More dark days ahead

Energy supply can be a really good source of providing high-level, rapid assessments of how "developed" a country is. Generally, the consistent delivery of energy supply reflects the levels of infrastructure developed, the variety of financing mechanisms instituted (usually for public, sometimes private sector), the elusiveness of corruption, the length and productivity of an average workday, fluctuations in gas/diesel prices, the difficulty in storing goods (especially medicines!) in refrigeration, and so on.

I received this warning a few days ago from International SOS:

Tanzania: Electricity company announces 15-hour power cuts from 19 to 26 May
The state-owned Tanzania Electric Supply Company (Tanesco) on 8 May announced that it would impose 15-hour daily power cuts from 19 to 26 May. The power cuts will be in effect from 08.00 to 23.00 (local time), though Kigoma, Rukwa, Kagera Mtwara and Lindi regions will not be affected as their power supply does not come from the national grid.

Apparently when the lights are off, you can't see any progess...and you can't see any corruption either.

Desensitization

When you first travel to a developing country from the US, you tend to notice everything that's different - from the people to the language to the absence of toilet paper in squat restrooms to the free-range chickens and goats roaming the roads. It's part of the culture shock, but also part of the intrigue that keeps you going in global health when you first start working in the field. You tend to seek out what's different.

After having lived in a few developing countries now though, the initial culture shock that I get fades away pretty fast. So the things that now seem "normal" to me, are the things that I forget to write about. But you might still find them interesting, so here are some of my top shocks, now absorbed:

• Books: Just like new clothes, new books are ridiculously expensive. The average Tanzanian lives on less than $2 a day, and a new book is at least $10. There are only a handful of bookstores in Dar (see: A Novel Idea), and if you're coming from a big US city, these stores will look like shoe-boxes. But hey, they carry NYTimes Bestsellers!
• Energy: Like India, Tanzania suffers from a power crisis. Unlike the Philippines, they do not call them brownouts or blackouts [obviously]. We have "power outages" everyday. So you either freeze where you are until a generator kicks on (if you're lucky), or you go find a candle.
• Switches at every outlet / electrical socket: When I first moved into my living space, I didn't know how to turn my stove / hotplate on in the kitchen. I thought I was turning the knobs and pressing the button correctly, but I couldn't get the gas to ignite. So I had to call for help. When my savior came with a match (thinking that was the problem), he looked at me, and then he looked at the switches on the wall. He looked at me again, and then he flipped the switch that corresponded to the stove. He shook his head and then left.
• The absence of bathroom vents: It's not very common to see bathroom vents like you see in most suburban American homes. Although I've lived in a few old NY apartments that didn't have bathroom vents other than windows, I still think they can be very helpful. [Not for me, of course, but for others...]
• Water heaters and switches: Yes, there is an "on" switch for this too. You have to turn it on at least a few minutes before you get into the shower. It gets added into your daily routine, along with opening up windows, if you don't have a bathroom with a vent. 
• Always having to consume bottled water: It's a different situation when you're forced to drink only bottled water because you could contract an illness from regular tap water. You get used to it because you have to do it; and you slowly forget about how many plastic bottles you're throwing into the ocean. But then you think, "Well, I could save my conscience from this next plastic bottle by ordering a soda which comes in a glass bottle that will be recycled here." [Yes, they still use old fashioned, refillable glass bottles.] But that's how you start to consume more calories than you planned, which isn't good because -
• Gyms are for the wealthy: If your hotel doesn't have one, good luck trying to find a spacious facility that's reasonably priced, has a working AC, and offers machines that won't squeak or break down within a few minutes. Well hello there, spare tire...
• Stoney Tangawizi: It seemed so foreign at first sip - it's so gingery. But it's so good that I'll save a few plastic bottles here and there for this ginger ale and I won't mind the spare tire.
• Dudes whipping bulls on the roadside: That's right. In Zanzibar, just like in provincial areas of the Philippines (or any rural Asian area, for that matter), many farmers have male cows or yaks or the like that haul carts of stuff for them. To keep them in line and going at a normal walking pace, they [lightly] whip the animals.
• Giant bugs, house lizards, and other creepy crawlies: You may shriek at first, but they happen to live in your space too. So far, I've doused 2 giant roaches in mist that will float them up to heaven.
• Internet streaming: Even at the hotel with my really awesome wireless connection, I'm lucky to be able to stream a YouTube video or iTunes song in real-time. Welcome back to my life, patience.
• People sweating: It had to be said. We've become overly disgusted and overly conscious of our natural sweat in the US. When you're abroad, especially in a tropical/humid climate, everyone sweats and no one really notices...Until you're in close quarters - like on a jam-packed bus, everyone sweats on everyone else. Then you get out of the bus and dirt immediately sticks to you. You have to go about your normal day until you can get home and shower. 
• An overabundance of stray cats...and flies: Okay so I'm not entirely desensitized to these because I can't stand them...but they don't seem as bothersome as before. Now when I watch a commercial of a poor, dirty, sweaty kid on TV surrounded by flies or stray cats in Asia or Africa, I can think - ooo...I looked like her once! 

(A few credits - MH & TB for helping me remember a few of these :))

Searching for [new] Western wear

I know I’m behind on my blogging, but there’s something I want to write about before I give a meatier update on my project here. I want to tell you about shopping. Yes, shopping.

I enjoy shopping, not just for native crafts and fresh fruits at the local markets, but for regular clothes and shoes. This past weekend, I decided I would try to expand my wardrobe a bit here because I’ve been assigned to stay an additional month, but I was really surprised to find out that I had incredibly limited options here in Dar!

There aren’t really any malls here – not like the giant, air-conditioned wonderlands of the US, the Philippines or even South Africa. No, Dar only has a handful of commercial plazas that are home to a myriad of diverse businesses – restaurants, computer shops, mini-bookstores, groceries, and just a few clothing stores. There’s a small Woolworth’s department store in the City Centre, and there are a few boutique clothing stores at Shopper’s Plaza, Oysterbay Shops, and Sea Cliff Village. Most of these boutique shops cater to tourists, so the clothing here is either touristy (with catch phrase t-shirts) or very dressy and pricey (around $50 USD for a shirt!). So after a slightly disappointing trek, I wondered where everyone else shopped, only to find out that…

The cost of brand new clothes from the shops I had visited are all very expensive and out of reach for the average Tanzanian family. [I didn’t even want to pay $70 USD for a linen skirt at Woolworth’s!] So most Tanzanians shop for mitumba – secondhand clothes at the market. Mitumba is clothing that originates from abroad, like the UK or the US and is used. These t-shirts, blouses, dresses, pants, etc. are “throw-aways” from Europeans and Americans – but what I haven’t uncovered yet is if these said throw-aways were originally donated to be given away to the poor. I don’t think it’s really widely thought about (whether or not these are “intended for the poor”) because buying and selling secondhand clothes has become a natural part of the Tanzanian lifestyle. Mitumba provides many people with an easy way to begin a business and families with much more affordable clothing options.

Of course, traditional African or Indian dress isn’t included in this discussion – they’re in a class of their own (somewhat more affordable, of course, for their constituents). So I think I may just continue rotating my current set of clothes as a Westerner, until I feel more comfortable wrapping myself up in a brand new African kanga.

On the Road Again...Tanzania

Since my last blog post, I wrapped up my UNICEF India research paper (which, excitingly enough for my exhausted team and I - recently got published!), consulted on a few global health projects, packed up my things, said a bittersweet goodbye to NYC, moved to warm and sunny Los Angeles, and started a new job. I'm back on the West Coast to start a new chapter in my life and revive my wanderlust.

I've been very blessed to have received the opportunity to continue chasing my dream - establishing a career in global health and making a difference in the lives of others. I'm carving out a niche now, focusing on the provision of access to medicines for maternal health with my new non-profit organization. It's innovative and exciting work, and it's put me on the road again to help launch an access to medicines / availability program.

In the global health field, you can create access to medicines in several ways - mainly though through policy change and drug registration. Creating access is like telling someone that they can have something, like they are legally allowed to drive. However, this has to be paired with availability, which means that something, like a car, is reasonably within reach. It's available (and ideally, affordable). With both access and availability, an individual can then drive themselves from one place to another - in global health terms, they are empowered to attain better health standards. Of course a person has to receive the proper education in order to know how to drive; this is addressed in global health through proper [medical] training and education campaigns.

Approximately 529,000 women - that's about 1 every minute - die from complications of pregnancy globally every year.  Postpartum hemorrhage is the leading cause of maternal mortality, responsible for approximately a quarter of these deaths - the portion even higher in sub-Saharan Africa.

In the US, we don't normally hear about PPH because the drug used to prevent it (oxytocin), is already part of the standard of care in health facilities for laboring mothers. In many developing countries, PPH occurs for many reasons - including the inability of rural women to reach health facilities for labor and delivery, and the challenges of providing oxytocin. Oxytocin is the WHO recommendation for care as a first line treatment, but it is a temperature sensitive injection (it requires consistent refrigeration). It can be unstable and ineffective in countries where there are intermittent power outages, long transport times to rural facilities, and facilities without any electricity at all, like in Tanzania. It has also been subject to stockouts - where it is simply unavailable at facilities.

So misoprostol - a heat-stable, low-cost pill, which has a comparably effective rate as oxytocin, can be a powerful solution for the prevention and treatment of PPH. This can be more easily transported to both urban and rural health facilities.

In 2007, Tanzania created access to misoprostol. It was registered in the country, but since then, the availability of the drug has not been formally researched or documented. Tanzania's pharmaceutical system has endured a myriad of challenges and changes over the past several years, and an efficient and effective supply chain system has yet to be established. This makes availability quite a challenge, but not one that can't be surmounted to save the lives of mothers.

On the road this time, my global health journey will take me through the Tanzanian system to help assess  availability and comb out the challenges to safe motherhood. It'll be an interesting and exciting experience, which I hope will be complemented with some great stories and findings. Stay tuned...

A glimpse of Tanzania thus far: