The Universal Language of Soccer

The following is a commentary piece that I have written for the Kingston Whig Standard. It will be published today (Monday April 23rd). Just some reflections on life as we know it.

The Universal Language of Soccer
We have been living in Tanzania for more than 6 weeks now and it has truly been an experience beyond all others. We have worked hard to become part of our little rural, mountainous community of Kilema, Kilimanjaro and, in return, have received nothing but the warmest welcome from these wonderful people whose spirit of giving seems endless.
When I look back on how we became friends with these hard-working, impoverished people, I realize that it was soccer, and the universality of its language, that brought us together.

Not long after we arrived, my husband Roman, and, my eight year old son, Jack, insisted that we take our new soccer balls out to the field behind the hospital. School had finished for the day and children were milling around the field behind the school. When they saw Roman and Jack with the soccer balls in hand they quickly made their way over to where we were. I wish I had my camera because the site of more than 300 African children yelling in Kiswahili and running towards my unsuspecting family was something to behold. The children quickly made it known that what they wanted was to play soccer, with the first real soccer ball that many of them had seen in years. You see, the children in this region are poor, with the average family income at less than $30 per month. Most live in small dwellings with no running water or electricity. Although they all wear a school uniform, most are threadbare bits of clothing that resemble what was once a school uniform. The children carry water in old gasoline containers or bundles of wood on their heads to school each day so that they can help to prepare their noon meal which is provided through the school; typically a bowl of corn maize and beans. For some it is the only meal they will have that day and many display the tell-tale signs of protein malnutrition and vitamin deficiencies.

On that day it wasn't long before their game got off to a raucous start with most of the older boys holding onto the ball and running for the end of the field. Roman, through plenty of hand signaling managed to get a game underway. Jack was beaming from ear to ear…he really looked like he had finally found something in common with these children who lived such completely different lives; the love of soccer.

As the afternoon progressed, a group of older youth, and, men in their early twenties also started to appear on the field. Jack and the remaining boys moved their game to the other end and Roman and the men quickly got a lively game of soccer organized. These young men, mostly unemployed youth (as unemployment is more than 30% in this age group in Tanzania), played for more than an hour and a half. Roman worked up quite a sweat and a referee soon appeared with a whistle to officiate the game. We officially had our own Tanzanian soccer team.

Since that day, there have been endless hours of soccer. Roman, and Jack, the 'Mzungu Kakas', which means White Brothers in Kiswahili is expected at the field each day at 4:30 in the afternoon. And the men have appeared almost everyday, rain or shine, with snow peak of Mount Kilimanjaro sitting majestically behind them. The local priest has now officially welcomed Roman to the community in a formal celebration, and thanked him for working hard' to bring a ‘new life’ to the young men in the community. Indeed, other volunteers and locals alike have told us that there is an energy here that seems to build when foreigners come and live and work. Perhaps, seeing others investing time in your community motivates you to give a little bit more, even when many people here feel they have nothing left to give.

Since that day, the 'Kilema Soccer Team' has walked to neighboring villages for impromptu matches where it seems that the whole community has come out to see, my husband, the Mzungu Kaka, work his magic. What is most incredible is that all of this has developed with Roman and these young men never uttering a word that the other can really comprehend.

In our experience, soccer truly has broken down barriers of income, race, and, language. The language of soccer, and any sport, can be universal. It requires no money or special skills, just a love of the game and good sportsmanship. Wouldn't it be wonderful if we could take that philosophy beyond the soccer pitch and into so many other aspects of our lives. I believe that the world would surely be a better place.

Jack has Malaria

Well, just when we thought we would get away unscathed..Jack gets sick. It started yesterday with fever and back ache and headache..then vomitting and diarrhea. We had a blood smear done today and saw a doctor and his parasite load is quite high. He is now on treatment and seems better as the day is progressing. The whole family is getting tested today as we have all lived in the same house and Jack is also on malaria prophylaxis, which should have already decreased his risk, but, we are in an endemic area especially now that it is rainy season. We may as well be sure that none of us has it. We leave on Friday for a 5 day safari in the Serengeti and into two national parks in Kenya (Masai Mara and Amboseli) This is a major treat to ourselves for our hard work!. I want everyone to be healthy for the trip, especially since we'll be far from medical aid.

Jack is actually quite proud of himself and has already told two friends and the lady who served us coffee in the coffee shop this morning! He kept the lab sheet showing the positive test so he can paste it into his journal. The lady in the lab also let Roman and I have a look at those pesky parasites under the microscope...very fulfilling for the doctor in me but disconcerting to know it was my son's blood film!
I'll update you all later regarding the rest of the family's test results, including Roman's mom's (who already feels like we are trying to kill her by suggesting that she come to Africa for 2 months!).

Crazy Tanzanian things and Kiswahili Proverbs

I still don’t really think my blog has done this country justice yet (or ever will). There are so many wacky and quirky things that we experience on a daily basis that go beyond what I am able to convey. i try to write them down but many just seem to slip away.

Some examples...

1. The speed limit on the road is determined by how fast your car can go. I have never seen a 'maximum speed' sign.

2. This morning at mass a person decided to sit next to me where there was no seat. What this means is that they put their behind down on the very edge of the pew and forcefully push you and all the people next to you over so that their bum has a seat. Everyone looks straight ahead while this is happening too, pretending like they are not feeling like they are being squished beyond any level of comfort and that their personal space has been seriously violated. Occasionally, the person on the other end of the pew falls off and then the whole exercise repeats itself as they put their backside back on the pew and push the opposite direction.

3. A car stopped in front of the women’s center house yesterday and the man opened the trunk and out jumped a goat..just on their way home, I guess.

4. There are crazy old buses (luxury coaches that saw their day in China or India about 15 years ago) that take people around to various destinations in this country everyday. Many of these buses are run by private operators who compete for passengers (specifically, how full they can pack the bus), speed, and, how gaudy(or beautiful, depending on how you see it) they can paint the outside of the vehicle. By far, the most important thing about these buses is that they all have names. The ones in Moshi town that I have seen are as follows:
The Hans Blix (yes, the UN guy who looked for weapons of mass destruction in Iraq and didn't find them)…with, of course, a lovely mural of Hans himself on the back of the bus. There is the Paris Hiton (yes, sadly, the bus painter spelled it wrong..but who really cares) and unfortunately the back of the bus has a bad picture of Paris herself...she would not be pleased. There is the God Save the Queen bus (yes, you guessed it, the Queen is on the back)and, the Jesus Saves Us bus (with the Black or the White Jesus depending on the bus). I can't forget the long list of Rasta looking Bob Marley buses as well. There is one called Child's Play and Hero and Eddie Murphy..I could continue, but I won't because I think you get the picture…I am perpetually on bus alert as they are usually speeding by trying to kill us. Despite all the great names, I think The Hans Blix is still my favorite!


On a more spiritual note, there are lots of sayings in Kiswahili that are difficult to translate into English because of inherent differences in language structure and norms but, there are some Kiswahili proverbs that are easily translatable and nice to ponder. Here are a few of my favorites taken from my perpetually lifesaving Tanzanian handbook (Rough Guide to Tanzania)...

Haraka haraka haina baraka : Hurry hurry has no blessings
Mtumai cha ndugu hufa masikini: He who relies on his relative’s property, dies poor
Mchumia juani, hilla kivulini: He who earns his living in the sun, eats in the shade
Kila ndege huruka na mbawa zake: Every bird flies with its own wings (My favorite)
Ulimi unauma kuliko meno: The tongue hurts more than the teeth
Heri kujikwakidole kuliko ulimi: Better to stumble with toes than tongue
Haba na haba, hujaza kibaba: Little and little fills the measure

Some food for thought on a hazy Tanzanian Sunday.

Women's Center Pictures

Pamoja Tunaweza (Together We Can) Women's Center

We have had the keys to what will be our women’s center now for almost 2 weeks. We are all sleeping in the house as well when we come to Moshi from Kilema. Somehow the stars were crossed in our favour, because I really can’t believe how fortunate we have been to find this place. The purpose of the center is to provide additional support and services to women in need in the Moshi area and hopefully we will eventually have links to more rural areas outside Moshi. Impoverished (and often rural) women are often in the most difficult situations due to lower rates of education; with shocking illiteracy rates. The center has been the vision of Mama Minde, the director of KWIECO (Kilimanjaro Women’s Information Exchange Consultancy Organization). KWIECO established ties with CACHA a few years ago and CACHA ultimately sponsored Mama Minde to come to Canada in August 2006 for the World AIDS conference. Elizabeth (as I usually call her) presented her work on women’s land rights in Tanzania. She won an award at the conference and is definitely a trailblazer of women's rights in Sub-Saharan Africa. As I have ranted about in several blog entries, women need someone to champion their cause here and Elizabeth has been that person for more than a decade now.

KWIECO started as a small NGO funded by a Norwegian funding agency. They started with providing information and education on human rights (because it in the simplest sense, women’s rights are human rights). Elizabeth was somewhat of a one woman show initially, providing free legal counseling and going to court for women in need of legal defense. I am sure she was not well liked initially as customary law in Tanzania has dictated for centuries that women are ‘property’ of their husband and their husband’s family. They don’t really own anything within their marriage and when their husband dies, they often have difficulty retaining ownership of their land. The land is typically absconded with by a male relative of the husband (brother or father or even a male neighbor), the women can be left destitute and homeless, or, have some sort of arrangement with their in-laws to work for food and shelter for her children. HIV/AIDS has increased the number of women in this situation by a hundred fold and if the women is HIV positive, God help her, as her husband’s family is likely to shun her and her children completely. The option of returning to her parent’s home is not usually there as she is no longer wanted (and seen as a definite liability). Once a woman is married off here, she is her husband’s ‘problem’.
Many women in Tanzania are poor and unaware that the law does state that they are worthy of all rights afforded to men. Many of them have lived in marriages where they must get consent from their partner to go to the hospital, to work, to take on any role higher community role or try to further their education. A recent study completed by The Dignity Project in Tanzania looked at the causes of maternal and child mortality during childbirth and examined the rate of obstetrical fistula (where a canal develops between the vagina and the urethra..typically, these women leak urine, or between the rectum and vagina-they leak stool, or if they are lucky enough…they leak both). In 90% of cases of obstetrical fistula the baby dies. The fistula develops when the baby’s head is stuck in the birth canal for long periods. This happens because rural and even urban (yet poor) women live long distances from medical care or are unable to pay for it. The study showed that even after arriving at a medical center, many were turned away for being unable to pay or received sub- standard care because the center was incapable of performing a cesarean section. The study also determined that the type of relationship the woman had with her partner also impacted on the time it took to seek care. Many husbands insist that their wives deliver at home (even when the women have been instructed to go to a medical center to deliver because they are short in stature or have other pre-natal complications). In addition, the women who suffered from fistula also recounted that their mother-in –law had played a major role in the decision to take the women to seek medical care. Many women felt they were unable to make any of the decisions regarding the delivery of their own child. They also live with guilt for not feeling empowered enough to be able to save the life of their own child. These women are then subjected to a life as a social outcast if they cannot find or afford the specialized surgery required to repair their fistula. In simplest terms; they smell bad. This example of obstetrical fistula really provides a lens into just about all aspects of a poor and uneducated woman’s life here. The same type of empowerment issues also exist around HIV/AIDS. Many women know they need to be tested but are unable to have it performed because their husband or his family fears stigmatization from the community. Positive women who have received any pre-natal care have usually been told that they should deliver in a health care facility so that they can be provided neveripine during labor and deliver to prevent transmission of the virus to their newborn. The newborn is also treated with anti-retrovirals after delivery. This can lower the vertical transmission (mother to child) by 2/3rds. Tragically, these women are often prevented by their husband or family members from receiving this preventive care as well because of the stigmatization. Why am I on this tangent? Well, the issue of land rights (and human rights) in the simplest sense, is at the heart of all these issues. Elizabeth’s work to provide ‘one woman at a time’ with the right to land that is in all respects her’s is the first step to empowering women in many other aspects of their lives. KWIECO now also educates boys and girls about human rights issues.
The women that KWIECO serves are in need of more than legal aid. It has been Elizabeth’s vision to provide a safe and compassionate place for further social support and counseling to get these wome to the next step; beyond rightful ownership of their land. For those with HIV, even more indepth care is needed. We even hope to provide for the most at risk women, a safe place to stay if they are in dangerous marriages and are in the process of re-establishing a life for themselves and their children outside of the marriage. The building we are leasing has a self-contained apartment on the upper floor and would serve well as a place for volunteers to stay or women who need temporary shelter. The ground floor will house an office, meeting room and a counseling room. The counseling room will ultimately double as an exam room when we have a free women’s health clinic here (my dream).

I have uploaded pictures of the house. Roman and Jack burning brush from the garden, the office, bedrooms, upstairs kitchen, living room, patio and grounds (view from the front gate). I feel good here.

It is our eventual hope to provide free, open, safe access to women’s health care (mental and physical). We hope to provide education in reproductive and sexual health as well as offer HIV testing and treatment that goes beyond the norm, the taboos and the stigma that still exists here. It is my hope that our women’s center will one day fulfill that mission. I'll keep you posted.

Visiting Malinga...again

We were missing Malinga and needing a break from Kilema so we took the luxury bus (an oxymoron if I ever heard one) to Dar es Salaam. Roman's mom is now officially African as she survived the trip and seemed to enjoy looking at the beautiful countryside. We have done it a few times so it isn't quite as interesting and the high speeds, broken toilet and lack of air conditioning for 8 hours were enough to send me over the edge. The kids are currently fighting over who will sleep next to Malinga tonight as I type this from the hotel room...thank God for good internet in the big city. It has been a great day and we are all looking forward to when he will be with us permanently. The update on the adoption process now is that we have done all paperwork and it is in the hands of the Tanzanian social services person who will handle our case. Her name is Miss Moyo. She will meet us tomorrow for the first time. She needs to get our foreign reference report from Canada and then she will put our file before the Assistant Commissioner for Social Welfare. He is an imposing and often difficult to deal with senior government official named Mr. Charwell. Once he approves us as fosterparents/guardians we can pick up Malinga at the orphanage. We will then need to apply for a Tanzanian passport (and likely pay some bribes...I can't believe I just said that) to get the whole thing done in time to take him home. One of us needs to get back to Canada soon to work as we are running out of money...but it will have been worth every penny.

Orphans, orphans, orphans..

We had another orphan day on Friday and I think in a weird subconscious way it is getting easier. The kids are wonderful, tragic little human beings. The grandmothers who occasionally accompany them to the 'orphan day' are saints. We are compiling a list of those in the program who are HIV positive so that those that need treatment can start on ARV's. A pediatric HIV physician from the Elizabeth Glazer Pediatric AIDS Foundation was at the hospital last week. He asked if we could produce a list in the next month or so of children for him to see in May on his next visit. We tested 10 children who lived the farthest away from Kilema (ie. they had walked more than 5 kilometres on mountain roads to see us that day). These children I chose to test all looked relatively healthy and only one of the 10 we tested was positive (I was overjoyed). We made a list of those who had already been tested over the last few months and have 56 children. We have about 40 more to test from this group. We are at the tip of the iceberg as this group has already been identified as the high risk group (in need of as much care as we can provide right now) but, there are hundreds more that we see on the roads everyday who are not known to us. There is one orphan, Augustina (see picture) who is two years older than Hannah and a waif of a thing. I fear she will die in the next year if she doesn't start treatment soon. She has recently been sponsored by a Canadian woman who purchased foam mattresses, clothing and food for the family and plans to provide money for food so that nutrition for the whole family can be improved. Augustina cannot be started on ARV's until she is 'healthier' ...a crazy irony I guess. The little girl with that looks like a baby Aunt Jemima (picture) is also positive and I had to try really hard to not bring her home with me. She came with a kind hearted neighbor who has taken her and her older sister in after the death of their mother and father this past year. I was thinking yesterday about what North America spends on doggy beauty parlours....it is a crazy, crazy, world.

Our days in the hospital

It has been a good week. Roman and Canadian nurse , Sharmilla continue to be the extraordinary wound team at Kilema Hospital. They feel guilty now when they need to take a day off to go to town. The hospital we are working in functions reasonably well for minor ailments and women in labor but does not deal well with severely ill patients, especially children. We have no blood bank (families need to donate blood on theh spot for their loved one)and we cannot check kidney function, electrolytes or blood cultures. Writing an order on the chart and seeing it carried out can take hours even if a child is dying. I guess that is just the way things have always happened here. Human life is improtant but not seen in the same precious way that we see it in North America or in Western society in general but we are realizing that it is very difficult to change things with any significant speed. There is a definite resistance to trying new techniques and 'changing old ways'. It may be due to years (more like decades) of having only basic medicine and equipment available. Now that newer drugs are available (provided either by the Tanzanian health care system or by donations from various organizations), there is a reluctance to institute changes in care. I am not entirely sure why, there is certainly the feeling that we need to save things for a rainy day even if it means treating a burned child with inferior medicine or life threatening techniques (minus any pain control). I haven't quite grasped the whole situation yet but I am trying hard to understand it and make slow changes where I think they will take hold. There is a new computer here with satellite internet that is finally working but it needs to be locked up tight with only one of the nuns holding the key for fear it will get stolen. That will make my plan to teach the docs and clinical officers how to do a pubmed search somewhat difficult. I am trying to find a way to work around it. You often need to take the time to convince the powers that be that it was 'their' idea and then you can start to make new changes. The most iverwhelming issue we have in our hospital right now 9although the doctors assure me it is not new) is an epidemic of TB. The male medical ward has 8 out of 13 patients with TB and 4 of them have co-infection with HIV. Two of them are dying because they have stopped their antiretrovirals and chosen to be cured by a witch doctor. It hasn't worked. They have infected wives as well and several have infected children. We have a government funded 'TB coordinator' who I have not managed to meet or find yet. I asked this week how tracing of infected family members is done and they said it isn't as she is too busy with patients who come to be seen at the hospital clinic each weekday. The WHO advises that contact tracing be carried out for all potential contacts...this does not happen in our region. We just wait for them to appear at the hospital. HIV and its down stream effects seem to have taken over how i practice medicine here. Almost everyone I see needs testing or is already known to be infected. Getting people onto ARV's is difficult as they can be started but often run out of medication and don't get a refill because they cannot get to the clinic due to illness or family issues or distance. Stopping ARV's is good and bad as it can breed resistance...it is worse if they stop their anti-TB meds as well.
One positive is that the doctors and clinical officers that I make rounds with are very keen to learn (unlike the nursing staff)and seem to want to try to institute some of the suggestions I have made. The biggest (and most fixable) issue I see right now is that there is no running water in the pediatric ward (a nice looking broken sink) and moms (the dads are rarely around) who have babies with diarrhea cannot wash their hands easily. The families do all bathing and diaper changing of all patients (adults or children). If the sink does not work they need to go to the patient washroom area (and supply their own soap and towels) which is small and filthy and serves the whole hospital...you can see how disease gets spread...lets just say that Purell is my best friend! They are also expected to supply food if they can. Patients with no family are given millet porridge or maize porridge(ugali) and beans.
I have added picutres of a child receiving burn treatment (happy to say that Roman and Sharm pulled out the Flamazine that was locked in a cupboard for a year and the child has now gone home!), other pics of our soccer teams and some children at the nearby school.

Easter Blessings and small things

It has been a busy week with no internet access. Roman and Jack and Sharm (Canadian nurse extrordinaire) and I walked to the Kilimanajro Resort Hotel to use the internet. The walk from Kilema Hospital is beautiful with several waterfalls along the way. We had a wonderful Easter morning. The Easter Bunny some how found his way to Kilema...he even put Easter chocolates UNDER the mosquito nets! The kids had great egg hunt and we went to an early mass with some of the most beautiful singing and ululation (when the women click and roll their tongues to make a chanting sound). We walked to the shack of a large and very poor family who we had seen when we did the stations of the cross on Good Friday.
The hill behind the hospital, which I have mentioned before, has 'the way of the cross'on it...basically the steps Jesus took to his crucifixion (for all you non Christians!). It is a holy journey for us Cathiolics and Roman's mom, Hannah and Roman and I made our way up the hill on Good Friday. It was a great hike and very beautiful. Roman's mom said the $5000 was worth it (which is what her airfare, shots, anti-malarials and spending money cost her!). Anyway, I think my children really witnessed what it means to share.
This family with many children and a grandfather who seemed to be caring for them looking overjoyed to receive our cake, chocolate eggs and toys. Jack and Hannah willingly parted with a large amount of our candy that I had brought from Canada on my visit home. It is so much more enjoyable to share it (Pictures now uploaded).
It was a nice break from a busy few days in the hospital. Roman and I had a tough day on Friday (prior to leaving on our hike) as we lost a young boy (12 years old) who presented way too late with what I think was Rift Valley Fever. With this virus , which is transmitted by mosquitos, you get a flu-like illness and bleed from many mucous membranes. We got family members to donate blood and did everything we could with the resources we had. He died during our hike with his 15 year old brother at his side.

Karen is officially Tanzanian!

Hello again,
I have been away for 9 days in Canada then Germany (all work related) and now I am 'home again' in Tanzania. It was wonderful to see all of my beloved (and you really are) family and friends in Kingston. My house felt opulent and castle like for th first 24hours and then I started to feel that it was my new reality once again. It is amazing how you adjust to two very different worlds.
I had an interesting experience on arrival home in KIngston and, Jenn Carpenter is my witness. The story goes like this: I have had a small sore on my left big toe for more than a month now. I thought it was a bloo blister at first and didn't really know how I managed to get it. I sort of picked at it and tried to pull it off a few times but it would not budge nor did it seem to be healing in any way. When I arrived in Kingston and started wearing closed toes shoes again (although my feet really wanted to wear sandals. I started to feel some pain over that site. I described it to Jenn one day and asked if she would look at it to see if she knew the diagnosis. She said 'sounds likethe chiggers'. My heart sank and I felt sick all at the same time. Chiggers are a flea that burrows under the skin of feet in the part of Africa where we have been living. I had seen children with many of them on their feel but generally they were large infected sores so it never ocurred to me an early version of this DISGUSTING parasite. Any way, several hours later and after a glass of wine, we did the operation. Jenn soaked my toe in peroxide nd went and got a small foreps. I picked the top of the lesion off and out popped a white wormy like thing. She ran into the kitchen gagging (I am totally serious) and I felt very pale and sick all of a sudden). Yes, the ER physician who lances boils and drains pus was disgusted and sickened by the living creature in my toe!! After I calmed down a little, I managed to pull it out and it broke in half...so now half a flea/worm was stuck in my toe. After a bit of work I eventually pulled the second bit out. I went home and soaked my toe to ensure all the body parts of this tunga penetrans (its latin name) were fully extracted. My toes is now fully recovered and I bought a pair of better shoes as a birthday gift to myself in Frankfurt...ones that should prevent further foot flea infestations. I hope none of you are feeling too squeamish but it was possibly one of the most disgusting things I have ever done and it was on my body!! THAT, my friends, is why I now consider myself a true Tanznaian.

Picutres and more to follow tomorrow on the new women's centre....I got the keys today...this is a big step for PREVENTION THROUGH EMPOWERMENT.