Culture Shock

December 12 was the day I left Tanzania.  I remember looking out the window of the airplane and feeling a strange combination of pride, sorrow, and inspiration as I watched the world beneath me become a part of my past.  Pride that I had embarked on the greatest adventure yet-- all on my own-- and come out alive.  Sorrow that I was leaving a place that I had grown to love and appreciate in its own special way.  Inspiration for the way I wanted to live the life that I had in front of me.

It has been quite a year filled with lots of joy, but some sadness too.  I have embarked on a similar adventure, but this one has no end date when I know I'm going home.  I'm trying to make this my home.  Although I am not speaking Swahili, Kentucky can be just as much of a foreign land as I navigate my way through being a single twenty-something girl and learning how to be a grown up woman.

I could not have predicted the way the past year has gone.  I hope I get to say the same thing come next year. I've done a lot of soul searching recently and the task before me is clear.  So I'm harnessing the person that left for Tanzania not knowing where she was going to sleep that night, but who had faith that everything would turn out alright.  I have no idea what's coming, but I know it's going to turn out alright.

Rose-colored glasses

A year ago today, I boarded a plane headed for Tanzania.  I had no idea what I'd find.  I didn't even know where I was going to sleep when I got there.  That was the adventure I craved.

My time there was life-changing, because I've never lived in a world where everything was an adventure.  A trip to get groceries meant a mile walk, hanging onto the side of a dala dala (bus) for dear life while the pavement raced beneath me, bartering in Swahili with a local for pennies worth of delicious produce.  The children I worked with had diseases I had only ever read about in books.  But now I have seen rheumatic heart disease, rabies, and pediatric AIDS.

I had every target on my back: Single. White. Woman.  And yet I approached my life there confidently (and only sometimes with reckless abandon).  I have never lived so simply.  It's a true test of flexibility to forego all of the luxuries of Western culture.  And yet, I'd love to live without them again.

I miss the beauty of my surroundings: Kilimanjaro peeking out of the clouds, flowers blooming on every tree, the amazing fruits and vegetables that were picked straight from the trees, the feeling of Karibu and the sweet nature of all of the Tanzanians.

I miss Dana.  Happy friendiversary!!!!

I don't know if I'll ever make it back to Moshi, Tanzania, but that's okay because I live out the lessons I learned there every day in my life here.  Karibu, work hard, be present in your community, provide resources, care for the children like they were your own.

into Africa

http://nursing.duke.edu/wysiwyg/downloads/8518_NursingMag_lorezFINAL.pdf

Thought you might like to check out Duke Nursing Magazine's summer issue which features my time in Tanzania and the work that DUSON is accomplishing on behalf of our school.

Skip to page 10 and stay until page 15 for my story, fellow DUSON students, and my final reflections on life in Tanzania. (Also a big shoutout to Anne Derouin who is featured as a new faculty member! Yay!)

Reflections on Tanzania

I was asked to write an essay on my reflections of my time in Tanzania. I thought I would share that with ya'll along with some of my favorite pics:

After returning to the United States, my adventures in Tanzania fade to memories and my experience becomes tinted pink by the rose-colored glasses of my memory. The frustrations of everyday life do not stand out in my mind and I more readily remember the beauty and joy of the community in which I lived. I forget about the constant power outages and the toilet that leaked into my living room and instead remember the blooming flowers, Mount Kilimanjaro peeking out of the clouds, and Tanzanians shouting “Karibu! Welcome!” to me in the streets.

Learning as a nurse practitioner student was difficult since the profession is not recognized in Tanzania. I straddled the balance between learning alongside the doctors and still connecting with the nurses, and what I learned was that communication is sparse between the disciplines. The nurses were frustrated when their concerns were not heard by the physicians, and the physicians did not utilize the nurses to their potential. I see so much potential for advancement of nurses and improved patient outcomes if they simply collaborated and communicated.

I was readily aware of the color of my skin—white. I was called a “mzungu” or white person in the streets. My skin color is associated with economic prosperity and as I learned more and more Swahili, I realized that I was being beckoned to come into shops and spend my money. It did not matter to them that I was a broke graduate student from Duke. And in the hospital, my skin color was associated with Western medicine that can cure all maladies. But there is only so much that Western medicine can do if the families wait too long to seek medical attention. Sometimes there was nothing more to say than “Pole. I’m sorry," and plan for palliative care.

I plan to start my career in the United States because I am aware that health care disparities exist in our own backyards and I want to provide excellent care for the children in my community. Tanzania changed me in a way I could not have imagined—it opened my eyes and my heart to providing care for the entire family. Don’t just write a prescription; give the family food to nourish their bodies too. Don’t just write a referral form; give them bus money to get there.

What will I take with me from Tanzania? After the red dirt has long been washed from my feet and my sun-kissed cheeks have faded from being hidden indoors for the winter, I still remember the children. I remember their big heads sticking out of the tops of kangas (cloth wraps) on their mamas’ backs. I remember their big bellies and curious stares at my white skin. I remember feeling helpless in the face of limited resources and poor access to care. I remember how sick the children were as I wished for folic acid, vaccines, and well child visits. It will take a long time and a lot of resources to eliminate the health disparities that exist in Tanzania, but we must remember that health is not a privilege, it’s a human right.

Em & Aud's Excellent Adventure

Two of my classmates from Duke have just arrived in my old stomping grounds of Moshi, Tanzania. They took my place in the pediatric clinics, living on the compound, and exploring the greater Kilimanjaro area. Since I was the first student to go from our primary care program, I had a lot of kinks to work out and spent much time "trail blazing" to figure out how to survive in TZ and make the academic portion of our program a success. Their blog is www.emandaudintz.blogspot.com and you can follow their journey there. This was their post to say asante to all of my help in preparing them for this adventure... Hope ya'll have a great time! Safari njema!

Two brave PNP students, Becky and Kelly, embarked on this same experience previously on their own. These girls established relationships and set precedents for future nurse practitioner students to gain global health experiences at KCMC. A wise professor once said, “trailblazers experience the most bumps in the road!” Well, Becky and Kelly sure had their share of potholes to deal with, but handled them with poise thus paving the way for our time here in TZ. To you we are extremely grateful! Your advice, resources, packing lists, cell phones, and long Q & A sessions have helped us immensely. You are amazing… we will be saluting you from the top of Kili!

Becky the Superstar!

By popular request: Tanzanian superlatives

Top 10 reasons why I am (or am not) returning to Tanzania:

Am-
1. Karibu is the first word you hear. Welcome.
2. Summer year round? Ndio, asante sana.

3. Why drink water with parasites when you can drink Cokes all day?!
4. I could get used to Africa time: 4 hours of work, a nap every day, in bed by 10 pm.
5. I want to carry my baby in a kanga.
6. Bartering is really fun, even if you still get mzungu prices.
7. A fruit salad to feed a small army costs about $2 and you can buy everything from the mamas right outside your house.
8. There's a lot of work that needs to be done.
9. Swahili is a beautiful language.
10. I am a millionaire in Tanzania! ($1=1500 Tsh)

Am not-
(above: some of my favorite nurses at my "going away" party at The Station in Carrboro)
1. It's really hard to get hugs across the Atlantic Ocean.
2. Being a nurse is a difficult battle in Africa, and being a nurse practitioner is unheard of.

3. I love all 4 seasons.
4. I prefer to sit... not squat.
5. I'm spoiled and appreciate electricity... especially when it's dark.
6. Dala dalas make Carolina's U bus on a rainy Monday in August seem like a limosine.
7. The amount of cereal I eat in a month would cost $24 (36,000 Tsh) and I like it better when it crunches because it's fresh... not because it has ants in it..

8. I like wearing dresses, skirts, and shorts that are quite scandalous... the stop above my knees.

9. It's annoying to have your skin color be associated with wealth and therefore be harassed because of it.
10. White girl of Irish descent in Tanzania = sunburn

Before & after: What I had in my suitcase upon arrival and departure:
Before- (See the previous post on how ridiculously unprepared I was.) In short, a few medical supplies, 7 shirts, 4 pants/skirts, 3 tubes of sunscreen, 1 towel, 3 pairs of shoes, 2 packs of Skittles, my laptop and ipod
After- 5 pounds of coffee, countless bags of tea, 6 kangas (the wrap skirts that the women wear), 4 pairs of shoes (please note I came home with more shoes than I left with despite having left my hiking boots in TZ), antibiotics/antiparasitics/antifungals from the duka la dawa, very few clothes

5 foods I dreamed about while I was gone:
1. All things Mexican
2. Cinnamon buns
3. Tar Heel pie
4. Thanksgiving stuffing
5. cereal

Ways I grew that I never expected:
- I cannot have much sympathy for people in Tanzania because I don't actually have any idea what they go through on a daily basis. My capacity for empathy grew exponentially as I saw their situations, listened to their stories, and helped them deal with the circumstances of their lives.
- My passion drove my career to work with children because they are so dependent and vulnerable to insults against their health. Imagine how I felt when you add economic disparity, a resource-limited health care setting, and a country that has twice the health risks.
- I know that I am enormously blessed to be an American. I had no idea how blessed I was to be an American woman, have value in my family, to befrom a middle class family, to have an education at the graduate level, and never worry where my next meal will come from. I do not take so much for granted anymore.

Embarrassing moments a la East Africa:
-Messing up the greetings (which are very important) on my first day and having a room full of Tanzanians literally laugh at me.
-Hosting a dinner party at my house in the doctor's compound and having our ever-leaking toilet water run into the living room. Classy.

-Getting caught with my thighs exposed.

Bert asked me to use 3 adjectives to describe my experience in Africa:
welcoming, slow, delicious

Tutaonana baadaye Tanzania!

See you later Tanzania! I am spending my last day in Tanzania hanging with my TZ BFF, Dana. We have lived it up in town, chilled on the compound, and are headed out again after a splendid African afternoon nap. I am trying to pack my bag and feel like a bit of a stereotype of a female traveler as I sit on top of an overstuffed suitcase, trying helplesses (and hopelessly) to close the bulging zipper. Some rearranging will need to happen.

I leave tomorrow on the 5:15 pm flight out of Kilimanjaro headed for Ethiopia, followed by Rome and DC before arriving at RDU 28 hours later. Hamna shida.

I was told by a professor that after the initial culture shock, the next time I would feel sad would be when I left Tanzania. While I am very excited to go home, there is some truth to that statement and I will surely miss TZ. I have missed so much of the fall that I am unsure of what it will be like to get back to North Carolina-- perhaps another culture shock. I look forward to seeing all of you and I hope that my secret fans (read: school friends, family, friends' parents, etc.) will speak up and leave comments. I have loved all of your encouragement and support!

This will not be the last of local townie's TZ blogposts, but it will be the last from the ground in Africa. Kwaheri Tanzania, hello America!

The Circle of Life

I just got back from my safari and it was AMAZING! I'm pretty sure we sang the entire soundtrack to The Lion King from start to finish. I was surprised at how easy it is to find the animals and that they are totally used to the big "animals" that drive around and make a lot of noise.

We saw just about every animal and got into a few interesting situations...Don't worry nothing dangerous... There was a fresh wildebeast kill by the side of the road with a lion in a post-lunch coma and we watched two lionesses stalk a herd of wildebeast, hoping for a snack. Sadly, they spooked the herd and there was no kill.

The three parks are all incredibly beautiful in their own ways. Tarangire is full of foothills with winding roads and animals around every corner, while the Serengeti is vast and beautiful with unique architecture of trees and watering holes, and Ngorongoro is a giant crater that is beautiful from above and below and has the best of both worlds with its lush jungle and wide open plains. Camping was quite interesting since our last night had a few uninvited guests... hyenas and wild boards invaded our campground. I stayed put until they were long gone and got up to see the African sky at night. Sunrise was pretty impressive as well. I saw the sun rise over the Serengeti and Ngorongoro crater. I will post more pictures later, but I wanted you to get a taste of wild Africa.

Saving babies

Everything is exaggerated in Africa. Time moves slower, the mountains are bigger, and the kids are sicker. For those of you who know my background, you know that I am an ICU nurse whose heavy heart pushed her into primary care in search of healthy kids. But now the kids in primary care are just as sick are breaking my heart every day. Yesterday and today were particularly difficult.

We started off clinic with a very sick little boy with HIV and CP in respiratory distress. We ended up admitting him to the ward with a severe pneumonia.

The next patient was a 16 year old boy that we disclosed his HIV status to and he had NO IDEA. (In Tanzania, the children are simply given medicine and they have no idea why they take it. "Disclosure", or telling a child about their HIV status, happens around 12 or 13.) All he knew was that he took medicine every day because his father told him to and that his mother died when he was little. It remains unclear to me whether he was totally in the dark, or perhaps suspected that he had HIV, but we told him all about his disease. It was one of the more difficult conversations I have ever had with a patient. To him it was a death sentence and meant that he would be ostracized from his friends. We emphasized that he would live a normal life-- he just had to remember his medicine every day. He could even follow his dream of being a pilot if he studied very hard in school. After about an hour of tear-filled counseling, he said, "I would just like to go home if it is possible."

We re-admitted a kid that came back for a check-up after being discharged with a severe infection. He had cancer about a year ago and it had metastasized to the liver. No one told him that he had to go through another two rounds of chemo.

And the cherry on top of my Debbie week was that a beautiful little girl was abandoned in the pediatric ward today. Her mother left and the nurses brought her into the clinic. She looks about 6 months old and has the most wonderful personality. It has been outlawed for single women to adopt Tanzanian children.

Ugh. Rough. I'm headed back to my house now for lunch, a handful of Skittles (thanks Aunt Janet & Uncle Bob!), and a nap.

Tomorrow will be better.

Mambo vipi!

Mambo from Tanzania!
I'm so sorry to leave all of you hanging for so many days, but it has been a very busy week! I arrived in Moshi over 24 hours after I left home and was utterly exhausted and overwhelmed. I won't lie that my first night was a bit rough, but twelve hours later I had met all of my contacts at KCMC and my lifesaver Dana which made all the difference.

Allow me to recap the last week here and throw in a few of the highlights:
This week is the national elections for president which has been quite interesting. There has been lots of shouting and music in the street, lots of music, and lots of paraphernalia supporting one candidate or another. Today is election day and the town seems very calm.

I am working in all of the different pediatric clinics at KCMC. Since KCMC is a referral hospital, it gets very sick children whose parents have waiting to bring them because the expense of health care is often more than the family budget can afford. I have seen many clinical cases that I would never see in the US including rabies, congenital hypothyroidism, and lots of rheumatic heart disease. The mentality in treating these children is very different because of their co-morbid conditions (HIV/AIDS, tuberculosis, malnutrition, unvaccinated) which changes the entire approach to their care. Sadly, it sometimes becomes more palliative care because there is nothing more to do for their situation. The medical language is English but the patients and their families all speak Swahili so I am trying to learn key phrases. It is a difficult language to learn, but I am slowly gettin' there. The Duke collaboration with KCMC is quite large and there are a lot of really great physicians here. The idea of a nurse practitioner does not really exist in Tanzania so I had a difficult time in my first couple of days explaining that I needed to follow the doctors and not the nurses.

I live with 2 British 3rd year medical students interested in internal medicine, a Danish 1st year medical student studying lipodystrophy associated with antiretroviral therapy in HIV pediatric patients, and an American PA student doing OB/GYN. Our house has the essentials and that's about it! We lose power almost every day which I fully expected.

Yesterday I went on a trek with my roommates and my friend Dana up to a village named Materuni to see their waterfall (pictures coming later!). The hike to the falls took us through banana and coffee plantations and on the paths of the small village. Children love to see mzungu (white people) so we had quite an entourage throughout our hike. The falls are about 80 meters high and beautiful! We continued hiking to the border of the Kilimanjaro National Forest and took a sharp turn up the mountain where we ended up at our guide's homestead for lunch. As part of our dessert he brought us some dried coffee beans which we shelled, sorted, roasted, ground, boiled, and pressed into the most delicious (and time intensive) cup of coffee I have ever had in my entire life! You know how much I love coffee so that is a hefty compliment, but there's really no comparison when you're sitting on top of a mountain in Africa sipping kahawa (coffee) with beautiful Swahili watoto (children) in a house with dirt floors. We also tried maize beer (gross) and banana beer (equally as gross). I can't wait to show you the pictures!

I plan on hanging out and resting for the rest of today and while the rest of the Americans celebrate Halloween I will be resting for a bright and early day in the HIV family clinic.

Thank you to everyone who has made comments and emailed me! They are nice gifts to get during the week! Keep them coming, although I will respond to everyone here since internet is so scarce. Love you all!

Circle of Life

Tanzania will be easy... I mean, I've seen The Lion King like a thousand times.
...And I speak Swahili perfectly, "Naaaaaaaaaaaants ingonyama bagithi Baba"
They'll have no idea I'm a mzungu (white person).

Countdown to Tanzania! 1 month!

I received my visa today so it's official... I'm going to Tanzania!!! I will be in Moshi, a bustling town right outside of the Mt Kilimanjaro park and very close to the Kenyan border. For those of you who will be keeping up with my travels in Africa via Local Townie, I will post periodically before I leave on October 25 and will post as much as possible while I'm in Tanzania (although I make no promises with the internet access!).

The countdown is on! 1 month!

I will be staying in a compound for volunteers that are working at KCMC (Kilimanjaro Christian Medical Center) in Moshi, Tanzania with other international medical students, physicians, and volunteers. Duke has a relationship with the hospital and I will be attending rounds in the pediatric wards. A student went from the acute/chronic program last year, but no one has gone from the primary care program before so I will be the first, which should be interesting since I'll also be working in a children's clinic in town.

I'm starting to pack and starting with my small arsenal of a pharmacy which will include: advil, malaria prophylaxis, diamox (for high altitudes), cipro (for those GI bugs), pedilyte (for rehydration after the GI bugs), probiotics (to return to normal after the GI bugs), bug spray.

I am up to date on all my vaccines after next week with yellow fever, HepA, flu, and typhoid.

The reality of my trip has only partially set in but what's more unreal is that when I finish this trip, I will be finished with graduate school. Just one short month of Raleigh clinic work and two months abroad stand in the way of me being a PNP and that's pretty hard to believe!

My family and friends have done well to support me in organizing this trip while battling "Africa time" and encouraging me to take this opportunity. It will undoubtedly be the greatest adventure I have ever embarked on.