Random snippets from the week...

...although if there is one thing I have learned this week, it's not to send emails out late at night! Somehow in my exhausted state I must believe that my email recipients will know what I was thinking when I wrote the email... not! And thus resulted a rather frustrating one week of an important research project here hanging in the balance; at least some denouement today, though I will say, still a bit frustrated. Oh well...

My vodacom adventures continue... so I texted my buddies a few weeks ago and got Andy a modem in record time, 10 days! More recently, I texted my voda friend Muta again -- who sometimes flirts with me over text, 'Wow, Malavika, your swahili is nzuri sana (very nice!) -- to see if our voda modems would work in other African countries. This was a question for none other but the Vodacom Moshi manager and even warranted a phone call, not a text response -- and if you've ever been in a low-resource country, you know that everyone communicates via text only because it's so cheap!! Turns out my voda will not work in other countries... but in the process, I heard Voda's hold music, which is this corny Swahili jingle... and it was so funny that I asked Muta if he knew it, which he did and promised he would sing it next time we met :)

I'm still finding it difficult to stay abreast of world news and U.S. happenings -- health care debate? I've got no clue what's happening on that front. At least podcasts keep me busy and entertained. Here's are some funny pick-up lines and good responses from my favorite podcast of the week. I'll buy you a special tanzanian present if you can identify which podcast they are from...

guy: haven't i seen you some place before?
girl: yes, that's why i don't go there anymore

guy: is this seat empty?
girl: yes it is and if you sit there, this one will be empty too!

guy: your place or mine?
girl: both. you go to yours, i'll go to mine.

guy: so what do you do for a living?
girl: i'm a female impersonator

guy: i would go to the end of the world for you
girl: but would you stay there?

I've been listening to Tanzanian radio lately, mostly because Mama Rosie turns it on and I work from home every so often. She listens to a gospel Swahili channel (which I figured out because every song is about damu and mungu -- blood and god!) that also recites news from 1pm to 2pm. The news hour is hilarious on multiple fronts --

(1) The same news is read 3 times, from 1-1:20, 1:20-1:40, and 1:40-2. Each 20-segment alternates between a man and a woman reading the news, but it's seriously the same news!! How can I tell? Because although I feel rather cut-off here, even I know that nothing is so dramatic is happening that Benjamin Netanyahu, Mahmoud Ahmadinejad, Angela Merkl, or Hamid Karzai are worth mentioning 3 times in 1 hour. Or 'Barack Obama' and 'nuclear reactor,' which by the way, in case you didn't figure out, is Swahili for 'nuclear reactor.' :)

(2) Each repeated news segment is punctuated by music. Keep in mind this is the gospel channel (Bariki confirmed this). So far, the transition music has included Tupac's California Love, Beyonce's Single Ladies, Marvin Gaye's Sexual Healing, and Madonna's Holiday. Don't worry, I'm making a list.

Well it's fitting I should end this tired post on my favorite streams-of-consciousness sentence of the day. From a message sent by Sarah, who left Moshi last week: "Just got back from Kroger and was really surprised how little of the food actually looked appealing. Where are all the super cheap delicious vegetables?"

Me: "heehee, they were cheap and delicious until someone decided to freeze them spray them with chemicals transport them halfway across the world then create artificially colored bags so the grayish dry tangerines look too-good-to-be-true-but-you-fall-for-it bright orange in the store. dont you think? :)"

And with that, goodnight to a long week and a relaxing weekend ahead!

Don't forget to send in the name of the podcast from which the pick-up lines originated! :)

Eid Mubarak!

In other words, the end of Ramadan! Marked by none other than glimpsing the moon in the 22 minutes after sunset, the day after no moon. Needless to say, this was next to impossible for us, as the sun sets behind Mt. Meru (see prior post), which is often obscured by haze. As it was Saturday evening.

Nonetheless, in anticipation of Eid occurring Sunday, I joined the celebration at Sumera's with mehndi hair dying (I refrained), hand painting (I happily acquiesced), feast preparation (guacamole and tea, not necessarily together), and moon searching -- at the Moshi airport! (I know you're thinking, Moshi has an airport!?!?!? Don't worry, it's a dirt strip :))

As you can guess, we didn't see the moon, but apparently, it was sighted in some small Tanzanian town, and word later trickled our way that Saudi Arabia also decided Eid was Sunday. For us, that meant only Monday was a public holiday, as opposed to Monday and Tuesday. Clearly, I could have used a fourth day to read, do yoga, cook, and, oh, did I mention read? I'm reading 3 books right now -- The Book Thief (very addicting), Dark Star Safari (very condescending), and The Invisible Cure (very intellectual). I bet you can guess which one is closest to being done :)

Yes -- I am cooking now!!! Brandi and Sarah and Aaron left this week, meaning that I have large oven mitts to fill! Must graduate beyond scrambled eggs... of course, I started with my banana bread, which also tastes yummy in Moshi. Foster's would be proud :) Aaaand, Indian food cooking begins now -- I've already made daal twice!

Pictures from Brandi's and Scott's going away party at my house... I can't say I did much this week, especially not at work, in my last-minute attempt to finish Brandi's going away present -- a scarf for the incubating mtoto, with the cable in the middle knitted thanks to a twig. Only in Africa.... :)

I bought chana daal from the market... note all the
crap I have sifted out!
working hard...

the spread... (yes, that IS strawberry shortcake!)

Safari!!!! Arusha National Park

A post with pictures only :)

We went to Arusha National Park this past weekend, thanks to an unexpected gift of a car for the weekend....

The entrance to the park... probably the best bathrooms I've seen in Tanzania are here!!

Below are the highlights of the animals we saw....

Aaron spies the first animals!

Giraffes -- including babies!!! Definitely the cutest animals...
so soft and fuzzy. I kind of want one as a pet!!

Flamingos -- probably the most beautiful sight is how they
run across the water before they get enough speed to fly.

Water buffalo -- rather ominous looking...
remember the skull cemetery in The Lion King? Water buffalo.

Babboons and colobus monkeys

Zebras and warthogs coexisting...

A rare hippo sighting...

Last but not least, bush buck/deer-like animals

Scott started drawing the animals we saw :)

And some highlights of the landscape...

Mt. Meru

Mt. Meru is in Arusha National Park, and we had an amazingly clear view of the day, in particular when were on lookout point sandwiched between Kili and Meru.

The Sandwich -- Kili

The Sandwich -- Meru

Cool trees!!
the Momella Lakes (with a water buffalo skull)

On va aller au cirque... (we're going to the circus!)

I found something I miss!! And it's huge (maybe even legen.... dary)!! Clean feet. Seriously. I can't win -- they are dirty and dusty pretty much 24/7. And I look at the feet of locals and I do not want my feet to end up like that... So I soak my feet in hot water about once a week, then pumice stone like crazy, and come away with nice-looking feet again... only to walk down the barabara (street) to my friend's house and become dusty allll oooooover agaaaaain. Such is life :) TIA -- This Is Africa, apparently the cathartic exclamation for all things that go awry in Africa, although I prefer my personal motto -- always an adventure in Moshi.

Speaking of adventures, do I begin with going to the circus or singing Kumbaya?

Maybe Kumbaya, that was pretty classic! The KCMC-Duke collaboration works with an organization in town called KIWAKKUKI, Swahili for Women Against AIDS in Kilimanjaro. KIWAKKUKI does lots of good work in the community, empowering especially women who are HIV-positive, doing outreach through home-based care, improving access to voluntary counseling and testing.

But my favorite activity of theirs is helping children create memory books. Many children in Africa are orphaned due to HIV-positive parents. They can end up being taken care of by other siblings, by grandparents (believe it or not, this occurs! If you're interested, read about the topsy-turvy demographic tree in sub-Saharan Africa), by distant relatives, or they can end up in an orphanage. Depending on the family structure, these orphans can end up as second-class citizens among their extended families, as they are viewed as an extra mouth to feed, and often work very hard every day at the bidding of the relatives to whom they are beholden. So KIWAKKUKI works with children of HIV-positive parents to help them create 'memory books,' about their parents, their families, their lives -- all the things kids yearn to know and ask their parents when they are much older. What was my first word? What was my first day of school like? These books are pretty powerful and really sweet.

The reason I talk about KIWAKKUKI at all is because two of my research projects this year are thanks to data collected at KIWAKKUKI, so I wanted to introduce myself to them -- a whole rigmarole!! They start every morning with a song praising God -- Jesus is my rafiki (seriously!) -- then each department gives updates... and then it was time for me and Andy (another research assistant with our collaboration) to introduce ourselves. It is tradition at KIWAKKUKI that we be welcomed with a dance, in which we must participate!

The traditional dance is rather odd -- it's going low and ending up in a squatting position. Andy was pretty mortified, but I had a lot of fun!! The best part was that Andy said, Oh, we didn't get a picture -- so we did it all over again!! (I confess, these pictures are from the reenactment.) And at the end of many hugs and handshakes, we sang Kumbaya -- it was like being at a revival!! Entertaining, indeed!

And now, to the circus... Mama Afrika circus came to Moshi for the first and probably last time ever!

they had a monster-like tent!!

They were really more like a Cirque du Soleil troupe, no animals, though lots of contortionists! The acts were really cool -- lots of African dancing and drumming, juggling, balancing on 5 axles, a couple of trapeze-like artists, and most impressive -- crazy bendy people!!! Three guys just walked around like crabs/spiders. Their legs were up on their shoulders so that their knees bent over their shoulders.

One guy was standing on his arms, his legs were curved up from behind (I think) over his head and firmly planted on the floor -- and then he proceeds to light a pipe by striking a match with his toes!! Sheer talent. (Ehlers-Danlos, anyone?!?!)

Then the pantomiming clown came out, and he was hellbent on selecting wazungus for his mimed act of Tutti-Frutti! Thankfully, our group was safe, but he did thoroughly embarrass the participants -- stripped some guy's shirt off! Then it got a bit weird -- a sinister clown on stilts ran around the arena to some drumming, fell over a few times, and proved he could hop back up no problem.

But the best part was the jugglers who turned into rappers about "24-7, Africa," and concluded with a breakdance-off. Bet you'll never see that in the States!

A busy week, all in all!! Updates --

--I am soooo close to my IRB being submitted for one of my projects and then not thinking about it until data collection is complete!

--a different IRB got exempted at Stanford (phew!!)

--Jeff and I met with high schoolers at the expat school, ISM (where Greg Mortensen, from Three Cups of Tea, went to school!), to recruit some help on the blood drive

--rounded on Brandi's last clinical day on the peripartum and postpartum service -- no maternal deaths this time, thankfully!

--saw an interesting case in the OR with a 16 year old girl who actually has... testes (that we took out because they are a cancer risk) and no ovaries. Unclear diagnosis right now, but she really needs a karyotype!! (A test that tells you whether she has two XX chromosomes like women have, or an X and Y, like men have.)

--I had to be introduced officially to the head of KCMC during our monthly Duke-KCMC meeting. Believe it or not, my introduction by my famous ID attending housemate was as follows: former Duke undergraduate, current Stanford medical student, and future Duke Ob/Gyn resident, although she doesn't know that yet. !!!! I was a bit surprised and a bit embarrassed!! But it's nice to be recruited :)

PS -- the legen.... dary is for all you How I Met Your Mother fans. Please tell me at least one of you knows what I'm talking about!!!

PPS -- the end of season 2 of How I Met Your Mother is so sad!! Who wants to send me a burned copy of season 3? I have to know what happens next!! :)

Time for another week to begin... still more to tell you. I swear I'll be less delinquent this week!

Lyrics to Kumbaya, because despite my jesting earlier, actually it was really nice to start the day singing together -- I felt more connected to 12 strangers than I ever have before.

Kumbaya my lord, kumbaya
Kumbaya my lord, kumbaya
Kumbaya my lord, kumbaya
Oh lord, kumbaya

Someone's singing lord, kumbaya
Someone's singing lord, kumbaya
Someone's singing lord, kumbaya
Oh lord, kumbayah

Someone's laughing, lord, kumbaya
Someone's laughing, lord, kumbaya
Someone's laughing, lord, kumbaya
Oh lord, kumbaya

Someone's crying, lord, kumbaya
Someone's crying, lord, kumbaya
Someone's crying, lord, kumbaya
Oh lord, kumbaya

Someone's praying, lord, kumbaya
Someone's praying, lord, kumbaya
Someone's praying, lord, kumbaya
Oh lord, kumbaya

Someone's sleeping, lord, kumbaya
Someone's sleeping, lord, kumbaya
Someone's sleeping, lord, kumbaya
Oh lord, kumbaya
Oh lord, kumbaya

A mismash of happenings last week

So, another blog post composed circa the latest Harry Potter viewing... this time, we watched a better version, Harry Potter y el misterio del principe, (yes, Spanish, and not exactly a half-blood prince!!) at the outdoor 'theatre' at the Watering Hole, with the unique Moshi special of bats flying everywhere. It was pretty spooky!! :)

Backing up to last week for a bit... on my birthday, I also received two new housemates -- a very famous Duke ID attending and his wife. Yeah, I know what you're thinking, so I'll just put it out there -- it definitely is weird to be in my PJs and glasses making tea every morning in front of an attending-level physician!! But, I will say that both of them have been absolutely awesome and super fun :) The attending helped establish the Duke-KCMC collaboration, so he was on a whirlwind mission of seeing all of his old friends -- which meant I met new people!! (Ok, they are old(er), so not exactly people to hang out with, but I can't be picky in Moshi!!) And they used to live in A5 for 4 years, so they totally gave me the skinny on Moshi, and took me to my first hash!

What's a hash? I hope you have that question, because I sure did, and everyone was like, Umm, do you even speak English? A hash is hiking trail that someone sets, with an "X" marked on the ground, indicating there is a treasure buried there!! Just kidding, actually it indicates that there are 2-3 possibilities of where the trail could go and you just look around until you find the next flour mark indicating the proper direction. It's really a lot of fun -- you can run or walk the hashes, most of which go through the backwaters of Moshi. My first hash, the day after my failed Kili hike, was actually on the slopes of Kili -- so I got a hike in on Kili after all on my birthday weekend. And it was tough!! ... because we took the runners path though we were walking, AND because the guy who set it holds the record for the fastest ascent and descent of Kili. All 20,000 feet in 8 hours!!! yes, CRAZY. Oh, and his day job is making some of the best coffee in the Kili region...

Some pictures from both hashes I've been on...

see?? proof we were on Kili!!

cute children on the slopes of Kili

seriously walking through people's yards

many rock paths through rivers... one day we'll be in the river, I'm sure

I can tell, bridges are going to be a huge theme this year...

Coffee plants and banana trees, the lifeblood of Kili agriculture

Little kids play hopscotch here too!!!!!
the sun setting over Mt. Meru... end of hash #1

On a more sobering note, the most salient memory from last week was watching two patients die during rounds. Literally. The first lady (23 wks pregnant with twins) died due to respiratory distress as a result of presumed PCP pneumonia (an infection that only HIV positive people get). It's presumed because there are no diagnostics here -- so many diagnoses are presumptive, which really makes me wonder... do we do too many tests in the US to diagnose or do we diagnose wrongly out here too often? Of course, on the whole, I believe the latter, but on the margin, maybe we could use our resources more wisely in the States....

Anyway, we walk into the next room over to find another patient, this time 26 weeks pregnant, unconscious/not breathing, with an unclear diagnosis -- meningitis, subarachnoid hemorrhage? So we started resuscitating her, although really she looked like a rag doll -- totally floppy, eyes open and lolling around... we finally got her intubated by anesthesia about 35 minutes after ventilating her... at which point someone comes in frantically asking, 'Where's the epi?' (That's epinephrine, usually a drug of last resort that tells you someone is really sick.) At that point the first lady had coded, meaning she wasn't breathing and her heart wasn't beating, so then we started CPR/chest compressions on her, but of course she was already gone. Meanwhile, the other lady had gotten transferred to the ICU, but she was brain dead and extubated 12 hours later.

It was horrible. I have never seen a scene like that, and compressed into 60 minutes on top of it all. I was pretty much sleepwalking through the rest of the day, trying to get those pictures out of my mind and at the same time, trying to remember every detail so that next time, maybe I could be more helpful, maybe we could save someone -- even one out of five might have been a good outcome -- but here, none of them would have had a better fate alive given how sick they were.

Everyone has stories like these when they do work in low-resource settings. Even two weeks ago, this patient whose emergency c-section I watched died about 4 days later, on my birthday, of completely unclear causes. Everyone can tell these stories. The thing that is great about research is that we understand so much about the obstacles, the diseases, alternative treatments, etc, and ultimately we can make the situation better, but I also realized that it doesn't change the outcomes of these single patients day-to-day. So again, I am thankful that Jeff is so clinically-oriented -- although many researchers would disagree, to me, there is no point studying all the problems and waiting for the results of your work to get published to make a difference, when the patient down the hall could survive if you did something about it. And he does, every day. So although I don't have such clinical skills yet, I still hope to make a difference for our patients -- and I'm determined for my blood drive to become a recurring event in Moshi.

Hash #2 pictures....

the people who set the hash had bunnies!! (but they eat them :( )

you can't quite tell, but we caught some boys bathing... they are hurriedly clothing in this picture :)

cool tree we saw!
Typical construction around here... really sturdy!
1+1=11. Explains so much about Tanzanians' math skills