Everyday stories about life in Tanzania, written October 9, 2017 by Debi

Wow!  I just realized we leave Tanzania three months from today on January 9.. Don has got our trip home all booked. This time we will travel EAST and it will take six weeks before we are back in Walla Walla!  We used a travel agent to help with flights because it is a rather complicated trip. We will stay approximately a week in Phuket, Bangkok, two places in the Fiji Islands and Cabo San Lucas where we will be joined by all three sons. 

We wanted to be in Tanzania through the holidays at least once and we picked a doozy of year because Seth (Erik's son) and family will be here for Christmas. More on those plans another time. 

Attached are some pictures of typical places to buy produce. Even nice stores sell the produce outside in little shacks. The last picture is outside a particularly upscale store. I only took pictures without people in them because it is considered rude to take pictures without people's consent. 

I try to walk every day. I have chosen a route that winds up the mountain and has a soccer field on top. This route is not heavily traveled by vehicles so there is less dust. On clear days there is the most glorious view of Mt Meru. I encounter people along the road and I will share some of these interactions and observations. 

Tanzanians tend to be very soft spoken and rather shy. When meeting someone going the opposite way, they don't look at you (well I stare at the ground too because the path is so rough) and they tend to wait until they are next to you or even past before uttering a greeting. Invariably, if you pause to visit a minute, they will ask, "Where are you going?"  Don says this happens when he is bike riding too. It must seem strange to them that we have no destination in mind. 

I asked a man with a stop watch, who was timing what looked like world class runners going FAST around the soccer field, if he knew the distance of one lap. He said 550  meters. So three laps is one mile. Orjantan heard Don telling me how far he rides his bike to work and I told him about the length of my walks. Orjantan said he found this discussion hilarious. He said no Tanzania wonders about such things. You just walk where you need to go and never think about how far it is. In fact, if you ask a Tanzania how far some place is, the pat answer is, "Not far."  

I pass several school yards on my way. Little girls, especially, seem to find me fascinating. They drop what they are doing and run full speed to greet me. It is hard to tell how old they are because they are so small. So many are "stunted" from malnutrition. They love to touch me and grab my hand. Sometimes I have three girls holding each hand. That tends to slow me up!  One little girl looked at me so adoringly and said, "You are so beautiful (I am in my oversized t-shirt and stretchy pants wearing a sweat band). I especially love your hat!"  I definitely feel like a novelty. The boys play a different game. They take turns as if on a relay running up and touching me and then running away. Or they hold out their hand and say, "Money?"  I have started answering by saying, "Money? You want to give me money?" They laugh and run away. 

One day I passed a school and there was a group of men talking. One looked like a professor wearing a suit coat, trousers and dress shoes. Another had on a jean jacket and a jaunty sporty hat. Next was a traditionally dressed Maasai with red robes, tire sandals and a long walking stick. The last two were wearing PINK puffy ski jackets. You see everything!

I must mention the smell. In addition to dust, there is the stench of burning garbage. If too many households burn at the same time, it makes my eyes water. Unfortunately they burn plastic along with leaves and other garbage. 

One day I could hear chopping which is not unusual because people are always gathering and chopping wood for cooking over outdoor fires. Suddenly, I heard a cracking sound which I recognized from my wood gathering days with my father. It sounded like a tree coming DOWN!  I looked up in time to see a huge branch coming down on top of me!  I RAN to the other side of the road. Thankfully, a motorcycle did not collide with me while I was in flight mode!  I only had a few small branches fall on my head and shoulders. The bulk of the branch was caught by a hedge which was leveled. There was a man way up in the tree holding a machete. I hollered , "WHAT?!  WATCH OUT!!!"  He answered back meekly, "Sorry." I see that leveled hedge everyday along with the broken off branch and I am thankful to be alive and writing about it. I have never had that happen at home!

Wema's family feels pretty at home at our house. One thing they love are my ice cubes.  One day Orjantan said, "Debi, there is something I do not understand. How do you get your ice in such perfect little squares?"  

It took me a second to wrap my head around the question. Can you imagine not knowing about ice cube trays?  I think it illustrates well the gulf between industrialized nations and the developing world. I can't help wonder what the world would be like if more people could experience what life is like for 80% of the world's population. I know it has opened my eyes....and my heart.. 

❤️Debi

Our anniversary trip

For our 39th anniversary, we visited the historical town/port of Bagamoyo. It is an old port dating back to the 13th century (Arabs and Indians) and later became a major port and the German capitol of German East Africa.  It was a terminus for caravans from the interior - ivory and slaves. The local museum has a lot of information about the slave trade, but the major mainland port may have been farther south.  Slaves went from the coast to the island of Zanzibar where there was a large slave market.  I will send you photos from there is a couple of weeks.

A neck shackle  was one type of slave restraint.  The other was attaching one slave to another by tying the necks of the slaves to the fork of a branch as seen in the drawing.

This chain was used to attach to the neck shackle.

The last known survivor of slavery in TZ. Died in 1974! The slave trade was finally outlawed by the British, but existed as an underground human trafficking trade for another couple of decades.  They finally caught the last of the slave traders in the sea cave where they plied their trade.  I told you it was underground.

Sewa Haji was an Indian businessman/philanthropist who built/donated multiple community buildings including a hospital that later moved south to Dar es Salaam and is now the big national hospital, Muhimbili Hospital.

19th century German government buildings still exist.

Slave "quarters" at the toll house.

Cannon from the Portuguese era 16th to 18th centuries that were still used by the Germans as late as 1905.

This tower is all that remains of the first German Lutheran church in Bagamoyo.  Dr David Livingstone, medical missionary, explorer, slavery abolitionist and of "Dr Livingstone, I presume." fame died in present day Zambia from malaria and dysentery.  His heart was buried under a tree where he died and the rest of him was embalmed and carried by porters 1000 miles back to Bagamoyo where he laid in state in this tower then made his last expedition to Westminster Abbey where he currently resides.

19th century water purification system.  Water is placed in the stone basin, percolates through the porous stone and drips into a bucket underneath.  I use this same technology in my house in Arusha today.  The materials are newer.  Stainless steel didn't exist then.  The basic technology is the same.

There is a bustling, aromatic fish market on the beach.  Fish is sold fresh or cooked.  Here are these little fishies being deep fried.  The crunchy final product is eaten whole.  Heads, fins, bones - the whole thing. Place your orders now and I can bring some back for you.

Don

Debi's blog entry about our halfway mark and Maasai friends.

It is hard to believe we have been here three and a half months!  Honestly, I think you are expecting me to say that time has just flown by, but actually, I feel like we have been here a year already!  Everyday life is HARD. And being a "people person" like me, makes transitions lonely for me. I stay "busy", but I miss my friends and family. Each time we have moved, I have been surprised at how long it takes me to feel at home. You just cannot create a mountain of friends instantly....and especially not in such a foreign place!  However, I am happy to report we are WELL and Don's hearing is back to baseline. I struggle with the dust and that continues to cause coughing and sneezing and blowing, but that is due to allergies and not illness. 

Don feels useful at work. His stories about the patients he sees and their diseases fascinate and sadden me. I will let him write about that. My role tends to be "hospitality coordinator" for all the visiting nurses, medical students, residents, biomedical technicians, etc. Most people come for  1-2 months, but some stay for six months. Saki, a University of Minnesota pediatric resident from JAPAN, is here now. She is the ONLY visitor right now so she needs company as much as I do. We have gotten together often for dinner and shopping and games and movies, etc. I will be sorry to see her leave September 22. Fortunately, that is the day Wema comes home from school for a break. 

Speaking of Wema (the 14 year old Maasai neighbor who rescued me from bad dogs a year ago), the connection with her family continues to unfold. She is attending a boarding school in a neighboring town, but we see her older brothers, Orjantan and Ombeni, and her younger brother, Herison, often. They bring their laptops and various devices to our house to use our wifi. We also play games and they get to experience all kinds of new food....like broccoli!  Anyway,  those computers have been life changing for them!  It has truly opened the world to them!  Yes, they download movies and play games, but they also download tutorials on how to prepare for SAT exams! They are SO bright and self disciplined!  The older brothers have big dreams of going away to college and they are pursuing scholarships and wish for sponsorship. Sponsorship is HUGE here. It seems like every Tanzanian success story has a sponsor behind it....Someone willing to invest in that person's education. 

Ok, here comes a long story about Wema's family.  If you continue reading, I promise a surprise ending!  We recently met Wema's cousin, Allan Kilevo, who lives in the US (Virginia) and was here for a wedding. Orjantan brought him to our house for a quick visit on his way to the airport. We encountered a very bright man in his 40's? who speaks flawless English. He married a Caucasian and has two children. We were delighted to meet him and hear the story about how he ended up in the US. 

Turns out, he was working as a waiter at Tarangire, a safari lodge about three hours from here, when he struck up a conversation/friendship with visiting tourists. These tourists were friends of the owners of the safari lodge, the SIMONSONS, long time missionaries here. The Simonson's and Rowbergs have had deep connections for decades! Long story, but these tourists were so taken with Allan that they eventually provided his plane ticket to the US and helped him attend a community college. He excelled and wanted to continue studying business at a university.  Simonson's used their influence to get him an international scholarship at Concordia College in Moorhead Minnesota!

Well, this was all just mind boggling to us to learn that Wema's cousin was connected to the Simonsons!  Dave and Eunie Simonson started the Maasai Girl's School where Wema now attends!  That made us curious about Wema's family tree. We heard she comes from a rather influential family, but we did not know how everyone was related. Orjantan talked with his mom and provided us with a family tree which is complicated. The family is large and people here take their father's first name as their last name. 

The tree starts with Wema's grandfather named Kilevo who had a first wife and after she died, a second wife. (Many Maasai have more than one wife at the same time). Kilevo had five children, including a son, Mesiaki who is an influential person around here, with the first wife. Then Kilevo had 11 more children with his second wife. Victor (Wema's father) was number 9 from that mother. Incidentally, this wife (Wema's grandmother) died last summer when we were here and she is buried on their property. I remember when she died and am sorry we did not get an opportunity to meet her. 

Apparently, Kilevo was fairly well off, at least in terms of land. The large family has now divided up this land, but most of them still have generous parcels next to each other and within walking distance of our house. 

Ok....so back to Allan and our remarkable visit. We learned that Allan's father was Mesiaki. That is a well known name here but we did not understand his connection to Wema until we studied the family tree. Mesiaki is Wema's uncle. We were curious to meet him, especially after meeting Allan. Both Linda and Erik had told us about Mesiaki but no one knew the exact connection to Wema. 

So, last week Orjantan brought Mesiaki to our house!  (Saki was here too and finds the connection to Tanzanians through us fascinating.) In walks this handsome, stately gentleman using a cane. We were so happy to meet the patriarch of the family!  His story is every bit as remarkable as Allan's, who is his 6th child out of 8. We learned that he is 84 years old and living nearby with his wife. He is a retired Lutheran pastor! He also received sponsorship in the 1960's and even attended Luther Seminary in St Paul Minnesota!  He used his newly acquired smart phone (just amazing that he is so capable!) to show us family photos. So we had a glorious evening getting to know this remarkable man. He has written a book....a memoir, but it is in Swahili. 

Anyway, here is the the punch line:  Mesiaki finally figured out who we are because he has met met Erik....and we discovered that he also had known Ray, Don's father!  Now this just seems hard to fathom that Wema's family has had connections with our family from long ago...and we are just now figuring it out!

Tonight we are invited to Wema's house (Saki too) for a dinner of bananas and beans cooked in coconut milk. They asked me to bring a plate of fresh veggies and dip. Eating cold food is new to them but they tried it at our house and enjoyed tasting hummus and curry dip. They love experiencing new things!  So our relationship with this family continues to be one of the highlights of living here!

I wanted to end with this story. As I mentioned, my main function is to provide various types of gatherings for various people several times a week. Preparing all that food requires a lot of effort because the shopping is so difficult and involves so many stops in the midst of traffic that is nerve wracking. Each time I do this I am aware of how difficult everything is here!  Everything is so much harder and more time consuming than at home. 

I decided to throw a "going away party" for Wendy, a visiting medical student from New Zealand. I invited Jacobsons and another American couple our age who were leaving the next day as well. I told Wendy I could handle up to 14 people so she could invite 8 more including herself. Included on her invitation list was a Japanese woman she met on Safari, her safari driver and a performer she met at a nearby safari lodge!  With such a wild assortment of guests, I knew it would be an interesting evening. 

I knocked myself out and fixed a vegetarian meal since Wendy and a another visiting resident are vegetarians.  We enjoyed carrot curry soup, mediterranean rice salad, Thai peanut salad, chutney, fruit salad and an amaretto/almond/ lemon bundt cake for dessert. Wendy is Chinese and she brought dumplings made from scratch!  Linda contributed a green salad. The evening was such a fun global experience!  That is probably my favorite thing about being here....all the global connections. 

So the "old folks", like us, left first. The last to leave were the Tanzanian young men: the safari driver and the back flipping, fire tossing performer. They thanked me over and over for including them and for all the good food. As they left, they said my name should be changed to MOTHER AFRICA!  This would not be so funny if they said this to Linda....she actually deserves that name!  But for me, with all my difficulties adjusting and all my grumbling about the inefficiencies in this strange place, the irony of being referred to as "Mother Africa" has kept me laughing! And laughing is indeed the BEST medicine!

❤️Debi

Sunset in Tanzania

More hospital cases from Don

What do you do when somebody doesn't have a measurable blood pressure? That's kind of a problem. A 26 year old woman came into the hospital in the midst of having a miscarriage. That's the first problem. She does have a heart beat, but the blood pressure is so low that it can't be measured. This is considered to be a bad situation. She also had excess fluid in her body, heart failure. Her heart was huge on chest X-ray. The platelet count was low so we initially were concerned that she had HELLP syndrome.  Yes, that is really the name of that syndrome. The platelet count came up quickly so either it reversed quickly or it was a lab error. We don't have any of the intensive monitoring equipment to duplicate monitoring that happens in the US.  We also don't have blood pressure or heart contraction stimulating kinds of medications. We used very small doses of a diuretic to increase urine production.  We can't help the blood pressure, but can carefully reduce the excess water situation. By the next day she is feeling somewhat better and I am barely able to find a blood pressure..  Her echocardiogram showed massive chamber enlargement and mitral valve stenosis and regurgitation; the valve is too tight and leaking at the same time most likely due to rheumatic heart disease which has become fairly rare in the industrialized world, but is still common in the developing world. She survived and we are following her as an outpatient to continue to get the rest of the fluid off and adjust her heart failure medications plus she will see the gynecologist to manage contraception.  She will not likely survive another pregnancy. It pays to be young if you get sick.

Two weeks earlier, another no blood pressure and in heart failure ICU patient came in and we also couldn't hear bowel sounds. You hear your stomach growl every once in a while.  Your doctor can hear bowel sounds ALL the time. Normal hemoglobin is higher than 12 and we think about transfusion at 7.  Hers was 2.8 probably from a bowel perforation and internal bleeding.  We gave her a transfusion which can help the anemia and blood pressure, but contributes more to her heart failure so we also gave her the diuretic.  The next day we also found pneumonia. She won't survive anesthesia or surgery so we treated her multiple problems medically and she did seem to perk up then suddenly died two days later. I don't think she could have survived in a US ICU either.  When you get so many strikes against you, additional organ systems start to fail and survival becomes impossible. Failure is more likely when practicing medicine in a "resource poor" setting. My digital medical textbook recognizes that 80% of the world's population live in resource poor countries and gives different treatment recommendations for resource poor settings.

We do get some straight forward and almost always successfully treated kinds of problems.  High blood pressure because of stopping the pills, new diagnosis of diabetes, malaria. Globally, malaria is the #2 cause of human death behind humans killing other humans. I have not had a patient die from malaria while I have been out here. It is particularly deadly for children and pregnant women so the OB and pediatrics wards have the high risk patients.

We just sent home a patient with a disease I have never seen before.  After seeing my photos, you will be more experienced than 99.99% of doctors in the US. A Maasai women came to the hospital with the right side of her face extremely swollen.  I had to pry her eyelids apart to get a peek at that eye. She also had two funny looking skin ulcers on the back of her neck.  I didn't have a clue as to what those things were.  The intern in casualty (urgent care) suggested a diagnosis. I looked it up in my digital medical text downloaded in my smart phone.   Sure enough.  That is what the patient had.

Raised, swollen edge and black eschar (like a scab) in the center.  Anthrax. There was that anthrax bioterrorism in Congress in 2001 with a bunch of anthrax cases.  However, in the 2 decades prior to that, there had been only 7 known cases.  It is not common among the cattle-herding Maasai, but it isn't rare either since most human infections come from infected animals.  

The humorous puzzle was the intern's history that the patient got the infection from eating a "caccus." I wondered if the intern was misspelling "cactus." When I asked about that, the verbal report was that she had eaten a "cawcus" (my phonetic spelling). That was when I recognized the Tanzanian soft R sound in that word.  She had eaten a dead sheep, a carcass. The intern had written a phonetic spelling of how he pronounced carcass. The Maasai think cooking meat well cures all ills which is partly true, but in the processing of the "caccus," you get exposed to the bacteria and the bacterial spores. Infection follows.

She was a particularly delightful Bibi ("Grandmother" in Swahili which is  a respectful title), waving to us with both hands when we saw her on ward rounds (2 weeks of IV antibiotics). She only spoke Maa, the Maasai language, so I had to talk to her through a series of 2 translators (Maa to Swahili, then Swahili to English). She consented to posing for a photo with me which I appreciated since Maasai are reluctant to be photographed unless you pay them a modeling fee.

Then she decided to be funny and rub my head. She needs 2 months of anti-anthrax pills to protect against repeat infection if the spores start to activate and grow. After 2 weeks of IV therapy, my risk of getting anthrax from her was slight, but that was more exposure than what I was planning on. At least I will recognize it if I get anthrax skin lesions.

Don