Letter Four from Tanzania

Salama!

The tide is high this morning, and the waves are crashing on the beach outside my bungalow. I heard a scurrying under my bed, and worried that I’d find a mouse or rat in my suitcase. Nope. It’s a crab. What do you do if you find a crab under your bed? I’m not exactly sure, but I guess I’ll find out. TIA.

I’m preparing the last of the tropical disease lectures for the students. It’s hard to believe that the students go home in 4 days – well, home or off to other destinations. There are students going to South Africa, Greece, London, and even one who is going to go stay in Masaai village. We’ve lived multiple lives since we’ve been in Tanzania, yet it seems there is always more to do, see, and experience.

Zanzibar has been a wonderful host, and the Seaweed Center has been a perfect locale for the students this past week. The Seaweed Center is a non-profit dedicated to helping the women who harvest seaweed. As I’ve mentioned previously, seaweed mamas typically make about $1/day. However, at the Seaweed Center, they turn the Seaweed into products, adding value. They’ve been able to increase the profitability, and as a result pay the mamas about $8/day – which is enormous. I don’t know about you, but I’d love an 8-fold increase in pay. A lot of the products to date are ‘spa’ type of products, lotions, massage oils, and soaps. In the future, they’d like to include a medicinal product line – something that NUNM students can help develop.

This year, the director of the Seaweed center, Kelly, wanted our help in increasing the health of the seaweed mamas. Since they’re often bent over in the sand harvesting seaweed, many suffer from back pain. Stirring the products causes shoulder and neck pain. There are upper respiratory issues from the fires that they use to heat the products. Others have issues with sleep – i.e. they don’t get any because they get up at 3 a.m. to cook for their family, they harvest seaweed from their own farm, and then they come work at the seaweed center all day. By the time they get home and make the evening meal for their family, and clean up and do laundry, it’s midnight. 3 hours of sleep each night doesn’t cut it. Thus, these mamas tend to fall asleep in the storage room. I don’t know how we fix that one. That’s a cultural issue, and a poverty issue.

The students spent the first two days getting to know the mamas and building rapport. On the first day, they went out to the ocean with the mamas and learned how to harvest seaweed – truly back-breaking work. That way they had a better understanding of what the mamas did each day, and they earned some respect. On the second day, they divided into small groups and spent 3 hours with the mamas asking questions, learning about their culture, and discovering what the mama’s priorities were. The mamas then led the students through their village, showing off their homes, and their families.

The mamas dropped us off at Mr. Kahawa (Mister Coffee) on the beach in Paje. Here, the students could get lemongrass and mango smoothies, or cappuccinos, while they shared the mama’s different issues within the large group. That way all of the students could learn from each other. The students came up with public health strategies for the different small-groups of mamas and developed plans for day 3.

The last day at the Seaweed Center was nothing short of amazing. I’ve been impressed by this group of students all along, and they really performed for day 3. The first group was dealing with the mamas who were experiencing pain. The students developed a lesson in stretching, yoga, and qi gong. Using a translator, they explained how the muscles got tight, and how to release the tension. They had the mamas shaking, and touching their toes (that’s an easy one for someone who harvests seaweed) and laughing. The students also identified which herbal teas the mamas had access to that were anti-inflammatory. The second group of students addressed the self care issues. They discussed exercise, nutrition, wearing face-masks when they are breathing the smoke from the fires, etc.

The third group of students was a little different. This group worked with the mamas who were midwives in the village, and a mama who had just had a baby. Lauren, one of the students in the group, is a doula. She showed the women how to relieve pressure on the hips, massage, and move the baby using just a scarf or their hands. The mamas practiced on the students. These mamas have been delivering babies for more than 30 years, but no one had ever told them that they could make it easier on the pregnant women. They were so grateful.

After the small groups were done with their lessons, all of the students and mamas and translators gathered together for a moxa lesson. Moxa is a Chinese herb that is burned on acupuncture points. This past year, NUNM joined forces with the Moxa Africa project, which has been teaching locals how to use moxa in Uganda. They’ve been observing great success in treating TB and drug-resistant TB using moxa on one particular acupuncture point (stomach 36). Kelly was afraid that the mamas would be resistant to learning moxa because they somewhat fear incense, thinking it’s a tool for black magic, and moxa usually uses an incense stick to light it. We replaced the incense with a thick stick of dried lemongrass, and then asked for volunteers. All of the mamas bolted to the front. They all wanted to try it! In fact, everyone wanted to try it. The students spent the next hour demonstrating moxa, and then letting the mamas do it on each other. They had no trouble locating their acupuncture points. In fact, the students were trying to do it the way they’d been taught by the Moxa Acupuncture project, but the mamas would already have their fingers on the point by the time the students figured it out. They know their bodies well.

The day was a resounding success. When the students boarded the dala dala to leave, the mamas started singing and dancing to show their appreciation. They asked them to come back again – not just next year. They requested that some of the students come back again on the following week!  Other students were invited to attend church or mosque with the mamas. I can say with confidence that we made friends, and our relationship with the Seaweed Center is solid which makes me really happy.

You can’t visit Zanzibar without visiting a spice farm. This year, we visited the spice farm of Mr. Spice – who my students have renamed: Mr. Super Spice. They decided that there would be no royalty issues with Posh Spice, Sporty Spice, or the rest of the Spice Girls since Super Spice wasn’t taken. Mr. Super Spice took them through his wild crafted farm, having the students taste all of the spices and eat all of the fruits. Cinnamon, nutmeg, cardamom, turmeric, black pepper, clove, lemongrass – always he had the students guess what the plant was either through the leaf of the plant, the taste, or it’s medicinal quality before he told them. And Mr. Super Spice was a wealth of medicinal knowledge too. He’d talk about which spices were good for which diseases and ailments. This trip has been good for identifying additional herbal medicine experts. I was worried when our friend Bongo died last year that we wouldn’t have the same level of knowledge presented to the students. However, we’ve encountered several people now who have stepped up.

We also spent a day in Stonetown, the ancient Arab port of Zanzibar. Fahrid, our tour guide, filled us in on the various countries that occupied the country – Germans, Dutch, British, and Omani. He showed us how to read the door frames to tell how many people lived in the house, what religion they were, what ethnic background, and whether or not they had slaves. He also trained us on the traditional Swahili kanga. The kanga is a piece of colorful fabric that the women wear. It can be tied around the waist, cover the head, or crafted into a sort of sari (like is traditional in India). As it turns out, the color and the way the kanga is tied has significant meaning historically. You could use a kanga to tell a man that yes, you are single, but you’re really not interested in him. You can signal that you’re pregnant with a kanga. You can even put a kanga in the bed of a houseguest to tell them that they’ve overstayed their welcome!

We have continued to learn how we, as Americans, are viewed by our Tanzanian friends. Eliphas jokes that Americans take up a lot of space – not that we’re big, just that we take up a lot of space. When we sit down, we spread our arms and legs to fill a chair. Three Tanzanians would sit in the same space. Julius is disgusted by our protein bars. “That’s not food,” he says, and he rolls his eyes. Well true, but they have a lot of nutrition, we argue. He just shakes his head. Eliphas tells us that the Kilimanjaro guides are always happy to take Americans up Kili, because we tip well. They say to each other, “I have guests from the BIG country.” In comparison, Brits will tip $25 for 7 days on Kili. Yeah, have to admit I’d feel guilty tipping that little for someone pushing my butt up a 19,341 foot mountain.

We have two more clinic days and one more class day left. And then I’ve got a day of relaxation before I meet Don to cruise the North Sea. I hope you’re having as interesting a summer as I am!

Peace, love, and crab for lunch!

Heather