Sunday, June 26, 2011
Vignettes from Honduras
Letter from Njombe Town
I also saw the most astounding poverty I’ve encountered in my life. On one of my free days in Dar, I visited a ‘cultural museum park,’ which exhibited various mud huts used by different tribes in the country. I toured each of the musty low-grass-ceilinged structures with a flashlight, and tried to imagine what it could possible mean when a sign pointed to two square feet of dirt floor and said ‘The Living Room.” But after all, it was a museum, and I like modern art, so mostly I was able to relegate it to an abstract ideas area of my mind and move on.
But all along the Tanzam highway, I saw villagers living in mud structures and collecting firewood. These mud homes weren’t even as nice as the ones in the museum, but were shabbily thrown together and covered with sloping straw mats. I watched small children chasing each other around the houses and women carrying bundles of rice or wood on their heads. Here was the abstract in reality.
Being in Njombe for the past week, I’ve also noticed the distinct and sometimes surprising markers of poverty in town life. The per capita GDP in Tanzania is $500. To drive myself crazy, I like to think about how my annual medical school tuition is $50,000, or 100 times more than what the average person here makes in a year. For the golden price tag of 50 grand, I am provided with the online password to a cache of lecture videos, about four school sponsored keggers, and the legitimacy to travel here as a summer intern. It’s a funny idea to imagine, on the one hand, a laptop with lecture videos that amount to my medical education, and on the other hand, 100 Tanzanians. Or, if you like, my Macbook, and two Tanzanians. Or my iPhone, and one Tanzanian. These comparisons make life seem so unbearably arbitrary.
So what is life like in a town with a per capita GDP of an iPhone? I think on of the first things I noticed going up and down the one road in town is the lack of any bookstores, or music shops, or art establishments. For $500 dollars a year, you don’t get any of these niceties. What you do get though, is a choice between 15 different churches in which to worship. The churches are invariably the nicest and largest standing structures in town, and their soaring spires make an odd picture beside small stands selling used socks and potatoes. Not surprisingly, everyone is religious.
Poverty also does not lend well to culinary creativity, and ‘Tanzanian cuisine’ consists of rice, beans, steamed maize called ugali, fried chicken, friend potatoes, fried eggs, and fried potatoes with eggs. Ordering at a restaurant means getting a plate of one of the three things they have, which rarely changes day to day. Amazingly, local people don’t seem to notice the monotony of it, and ask me sincerely if I’m ‘enjoying Tanzanian food.’
The government does not provide a garbage collection service. I didn’t realize this until one day when we were unpacking boxes and boxes of surgical instruments, and were left with a pile of plastic bags as waste. We asked some kids on the street to help us clear the mess, and a while later I stepped outside to discover them burning the plastic bags in a big pile in front of the house. I was overwhelmed by the intense smell of carcinogens filling my body, and I turned to a co-worker to ask what the hell they were doing. ‘What else do you want them to do with the garbage?’ she asked, bewildered. And then I realized, every household across town, and in the villages does this. This was the smell that I had noticed for days but couldn’t place. Njombe is developed enough to have Coke bottles and plastic wrappers, but not developed enough to have a central garbage service.
Hans Rosling has a great and simple idea about differentiating between the means of development and the ends of development. Healthcare, economic growth, stable government: these are only the means, and not the ends of development. They aren’t the things that make life worth living. But to have books, music, plays, cake, and lets not forget cookies, doughnuts, strudel, muffins, pancakes, turnover, and dessert sampler plates, etc, these are the things that really make people happy (or if you don’t like my hyper-western/sweets-centric value system, we can just say ‘culture’).
I think something that does amaze me about the local people I meet is that everyone seems pretty happy. Locals regard me with a confused look, but a simple hand wave and a ‘Mambo’ usually gets a big and ready smile. But still, I can’t imagine my childhood with no bookstore, no library, no music hall, no sports teams.
This post amounts to an ineloquent but realtime effort on my part to come to terms with the unfathomable differences between life here and my life waiting for me back home come August. But until I come to some kind of satisfying unified theory on this, here are some pictures of animals and such.
Elephants
Masaai girl herding cattle by the highway
Overturned truck with spilled cargo along the highway
Saturday, June 11, 2011
Male circumcision, WTF? (what are the fundamentals?)
I’m in Tanzania this summer with a Johns Hopkins affiliated NGO that works on bringing innovations to practice in developing countries. Specifically, I’m here to help on an 8 week male circumcision campaign in the rural Iringa region of southwest Tanzania.
Before I go on, here’s a primer for the general audience. Over the past several years, three definitive randomized controlled trials (the most badass, legit kind you can do, for you non-medical folks) in sub-Saharan Africa have shown that circumcising adult males reduces their risk of HIV acquisition by 60%. SIXTY PERCENT. In fact, in all three studies, the differences in acquisition rates between the control group and circumcision group were so extreme that the trials were stopped early, since it would be unethical to allow the control groups to go on not receiving the procedure.
(If you’re curious about the science, the risk reduction has something to do with the high number of Langerhans cells on the underside of the foreskin, through which the virus particularly enjoys attacking and entering the body.)
When you factor in that circumcision is relatively low risk and inexpensive, you might conclude that circumcising as many men as possible in high HIV areas is a very effective strategy for preventing HIV transmission, which is what the WHO concluded in 2007. But now that the science is proven, the question becomes one of implementation.
(A branded truck advertising MC services. We'll be driving this around the countryside.)
The challenge is how to get the service to tens of thousands of men as soon as possible, which brings us to right now, when I’m about to embark on a 9 hour car trip from Dar es Salaam to Njombe, in southern Iringa, to kick off the 2011 male circumcision (MC) campaign. Although the Iringa Regional Health service offers circumcision services three days a week year round, they have contracted Jhpiego to help run an 8 week high volume campaign the will offer clinic six days a week to reach a high volume in a short period. This is the second year of the campaign: last year, the goal number of clients was 6,000, and the campaign ended up circumcising 10,000. This year, the goal is 20,000.
To reach out to and care for so many clients in a short time, especially in a rural area, the Jhpiego team uses several creative strategies. To generate demand in the community, the team created several radio ads, and employed a social marketing team to head to the field in advance of the clinic kick off.
I found out over the last week that social marketing in this context is a group of entertainers, who have been trained in the concepts of MC, that will go out to villages and use tools like music, dancing, skits and games to get people interested in the process. (This was the training I attended last Monday.) When this concept was explained to me, I had a hard time imagining what it would look like, but last Thursday, I saw a test run of the show the group would put on. And it was impressive. These performers were seriously talented, they acted, danced, sang, kicked soccer balls, all in relation to male circumcision. It was the MTV music video awards of male sexual health.
(The social marketing team/performers. They loved the camera.)
I’m looking forward to seeing them in action in the field. And me in action in the field, I hope. It sounds like I will be co-managing the logistics at the headquarters site. I also volunteered my photography services, so I will also be heading around to all the satellite sites as well to document the process. Stay tuned.
Wednesday, June 8, 2011
Blackouts, scandal and sexy US diplomats: An adventure through the interwebs!
After a while, I realized we were in a power blackout. (I sit by a big window so we usually don’t use overhead lights.) Supposedly, the office was supposed to have generators so that we could work through the day, but these weren’t working. So people finished their meetings, and eventually trickled home as laptop batteries ran dry. Some of my co-workers asked me if we had power blackouts in the US. At this point, I naively failed to realize these were scheduled, rationed blackouts. I stammered something about storms and tree branches hitting power lines. I got some confused looks.
That night, I went to a local outdoor pub for rice and beans with my coworker C. and his brother G. Both are from a rural town in Tanzania, but G. went to graduate school at a large US university that rhymes with Barvard, and currently hosts Fogarty fellows at his NGO here in Tanzania.
As we sat in almost complete darkness, I asked them what the deal was with the power outages. Ah, G. said, good question. The story he went on to explained was a complicated tale.
Traditionally, Tanzania’s electricity relies on hydroelectric power. In the past ten years, two factors have come together to generate a large gap between supply and demand: El Nino and global weather changes have lowered available supply, while at the same time the growing economy and urbanization has led to a surge in demand. These two things add up to rationing, or rolling blackouts.
These elements of the story are natural. Now enter 1. Ostensible desire to help and 2. Human fallibility. G. explained that four years ago, the government contracted with a US company to buy, install and generate power using large turbines to be placed in Dar. However, after years of protracted dealings, no turbines emerged, the US company shifted their assets around, no power was generated, and eventually the Tanzanian prime minister resigned over the scandal. Though stable, Tanzania is one of the poorest countries in the world. The rolling blackouts have had an immense effect on depressing productivity and the entire economy.
G. then entered into a lengthy (and informative) discussion of the imbalance of power between a developing country like Tanzania and world powers with a financial interest. Of course, GL, BM and I, as card-carrying yuppies interested in moving abroad to do ‘development work,’ have all read the basic curriculum of Sachs, Easterly and Collins. We know a little bit about a few things. But as I listened to G. talk, I started to wonder just how sheltered our perspective still was.
G. mentioned scandals and seemingly conspiracy level situations as if they should be basic knowledge, but these were not things I’ve encountered in the New York Times or New Yorker. When I got home, I decided to see what the internet could tell me. What follows is my while goose-chase around the web.
I started by googling ‘tanzania energy scandal.’ After reading various articles (mostly from Africa focused online publications, no nyt or wapo, of course), I found the name of the US company: Richmond Development Co, from the mighty state of Texas. I changed my google search for ‘tanzania energy richmond llc”
Here’s short version of what emerges: In 2006, Tanesco, the Tanzanian government energy group, entered into a contract with RDEVCO, for RDEVCO to design, install and run power turbines in Dar es Salaam. Interestingly, Tanesco would not own the turbines, but would instead pay to then ‘use’ power produced by RDEVCO on Tanzanian soil. That is stupid and has kickbacks written all over it, but fine, whatever.
RDEVCO then contracted with another US group, Vulcan, to purchase the actual turbine. Then, RDEVCO contracted with a Tanzanian holding company, and signed over the rights of the Tanesco contract as well as the turbine purchase agreement to Dowans, the new Tanzanian company. Yes, this is all very confusing, and now RDEVCO and Dowans are currently fighting over who actually did own the turbine when it arrived in Dar. But here’s the kicker, somehow in all of this, the International Chamber of Commerce, in Paris, France, has ruled that Tanesco is the one in breach of contract with Dowans, and last fall has ordered Tanesco to pay $120 million for breach of contract. Let’s keep in mind that during this time, regular Tanzanians have been living with constant and devastating blackouts.
One might wonder, who is this mysterious Richmond Development Co.? To the internet! RDEVCO’s dark blue template style website informs me that “Energy Infrastructure Development helps economies and communities struggling to meet their rising demands for electricity. By designing, overseeing, and securing financing for large scale energy projects, RDEVCO meets this need and helps aspiring people find success and build a brighter tomorrow.” How nice. The leadership page also tells me that they have a Mr. Nick Lampson, a US Congressman, on the team. In fact, the second person listed.
Now, it’s understandable that if, for the last four years, 40 million Africans have been cheated out of having affordable electricity delivered to their homes through some shady business contracts, it wouldn’t be news I’d hear about. I mean, who cares. But, doesn’t the involvement of a US Congressman make it at least worthy of an inside page NYT blurb? Apparently not. Mr. Lampson’s Wikipedia page has no mention of anything related to Richmond or Tanzania or blackouts.
So what’s going on with the turbines now? Why did I go home yesterday instead of working to eradicate HIV through Excel spreadsheets from my air-conditioned Dar es Salaam NGO office? Well, this gets weird too. The latest news results for Tanesco show that they are in the process of signing a contract for a new US company to operate the turbines in Dar. This company is called Symbion Power, and it’s CEO, Paul Hinks, came to Dar yesterday to sign the papers.
What I did find in the British Guardian though, was a curious little stub article from 2002 that implicates Mr. Hinks, at that time a managing director of a UK energy firm, in possibly illegal kickback payments to a Ugandan official in relation to a dam construction contract. As a result, the dam project was stalled, and I’m assuming, some Ugandan people didn’t get the electricity they were promised.
Huh, weird. Now, who is Symbion Power and this elusive Mr. Hinks? The website of this US registered company tells me that “Symbion Power was built on a foundation of partnership and cooperation. Even our name – a derivative of the word Symbiosis – reflects the cooperative relationship we maintain with key suppliers, local partners and subcontractors.”
…Really? Do these companies hire middle school cheer-camp directors in the off-season to write their PR? Perhaps the most urgently needed NGO is one that teaches African leaders how to smell bullshit.
Anyways, I’m much more reassured when I get to the leadership page, because lo and behold, they also have a trusty US public servant on the team: Mr. Joseph Wilson, the former H.W. appointed ambassador to Gabon and Sao Tome and Principe. (I once read in some article that when you become president, you have to find jobs for all the people you kind of want to please but really don’t know what to do with, so you stick them as ambassadors to obscure countries.)
So, we will see if Symbion, Mr. Hinks, and Mr. Wilson will save the day and the blackouts improve this summer. I have a hunch that they won’t.
Now here’s a caveat, I’m not an investigative journalist. I tried to find multiple sources but I didn’t really validate or fact check anything here. This is why blogs, like women, are both beautiful and dangerous. But this is what I found to satiate my own curiousity, and furthermore, this example is an interesting entry into a debate that GL and I have had in the past, about whether in the end, NGOs or for-profit business will save the world.
G., my Tanzanian friend, repeatedly told me that what US companies are not allowed to do in the US, they come and do it here. And now that the scandal has been perpetrated, is there a court in the world that will rule in favor of the people who actually need the power? Apparently not. Of course, this doesn’t acquit the corrupt Tanzanian leaders who got the country into the mess by signing contracts that obviously didn’t benefit their countrymen for the sake of some personal kickbacks. But still, is it then valid to say that even relatively stable developing countries like Tanzania do not have the political infrastructure to benefit from the undeniable perks of well-regulated capitalism? I don’t know.
In other news, I’m getting eaten alive by mosquitoes and might well have malaria. Stay tuned.
Monday, June 6, 2011
Who do you worship!?
GL, the illustrious executive editor and publisher of this virtual publication, once told me that if I wanted to write down my daily occurrences, only my mother would be interested in reading them. However, since today was my first day of work in Tanzania, it might be worth mentioning. In my short life, I’ve been a waitress, an SAT tutor, a shopgirl, a lab rat, a nurse’s assistant, a financial consultant, a food blogger, a public health research assistant, and a medical student, but I’ve never been a field intern for an international medical NGO. Therefore, I had almost no idea what to expect on my first day.
Before coming, I had corresponded briefly with several of the local office staff about my position this summer and what I would be working on. I had done some other work with male circumcision for HIV prevention, so I knew the science behind it, but very little of the actual field implementation. I also just couldn’t guess what the day to day work flow would look like.
I arrived in Dar es Salaam on Saturday night, and spent most of Sunday at the hotel sleeping and getting unpacked. This morning (Monday), I woke up at six, but really had no idea when I was supposed to arrive at the office. I had been told via email that a driver from the hotel would take me to the office. After wasting some time unsure of what to do with myself, I sat down to breakfast in the dining room sometime around 7:30. A little while later, one of the receptionists found me to tell me that my ‘car was ready.’ I thought this meant a driver would be ready to take me when I wanted to go, so I thanked him and continued to eat breakfast. A little while later, I saw the same receptionist wander back to the dining room to smile nervously at me. ‘Yes,’ I said, ‘I’ll just finish and we can go.’
After I ate, I went back up to my room, packed my bag, and wandered downstairs. When I stepped outside the hotel, I saw to my horror that a Toyota Landcruiser with my NGO’s label stamped on the side was idling in front of the door, and inside sat a very impatient looking man. It dawned on me that someone from the office had come here to pick me up, and had been waiting the whole time while I lackadaisically spread jam on toast.
I ran to open the door and breathlessly apologize for the mix-up. S., the supremely irked driver, informed me that he had been waiting over half an hour, and that there were a limited number of cars to go around! I apologized repeatedly while trying to awkwardly hoist myself into the rather elevated car, and in the process bumped my head against the doorframe. While apologies continued to stream out of my mouth, I thought, ‘Oh shit, did my headband just crack?’
I closed the door and saw the two pieces of forlorn plastic that had fallen from my head onto the floor of the car. S. had already started pulling the car forward. My mind raced as I tried to think of some way to salvage this situation without asking him to stop the car. Did I have any spare clips? No. Did I have some way I could wear my hair down? No. Did I want to show up for my first day looking like a raving lunatic? Um…
Finally, when we had reached the end of the block, I blurted out, ‘I’m SO sorry, but do you mind if I run back upstairs to get a headband? Mine just broke…’ S. braked, and looked at me like I had just asked him for a blueberry lollipop because I had left mine at home. He narrowed his eyes and said, ‘You have another one upstairs?’ I quickly nodded and darted out the Landcruiser before he could say no, yelling that it would only take a minute.
After we were back on the road, S. turned out to be very nice. We drove the dramatic distance of half a mile to a white gated compounded on the side of a major road. Pulling into the parking lot, I saw a lot of Tanzanian men in business casual congregating around the front door of the building. Everyone was busy greeting each other good morning and shaking hands. S. pulled us to the front door, asked me to sign a car usage form, and waited for me to hop out. Wait, I thought, weren’t you supposed to take me in? What now? I nervously stepped out of the car and looked around for someone to save me. And then like a miracle, the country program director, and American, stepped out from behind the vehicle and asked me if I was Linda. Yes! If I ever was.
H., the country director, took me upstairs and rapidly introduced me to several men who’s names I promptly forgot. I noticed that despite the dirt roads outside, 1) this was a normal office, complete with copy machines, communal fridge and water cooler and 2) everyone else was wearing business casual. I, on the other hand (and to be fair, against GL’s explicit advice), was wearing hiking sandals, North Face capris, and a Columbia hiking shirt. I suppose the native Tanzanians here will just forever think that Asian American medical students are all a very poorly dressed lot, or else hopelessly over-zealous outdoorsy types.
It was somehow decided that my first day would be best spent attending a training session for a new community outreach team helping us with the circumcision campaign. This sounded like a reasonable idea to get me oriented, so I enthusiastically agreed. And so, I followed three of my new colleagues a short drive away to a hotel conference room, where I proceeded to sit through an entire day’s training…entirely in Swahili.
Luckily, my three Tanzanian colleagues were extremely nice, and gave me background materials to read in English, and also translated bits for me along the way. It was interesting to see how the audience interacted with the presenters, and hear the questions they had about the campaign. (This is an outside media group contracted to do community outreach ahead of the campaign dates in order to address local concerns and create demand, more on this later.) I also wrote down individual Swahili words that stuck out (tohara means circumcision).
Halfway through the day, I saw a slide that looked like a biblical quote in Swahili. Curious, I leaned over to C., one of the community outreach officers, and asked him what it meant. He explained it was the pact between God and Abraham. I nodded, but really I had no idea what this meant.
‘You are Christian?’ C. whispered to me.
I smiled apologetically and shook my head no.
‘Oh,’ he nodded understandingly, ‘In China you have your own…?’
Again, I shook my head no.
‘You have…nothing?’ he asked. ‘Who do you worship?!’
I dumbly shook my head and flexed my lower lip from a smile to a nervous pout. But he wasn’t done.
‘Who do you pray to? ... No one? …It’s just you?’
I nervously glanced around at the presentation that was still going on around us. I timidly shrugged my shoulders and turned back to my empty notepad. Of course before coming here, I had read about Tanzanian culture, the breakdown of different ethnic and religious groups in the country. Somehow, the percentages of Christians and Muslims and indigenous faith-ers all seemed very abstract in my mind. I never expected to encounter this kind of reaction to my own beliefs, which I found very irrelevant to my coming here.
Luckily, a few minutes later C. nudged me to help him add me on Facebook, and this relieved some of my fears of being a complete social outcast for the next two months.
Despite a rocky start, it would be unfair to end this post without saying that I ended up having a fun day and enjoying my co-workers a lot. I felt the palpable disorientation of being plunged into a culture I know very little about, and a language I don’t understand at all. Still, I’m looking forward to having a great summer, especially when we leave Dar next week for the rural Iringa, where we will actually be conducting the circumcision campaign, and where my awkward hiking shoes will have their day to shine. Stay tuned.
Saturday, June 4, 2011
Arrived, and it's a bit like home
Monday, May 23, 2011
The Most Dangerous Road in the World
In my mind, the gangs and those that work for them are merely rational, profit seeking actors, just like everyone else. If I were a poor Honduran that had little education, no legitimate job prospects, but a chance to make it big selling drugs, who knows what I might do. Keeping in mind that the industry (again thinking of only cocaine sales in the US) is worth $38 billion, less minor production costs, we can expect that, as a whole, the gangs would be willing to invest up to that amount in “logistics”, weapons, and influence to turn a profit. In this light, the $80 million a year promised by Obama on a recent trip to Central America is hardly anything.


