For starters, today my sister Molly turns 19. Happy birthday Molly!
I live in a medium sized village in the southern highlands of Tanzania, not far from the city of Mbinga. It is beautiful in a way that it is hard to describe and escapes accurate comparison. Picture an idillyc Italian hill town, now sprinkle in the harsh, jagged rockiness of the Scottish highlands, and then add some of the tropical verdant goodness of the Andean jungle–replete with coffee and banana trees lining the paths where you walk. It’s not too bad.
I have begun to work on my first project, which in essence is to learn about the village so that I may effectively contribute. In practice this looks like hours spend reading data and asking questions at the clinic, school, and government office, as well as conducting interviews with people who live in the village. It’s been fun, and it keeps me busy. So far the areas of main concern include:
-malaria, which is a rather common disease in Tanzania. It is very common in the region in which I live, but it is also likely extremely over diagnosed. Literally every single person to whom I have spoken believes that they have had malaria in the last year, and while this is not impossible, it is unlikely. Malaria has many of the same symptoms as bacterial and viral infections, and as such the prevailing wisdom that it’s always malaria is likely wrong on many occasions. Combine this with the fact that malaria is often diagnosed clinically instead of by microscopy or with the rapid tests, and it becomes clear the potentially the biggest problem with malaria is that people are mistreating other illnesses. The mistreatment of these illnesses could spell disaster in two ways, for starters, people can die if they get an anti-malarial instead of an anti-bacterial, and second this could lead in the long term to anti-biotic resistant malaria in tanzania, which would make the disease even deadlier and much more expensive/difficult to treat. Luckily malria is preventable! We used to have tons of it in the us, but through environmental measures the disease was eradicated. Here, capital intensive environmental projects are less likely, but the use of bed nets, and treating people when they are sick can eliminate contagion vectors and drastically reduce the spread of the disease. Woo.
-HIV, the region in which I live reports having an 8% rate of infection. It’s likely higher, sadly ruvuma region has an extremely high stigma against the disease which likely leads to lower rates of testing, and thus, a higher than reported rate of HIV. The village in which I live currently has no support group for people living with the disease. This is a problem because one of the ways that has been shown most effective to slow the spread of the disease is to have people adhere their medical regimen. Anti-retroviral therapy can lower a person’s viral load to the point where they no longer transmit. In an ideal world, people with HIV would be extremely careful to avoid engaging in activities that could transmit the disease, but we don’t live in an ideal world, and people are not perfectly rational beings. Keeping down a person’s viral load also keeps them healthier and they’re more able to stave off the opportunistic infections that plague immuno-compromised individuals. It’s a win win. Additionally, creating support groups or other programs that encourage medical adherence is a cheap way to fight the disease. When Bush started PEPFAR, the us aids program, that essentially is tantamount to the world funding to eliminate the disease (don’t say the U.S. never does anything good!) the goal was to spend the disease to death, to encourage every person in high rate countries to know their status and to get positive people the appropriate treatment. Well the U.S. has spent a crazy amount of money, and has made admirable progress, but it has become clear that no one has enough resources to spend the money to death, so the approach has become more targeted. Please forgive the violent metaphor, but if we were trying to carpet bomb the disease before, we’ve switched to laser guided missiles now. The U.S. government’s approach today, has switched to targeting most at risk populations and ebcouraging people to adhere to medical schedules. I will be able to help with both, and thus far have found through the data I have collected that many HIV positive people where I live are not getting their medicine each month. This is where a support group can help. People living with the disease also have heightened nutritional needs, as the medicine is hard on their body, so also I hope to create a vegetable garden open to the group.
-Unsurprisingly infrastructure can be a problem too, after a few months of operating without an adequate scale, the clinic got one last week! Which was cause for celebration, and a good opportunity to make sure that I haven’t lost too much weight, I haven’t. But they struggle with other small things as well. The eyepiece on the only microscope has broken, rendering the machine difficult to use at best, and currently the clinic doesn’t have a blood pressure cuff–a huge issue for health workers trying to care for a large population of pregnant women. It’s not impossible to get these things of course, there are ways of doing so, but funding is an issue as is efficiency. The company from whom the clinic would regularly get the cuff has been out for months. Improving effiency is something that may be difficult but I’m hopeful to find a way that I can find a way to help.
-Coffee, which is both a concern and a way of life here. The concern has to do with making sure that the farmers are using good practices, both for their crop but also for the earth, in order to get good prices and by entirely destroy the ecosystem. Coffee is big business in Mbinga. We have the elevation (everything seems to be over 5,000 ft above sea-level) and the volcanic soil necessary to produce some of the world’s finest coffee. The country as a whole isn’t quite there yet, and a lot of that has to do with farming practices and processing practices. The village where I live is large enough to support three central processing units, where coffee can be washed and pulped. This is the ideal. The trick now is to teach farmers how to process their coffee properly, and to convince farmers who process at home not to do so. Coffee processing is a pretty intense process that requires certain facilities most notably big pools of clean water, and raised beds where the beans can dry and ferment. Usually individual farmers have neither. One reason that farmers are reticent to use the CPUs is that they are owned by coffee buying companies, if you use the unit, you have to sell to that company, some farmers like to shop around with their crop, which is fair, but processing at home adds risk as they are more likely to ruin the cherries before they can go to market.
-I might miss the NBA more than all of you, not being able to watch The playoffs and draft was sad, but I have been able to keep up by reading articles incessantly.
-I bought some hienz ketchup, and it’s good, but it’s made in Egypt and is clearly a little sweeter, like the more European style… It’s just not the same, especially for a Pennsylvania boy.
-I miss decent wine. Working at a fancy restaurant may have turned me into a little bit of a snob. I don’t think that I am, I think I just know what I like, and what I like is not here. Instead I get South African wine, which gives off secondary notes of garbage fire. After a co-worker Elton told me that I haven’t been able to un-taste it.
-also cheese, not even fancy cheese, just any damn cheese. There is almost none made or eaten in the whole country.
-finally I learned that macadamia nut shells are crazy hard. I dented a metal thermos trying to open them, and have put some pock marks in my cement floor smashing them with a rock, because the shells are so hard that they just wedge themselves into the concrete before they break. It’s remarkable. We should build things out of them. They’re so damn strong. But they’re alsk delicious and absolutely worth it.