This post comes after the end of internships one, not before.
So, a total of six of us wanted to go to Zanzibar for a few days over break here. My friend Stephanie and I had a slightly shorter itinerary than the other four, because she flew back home on the 16th and I had to meet my mom at the airport on the 18th, while the rest of the group had a little more time to kill. We all rode an overnight bus to Mombasa together on Wednesday night, then we split up: Steph and I got a flight from Mombasa to Zanzibar, while the others went down the coast a little farther by land then caught a sailboat into Kendwa, a village on the northern tip of the island of Zanzibar.
First, I must say something about overnight buses from Nairobi to Mombasa. They are not pleasant. I slept very little thanks to the bumpy roads and the constant starting and stopping- even in the middle of the night the Mombasa highway is packed, bumper to bumper traffic because it’s such a major route for distributing goods shipped in through the Mombasa port. Then, when we arrived in Mombasa at about 6 in the morning, we had to sit and wait in the bus station for a while until it got light enough to be safe to walk outside.
Mombasa is HOT. At seven in the morning, as Steph and I wandered in search of a cab to take us to the airport, we were already drenched in sweat. It just doesn’t cool off in Mombasa, at least not in December. We found a taxi and set off for the airport. A short 45 minute plane ride later, we were at the Zanzibar international airport. Which is roughly half the size of the Central Wisconsin Airport, but with none of the security features. As we walked toward the door with our luggage, we noticed a cardboard sign with “CUSTOMS” written on in in Sharpie. Under the sign sat a friendly looking toothless old man. Turns out “customs” in Zanzibar means waving a polite greeting to the old guy then heading on your way. The heat in Zanzibar puts Mombasa to shame. As we walked out of the airport into a tropical sauna, we were attacked by about seven thousand cab drivers. I stuck with my usual selection tactic for this sort of situation: find the tallest guy and get out of there.
“Which hotel can I take you ladies too?” Hmmmm, it’s just that we don’t exactly have reservations anywhere. Steph had heard that a hostel called St. Monica’s was pretty cool, so we had the taxi take us there and hoped they had an open room. We were in luck. The room was amazing, small and cozy but with a private balcony. Bednets and ceiling fan included, all for $25 per night. St. Monica’s happens to be the site of the last slave market in Africa. As part of our overnight package we got a tour of the cellar below the hostel where slaves where kept until market day, and the cathedral built in honor of a British guy that worked to end slavery in East Africa.
Stephanie and I spent our afternoon just wandering Stone Town. It’s a perfect town to just let yourself get lost in. The architecture was fantastic. Brief cultural lesson: all along the coast of East Africa from Somalia as far south as Mozambique there is a common culture referred to as the Swahili culture. Aside from the Swahili language, these groups share the mixed influence of East Africa and the Middle Eastern and Arab traders that settled there for centuries. Stone Town is a perfect manifestation of that cultural mix. It was impossible to walk more than a block without running into an ornate mosque dating to the 15th century or some equally interesting building. The buildings are all very tall and close together, and the streets narrow cobblestone, so it feels like trying to get through a maze. A lot of the street scenes seemed more reminiscent of Europe than Africa, at least until a lady babbling away in Swahili offered you “good price for khanga, best in town”. For dinner, we had traditional Swahili food at an inexpensive local restaurant called Lukmaan’s near our hotel. Swahili cuisine is absolutely fantastic. The best food I’ve had in Africa. It’s all about spicy rices and curries and seafood. We went to bed tired from all the traveling and wandering, but highly content.
The next day was rainy. It was a true Storm Over Paradise!!! (couldn’t help myself) Steph and I wanted to find cheap public transport to get to Kendwa, where we would meet the rest of our group for a few days of relaxing on the beach. You’ll notice that “cheap” is a consistent theme throughout this vacation. I’m quite proud of what we accomplished in the end.
Anyway, the least costly way to get to Kendwa from Stone Town is to take a dola dola. They were described to me as similar to Kenya’s matatus, but that’s a lie. A dola dola is in fact a pickup truck with an extra long bed with benches running around the perimeter and a tarp overhead. These benches could seat about 12, so of course we piled 28 people in and set off. The island of Zanzibar really isn’t too big, so the drive to Kendwa was only 30 or 40 km. But it took a long time to get there because of frequent stopping to let passengers off and on. And the rain continued the entire way.
A soggy Stephanie and I found our resort in Kendwa, a beautiful place right on the beach. We checked in just as the rain was letting up, and went to dip our toes in the Indian Ocean. For those of you who’ve never seen it, the Indian Ocean looks strikingly similar to other oceans. Which is to say, it’s gorgeous and I love it. That night we did a little cooking of our own (to save money, you know) on a jiko, which is basically a tiny portable charcoal grill. The next day was packed full of Zanzibari adventure. We got up and walked toward the village a few kilometers to the north of all the Kendwa resorts, since everybody in our group firmly believes it’s important to see how the locals live and get out of the spotlight of tourism. High tide hit when we were about half way there, so we enlisted the help of a boat taxi to help us get around the cliffs. The village was everything our resort was not: dirty, on a rocky stretch of beach with a ton of seaweed. Barefoot, and sometimes naked, children approached us and showed us their skill in cart wheeling over the sand dunes. It was impressive; I’ve got a video to prove it. We ate lunch at a local food stand. It was delicious but I’m shocked that none of us suffered from adverse gastrointestinal effects.
After lunch we went snorkeling with a friendly guy named Romeo who charged us $3 per person for the whole afternoon. He sat on his dhow boat and worked on his tan while we flippered around. He may or may not have had any licensure to guide a snorkeling expedition, but it was a lot of fun.
After dinner all of us just hung out on the beach and looked at the stars. With no light pollution and a clear sky, it was quite a view.
Next morning Steph and I caught a dola dola back to Stone Town for two more days of shopping at the markets and visiting historical sites, as well as just reading in the shade at the beach. We’re both capable of spending many hours at a time doing this. One of the cooler touristy things we did was a spice tour- you go out to a spice farm and see how various spices are grown and harvested and you taste a lot of tropical fruits. At the end we ate a lunch made with all the spices we’d seen in the morning.
I feel like I talk about food a lot, but so much of it was so good, so I’m going to give you one more highlight. Every evening, street vendors cover the huge garden on the waterfront in Stone Town. The food is cheap even by our standards and unlike anything I’ve ever had before. There were dozens of men operating these pressing machines that squeeze the juice out of sugarcane, then they add lime and ginger and ice to the juice, which makes for a very tasty and refreshing beverage. Then there’s the Zanzibar pizza, which is not pizza in the American sense of the word. It’s a piece of dough topped with spices and meat and vegetables, then the chef cracks an egg over the whole thing, scrambles it up, folds it into a dough- omelet pocket sort of a thing, then grills it. It’s heavenly, even if it sounds strange. There were fresh seafood stalls everywhere selling lobster, crab, tuna, squid, octopus, basically if it came from the sea you could buy it. A popular dessert was the “banana nutella chocolate pancake”, which I think speaks for itself.
Leaving Zanzibar was sad. As Steph and I walked back to our hostel that night, with the sound of evening prayers drifting out from mosques all over the city, I felt at peace. It had been a very good vacation. Zanzibar is a place I’d visit again in a heartbeat. The people are far friendlier and more accepting to strangers than Kenyans. Also, I was forced to speak a lot of Swahili since English is not as common in Tanzania as it is in Kenya, but the people of Zanzibar talk slowly and have good grammar, which is useful for a beginner like me.
Finally, Tuesday morning Steph and I headed back to the Zanzibar International Airport. We were asked “Do you have anything illegal that you should declare?” and we passed through security. We had a few hours to kill just wandering in Mombasa before our night bus back to Nairobi, where I am now, for the time being. My mom is arriving in two days (two days!!!) and we’ll be off to explore Mt. Kenya, Maasai Mara, and the south coast of Mombasa.
I have exactly one complaint about Zanzibar: there’s no electricity. Some hotels have generators but they use them sparingly. We spend several long, hot nights looking up at our idle ceiling fan and hoping for a breeze that never came.
Thursday, December 17, 2009
End of Internships and Closing Seminar
This is what happens when you commit to writing a travel blog because your friend made you, then you neglect it for several weeks: you find you have a lot to say. Following are two very long posts. If you find them interesting, read away.
The last week in Ukwala was hard- I didn’t feel at all ready to leave. Lucy and John had become a real family for me and I was far happier than I ever expected to be working at the clinic. Luckily for me, my last week was a busy one so I didn’t have too much time to dwell on my departure anxiety.
I’d spent a good deal of my time at Matibabu working with a few different maternal- child health initiatives, mostly infant vaccination campaigns but also the well- child and antenatal clinics. Apparently, in Kenya, this qualified me to help with the process of childbirth, so during my last week in Ukwala, I was called upon to assist with four deliveries. Of actual human infants, mind you. I should come clean here though- I’m exaggerating when I claim I helped with four deliveries. One was a set of twins, so it was in fact three deliveries that yielded four babies.
One special initiative that’s been getting a lot of attention in Nyanza Province is that of male circumcision. The CDC in partnership with the Kenya Ministry of Health recently released official recommendation for male circumcision to reduce the spread of HIV and improve general reproductive health and hygiene. This recommendation was met with a good deal of skepticism in Nyanzya Province, which is largely considered “Luo land” because the Luo tribe does not recognize circumcision in its cultural values. However, a number of free clinics have been set up throughout western Kenya, and I was offered the opportunity to observe the educational talks that preceded the circumcision (I didn’t get much out of that, as it was all in Luo) then help with the procedure itself. Let’s just say that I wasn’t exactly struck by a clear “Wow, circumcision must be what I’m meant to do with my life!” feeling, but all the same it was very interesting to learn about the cultural and medical significance of the procedure and talk to patients about their conceptions and motives for going ahead with it.
Another temporary program that was cool to get involved with was the distribution of “essential care packages” to HIV/AIDS patients. These were packages put together by donations from USAID and a number of other organizations. They included an insecticide- treated bednet, a water purification system (to prevent diarrheal diseases, which are a leading cause of death for AIDS patients in this region), a small basket of food grown in the community garden set up by Matibabu, and a few other things. Though the work I did for this project was largely clerical- ticking a patient’s name off the list and handing over their package, it was still pretty rewarding and involved a lot of contact with community members, so I enjoyed it a lot.
ALSO during my last week at the clinic was World AIDS Day, which involved dozens of celebrations all over Kenya. The Matibabu staff sent a group to the Ugunja gathering, and I opted to tag along. It was a hot day out in the sun, with tons of organizations setting up VCT booths, blood drives, informational booths, and running skits and talks. The skits tended to be humorous, and for the most part I really respected the quest speakers. They talked selflessly of their personal struggles against AIDS and of everything they were doing to help their peers learn the importance of getting tested. One man really upset me though; he spent at least half an hour talking about how he was certain his wife infected him through witchcraft. I guess everybody’s entitled to their own opinion.
My last full day at the clinic, Thursday, had to be one of my favorites of all. I was invited to go on a field visit with a few of Matibabu’s outreach workers. The four of us borrowed a fleet of bicycles that would probably qualify as antiques and set of for the remote villages surrounding Ukwala. We must have looked like a gang from The Sandlot, peddling around town. I certainly felt I was the essence of cool. We had a goal to visit ten homes that day, a goal one of the nurses told me was unlikely to come to fruition. Our fist stop was about a 45 minute bike ride from the main clinic, though it’s hard to estimate what distance this would translate to because Kenyans take a nice leisurely pace. No hurry to get anywhere, just enjoy the ride I guess.
Our first clients for the day were a middle aged couple and their son. All three were “positive”. That’s how people refer to HIV status, just “positive”. The stigma still runs so deep that a lot of people are too anxious to seek testing or treatment. All three had defaulted from ARV treatment and were firmly opposed to returning to Matibabu for further evaluation. This was extremely frustrating for me to see as an outsider. I’ve been very impressed with the effort put forth by Matibabu’s field workers. They scour the most remote areas of the district, seek out patients, and bring the care and drugs to them. Patients that would in the US be placed in a nursing home, but who obviously have no access to such facilities in the impoverished parts of rural Kenya still get care, because outreach workers come to bathe them, cook and clean, whatever needs to be done. And yet sitting before me were three stubborn defaulters. The issue at hand was not the cost of drugs- they’re free to all patients in Kenya needing assistance. Nor was it the logistics of travel- Matibabu had offered to help arrange transportation to the main clinic to re- commence ARV therapy. No, it was “What will the neighbors think if they find out we’re going to the clinic?” We sat in their hut for well over an hour, progressing from politely requesting they make an appointment to demanding to begging. No luck. Then, again frustrating to me, the ultimate conclusion was “Well, I guess if this mzungu came all the way out here and wants me to come to Ukwala, I’ll do it.” As much as I was glad that something finally worked, I was disappointed and ashamed that it was just my race that did the trick. Shouldn’t Kenyans be listening to other Kenyans, not just outsiders like me? I hadn’t done anything but listen and observe, the field workers are the ones who trek out every week, working so hard to deliver care to unwilling patients.
The rest of our visits that day followed roughly the same pattern: nobody wants to admit they have AIDS, that they’ve defaulted from treatment, that they should return to the clinic and get help. The field workers spend an hour coercing, we leave feeling we’ve accomplished something, but only a small something. We made it to three homes of the ten we’d hoped to visit that day.
Just as we were heading back to Ukwala around 5, it started to rain. Hard. We took shelter in the hut of the last patient of the day, and the storm passed in about a half hour. The roads were a complete mess. Mud a foot deep. It was impossible to ride our bikes, so we pushed them, stopping every few yards to scrape out the mud that clogged the tires. We came to a huge hill, and starting shoving our bikes up, making progress just inches at a time. The village kids that ran up ahead of me barefoot found my efforts to be hilarious. I was sweating hard and probably looked like a complete idiot. The nurse told me the kids were so thrilled because “now they see you’re a person just like them”. By the time we got home, dusk was settling and I was exhausted. I walked through the door dripping mud everywhere. “Oh, so you went to the field today” Lucy said by way of greeting. Yep, I sure did. I learned a lot in the field, but I couldn’t get over the frustrations I felt, that no matter what the community health workers do, there will be patients that don’t get the care they need or just suffer in silence rather than face the scrutiny of their family and friends.
Friday it was time for me to get to Kisumu, since I had an early morning bus back to Nairobi on Saturday. I stopped by the clinic in the morning to say my final goodbyes to the staff. There were hugs and jokes all around. The head clinician, Dr. Fred, requested that I leave a recording of me saying “Good morning, Dr. Fred!“ so he wouldn’t have to forget the sound of my voice. I’ve made a lot of wonderful friends and gained a lot of insight from the staff of Matibabu, I could never thank them enough.
Saying goodbye to Lucy and John was one of the most difficult obstacles I’ve faced over the course of this semester, way worse than saying goodbye to everybody at home because this time it felt a lot more permanent. The company car gave me a free lift to Kisumu, where I dumped my luggage at my friend Amanda’s house then we left together for another student’s house where a farewell dinner was being hosted in honor of all ten of us stationed in the Kisumu area. The food was amazing and it was fantastic to see the other students again, to discuss with them how hard it was to leave our internships and host families. A lot of us were really lucky to have wonderful experiences during the internship phase, but leaving was not easy. Furthermore, most of the students were flying back home on December 12; I just chose to extend my stay so I could do some more traveling, first with my friends from the program, then with my mom when she arrives. That’s a lot of goodbyes to have to deal with.
Saturday afternoon we got back to Nairobi and went to our respective host families there to rest up until the following morning when we had to check into the Methodist Guest House, the hotel where our final exams and closing seminars were to be held.
The closing seminar was a three day ordeal at the guest house, a chance for us to catch up with all the students who had been working in different parts of the country, take exams and finish term papers, and relax a little bit before heading home. Our final exams weren’t too terribly difficult but were a good way to reflect on what I’d learned over the course of the last three and a half months and to put my internship experience into the context of development. Our closing seminar activities included a lot of everybody talking about their respective internships and the challenges they’d faced as well as discussing what to expect when we go back home and how to deal with “re-entry shock”. The very night our program- related activities concluded, a group of us set of for the island of Zanzibar, but that’s another post.
The last week in Ukwala was hard- I didn’t feel at all ready to leave. Lucy and John had become a real family for me and I was far happier than I ever expected to be working at the clinic. Luckily for me, my last week was a busy one so I didn’t have too much time to dwell on my departure anxiety.
I’d spent a good deal of my time at Matibabu working with a few different maternal- child health initiatives, mostly infant vaccination campaigns but also the well- child and antenatal clinics. Apparently, in Kenya, this qualified me to help with the process of childbirth, so during my last week in Ukwala, I was called upon to assist with four deliveries. Of actual human infants, mind you. I should come clean here though- I’m exaggerating when I claim I helped with four deliveries. One was a set of twins, so it was in fact three deliveries that yielded four babies.
One special initiative that’s been getting a lot of attention in Nyanza Province is that of male circumcision. The CDC in partnership with the Kenya Ministry of Health recently released official recommendation for male circumcision to reduce the spread of HIV and improve general reproductive health and hygiene. This recommendation was met with a good deal of skepticism in Nyanzya Province, which is largely considered “Luo land” because the Luo tribe does not recognize circumcision in its cultural values. However, a number of free clinics have been set up throughout western Kenya, and I was offered the opportunity to observe the educational talks that preceded the circumcision (I didn’t get much out of that, as it was all in Luo) then help with the procedure itself. Let’s just say that I wasn’t exactly struck by a clear “Wow, circumcision must be what I’m meant to do with my life!” feeling, but all the same it was very interesting to learn about the cultural and medical significance of the procedure and talk to patients about their conceptions and motives for going ahead with it.
Another temporary program that was cool to get involved with was the distribution of “essential care packages” to HIV/AIDS patients. These were packages put together by donations from USAID and a number of other organizations. They included an insecticide- treated bednet, a water purification system (to prevent diarrheal diseases, which are a leading cause of death for AIDS patients in this region), a small basket of food grown in the community garden set up by Matibabu, and a few other things. Though the work I did for this project was largely clerical- ticking a patient’s name off the list and handing over their package, it was still pretty rewarding and involved a lot of contact with community members, so I enjoyed it a lot.
ALSO during my last week at the clinic was World AIDS Day, which involved dozens of celebrations all over Kenya. The Matibabu staff sent a group to the Ugunja gathering, and I opted to tag along. It was a hot day out in the sun, with tons of organizations setting up VCT booths, blood drives, informational booths, and running skits and talks. The skits tended to be humorous, and for the most part I really respected the quest speakers. They talked selflessly of their personal struggles against AIDS and of everything they were doing to help their peers learn the importance of getting tested. One man really upset me though; he spent at least half an hour talking about how he was certain his wife infected him through witchcraft. I guess everybody’s entitled to their own opinion.
My last full day at the clinic, Thursday, had to be one of my favorites of all. I was invited to go on a field visit with a few of Matibabu’s outreach workers. The four of us borrowed a fleet of bicycles that would probably qualify as antiques and set of for the remote villages surrounding Ukwala. We must have looked like a gang from The Sandlot, peddling around town. I certainly felt I was the essence of cool. We had a goal to visit ten homes that day, a goal one of the nurses told me was unlikely to come to fruition. Our fist stop was about a 45 minute bike ride from the main clinic, though it’s hard to estimate what distance this would translate to because Kenyans take a nice leisurely pace. No hurry to get anywhere, just enjoy the ride I guess.
Our first clients for the day were a middle aged couple and their son. All three were “positive”. That’s how people refer to HIV status, just “positive”. The stigma still runs so deep that a lot of people are too anxious to seek testing or treatment. All three had defaulted from ARV treatment and were firmly opposed to returning to Matibabu for further evaluation. This was extremely frustrating for me to see as an outsider. I’ve been very impressed with the effort put forth by Matibabu’s field workers. They scour the most remote areas of the district, seek out patients, and bring the care and drugs to them. Patients that would in the US be placed in a nursing home, but who obviously have no access to such facilities in the impoverished parts of rural Kenya still get care, because outreach workers come to bathe them, cook and clean, whatever needs to be done. And yet sitting before me were three stubborn defaulters. The issue at hand was not the cost of drugs- they’re free to all patients in Kenya needing assistance. Nor was it the logistics of travel- Matibabu had offered to help arrange transportation to the main clinic to re- commence ARV therapy. No, it was “What will the neighbors think if they find out we’re going to the clinic?” We sat in their hut for well over an hour, progressing from politely requesting they make an appointment to demanding to begging. No luck. Then, again frustrating to me, the ultimate conclusion was “Well, I guess if this mzungu came all the way out here and wants me to come to Ukwala, I’ll do it.” As much as I was glad that something finally worked, I was disappointed and ashamed that it was just my race that did the trick. Shouldn’t Kenyans be listening to other Kenyans, not just outsiders like me? I hadn’t done anything but listen and observe, the field workers are the ones who trek out every week, working so hard to deliver care to unwilling patients.
The rest of our visits that day followed roughly the same pattern: nobody wants to admit they have AIDS, that they’ve defaulted from treatment, that they should return to the clinic and get help. The field workers spend an hour coercing, we leave feeling we’ve accomplished something, but only a small something. We made it to three homes of the ten we’d hoped to visit that day.
Just as we were heading back to Ukwala around 5, it started to rain. Hard. We took shelter in the hut of the last patient of the day, and the storm passed in about a half hour. The roads were a complete mess. Mud a foot deep. It was impossible to ride our bikes, so we pushed them, stopping every few yards to scrape out the mud that clogged the tires. We came to a huge hill, and starting shoving our bikes up, making progress just inches at a time. The village kids that ran up ahead of me barefoot found my efforts to be hilarious. I was sweating hard and probably looked like a complete idiot. The nurse told me the kids were so thrilled because “now they see you’re a person just like them”. By the time we got home, dusk was settling and I was exhausted. I walked through the door dripping mud everywhere. “Oh, so you went to the field today” Lucy said by way of greeting. Yep, I sure did. I learned a lot in the field, but I couldn’t get over the frustrations I felt, that no matter what the community health workers do, there will be patients that don’t get the care they need or just suffer in silence rather than face the scrutiny of their family and friends.
Friday it was time for me to get to Kisumu, since I had an early morning bus back to Nairobi on Saturday. I stopped by the clinic in the morning to say my final goodbyes to the staff. There were hugs and jokes all around. The head clinician, Dr. Fred, requested that I leave a recording of me saying “Good morning, Dr. Fred!“ so he wouldn’t have to forget the sound of my voice. I’ve made a lot of wonderful friends and gained a lot of insight from the staff of Matibabu, I could never thank them enough.
Saying goodbye to Lucy and John was one of the most difficult obstacles I’ve faced over the course of this semester, way worse than saying goodbye to everybody at home because this time it felt a lot more permanent. The company car gave me a free lift to Kisumu, where I dumped my luggage at my friend Amanda’s house then we left together for another student’s house where a farewell dinner was being hosted in honor of all ten of us stationed in the Kisumu area. The food was amazing and it was fantastic to see the other students again, to discuss with them how hard it was to leave our internships and host families. A lot of us were really lucky to have wonderful experiences during the internship phase, but leaving was not easy. Furthermore, most of the students were flying back home on December 12; I just chose to extend my stay so I could do some more traveling, first with my friends from the program, then with my mom when she arrives. That’s a lot of goodbyes to have to deal with.
Saturday afternoon we got back to Nairobi and went to our respective host families there to rest up until the following morning when we had to check into the Methodist Guest House, the hotel where our final exams and closing seminars were to be held.
The closing seminar was a three day ordeal at the guest house, a chance for us to catch up with all the students who had been working in different parts of the country, take exams and finish term papers, and relax a little bit before heading home. Our final exams weren’t too terribly difficult but were a good way to reflect on what I’d learned over the course of the last three and a half months and to put my internship experience into the context of development. Our closing seminar activities included a lot of everybody talking about their respective internships and the challenges they’d faced as well as discussing what to expect when we go back home and how to deal with “re-entry shock”. The very night our program- related activities concluded, a group of us set of for the island of Zanzibar, but that’s another post.
Wednesday, December 9, 2009
Vacation
Hello everybody! The last week at the internship was amazing, I'm now back in Nairobi and done with final exams. I want to share a lot more details BUT I'm taking a well deserved beach vacation to Zanzibar, so you'll just have to wait until I get back.
Subscribe to:
Posts (Atom)