Kariakoo & Mzizima Fish Market

(Kariakoo market & Mzizima Fish Market. Photos taken with my point-and-shoot because I didn’t want to risk my SLR being stolen)

Last Thursday, A and I went to downtown to explore. I’d never been to a legit African fish market, so we decided to do it the right way and head straight for Mzizima Fish Market in Kivukoni instead of going for the “gentle introduction” that is in Msasani. We stepped off the bajaj and were greeted by throngs of people selling seafood in large platters complete with chile sauce and fried sardine (?) things in recycled paper cones. A suggested we find the actual fish market by following our noses — sound advice, because 2 steps later I was hit by the unmistakeable aroma of sea creatures.

It was unlike anything I’d ever seen. An expanse of platforms with piles upon piles of fish, people yelling in Swahili, the ground permanently caked with fish scales and questionable liquids. We walked, people stared and yelled out their usual greetings towards foreigners. I stepped over a stingray the size of a twin bed. After browsing for a bit, we decide we had to buy a fish and have it fried for us. While bargaining for the fish shown (fried) above, another seller approaches me and starts shoving a lobster in my face, insisting I buy it. I refused, but perhaps not firmly enough as I was still talking to the first man about the fish, and the second seller remains at my side, staring at me as the lobster tentacles poke into my clothes. After settling on a price, the fish seller leads us to the “kitchen”: an outdoors seating area encircling barrels of rice and ugali and buckets of water of varying cleanliness. The seller tells us to sit at a bench with just enough space for the two of us, and I plop down next to a man skillfully picking meat off of bones. A couple of minutes later, our seller brings us our fried fish that we demolished with our fingers. Freaking delicious.

After the fish market, we trekked to Kariakoo where I bought curries for 25 cents USD a bag, a quarter kilo of millets (“full of protein to make you strong!”), local eggplants, and another kanga. We ate coconuts and passionfruit from the street and ended at Chef’s Pride for dinner, where I had mutton stew and A a hotdog. An amazing day.

HIV/AIDS Care in Tanzania

There is so much to say about the hospital where I’m working that I keep feeling too intimidated to write about it, and as a result fall more and more behind. A vicious cycle.

With every passing day and with every longing for certain modern conveniences, I see how incredibly spoiled we are in the US, how high our expectations are. This observation extends much beyond the scope of health care, but I’m going to focus on this first. Take, for example, basic sanitation. If you go into any major hospital in the US, there are going to be signs for Handwashing saves lives! Without a doubt, the handwashing crusade is important, and I would personally be horrified if my doctor even touched my face without washing his/her hands first. But in the hospital where I work in Tanzania, and at every other hospital I’ve been to here, there isn’t even running water. There are sinks, yes, but they’re dry, and I sometimes wonder why they even exist. Decoration? To give an impression of cleanliness? Instead, they use a bucket system where a stand holds a water-filled bucket with a small tap (like a water cooler), and there is a pail underneath the tap to catch the run off. The bottle of soap kept next to the bucket is usually diluted and frustratingly watery. Even with this, I almost never see any of the providers wash their hands while they examine the patients. And there are certainly no gloves.

And what about the doctor-patient relationship, the good bedside manner, that is the topic of so many magazine columns and form the buzzwords of medical education in the US? While I can’t describe the verbal exchanges with blazing clarity because of my ineptitude in Swahili, I can note that if an American were to seek care here, s/he wouldn’t last a half hour before erupting in a fiery rage over the often day-long wait time for a 3 minute visit with the doctor who does not hesitate to pick up her cell phone and have a chat in the middle of it.

Patient privacy is also high on the priority list for Americans, what with HIPAA and patients suing for reasons like exposure that they even sought care in the first place. Here, doctor visits and counseling sessions are done with the door wide open with other patients waiting in clusters outside the rooms. On Friday, there were a total of 12 patients in the room while I was trying frantically to keep them straight. As one patient is being wrapped up, the doctor sometimes tells him/her the full name of the next patient to call out when s/he goes back to the waiting room. Patients watch me as I’m working on other patient files right in front of them. Keep in mind that I work at a clinic that exclusively treats HIV+ patients. What confuses me further is the accompanying stigma associated with HIV/AIDS — why, then, is there lack of any attempt at guarding patient privacy? I know for a fact that patients do mind; I’m told that if they see someone they know, they make a run for it. One patient did her visit through a window because she refused to enter the hospital and let the people in the waiting areas see her and consequently know her status. Yet there seems to be no movement towards greater privacy and I have heard no real complaints from either the provider or patient side. Perhaps people have come to unhappily accept it.

On the other hand, HIV/AIDS care here is free and highly organized. The only cost patients must pay are transportation (which is major barrier to followup) and time. To be honest, I don’t know much about HIV/AIDS care in the US besides the fact that it’s expensive so I can’t compare specifics, but the care that I see in my hospital is comprehensive and integrated. In one day, patients will be group educated in nutrition/importance of ARV’s/importance of disclosure to relatives/etc, individually counseled on safe sex*/family planning/health maintenance, seen by a doctor, undergo any lab tests, and pick up their drugs. There are three blocks of patients a day and they move in a circular fashion around the hospital because the rooms they visit are sequential in terms of the services they receive. The documentation forms are standardized nationally; patients carry a CTC-1 form on their person that entitles them to free treatment regardless of which hospital or dispensary they go to, and the health center keeps a CTC-2 form (among other documentation) that records their health status and ARV regimen. If patients miss their scheduled appointments, they are tracked by health workers who determine the reason for their absence and counsel them to come back. I saw the form the trackers use — reasons include, but are not limited to: died, lack of transportation, not HIV+ (e.g. because they believe they were cured by religion).

To make a sweeping conclusion, let’s just emphasize the importance of traveling here. Not just for cultural intelligence and a more holistic view of how the world really works, but even in health care alone, there is much to be learned from any country, not just ones that are seen to be highly technologically advanced. Countries with fewer resources learn to be more resourceful and often yield impressive results with very little.

* The counselor I worked with for a little bit told me that they use a wooden penis model to demonstrate proper condom use. When I asked her to see it because I hadn’t seen one before, she asked me, “you don’t have a boyfriend?” and laughed. I told her I just hadn’t seen a wooden model because we use ndizi (bananas) in the US. I’m pretty sure the model is made from ebony — high quality stuff — and it comes with its own stand. After a minute or two, the counselor announced that she had to put it away because it would scare the children.

Snakes in Bagamoyo

Bagamoyo, Tanzania

As I’m typing this, I’m eyeing my gecko roommates as they slither around my walls. There are a few little ones in the mix and I’m imagining that many of them are related.

Last Sunday, a few of us went to Bagamoyo to hang out with the kids at an orphanage. Within the first 15 minutes, there was a snake sighting among the dried palm leaves which led to some quite varied reactions, as you might be able to tell from the photo. Apparently kids here are told some intense tales regarding snakes and their supernatural powers and many of the children were afraid to even look at the snake after it was caught. We took a tour of their small but surprisingly well-equipped schoolhouse/classroom and got our butts kicked in baseball by one of the kids, who is likely destined for MLB. The orphanage itself is run by an American woman who’s lived in Tanzania for years. Two of the youngest kids are HIV+, and many have parents with mental illnesses that render them incapable of caring for their children. I hadn’t thought about this before, but it’s easier (for the orphanage) if the kids are simply abandoned; having parents who flit in and out of the kids’ lives makes for a much more complex situation.

Don’t stop walking

Early morning quiet.

It only took me three days but I did it: I Got Lost. I decided to be adventurous and try to find the Msasani Fish Market. The directions I was given were simple enough, but I somehow missed the fish graffiti I was supposed to see and ended up walking to the Slipway, which was fine. After getting some ideas of how much large wooden giraffe sculptures cost and walking away with only 3 postcards and a box of Tanzanian tea, I started heading back home. What threw me off was my decision to stop in a produce shop the size of my bathroom (where I bought green beans, tomatoes, potatoes, and snow peas for ~2 USD and was gifted an orange by the store owner), because I think I ended up turning the wrong way and ended up in a maze of buildings that all had KK Security signs and “Hatari” (danger) on them. When I reached a dead end, my heart sank a little. I don’t know if there’s any truth in this, but I have this idea that I have to avoid looking lost/vulnerable when I’m walking by myself here. I don’t walk around with a map or guidebook or even my Swahili phrasebook (the latter which I may have to rethink), and I don’t stop walking. A man sitting outside one of the buildings certainly noticed my escalating confusion when I reached the dead end and started speaking rapid Swahili to me, at which point I promptly pivoted and walked in the opposite direction. After another series of wrong turns, I decide to ask a security guard outside a building. I stated one of the landmarks near my apartment and she thankfully understood, motioning to a small 7-8 year old kid to direct me.

For the next 5-10 minutes, the boy and I walked side-by-side in silence. I tried to rack my brain for Swahili phrases but came up empty (yes, no, and hello don’t make up for very interesting conversation). The walk seemed disproportionately long, but the boy seemed to know where he was going and I followed him turn after turn. I said asante and we parted ways, and my tired feet in my new sandals now caked with dirt took me back to the place I’m starting to call home.

Msasani in Dar es Salaam, Tanzania

With my internet here in Tanzania, I’m only able to upload one photo before my connection dies a sad death and forces me to spend another 5 minutes reconnecting. After the 28th try, I’m not going to take any more chances and am going to post this before something else goes wrong. The area photographed above is a tourist-friendly area of Dar where the beaches are gorgeous and the souvenir prices inflated. The clouds and sky in Tanzania are possibly the prettiest I’ve seen anywhere. I’ve only been here 2 days, and despite usually having either water or electricity (but not both), and even though 2.5/3 showers I’ve taken so far have been cold, I’m incredibly happy to be here.

Dar, especially the neighborhood where I’m living, is quite beautiful. I don’t remember the last time I actually saw a sunrise, but thanks to jet lag and/or prayer call, I woke up at 4:30AM and caught the sun rising over a sea peppered with sail boats. The streets where I’m living are picturesque with its brightly colored houses and doors. The roads in my area are unpaved, but I feel like the word “unpaved” is inadequate in describing those roads. Not only are they not paved, they contain unintentional rocky speed bumps of variable size accompanied by deep pits, and driving on these roads feels more like riding a mechanical bull.

As a solo traveler for the first time, I’ve met some other solo travelers on the way to Dar. S. was in front of me in the security check line, and I discovered he went to my undergrad by a sticker on his laptop. I didn’t expect to see him again, until I ran into him again in Dubai and we went on a midnight tour of the city together. Y. was eating by herself in a hotel in Dubai and I uncharacteristically approached her and had a nice chat, during which I found out she was from London and had been everywhere. I met A. at the Dubai airport — we had the same flight to Dar — and we bonded over our Southern Californian-ness.

More soon.