mama paulo, was out of the village, so while they sent someone to track her down, the men made the decision to do the westernized-type funeral gladness is trying to bring to the village for sanitation reasons (it’s not good to have dead bodies littered around the outskirts of the village). they ordered a coffin, which arrived later that day, a beautiful deep colored wooden coffin decorated with, oddly enough, pink and purple ribbon. ok… dr. lace, gladness, and a few non-maasai had agreed to clean the body and prepare it. they washed him and dressed him in a mzungu shirt he had been gifted a few days prior that he had been very proud to own, and his shuka (maasai blanket) around his legs. when the coffin arrived they lifted him out of the hut and placed him inside while the women sang mournful songs and everyone gathered around to pay their respects. the men stand apart, observing. the genders stay relatively separate throughout the entire procession.

we paraded down to the burial site. a small cemetery, maybe only half a dozen graves from what I could tell (this idea of burial is very new to the lengasti), all surrounded by rocks and covered in the thorny bushes to prevent animals from digging up the bodies. the coffin was brought down on a truck and lowered into the pre-dug hole. more songs were bellowed out by the women mostly, as the men walked away and returned with rocks and thorny branches they had collected to place around the grave. I had another one of those moments, I am standing there with two of the women who work in gladness’ kitchen (the rest of the mzungus were off near dr.lace), I am very hot in the afternoon sun and both the flies and dust are bothering me tremendously but im trying not to let on that they annoy me. I am wrapped modestly in a neutral green scarf, around my head and shoulders, with a skirt down to my ankles, trying to blend in, though the sunglasses give me away. the voices of the women are beautiful in an eerie, sorrowful kind of way. I consider where we are standing, in the middle of the bush, so far from any city, unfathomably far from home, with people who do not speak the same language, who live lives so different than my own, and yet we’re all mourning a death together. how did I get here?

we walk back to the main boma where paulo had lived. the men and women segregate (in this case the reason is that the men will be served better food – more meat – than the women and children). all of us head to where the women and children have gathered, even dr. lace and kurt. they are gathered in the shade of the huts, sitting low around the edges and leaning against the dried dung. we stand in the opening between several huts and listen to the task gladness is giving us. thu and I are to wash the women’s hands, amy and kurt will deliver the plates if pilau (beef rice). we were happy to help. gladness gives me a cup. I scoop water from a bucket. it is not clean, but relative to their hands it will help. I walk from woman to woman pouring a thin stream over both hands or often just the right as they rub their fingers, rinsing off the superficial dirt but doing nothing for the black stained nails and dirt deep in the cracks of their weathered hands. I pour until they signal for me to stop, them move to the next woman. on and on, cup after cup, until the bucket is almost empty. once all of the women have washed, I moved to the children. they swarm the stream of water spilling from the cup like it’s candy, I move the cup higher to escape their eager fingers. their outstretched hands dirty the water so that the littlest children are washing in water muddied and brown from the hands above. it’s quite the sight, very national geographic-esque :) and I couldn’t help but laugh… children around the world are so similar.

finally we are done with our task and it is time to eat. we wash the same way, and amy brings over the plate of rice. we stand around it staring for a moment, still too full from lunch to even think about pulling more food in our swollen bellies. the children are nearby being served a small portion of rice. I ask gladness’ permission, then kurt and I begin creating small rice balls from the plate of food given to us. I make eye contact with one of the children and extend my hand, filled with the pilau. she walks over and takes it. another child sees and comes over the get a handful from kurt. the rice is steaming and keeps burning our hands, but word is spreading fast and we cannot make the rice balls quick enough to keep up with the outstretched hands. fistful after fistful of pilau is given out, we’re trying to make sure every child gets some but some keep coming back for seconds and thirds. they’ve mastered their method of obtaining the most rice. as soon as you place the pilau in one outstretched hand it goes straight to the face and the other reaches out simultaneously in hopes of getting more. it was cracking me up. if they’re lucky enough to get another handful, that one starts stuffing their mouths while the first hand, now licked clean, comes forward seeking more. survival of the fittest, these kids are always hungry, they’ve maximize their food obtaining techniques. once the rice was gone and the children seemed adequately filled we headed back to gladness’.

gladness has started a women’s group in lengasti. she brings in supplies and teaches them how to make bracelets, necklaces, baskets and more. they are then able to sell these goods and make a profit so that they do not have to rely only on the men for income. it is very empowering to teach women such skills, and helps them earn money of their own. that empowerment can ultimately lead to a lower fertility rate and allow the women to take better care of their children. to say the least, the effects are widespread, and we were more than happy to support these women. no bargaining went on, we simply paid the asking price and were happy to do so. I got the coolest maasai necklace! not exactly something ill be wearing around town, but it will make a wonderful wall decoration. quite elaborate and interesting. or who knows, maybe ill be starting a new fashion trend in the states :)

Thursday, August 5, 2010

maasai mountain

so much writing, I know, it’s overwhelming! pole sana. but there’s a lot to document. if you want my favorite story of this entry just skip to paragraphs 4 and 5.

we worked for a few hours at the clinic and then gladness insisted we take a tea break, though no one was ready to stop. we chugged cups of tea and stuffed some roasted peanuts in our mouths to appease her, then convinced her to continue letting patients in. a few hours later and she insisted we head back for lunch. we were still full from breakfast, pushed beyond comfortable by the tea break, and in no way wanting lunch, but we had it just the same… ugali and spaghetti, the veggie curry and beans and, gasp! an american salad that gladness had learned to make on her visit to the u.s. and prepared using veggies from her garden. I have never been so full! pain, lots of pain. but despite the discomfort the food truly was incredible and greatly appreciated the effort the women put into making our meals.

next it was time to learn how to make chipati. here’s how it goes. you take the chipati flour which I think might just be normal flour. you add salt and you add water and kneed the dough until it is a nice consistency like for bread. you oil it a little so it doesn’t stick to the sides, then take pieces of it and ball it up into neat, fist-sized dough balls. next you roll out the dough balls and spread oil on top (when you hear how much oil it takes to make chipati you’ll understand why they taste so good :) then you cut a line from the middle to the edge and roll the circle into a cone. you wrap the end around tightly and plop it down, smushing the end of the cone into the center so that you have a ball again that resembles an uncooked cinnamon roll (this is what makes the flaky layers once it’s cooked). this is what you roll out and place in a frying pan, with oil, and then more oil, and cook over an open fire, and flip and add more oil and then a little extra oil just for flavor and finally some oil, to make sure it’s all nice and oily and every part has some oil. got it? oh, did I mention you use quite a bit of oil? there is a reason chipati is so delicious and we have discovered the secret! :) we took turns trying the technique, kurt’s was hands down the worst, but thu’s came in at a close second. We ate freshly cooked chipati there in the kitchen when I helped flip the others and it was the best chipati I’ve ever had. I was surprised to learn what an involved process it is. in the city we are always baffled that most places run out of chipati by noon. you’d think they’d realize the demand is there and they’d make more in the morning in preparation for all of the people who show up wanting to chipati in the afternoon. after learning about and helping with the entire process, I understand why only a limited amount is made each day. I’m def gonna have to try making this stuff at home. get excited!

our adventures for the day were not over we were soon in the land cruiser headed for the maasai mountain, a formation made of a granite rock that was super grippe and allowed you to walk right up the 45 degree plus angle of the rock face. it was interesting because gladness was a little nervous. she kept going on about there not being goats or cows around and it was concerning her that there might be lions nearby. I couldn’t tell how much she was joking, but it is possible based on our location. when we got to the top of the rock and took in the 360 degree view it became clear that there wasn’t a hint of civilization in any direction. cool. the only people we saw were some maasai men who drove by on the dirt road far below on motorbikes. that’s quite a scene… if the maasai on bicycles aren’t enough, their blankets flapping in the wind behind them, stick two of them on a motorbike and you’re sure to be entertained. we decided to disregard the threat of lions because we had brought a maasai warrior with us. gladness seemed relatively confident he’d be able to protect us in the event of an attack. standing atop that rock it felt like something out of the king. there was even a sun beam shining down through a hole in the clouds. The hike back down was more of a challenge. The grass was slippery and gladness kept pointing at plants and reminding us to ‘take care’ – I guess there are quite a few plants in the area that cause bad itching on contact. She also fell on her ass at one point and then just goes ‘I wanted to have a sit’ like she had done it on purpose though we all saw the slip. Doesn’t matter where you are, humor is universal. sliding down the rock fighting your momentum took a little more time than running up it using your momentum, and I definitely encountered a snake midway down that made me almost leap completely off the steep incline – I screamed in genuine terror and for those of you who’ve heard my scream you know I probably scared away every lion within a 20 mile radius. By the time we made it to the bottom we were covered in sticky plants and pokey spines and these crazy little of balls of thorns that are so sharp when you try to remove them with your fingers they stick into your skin. I’d classify the area as a fairly hostile environment.

paragraph 4: here’s a story about how I realized maasai warriors are legit. it was during the drive back to the maasai village. we were sweaty and dirty and decorated with brambles from climbing maasai mountain. I was sitting in the far back of the land cruiser with kurt and the maasai warrior, who I think might be gladness’ brother (but I’m not sure), who hung out with us a lot. we were sharing one bench, kurt was sitting across from us. the situation began when thu realized that an inch worm was hitch hiking on her shirt. she wasn’t so keen on the company and I volunteered to take it off and put it outside. I reached forward, got the worm on my finger, and stuck my arm out the back land cruiser window as I tried to shake the sticky little green worm off. my arm was outstretched, my entire forearm out the window, my fingers twisting to try to get the worm to let go. I searched my hand, trying to see if I had succeeded in getting the worm off. I was studying my finger when a series of events happened so quickly the next thing I knew my arm was somehow safely inside the car and the screech of thorny branches was echoing in my ears.

paragraph 5: kurt saw the whole thing and as I sat there in shock, trying to process what had just happened, his jaw literally dropped. so from what he said, and with my intact arm as evidence, the maasai warrior sitting quietly next to me had either seen and/or heard the massive thorned branches hit the side of the car as dr. lace flew down the dirt road. he had instinctively made the connection that my arm, hanging careless out the window, was in eminent danger of being totally mangled… meanwhile I was seriously laddy-daddy-dah all twisting my fingers around and having an absurdly ditsy moment with my hand/arm hanging in peril. the maasai warrior, before I even had time to realize the danger, had managed to grab my arm and pull it safely inside, without so much as touching it to the edge of the window, a mere fraction of a second before the hell plants of death literally tore up the side of the car. chunks of thorns flew in through the open window and I realized that it had been such a narrow miss one of the branches had grazed, ever so slightly, the very tip of my middle finger. I cannot imagine what my arm would have looked like had he not reacted so quickly but I felt truly fortunate to have been sitting next to a maasai warrior. my arm and I feel great affection to him, and I have a whole new respect for the maasai warrior ways. I’ve never been so appreciative of my intact left arm, ever. damn you thorn death bushes from hell, you almost won. thanks maasai guy, you have impeccable senses, lighting fast reflexes, and a stealth like ability to save limbs (that should remain inside the vehicle at all times, but sometimes find their way outside). all of that and with one bum eye. yeah, that’s right, makes the story even more impressive, I know. I am forever in your debt. thanks also for protecting us from lions. that’s how I know the maasai warriors are legit.

we made it back to watch a sunset like nothing I’ve ever seen. it was a huge, glowing red orb so deeply crimson it looked color enhanced. we sat atop a cement wall and watched it sink over the huts to the bellowing of cows and baying of goats. naturally we drew the attention of some local kids so once I had taken more than enough sunset photos with maasai guiding herds of cows home for the night in the foreground, we focused our attention on them. they were just staring up at us, so we decided to entertain. amy kurt and I (not sure where everyone else was) literally busted out ‘in the jungle the mighty jungle the lion sleeps tonight’ and I have to say, considering I can’t carry a tune in a bucket, it sounded pretty descent. they didn’t return the favor by singing to us, but somehow we soon found ourselves in a handstand competition with these kids and that was pretty funny. handstands are apparently just as universal as smiles.

more amazing food, a bucket shower, then sleep… get ready for tomo, it’s a doozy! but that's all i'm giving you for now because it's about a dozen pages of writing and my readers need some time to catch up. i've been away from internet from far too long apparently :)

save water, drink beer

day 2 with the maasai:

if you can’t already tell from the title of these blogs, gladness really enjoys her booze. she’s also a big fan of meat and eats as much of it as possible at every meal (more on that later).

I was up before 6, it was still dark out (I think, correct me if I’m wrong, that because we’re only 3 degrees south of the equator in lengasti, that the sun rises and sets at pretty much the same time every day), and I needed my headlamp to find my pants and fleece before leaving with thu and jennah. we headed out to one of the boma’s in hopes of helping with the morning milking. a boma is an area defined by a ‘fence’ constructed of branches of this plant that are covered in inch long thorns. talk about security. pretty much only the occasional stray and emaciated cat dares to navigate the thick blockade created by these thorny plants. they build pastures for cows and goats with them, drape them along the edge of their hay roofs so that the donkeys don’t eat it, and create boarders for their huts and land. we followed the sound of the noisy goats and came upon a pen packed with maybe 50 or 60 goats. there, a group of maasai were on the far side, mostly children, all with plastic cups in hand, finding the mother goats and pinning the babies between their legs as they bent to milk the mama. they made it look so easy! let me tell you, it is far from easy. getting the milk out is a trick, and trying to do it while keeping the hungry baby away is downright impossible. I needed to enlist help from the other children to hold the baby and show me again and again how to squeeze the milk out. ok, so im impressed with their goat milking skills. the children were getting a kick out of our struggle and I have to admit, it was making me laugh as well.

from there we left the milking to the kids, we were wasting their time with our futile attempts to get milk in the cup. gladness led us on a walking tour of the area, past mud huts quite literally made of cow poop (that has to smell great when you heat up the inside with a fire). we stared at the donkeys in one boma as we passed and they all stared back, a little creepy to have so many matching eyes on you. it is best to watch your footing around here, there are random carcasses (usually of goats) from recent kills. usually, if a baby is born in the village, a goat is killed in celebration. they leave the hide out to dry and then use it to sleep on. that and cow hides make up the beds. you can see why bugs might be somewhat of a problem as we would later observe firsthand in clinic. we walked down the ‘main highway’ as gladness called it – a winding dirt road hardly distinguishable from the rest of the dusty bush. gladness was leading us to her maize field. she had hired a guy to guard the maize, which has already been harvested. she hollers to his tiny hut, we can see smoke seeping from cracks in the ceiling. a male voice calls back and soon a man appears, removes a spiny branch from the ‘fence’ and karibu’s us to enter (karibu = welcome). we get to peak inside his tiny hut, even standing in the doorway my eyes are watering from the smoke of the small fire. there is another person inside, it hardly looks big enough to fit one and yet they both eat, sleep, live in this tiny, made-of-poop hut. what?! how the heck are we so freakin’ lucky?!! that thought must’ve crossed my mind an infinite number of times during our stay.

the maize looks great and gladness is very proud of the harvest. we say our goodbyes and head back for breakfast. we pass another baobob tree. these things are wild to me, wait until I show you a photo. I tried the baobob seed candy they sell when I was in zanzibar, it is very odd, im bring some home for people to try. the baobob tree we passed had some strange wood hanging in it. turns out they hollow out a piece of a log and hang it in the tree so that bees come there and create a hive, then they can harvest honey. let me tell you, it is the best honey you will ever taste and we ate it on our chipati for the duration of our visit. we pass through a herd of cattle, they mosey across the bush, kicking up a cloud of dust as they go. they don’t seem to mind us and the maasai steer them directly into our path so that we are weaving through the herd as we head back to the main bomas.

we see more children, very young children, up far too early doing chores, and staring curiously at the strange wzungus walking outside their homes. im sure for many of them it is the first time they’ve seen a mzungu. we stare back, equally intrigued. they wear so little, and it is not warm here. I am in long pants and a fleece, and I’d say im fairly acclimated to cool weather after the spring we had in oregon before I left and then the cool winter weather we’ve had in arusha. these children are draped in worn cloth, small maasai blankets, usually with holes and so thin they’re practically transparent. they wear nothing under them, just as their parents do, but at least the women and men are usually draped in three of these cloths. the childrens’ single cloth flaps in the wind and their naked bodies are completely exposed to the elements. does make it very convenient to do your business in the bush, and we definitely passed a squatting child and gladness points at him and tells us he’s pooping. very classy. as you can probably tell, she’s not to the point at all ;) then she tried to convince us that we had to poop in the bush at least one time during our trip… not a chance. sorry gladness.

breakfast in the bush… now we toyed with this dilemma during the entire trip, and after clinic it became even more of an issue – the fact that they would feed us to excess, literally so much we couldn’t come close to finishing what the three female cooks prepared for each meal, and yet we heard about and saw the malnourished children constantly throughout the day. talk about a moral quandary! i’ll come back to this but here’s an example. for breakfast we were served roasted bananas (seriously one of these plantines prepared this way is enough to fill you), toast, banana fruit, omlette, and roasted peanuts with tea and coffee. we politely sampled everything, but by the end of the trip we were done with polite and pleading to give the children even a portion of what they had prepared for us. we would also ask that the leftovers from our breakfast just be saved and we’d eat that for lunch, but they refused, each meal was prepared from scratch with portions far greater than we could stuff in our faces. awesome.

we piled in the back of gladness’ truck and she drove like a maniac to the clinic a few minutes away. we unpacked all of the drugs into one room, our pharmacy, and a lot of the supplies. dr. lace and kurt were in that room seeing patients and distributing meds, the girls were in the next room seeing patients and prescribing meds. he really did just let us loose, and it was pretty awesome getting to see patients all on our own with gladness as our interpreter. of course we consulted with him and ran cases past him to be sure we weren’t missing anything, but for the most part we were in charge. it was a great way to brush up on physical exam skills. we listened to soooo many terrible lungs, did abdominal exams, musculoskeletal exams, listened to hearts, took temps and bp, did pre-natal exams, looked in lots of disgusting ears, and diagnosed more ringworm than we’d like to admit. pretty much every child was covered in fungus and thus treated for ringworm, and we gave mebendazole universally as well because most of the children hadn’t been dewormed in a year or more and they really try to do it once every six months. their swollen bellies were sure evidence of the parasites living inside.

the other prevalent issues were the obvious malnutrition. the children had the distended bellies and frail limbs. we saw one or two with rickets from severe vitamin deficiency. the problem is most of them are fed only porridge each day and we’re not sure how much. no meat, no eggs, little milk, and absolutely no veggies. talk about an utter lack of variety in the diet. how are children expected to grow and thrive on porridge?! they’re not, that’s pretty much the bottom line. we had brought a vitamin supplement liquid thing that is meant to be given each day, only a tablespoon, and we distributed it to every child that fit the malnutrition bill, and also to the pregnant women who came in complaining of being tired, who were severely anemic on exam, and had bellies substantially smaller than their stated delivery date would suggest. not surprisingly, we ran out on the second day of clinic. this just emphasized even more why the work gladness is doing is so important. the vegetable garden, among many other things, could greatly improve the lives of these children. equality between women and men would also make a great difference as generally the men are the only ones allotted meat to eat.

we saw 35 patients that day and prescribed three times that many meds. all of them were covered in dust and wearing tattered clothing so worn even the most impoverished cultures would discard them as rags. all heads are shaved, and eyebrows as well, mostly out of practicality. and every last one was just crawling with flies. the thing about it is when a fly lands on me I can’t help but immediately flick it off – I find flies to be the greatest annoyance. they tolerate a dozen flies crawling on their heads, sitting in the corners of their eyes and around their mouths. it makes me squirm just thinking about it, but I suppose it is a losing battle and there’s a point when you learn all you can do is learn to deal with it. the adults complain of aches and pains. what do you expect when you spend your days plowing fields, milking animals, building your hut, sitting over a fire, and all of this with a child strapped to your back, not to mention the dreadful ‘beds’ they sleep on. ibuprofen was our friend. mostly they just want the attention, they want to be touched, to be examined, and to be given something with the promise that it will help. we could offer this to them.

the children, aside from the parasites, ringworm, and malnutrition, suffered from the effects of living in tiny quarters with a constant fire and no chimney. the smoke takes a serious toll on the people here. I’ll describe later what it’s like to spend time in one of the huts, but for now I’ll just say that every single maasai who walked through our clinic door wreaked of smoke and had the red eyes, runny nose, and raspy lungs to prove it. all of the childrens’ eyes hurt, all of them had awful sounding coughs, and most had otitis media. the ear infections, the junky lungs, the irritated eyes, all are because their huts are constantly filled with smoke from the ever-burning fires in the tiny huts. chimneys would help a great deal, but part of the problem is that they don’t make the connection between their ailments and the smoke. also, building a chimney in and of itself poses a problem. it seems so simple to me, just make a hole in the hay you build the roof with and add a tube with a cover (for when it rains), but leave space for the smoke to come out. if some factory could come up with an easy plan to make this and distribute it the people here would greatly benefit, but as it is building chimneys are not a practical part of their house planning. the women are responsible for building the huts to attract a husband. if she does not maintain it properly, for instance, if rain gets inside, she will be beat. you can see why maybe a potentially leaky chimney is not worth the risk.

hmm, yet another culture where the women are expected to do absolutely everything and the men just sit around and socialize and drink kunyagi. it was just like this in the philippines, and it’s definitely like this in most of arusha and even in zanz. doesn’t quite make sense. let us take a moment to consider how it happens in the animal kingdom – birds are a great example. the males have to be bright and beautiful and build amazing nests to attract mates, makes sense to me :) here in lengasti the women build the home, they care for the children, they prepare the food, and the submit to the man always. we learned that the idea of foreplay does not exist. the man walks into the hut and demands sex. the woman has no choice in the matter, they make sex (as gladness says).

the talk of sex opens a box of worms when it comes to the maasai culture. for one thing, the idea of circumcision is quite interesting. we’ll begin with male circumcision because it’s more socially acceptable, though I’m not sure how acceptable it is to gather up the boys when they’re 15, throw them in a river until they’re hypothermic (this is if they’re lucky, to help reduce the pain), then cut off their foreskin using the same knife without washing between boys. they also leave a flap of skin they call the patrol, and gladness couldn’t quite explain the purpose of this. once the boys are circumcised they go sit in a hut for a few months, then they become a maasai warrior (we aren’t really clear on the logistics of this, but I think it is less relevant these days because no longer being nomadic means they don’t need to warrior much if you know what I mean), take a wife, and get 5 acres of land. simple as that. more wives equals more land. I tried to convince gladness they should change the rule so that the fewer wives and children you have the more land you get. she wasn’t convinced that would fly.

oh, did I not mention the multiple wives thing yet? yes, just so that we’re clear, the maasai are down with polygamy – at least the men are, I’m sure the woman would have something say on the matter were they allowed to speak their mind without fear of being beat. men often have about five wives, and twenty plus children as a result. but fear not! if a man happens to get bored with one or all of this multiple wives, he is perfectly allowed to demand another woman sleep with him, another man’s wife, it is no problem. just like so many things here – it’s no problem. riiighhhtt… fortunately, they’re not so big on paternity tests here, and since the men sleep around so much, when a child is born it’s kind of like everyone is the father. awesome, that many more men to potentially get a beating from.

if that’s not difficult enough to wrap your mind around, if you’re open-minded to the idea of these practices happening today, I’ve got more for you. female circumcision, more appropriately called genital mutilation, is a practice that gladness is fighting to stop, but sadly it’s still happening today. the sole purpose of circumcising the clitoris is so that women find absolutely no pleasure in sex. the goal is to prevent the women from sleeping around. how messed up is that?! I mean, let’s be honest, in a culture where the men are allowed to sleep around as much as they want they go to great lengths to circumcise the women at age 12 or 13 (just before they marry), which usually results in the death of at least one of the girls. same idea, stick all the girls in a hut, same knife circumcises them all, and the families actually pay the people who perform the circumcisions. #&*$ that!! gladness said her daughter elected not to be circumcised and she supported her, though her husband (who I think still lives when them but they’re not married anymore) didn’t really approve. go gladness!

here’s another fun fact: they’ve been doing a lot of work to encourage the use of condoms. we were going to hold a seminar on this during our time in lengasti but there were some unexpected obstacles – ill get to that later. the main thing is that you have to convince the men to use the condoms because if a woman were to ask her husband to use the condom she would be beat. did I mention that all of the men carry around their thick, wooden maasai warrior sticks. they use them to herd the animals, they lean on them when they’re standing around being lazy, the use them as walking sticks, and, oh, that’s right, they beat the women and children with them. how convenient to always carry a beating stick around with you.

so the thing is, I’m painting the men in such a negative way, but I don’t hate them. this is their culture, it is all they know. how much can you blame them? and it is obvious that in this particularly tribe they are making efforts to change. Unfortunately, I have just read the book ‘the girl with the dragon tattoo’ (original title: men who hate women) and it is a book about just that. it really makes you despise the male gender, and then to find myself in a culture where I could so easily relate the oppression of the women to the terrible events in the book… maybe not the best combo. it is good that we met a number of nice men during our time and of course we had dr. lace doing great things, and kurt being such a good sport, all redeeming the y chromosome. plus my dad is pretty much the most awesome guy ever, and he’s male, so fear not! I’m no man-hater :) though I do like the maasai women much more, I feel a greater connection and sympathy toward them (for obvious reasons), but the men are not all bad. again, it is how they were taught, they do not know otherwise, and I’m sure, were they to see the way our culture works, they’d find equally odd and unacceptable things.

it's killi time

day 1 with the maasai:

get ready for stories...

our adventure began in an old land cruiser, probably a retired safari vehicle, with torn up leather seats and almost 400,000 miles on it. we were loaded down with boxes of medical supplies and our personal necessities, sitting 4 girls across the back seat with kurt packed in the back on a bench seat with all the stuff, and dr. lace driving. I wrote about this surreal day by the light of my headlamp, lying in a small bed in the middle of nowhere tanzania. it was definitely one of those moments when I wonder exactly how I found myself in such a situation. I had an idea of what to expect on this trip, but I was somehow very unprepared to spend several days living in a maasai village far from where mzungus usually travel. if we thought we drew a lot of attention in arusha, imagine what show stoppers we were in this isolated village. wzungus are a genuine novelty and we were constantly reminded of it on this adventure.

it took us about six hours of travel time to reach lengasti, the maasai village that was our destination. about 30 minutes of that was on the paved road leading out of arusha. aside from the wild drivers passing in dangerous places and speeding around dr. lace as he putt-putted along in the land cruiser, the most you have to worry about is the dreaded triple bumps- three abrupt pavement bumps spaced just right so that as you come down the second with your front tire you’re hitting the first with the back, and again and again so as to get maximum shake-age of the care and it’s passengers. most vehicles all but stop for these bumps, but it took dr. lace a couple of times abusing kurt in the far back of the car to realize he had to take them a bit slower. the shocks on this ancient car certainly aren’t what they used to be. our other 5 plus hours were spent on pot-hole-ridden dirt roads that were a constant remind of the lack of shocks on the car. we had picked up an acquaintance of dr. lace’s before turning off the paved road, and he was directing us through the maze of back roads, instructing dr. lace right then left then right again, to the point where I was sure he was lost.

we eventually made it to the first of several destinations, an orphanage-type child care place called Rafiki. but not before taking too many detours and venturing through a side road so packed with men that I was genuinely concerned they might decide to overtake the vehicle. this hustle and bustle area was a hot spot for tanzanite to be chipped away and worked on so that it can be sold after harvest from the nearby hillsides. we drew some serious attention from the crowds and crowds of men, there was hardly a woman in sight and we must’ve drove for several blocks… um… if you can call them that… before finally escaping the male dominated mob and proceeding the rest of the way to Rafiki.

there we were greeted by 20 or more children of all ages, who were singing to us, one of which was an older boy with “I <3 obama” embroidered on the pockets of his jeans. the kids were too cute, and then our “guide” for the day went over to them and whispered our names one at a time to the lead singer, a young girl, and she incorporated it into the song. granted, the telephone that ensued from us telling him our name to him telling them our name, to them actually singing our name made the names almost indistinguishable, but it was sweet nonetheless, and their dance moves to accompany the song were pretty awesome as well. we got a tour of the facility, very nice and new, apparently this is one of the orphanages that dr. lace supports. they force fed us a meal though dr. lace insisted we had plans to eat in lengasti. people love, love to feed you here, as we learned all to well during the rest of our trip… I have never felt constantly full for so many consecutive days. our meal at rafiki was pineapple and passion fanta (yes, they have delicious fanta flavors here), and rice and sekuma wiki, the cooked green cabbage stuff that I actually really like. and we ate with our hands like true tanzanians. it makes you feel like such a child, food all over your right hand (it is rude to touch the food with the left hand) and lifting it to your face so sloppily, but a lot of fun just the same.

we left guide guy there and picked up the famous gladness. where do I even begin with gladness? she is spunky 40-something maasai woman who breaks basically every rule of the culture. when we arrived she climbed out of her toyota truck and strutted over to us in safari pants, a plaid short sleeve button-up, and a white baseball cap. this woman is somethin’ else. get excited for all of the gladness stories I have to tell, she’s a once in a lifetime kinda person. to begin, she entertains us the entire rest of the car ride to lengasti. she’s asking ‘how do you find the road? it shakes the breasts’ she says and we all bust up laughing at this unexpected comment. we discuss how someone who works with dr. lace’s orphanage foundation hit a goat the other day, costing 30,000 tzs. when a goat later crosses the path of our land cruiser, gladness says ‘no problem, that one is small, only 20,000’ joking about hitting it. she proceeds to lead our ‘safari’ to lengasti, pointing out farm animals like cows, goats and donkeys and identifying them as rare gazelle, zebras and lions. we passed some really incredible baobob trees – one gladness estimated to be 500 years old. they’re not very beautiful, but more interesting with their trunks disproportionately thick to the spindly, leafless branches. I like them. I also find the massive termite hills to be very interesting, and fun to photograph, though I don’t like the idea of the actual termites. The land cruiser was a beast, taking on pot holes, dry river beds, branches, and rocks. We past the occasional dikdik due (apparently they mate for life) and birds of every color. For how dull the bush is, muted red dirt, dry shrubbery and a lot of dust, the birds are bright and beautiful with feathers every color of the rainbow. The dull landscape also makes the reds, purples and oranges of the traditional maasai drapery pop out and the contrast is truly picturesque.

we made it to the village of lengasti with a plan that had been laid out by gladness in the car. when we arrive we were to greet everyone, tour the garden, and see where we’d be staying, then we had to go get cleaned up and ready for dinner. there would be no sitting with the maasai people before that point, if we sat to talk we would never be left alone, did we understand? everyone agreed to the plan. we were welcomed by a pink sunset, 15 plus women and a handful of men, all eager to shake our hands. we repeated the maasai greeting (great, just when we’ve mastered the basics of Swahili we’re thrown into a situation where no one understands swhaili).our bags were unloaded and we were led to the garden by the proud maasai women who sang the whole walk there. The people here do not have vegetables because it is too dry to grow them. gladness has created plant boxes lined with plastic and is working on growing fresh veggies so as to show the women it is possible. The women and children here are in desperate need of better nutrition and more varied diet, and gladness is trying to show them they can take charge of this and grow the veggies for themselves. Healthy kids are a sign of a healthy community and the children here are sadly far from good health. gladness is working to change that. the chanting of the cultural songs continued and we joined in, clapping along and following the brightly dressed women back to gladness’ house – what dr. lace calls ‘the gladness hotel’.

the women stopped on the way and circled up. we did the same. they were singing loudly and clapping along. the women would take turns stepping into the center and jumping to the beat of the music. the younger women would get goofy and do funny dance moves that would make everyone laugh. it was one of the those moments when I was standing in the circle with the maasai women clapping along to their chant, the sun setting over the huts in the distance, that I wasn’t quite certain how I had found myself in such a situation but I was thrilled to be there. what a treat to get to experience this culture!

We were finally permitted to head back to our two small rooms to shower. Amy and I were in one, thu and jennah in the other. The shower was a trickle from the ceiling of the bathroom and the water was icy, but it felt amazing after our long day of travel and it was quite a treat considering we weren’t sure we’d have water at all. it was also very interesting to shower to the sound of the women singing outside. Gladness had mentioned they would do this, but we thought she was joking. Wrong! Talk about a soundtrack for the shower.

dinner was as amazing as could be. Guests served first and we were all hungry despite our snack a few hours before. We dished up rice and beans and this amazing vegetable curry type stuff they had made especially for me, the lone vegetarian. The women served themselves next, which was apparently a big deal because in the maasai culture the men usually eat first and are served by the women. Instead, we saw the women serve themselves and go sit down to eat. Then we watched gladness go over and say something to the handful of men who were sitting nearby and they stood to go serve themselves. Gladness is a pistol! The food was the best I’ve had in arusha so far and we sat by the light of the lantern digesting after we had helped ourselves to seconds. They brought out tea and roasted peanuts post-meal, and I was perfectly content sitting there listening to the murmur of the maasai people as they ate.

We enjoyed our food outside under the stars. Mosquitoes are not a problem because it’s too dry and cool but the flies are the greatest nuisance! Those who attended the dinner were representatives chosen from the 7,000 maasai living in the area. The moon was bright, casting defined shadows as the night’s conversation began. Dr lace would speaker and a local teacher they had brought it would translate. He spoke of all that he plans to do and reminds them of what he’s done so far. He also shared several stories about when gladness went to the states. We’re learning about the dynamic as the trip goes along but from what I understand dr. lace and gladness traveled in the u.s. for a few weeks going to high schools and other places to speak and raise awareness (and money, but that didn’t so much happen) for the maasai. He had stories about gladness going in a hot tub, which was pretty funny trying to explain what that was. Also he told a story about her leaving the ‘maasai mark’ in a cave in central Oregon (aka peeing). The maasai would talk, ask questions, thank dr. lace and gladness and she would translate. She asked if we had anything to say and we went around basically thanking the maasai for having us and letting them know we appreciate them opening their lives to us. Then it was kili time! that the logo for kilimanjaro lager ‘it’s kili time, make the most of it’ or the one I like better, if you can’t climb it, drink it :) the three of us, dr. lace, jennah (a nursing student from an ohsu satellite campus – did I already explain that?) and kurt (a college student and canadian contemplating medicine) followed gladness into her house for some drinks before passing out to the sound of a rooster - yeah, i thought they were supposed to crow in the morning too... unfortunately not.

alive and well

back in contact with the world! wow, life without internet is a trip! and quite liberating to say the least. if we thought internet was hard to come by in arusha, it is downright impossible to find with the maasai (for obvious reasons) and far too expensive to hassle with in zanzibar (but let’s be honest, who really wants to spend time on the internet when you’re in paradise anyway?). I hope none of you were too concerned/confused, I think my last blog I made it sound like I’d be back in contact once we returned from the maasai village, turns out that didn’t happen. and our trip to zanz might have been extended a day or two because really, no one wants to leave that island… there’s a reason your return ferry ticket has no date on it (I think people frequently decide to stay longer than they planned).but we’re back to reality and feeling well rested after a few days of leisurely travel without the stress or moral dilemmas that come from working at mt. meru hospital. it was a much needed emotional break but we’re happy to be back at centre house, the hostel is our home base and feels accordingly comfortable. it really did feel like coming home last night when we walked through the front gate, dirty and smelling of salt water, weighed down by our hastily packed bags. we sleep well and started up at the hospital this morning. I’ve already got stories but they’ll have to wait… first, an aside:

to clarify about the case I mentioned a while back, the boy who came in with the non-patterned, writhing muscle movements, that is called chorea athetosis and it is a motor disturbance that is often seen in kids with cerebral palsy (of which there are many here, and the prognosis is usually very bleak for them, though it depends on the severity). the delayed onset type, which we saw in the young male patient, can be the result of rheumatic fever, and can occur 1-8 months after infection. the jerking of the hands, face, feet and more generalized muscle contractions usually improve with sleep (as was the case with our patient) and can be improved with antibiotics and, often, time. very interesting case, hopefully they managed without us while we were gone.

now… living with the maasai:

Tuesday, July 20, 2010

you know you’re in tanzania when...

hi friends, wanted to let everyone know we’re leaving for a maasai village tomorrow. we will be bringing tons of supplies and meds and spending four days running a clinic with two other students (one nursing and one still in college) and dr. lace. the village is very large and we’re going to be extremely busy as they usually only get medical care when we come. it should be a very interesting experience and I’ll do my best to catch up with the blogging once I’m back. we’ll have no electricity or anything while we’re there, so look for an update maybe by next week. wish us luck! this will be an experience for certain… I just hope they’re joking about eating goat testicles… miss you all!!


we’ve been here almost a month and trust me, this is a long overdue blog. it is my, you know you’re in tanzania when, blog. i'll add more when i have time... so here it goes:

you know you are in tanzania when:

-every price is negotiable and anything & everything is for sale.

-all locals stop what they’re doing when you walk down the street and the word “mzungu” follows you wherever you go. (I find this particularly odd because there are so many white people in arusha, im not exactly sure what the novelty is).

-grasshoppers are in your “sterile” operating room, always.

-a feeding tube can double as a foley catheter.

-milk tastes like it just came out of the cow… because it did.

-condoms and gloves make great bargaining tools.

-everything is fried in oil. everything.

-it is socially acceptable to answer your cell phone in any situation. cell phone etiquette does not exist and whether you’re in the middle of an important meeting, the doctor is rounding on your sick child, or you are doing a pelvic exam, if that phone rings you will let it play, (to enjoy your ring tone of course), and then answer it, no matter what, vaginal fluid on your glove and all.

-you feel a need to edit your will before crossing the street.

-being asian excludes you from having a US citizenship.

-a crosswalk is not a place to yield to pedestrians, it is a way of concentrating people so it’s easier to hit them – 5 points each?

-pens = extremely valuable and cherished.

-strangers will take your hand when you cross the street if you look particularly incompetent.

-food is served randomly, but consistently randomly, at restaurants. appetizers will come out last, main dishes will be brought to half the group and 20 minutes later the rest will get their food… customer service, what’s that?
-kids you just met think it is perfectly appropriate to take your hand as they walk down the street with you.

-everyone loves chelsea (the futbol team)

-you place your child on the laps of strangers when you’re on the dala dala

-carrying a purse around, carrying a live chicken around, both are equally socially acceptable.

That’s all for now but there’s much more to come!! t.i.a. :)

a few to add... you know you're in tanzania when:

-mosquito hunting is a sport. my tag line in arusha: fighting malaria, one mosquito at a time (that said, in the bush flies are much more of an issue, and quite a bit more difficult to kill. assuming my doxy works, I’d take a mosquito over a fly any day).

-you know to avoid bridges early in the morning, at dusk, any time it’s dark, and usually on sundays. you’re not exactly why but everyone has warned you about this and there are police at the bridges, so you don’t push your luck.

-you know several people, and they know several people, who have been robbed or mugged here in arusha (that’s comforting)

-it is not usually to see a truck with 20+ people standing in the back.

-men riding in the bed of a truck frequently wear hospital masks (if that’s any indication of the level of pollution here, just please take a deep breath of clean oregon air and appreciate it for me, because my lungs are dying here).

-no matter the day or time, there’s always a special price for you: special sunday price, special morning price, special rafiki price and on and on forever.

-you get called dada by the local women, and you’re no longer considering that they think you’re someone’s father, it means ‘sister’ in swahili.

-hand sanitizer and a little toilet paper accompany you everywhere you go.

-your boogers, you fear, are indefinitely brown.

-clothes need to be shaken very well before you bring them in from hanging dry. something about the detergent, just attracts the huge grasshoppers – awesome

-as a greeting, you bow your head to an elder so that they can touch it.

-you can do pretty much any activity to the light of a headlamp.

-the only two faces worth printing on khangas are obama’s and michael jackson’s.

-you do not find it unusual when two grown men walk down the street hand in hand. yes, we’d consider that a statement of homosexuality in the statues, here it is merely a sign of friendship.

-waving your arm around too close to the road can lead to a “freak accident” aka dr. ishmael breaking is arm on a car during his moring walk.

-there is a single porsche cayenne, red, and it goes 90+ mph no matter what road it’s on. see it and get far out of the way.

-you can fake your way through an entire swahili conversation using only three words: poa, sawa, and nzuri.

-everyone loves bob marley, and his music plays most everywhere you go. that or celine dion or michael jackson. they loovvvee sappy music here.

-you know to hold a rock in your hand when you’re let through the hostel gate late at night. the dogs are used to the guards chucking rocks at them, so if you want to be left alone, show those dogs the rock in your hand.

-a khanga has 731 different uses, probably twice that, but 731 is just the number of things I’ve actually seen it used for.

-everyone loves obama as much as you :)

-headwraps (which we think make us look like cancer patients) actually make for a great way to blend. Oddly enough you are 5 times less likely to be talked to when wearing a headwrap then when not…

-it is not unusual when driving to point out the window and exclaim “carcass” or “rib” or “skull” or some other type of animal remains.

-there’s no such thing as dark chocolate. terrib, I know.

-your taxi driver is most likely some local who got board and decided to make a few extra shillings driving mzungus around.

-it’s no problem is a phrase used regardless of the size of the problem.

Monday, July 19, 2010

same same but different

peds is peds here and then some...

pneumonia: lots of kids with respiratory issues, one, an eight year old, came in yesterday with pneumonia around noon and was dead by just after midnight – terribly sad. another newly admitted this morning with severe asthma. lots of coughing and congestion. on a good note, moses, the boy with the terrible chest xray who’s been here almost two weeks is finally improving with the combination of TB meds and antibiotics we’re giving him. his mother was complaining today that he cheeks looked swollen, the doc assured her it is simply that they’re filling in because he’s finally healthy again. it was pretty cute.

malnutrition: this one can be generalized to the maasai population though we see it in children from all over. but so many sick maasai babies, and their traditional medicine usually complicates the situation. the maasai baby I mentioned before, who was given lamande (a toxic herb used to help his diarrhea) passed away this weekend. very VERY frustrating because on friday when we rounded on him I had quite a conversation with dr. lace about what else we can do. he asked me what I wanted to do… of course I had no idea, we don’t have text books here to look things up, or internet, or experts of any sort, ugh! it just seemed like we were doing so little, or what we were doing was making the baby worse, and I wanted to bring in someone else to help him or take him to the OR or something! don’t just let him die alone without giving it everything we’ve got. unfortunately what we’ve got here is very limited and when we came in this morning I looked to the bed where he usually lays and there was an unfamiliar face, I was right to assume the worst, at least he’s not suffering anymore. so young… and disturbingly preventable. I just hope that mother goes back and shares the story with the others so that maybe lamande won’t be given to the next baby with diarrhea. our big malnutrition case today was frankie, a 7 year old boy weighing 14 kilos. along with malnutrition comes periorbital swelling (from protein deficiency) and usually severe anemia, both of which frankie had. we deworm these kids as a precaution, transfuse if their Hb is less than 5, and start them on the F-75 nutrition formula. frankie was getting the full treatment and then some. he was sent to the malnutrition ward. it is devastating to see the cases there, I don’t like when we round on those kids because it is so difficult to see... it makes you feel guilty for all you have, the nice meals you eat, parents who could care for you so well when you were growing up. there’s a lot to make most anyone feel a bit of guilt…

gastroenteritis: lots of vomiting and diarrhea. in these cases dehydration is a big issue. watched a little boy just vomit over the side of the bed this morning. mom cleaned it up with a khanga… those things have more uses here….

the mystery case: boy, age 9, comes in and dr. lace leaves rounds to see him, calls us over and at first all I see is a fidgety little kid. but a few seconds of watching him and I realize he’s actually having uncontrolled muscle movement sporadically across his entire body. how bizarre. apparently it started two months ago and has been getting progressively worse to the point where he can no longer talk and is having trouble feeding. I couldn’t take my eyes off of it. acute onset choriathatosis (im sure that is not how you spell it but google isn’t working here so I can’t look it up. actually, if anyone is able to research it at all it would be greatly helpful. we’re trying to figure out the cause but there seem to be a lot of things here that can cause neurological symptoms like this) and he’s degenerating. he could walk. we took a video. discussed some ddx. wild. I have never seen anything like it. he looked like a 9 year old parkinson’s or huntington’s patient. the doc is going to research it tonight, get a second opinion from another pediatrician. I wish we had a neurologist who could come take a look at him. we did a mini neuro exam and he did alright. it’d be nice to get a CT to see what’s going on in his brain but the chance of that happening is slim. anyway, ill keep you posted on this interesting case.