Outside the Lines

Seven weeks have already passed since I first stepped off my Precision Air flight into Mwanza on June 2nd. It's hard to believe that I have been working here at IHP's clinic for that long, but now that I stop to think I notice the small things that indicate I am no longer a new presence, but a part of the usual circle. Zefaniah, our favorite guard, greets me as cheerily as always, but so kindly lies through his teeth, “Ohh Amiti, very good, you are speaking Swahili now, it is very good!” Bibi, our clinic grandma, doesn't hesitate to ask me to start an IV, granted I still defer to Jimmy. Lucy, chef extraordinaire, knows chapattis and french fries at dinner are guaranteed to make my day.

Work here has been very rewarding, as I have learned a great deal about tropical diseases and medicine, become more comfortable with blood draws than I could have ever imagined, and had the opportunity to share time with people that laugh their way through any setback. One aspect of work that truly stands out, are the general health education presentations we have done in the local schools. The initial idea was to determine where there might be a void in health education and how we could fill it. Upon asking educators and students if there was anything they needed us to present on, one answer always found its way to the top of the list: STD's and sex education.

Last Wednesday, this seemingly benign concept led me to find myself with my friends and fellow medical students from IHP (Courtney – girl, Priyanka – girl, Natalie – girl, Sarah – girl), at the front gate of the Loreto Secondary School for Girls, ready to do a presentation on women's health, to include: reproductive anatomy, the menstrual cycle, UTIs, yeast infections, and more. In a relatively conservative setting, this situation made me wonder what in the world I was doing there. Pepsi in a Coke culture, I was trouble.

Beyond the gates, past the guard tower, and under the archway, the grounds opened out into a beautiful landscaped courtyard flanked on all sides by concrete education blocks. My mind didn't want to give in that I was actually nervous about this, but my involuntary physical changes yanked the cloak: erector pili muscles pulled my arm hair to attention, temperature notched up a couple, and palms became clammy. I dipped my head into the room filled with almost a hundred Form 3 girls in uniform. As we walked in and it became apparent to the Loreto girls that I was the only male presenter, the giggles and whispering began. I busied myself setting up the computer and projector, counted to ten, and looked up. This was going to be special.

Fortunately, Priyanka began the presentation and introduced reproductive anatomy and the menstrual cycle before time came for me to talk more in depth about ovulation, fertilization and dysmenorrhea. I started off strong. Ovulation and fertilization no problem. On to dysmenorrhea. “One risk factor of dysmenorrhea is having a positive family history.” Blank stares. I continued, “this means if you have a parent or a sibling who has experienced dysmenorrhea then you are more likely to have it.” Blank stares. My clammy palms had lost sensation, the room was shrinking, and sweat was forming on my receding hairline. “You know siblings, as in sisters or brothers...or, haha, obviously not brothers.” All I could do was laugh, run my hand through my hair, and look to Sarah and say, “I think it's your turn.”

Making a mistake always makes it easier. Having butchered dysmenorrhea, everything else seemed better and the rest of the presentation went smoothly. We fielded numerous questions that shall not be repeated and were asked to come back the next day for more. After two days, I am confident the girls had a much better understanding of STD's, how their body functions, and how they can, both protect themselves and receive the care they need. Having survived Loreto, the presentations in Zanzibar should be a breeze!

On a side note, Priyanka and I decided to write two completely different blogs about different aspects of our work here because we realize we cheated some of you out of different entries with our last joint post about the safari. So, to read a fabulous description of life in the clinic from both the student and patient perspective, hop on over to http://priyankarao.blogspot.com/

Tanzania tidbits:

1. I find it sad to report that, while the harmless act of yawning is contagious in the states, the not so pleasant act of in front of your face nose-picking is contagious here. While at the tailor the other day, we noticed one lady start, and then two more follow in suit. This is an observation that can be corroborated by several volunteers here.
2. An “i” is added to the end of almost every name. Amit = Amiti. The name, Martin, given to me by our driver, Mboto, actually equals Martini.
3. The collection of pumpkin foods we have consumed thanks to Paula's love for pumpkins is now: pumpkin pie, pumpkin bread, pumpkin bread pudding, pumpkin soup, boiled pumpkin with butter, and pumpkin cookies.

Safari!!!

One week has already passed since we left on our safari, but all the details are still fresh.

Friday, 8:30 AM anxiously awaiting the arrival of our already half an hour late vehicle we begin to wonder if we have crossed the threshold of African Standard Time. Urged to call our agent, Amit reluctantly agrees to drop 300 of his remaining 600 shillings in order to find out the ETA of our driver, Vincent, and cook, Bosco. Minutes later the souped up excursion sized, Landcruiser arrives: massive tires, three rows of paired captain seats, a built in fully powered mini-fridge, electrical outlets that don’t work, and best of all, the type of sunroof that would make a convertible jealous. Stocked with M&Ms, our saving grace, we’re off!

Crossing the gates into the western Serengeti, the landscape quickly changes from rows of Coca-Cola and Sprite faced buildings to endless straw shaded fields. We are all excited by our first sightings of zebras, wildebeests, and gazelles, but soon grow anxious to see the rarer animals. Priyanka’s wish list: 1. baby elephant, 2. male lion, 3. lots of giraffes. The landscapes are incredible. Herds of wildebeests are everywhere as the timing of our safari happens to coincide with their annual migration through the western Serengeti. Interestingly, just like humans trying to escape the heat, they often cluster in groups in the shade of some of the bigger trees that happen to spring from the occasional spot in the otherwise flat plains. Midday, they group directly under the trees, but as the sun looks sideways in the late afternoon, the groups slowly seep out from under the branches in pursuit of the slowly elongating shadows.

Only three hours past the western gate we happen across a water source, and with it a gathering of animals. In dry season, the dwindling number of rivers and streams funnel the herds in. Perfect bait for hungry lions. Just seeing the lions is a gift, but Vincent believes they may be preparing for an attack, so the engine is turned off and we become part of the scene. Female and cub arise from their slumber, ears point, shoulders tense, head lowers. Such a contrast, from our six bobble-heads, looking every which way trying to grasp what she senses. We click away knowing something is amiss, and then she shoots out from under the tree, through the brush and around towards the back of the car. Within seconds her jaws are clenched around the neck of a wildebeest and she is joined by the regal male, all of us had failed to even notice. The site is astounding. Just ten yards away from our vehicle. Male, female, and cub, with dead wildebeest are all that are left of the scattered herds.

We were more than spoiled on our first day, but nonetheless continued to be awed by the beauty of the landscapes. The grandeur of fifty plus elephants controlling their stomping ground and families of giraffes careening their necks to enjoy their balcony view over all the action were only a couple of the memorable sites. And interspersed throughout the weekend, lion spottings never failed to spike the adrenaline. On our last night we even enjoyed a special visit from the neighborhood elephant. Tired from a long day we had gathered at our campsite expecting only a mix of tents, tired safari goers, and a peaceful evening. Instead we found a crowd gathering near the fenced in cooked stations. Word was that one of the older wiser elephants had figured out how humans keep their water year round. Having departed from the toil of finding water in ever changing streams, he had made it a habit to just take a stroll in our campsite over Ngorongoro for a daily sip from the communal reservoir, haha!

By Priyanka and Amit