Monday, July 26, 2010

The Faves

It’s my last week in Mogo and I’ve been thinking about trying to write some sort of ‘highlights’ or top moments post. But, since trying to synthesize this entire year into one punchy blog post is clearly unattainable, I thought I’d share some of my random favorites – about Tanzania and my life here:

Favorite thing about living in Morogoro
– seeing the Ulguguru Mountains; the yogurt (seriously. You have not had this yogurt. It’s amazing); having my own house.

Favorite thing about having my own house – PARTIES! Movie-night, pizza-night, Mexican fiesta and Cinco de Mayo. It’s been awesome to have a place to invite people over to where they can relax, feel at home and have a good time.

Favorite songs that remind me of being in TZ
- well, obviously R. Kelly’s “Remix to Ignition”. Duh. But also the “Pole, Samaki, Pole” song, “I’m on a Boat” and “Live your Life”. It’s been the year of cheese-tastic hip hop.

Favorite Memories
– I could never pick just one, or even a top 5. But here are a few amazing ones that come to mind:
  • First weekend in Dar – there is just nothing like that ‘high on life’ feel of being in a new place at the beginning of a new adventure
  • Riding ‘mishkaki’ on a pici pici with Matema home from dinner one night in the rain – something about that was just so hilarious and so uniquely Tanzanian
  • The first time I saw the Ngoronogoro Crater – love at first sight
  • The booze cruise, I mean boat ride, with the Fellows during the midyear retreat in Rwanda
  • Driving through Saadani National Park as the sun set drinking Safaris and looking for animals – a truly golden moment

Favorite foods I make here – pizza (my pizza recipe has gotten pretty good this year; homemade dough and homemade sauce), Karen’s oatmeal bread (so easy, so yummy), peanut butter cookies (they’re legendary at this point)

Favorite run in Morogoro – from my house, down the hill through the pasture, down the Apopo road, through the university and out towards the Apopo TB site and then back. (FYI: this sounds a lot longer than it is)

Favorite thing to eat for lunch – my salad! I have eating this probably approximately 250 days this year for lunch: a cucumber, green pepper and a couple of carrots cut up, thrown in my glass bowl with the lid and toss with a dressing of olive oil, apple cider vinegar and soy sauce. Top with some sesame seeds or peanuts and viola! A lovely lunch.

Favorite movie to watch this year – If I’d actually had the BBC version of Pride and Prejudice I’m sure I would have watched that about 20 times. The newer Kierra Knightly version stood in nicely, but still cuts so much out! I also watched The Family Stone pretty often. I’m also on season 4 of How I Met Your Mother. Never had watched in the US…now I’m kind of addicted.

Favorite snack – mini bananas and peanut butter. They have these small bananas here that are so good and sweet they will blow your mind. And the peanut butter is made locally and is all natural = delicious!

Favorite thing to think about that I wish I would have done (kind of a stretch, but humor me) – buy some sort of transportation! Even if it was just a bicycle. Transportation here is freedom and freedom is worth a lot. If I were to move to live in Africa again for a year that would be the #1 thing I would do differently.

Favorite part of my day – mornings (if you know me well, shocking, I realize). The sun comes up over the mountains and floods my kitchen with warm, glowing light. I love to sit at the kitchen table, drinking coffee or tea and eating my breakfast.

Favorite trip outside of TZ – South Africa for the World Cup! Rwanda was pretty awesome but South Africa was the jam. Nothing like getting to be at the first World Cup held in Africa.

Favorite trip inside TZ – Kilwa for Thanksgiving. Pumpkins on the bus, scuba diving for the first time, laying on the beach and cooking up an amazing dinner of red snapper…it was one of my favorite Thanksgivings ever.

Favorite spot in Tanzania – The Ngorongoro Crater. I just love it.

Favorite name to be called when being greeted – “mamma”. Habari ocho mamma? Generally reserved for women who are actually mothers; or at least who you think are old enough to be mothers. That gets me every time!

Favorite thing I received in the mail this year – Hands down, Special K bars that my grandma made and sent to me. They may have gotten lost in the mail for 3 weeks, but they were still delicious. A close second is the beer Emily sent me from Colorado. Heart Dale’s Pale Ale.

Wednesday, July 21, 2010

AIDS 2010

The International AIDS Conference is going on this week in Vienna, Austria. It's a conference that happens every two years, and is a chance for the world's leaders on HIV/AIDS and global health issues to come together. This year much of the discussion is around trying to move closer towards the goal of universal access to HIV/AIDS care and anti-retroviral drugs (ARVs) for treatment. This conversation is occurring against a backdrop of what some see as a shift away from a committment to fight HIV/AIDS by the global community (including the US)in favor of other global health issues.

Without getting into a debate on global health policy and funding, I think it's worthwhile to point out that I think allowing the conversation to be framed as supporting HIV/AIDS or any other global health issue is exactly the debate we need to avoid. Former President Bill Clinton addressed the conference on Monday and I think his remarks sum it up nicely:

Clinton finished by running through six priorities global AIDS funding needed to achieve if the momentum towards global treatment and prevention was to be continued. These were: to avoid false choices between different disease areas; to strive for lower drug costs; to target prevention efficiently; to enact “disciplined, honest, no-backside-covering ways to save the costs of drug delivery;” to create better private donation and investment structures; and “to educate people why this is good.”

“Our only chance,” he concluded, “is that the positive forces fighting HIV are just that little bit bigger than the negative ones

With the very real limitations in funding and resources to address the myriad of global health issues (HIV/AIDS, maternal health, childhood illnesses, neglected tropical diseases, malaria, TB), it's tempting to plant your feet on an "issue" and want to fight for that one. But I think the tendency to digress into territoriality is one of the biggest, and potentially most fractious, challenges facing the global health community.

As I think about starting my PhD, in the very specific area of maternal child health, watching the discussion happening around the AIDS 2010 Conference is a good reminder to me that healthy mothers are only a piece of the picture; the overall goal is healthy and happy people that can live the life they want to.

We've seen in the past that vertical programming (programs that address only one disease or health issue, rather than strengthen the whole system) has been ineffective. Now we need to take the next step and realize that vertical advocacy or vertical funding will be just as ineffective at solving global health issues.

Monday, July 19, 2010

Three Weeks

Three weeks from today it will be August 9th, and I will arrive back in the US after a little more than a year in Tanzania.

In the last couple of weeks in Mogo, the university has let out for summer holidays and many people have left, so life has been relatively quiet. Thus, I've had a lot of time to think about what it's going to be like going home.

Obviously it's a bit strange to try prepare yourself for being back in the US. After all, it has been my home for the vast majority of my 28 years, how strange can it be? Still, I can't imagine it won't be a little weird... I somehow picture myself running off the plane, buying Junior Mints and ordering soy latte's, while shoving pretzels in my mouth and staring wide-eyed at all the bright lights. (Let's all hope this scene will be avoided).

And while I do look forward to some Junior Mints, pretzels and latte's (but probably not all at once), I doubt that the availability of chain-coffee stores and more junk food will be what strikes me about being back. The thing is, I don't really know what will strike me about being back. I think that's the toughest part of trying to prepare to go home. What will feel weird? What will seem different? Or will nothing seem different and that will be the weird part?

In past travel ventures, the experience being back goes something like this: initial euphoria at being home, clean clothes! an actual (hot) shower! your own bed! your favorite foods! you see all your friends and hug all your family and run around in a jet-lagged frenzy for a few days high on the excitement of being back. and then,....what?

It's hard to put your finger on exactly why, but I think one of the hard things about coming home, that "let down" you often feel after the first few days back, is something about having been in a situation that challenged and stretched you, almost constantly, for a long time and now suddenly life is just, well, normal. And it can be hard to switch back to that speed.

When I get home I'll be spending an action-packed week in MN that will involve a lot of a) seeing friends b) eating c) day drinking and d) kissing babies (but not necessarily in that order). And then I'll be heading out on an epic road trip to North Carolina with my dear friend Kristi and have just under a week to get settled before school starts.

It's going to be a little crazy (not exactly "normal" speed), and while I do wish I had more time before school starts, I think the fast-paced-ness of it will actually be good for me. It will give me something to dive into and to put my energy into. And it will give me a new place to explore and most importantly a new challenge to focus on. I think coming home without an outlet to focus your mental energy into would be tough.

As I hang out in Mogo my last few weeks, doing nothing much in particular, I'm taking time to enjoy the mundane-ness of it all: going out for a run, buying vegetables at the market, sitting outside in the evening drinking a beer, reading a book. There's not much going on here, and while sometimes I do get a little bored, I'm also enjoying it. Because I know in a few short weeks I won't have the chance to go to bed at 9:30pm if I'm tired or decide to make pizza sauce, just because. Life in the US will be back, and it will be busy and full and slightly chaotic. And I'm excited for that; I look forward to that. But I know I will miss TZ and being here.

So for right now, I'm trying to savor every moment of my last 3 weeks, and especially the quiet ones. I'm sure the Junior Mints, lattes, and all the rest of it will be there for me when I get back.

Tuesday, July 13, 2010

Post WC Blues

Now that the WC is over, I'm not quite sure what I'll do with my time. But, at least I can still hear the song that was on pretty much every single commerical played in TZ during the WC.

Tuesday, July 6, 2010

Friday, July 2, 2010

The Big Man

I read this column today in the NY Times by Richard Cohen, which tries to draw some parallels between the teams that have advanced to the quarter-finals in the World Cup and the politics of Africa. It's a bit of a stretch, but Cohen points out that the teams who relied on one "Big Man" (aka star player) have not fared as well other teams who rely on their collective strength and talent as a team. He brings in examples of other infamous African dictators (Mugabe, Mobutu) and how the proliferation of the "Big Man" syndrome in Africa has spelled disaster is so many instances.

Like I said, it's a bit of a stretch. A football team is hardly a nation, and playing together for 90 minutes isn't really that much like running a country. Yet, I do think Cohen has a point. Soccer, politics or any other arena, the "Big Man" definitely exists in Africa. Sometimes they go by different names, "The Big Boss" or "The Bwana Kubwa", but everybody here knows and understands what and, more importantly, who, is a "Big Man". Simply stated, they are the ones with the power. And they are not the ones you question or stand up to.

To state my personal bias upfront, I deplore the presence and proliferation of the "Big Man" syndrome that I've seen in Africa. The swagger, egoism and sheer audacity of (sorry to say, but it's always) men in power who presume themselves infallible, or at least un-catch-able, strikes me as odious and offends my deepest values of equality, justice and freedom.

But that is also part of the point. As a Westerner, I grew up steeped in the sacredness of democratic ideas. And as an Americans, I grew up steeped in the even-more-sacredness of the right to self-determination and the ability for anybody, from anywhere to become anything they want. That's what it means to be an American.

But in Tanzania, children grow up learning different values - hospitality, togetherness, providing for family members and helping each other out are much more central values here. Equality is nice, but everybody takes it for granted that hierarchy is a basic and intrinsic fact of life here.

So you can see how the "Big Man" syndrome lives on. Power continues to be centralized in the hands of a few and people continue to keep quite and not demand their rights and the "Big Man" cycles continues.

I want to stay away from making any assertions that I "understand" this situation perfectly or "know" how to improve it; I don't. I'm a guest in this country and I will never understand fully what it means to be a Tanzanian or African. But in my year here I have come to feel deeply that for Tanzania to progress, there does need to be a stronger sense of ownership and self-determination among the people; to not only acknowledge their rights, but to actually stand up and exercise them.

But how to do fight for better wages when you've not job at all? How do you demand better healthcare when you yourself are already sick? How do you instill a sense of self-determination in a place where people often have so little control over their choices or lives? And how do you foster a democratic spirit without trying to make Tanzania into America?

These are not easy questions and they're ones I wrestle with all the time. But as I think about America's upcoming celebration of her independence, I do still have to hope that despite the insane quagmire of issues and obstacles to negotiate, Tanzania, and Africa, will continue taking steps towards taking control of their own freedom, and ultimately destiny. I hope in 20 years there won't be as many "Big Men" around. I hope Tanzanians will feel like they have a greater voice in determining the course of their country. And I hope Africa will be a freer place.

Monday, June 28, 2010

This I Believe

As we enter into the last month of our fellowship, some of the other GHC Fellows and me have taken some time to reflect on how your experiences this year have shaped our views on justice, health equity and life, to share them with the rest of the GHC Community. And because I love and desperately miss NPR, we decided to write them as "This I Believe" essays! Here are my thoughts; here is what I believe...

Last week I had the unbelievable opportunity to go to the World Cup in South Africa. In addition to spending a huge amount of time watching football and enjoying the atmosphere of the World Cup, we took some time out on Saturday to visit the Hector Pieterson Memorial Museum in Soweto.

Soweto is a township right outside of Jo’burg and one of the early hotbeds of resistance to the injustices of apartheid. Hector Pieterson was a 13 year-old boy who was shot and killed on June 16, 1976 when police opened fire on unarmed protesters who were marching in opposition to school being taught in the Afrikaans language.

Walking through the museum are photos, videos, personal accounts and placards describing that day. Young black children, dressed in school uniforms, lining up and walking towards white police officers holding guns. Kids running, chaos and crowds dispersing as shots were fired. A man wearing overalls carrying the lifeless body of Hector; his sister staggering, distraught beside him.

Everytime I visit a place that makes me consider the depth of human suffering caused by division in our world and the strength of human courage to stand against those divisions, it makes me thing one thing: Where would I have been in this situation? Where would I have been in Soweto? Where would I have been during Apartheid? Would I have had the courage to resist Afrikaner domination? Or would I have kept quite because I was afraid of getting in trouble or of getting hurt. Where would I have been in Rwanda during the Genocide? Where would I have been during the Civil Rights Movement in the United States or colonialism in Africa or the struggle to abolish slavery? Where am in today’s unresolved questions of injustice?

Reflecting on my year as a Global Health Corps Fellow I have no easy answers about the injustices that plague our world. If anything, I have a greater appreciation for the complexity and confoundedness of issues like health equity and poverty alleviation. But something I do still have, something deep down inside of me, is the conviction that in the face of injustice and inequality in our world we do have to find the courage to fight against it. We do have to stand up. We do have to say it’s wrong. We do have to find our voice.

Because injustice will always be in the world, and the only thing that can stop it, or change it, is for people to come together and create a new path. But in order to do that, I think the critical step (and the one we often miss) is realizing that we have to be united. We have to come together, talk to each other, listen, and commit to working together towards a common goal. We have to be willing to give up some of our personal vision for the collective goal and we have to be willing to sacrifice individual gain for group success. We have to be willing to stand in solidarity with one another.

I have no easy answers about how to solve the problems of health inequality or any other injustice in the world. But as I’ve lived and worked in Tanzania this year, I’ve become increasingly convinced that the only tenable path forward is the one that calls for deep and profound solidarity. Not simply with people in poverty or facing injustice. But with all people.

Solidarity to realize we are all members of the same human family. Solidarity to know that suffering for some cannot be allowed in exchange for a benefit to few. Solidarity to say I am not always right. Solidarity to give up some of what I have to stand up what you do not have. Solidarity to let believing in something better cost you something.

I don’t pretend that philosophical discussions on solidarity and “togetherness in the human family” alone will solve the problems in injustice in our world. But I do think that if we don’t consider these questions, and struggle with them every day or our lives, then we will never solve problems of injustice.

Because no one wakes up one day and becomes a hero for social justice. We all make a million little decisions, everyday, about the people we are going to be and the lives we are going to lead. And all those small little decisions, actions and thoughts are what add up to the fabric of our moral character and courage. If I want to be the kind of person that marched with Hector Pieterson in Soweto, then I need to be the kind of person who can stand up against the little injustices I see happening everyday. And if I can’t find common ground with the people in my immediate sphere that I do not understand or agree with, then how will I ever bridge the immense cultural, economic and social divides intrinsic in working in the global health field?

What I’ve learned this year, and what I believe, is that who you are matters. What you do on a daily basis, the way you treat people, the extent to which you stand with people and care about them and love them and respect them, matters. It matters because if we are going to strive for solidarity in the human family to fight against injustice, we need to practice it daily, with the people in our own lives. And it matters because if we’re going to find the courage to end inequalities, we need to find the commitment and patience to work together.

I hope that if I had been in Soweto in 1976 I would have been at that march with Hector. I hope I would have had enough strength and moral integrity to go by myself. But, if all of my friends, who cared about standing up for freedom and equality, had been willing to go with me that day? Then I know, without a doubt, that I would have been there. I know, in solidarity, I could have done it.