IHP Health and Community: Globalization, Culture, and Care (Spring 2)

2009 Letters Home

Washington, DC Letter Home
The launch of IHP Health and Community Track 2 in Washington, DC was a whirlwind of activity. As one person put it, “Two weeks felt like two months.” Twenty-one of the women shared eleven bunk beds in one of the rooms, so the process of getting to know one another was accelerated. We celebrated four birthdays in the first week (including the birthday of Program Coordinator Jesse Delaughter). There was a basement “soccer” game that got quite competitive. This group came with a lot of energy!

The location where the group stayed provided them with a personal perspective of poverty in DC. N Street Village is an award-winning complex providing temporary housing for homeless women, day shelter for men and women, food, counseling, and other services. Over the weekend many of the students spent a few hours visiting with the women who lived on the floor above them. They heard their stories and got a better sense of how much this community means to them.

As we were gathering in DC on Saturday the 17th, the city was gearing up for President Barack Obama’s Inauguration. On Martin Luther King Jr. Day, we toured some of the neighborhoods in DC, such as Logan Circle, U Street, and Dupont Circle. It was hard to get a sense of the normal feel of these neighborhoods, as they were all filled with throngs of visitors for the Inauguration. The line to get into Ben’s Chili Bowl extended almost two blocks! The morning of Inauguration, one group of particularly ambitious inauguration spectators woke up at 4:30 AM and made their way down to the security checkpoints for the parade area. Unfortunately, they never made it in and had to turn back and watch on the jumbo-trons with the rest of us and almost two million others. We were all bundled, huddling with thousands of strangers, dancing to the music and getting to know the people around us. There was clapping and yelling every time President Obama appeared, and some people shed tears as he was sworn in and gave his speech. Two students did make it into the parade and got to see Michelle and Barack get out of their car and start walking down the street. One very lucky student had tickets to a ball. There were some star sightings, including Ben Affleck, Toby McGuire, and Jay-Z.

In true IHP style we had a packed academic schedule in DC as well. Professors Tammy Watkins and Roberto DeVogli gave their first few lectures. They worked with us to define “health”, “globalization”, outline the historic trajectory of the American economy leading up to our current economic crisis, think about the wide array of methods that can be used to do anthropological research and identify some potentially complicating factors. There were a variety of guest lecturers, including Ruth Levine from the Center for Global Development, who talked about some of the global health issues the Center hopes the new administration will prioritize, and Stan Dorn from the Urban Institute, who spoke about national health care reforms that may be passed in the next four years. One afternoon, we broke into small groups, and each visited two NGOs. Some of the organizations included WEAVE (Women Empowered Against Violence), MetroTeenAIDS, Prevention Works, and the Latin American Youth Campaign. Many of us were so excited about the work these organizations did that we really didn’t want to leave.

Later that evening four young women from MetroTeenAIDS came to speak with all of us about the work they do to increase HIV/AIDS awareness, encourage safe sex, and let people know about their free testing services. They give presentations in schools and for any community organization that invites them. They go out and talk with people on the streets and do surveys. Their commitment was inspiring.

As the DC program was winding down, the students got a chance to switch roles and exercise their voices as legislative constituents. Early on our second to last morning they headed up to Capitol Hill to spend a few hours being briefed by representatives of SIECUS – the Sexual Information and Education Counsel of the United States. They learned that for the past several years the U.S. Administration has been spending $1.3 billion on abstinence promotion but almost no money has been allocated for sexual education. Meetings had been pre-arranged with Congressional staff members from the offices of the students’ state representatives. Over the course of the afternoon they met with staff from several offices and discussed the REAL Act (Responsible Education About Life). This Act would provide a $50 million package for comprehensive sexual education. Interested states would formulate a program and then apply for funding. Answering the questions of congressional staffers with diverse views on the legislation was daunting, but the students stepped up to the plate and engaged them in a dialogue about the issues surrounding it. It was an incredible learning experience.

On one of our final nights in DC, we headed to an Ethiopian restaurant to have dinner with alumni of the IHP program – including one member from the first class of 1968, another from 1982, and others as recent as last fall. The group got some inside information on the IHP program, and realized that this semester abroad could influence the future course of their careers, and that many of the bonds they form will last a lifetime.

Country Coordinator Jeremy Ogusky was a nearly constant presence during our time in DC. He ran a smooth ship, and everyone really appreciated all his hard work. Many of the students wanted to raise enough money to bring him along with us on the trip but there just wasn’t enough time. They had to settle for mobbing him with a group hug instead.

On Wednesday the 28th we headed to Dulles International Airport – sad to leave behind so many great people in DC, but eager to escape the grey skies and ice-covered sidewalks. A few take-offs and landings later we arrived in the green and brown, tropical city of Dar Es Salaam. It’s the hottest time of the year here – averaging about 90? with 70% humidity. We’ve spent the past few days soaking it all in. This morning we talked about what we’re grateful for, and “the sun” was one of the more popular answers ? Country Coordinator Peter Risha, and his assistant Mamma Anna, have just gotten everyone tucked away in their homestays. We can’t wait to see what the next five weeks here have in store!

-Trustees Fellow Anna Brittain, February 1, 2009

Tanzania Letter Home
Every now and then, I remember in a slightly different way, where I am.
–Sarah Tracy-Wanck

What hit us first about Tanzania? Probably the heat. Who knew we could sweat so much? By 9 am each morning we’d all be covered in a fine sheen. Freshly washed clothes quickly lost shape and started to stick. The night air when we arrived was lovely, but by the middle of the next day we’d completely forgotten how cold we’d been just two days earlier in DC.

The first few days we stayed at the YMCA, which was a haven in the hustle and bustle of Dar. Beneath our mosquito nets we could hear the city come to life even before dawn. The church bells would ring, the calls to prayer would begin, the horns would honk, the hammering of construction would commence, and we’d know we weren’t going to get much more sleep. The Y had a basketball court with aged, sagging hoops, and by the time the heavy sleepers would emerge in the morning a third of the group was already downstairs working out – jumping rope, running laps, doing sit ups – generally refusing to give in to the somnambulant effect of the heat and the nagging jetlag.

Downtown Dar was a bit of a sensory overload. The streets were congested, full of cars and buses, with small stalls set up along the side selling fruit, phone cards, newspapers, shoes, used books, and more. There was a constant crowd of people at the bus stops, and all around us a tide of people moved up and down the sidewalks. They drive on the opposite side of the street, and we had to adjust to similar rules when walking. There were men in suits and women in patterned dresses layered with brightly colored kangas (imagine a starched cotton sarong) tucked neatly around their waists. Small buses with cursive “City Bus” labels on their sides would pass by literally busting at the seams with passengers.

Almost everyone was excited about the food – beans and rice, vegetable and meat stews, mangos, bananas and pineapple. Ah, but the daily beans and rice would start to get a bit old – especially for the vegetarians in the group. At the end of our first weekend in Tanzania we loaded up our luggage and packed into two buses to head to our new homes in a suburb called Tegeta. On the way there were long stretches without pavement – just wide dirt swaths with cars, bajajis (three-wheeled taxies), and daladalas (minivan-type buses) all haphazardly skirting the gaping potholes. To the east there were glimpses of the ocean. Schools and office buildings gave way to residential communities, with many simple cement homes and businesses covered with tin roofs. Scattered here and there were shops painted bright magenta – advertising for Zain – the most expensive mobile service provider. There were women carrying large loads balanced on their heads, and massive old trucks with their beds piled high and several men perched on top. We only traveled 25 km, but by the time we reached Tegeta an hour later we felt like we were much further away from downtown Dar.

Similar to many developing countries, Tanzania is experiencing significant rural-urban migration. Their infrastructure wasn’t designed to support current populations, and the government is unable to provide clean drinking water, sewage treatment, and trash collection to the majority of residents. Tegeta is a relatively new, wealthy community that seems to have been implanted on top of a much poorer community. We stayed in large, shining homes, surrounded by green lawns and trees, then bordered by tall security fences. On the other side were uneven dirt roads with deep holes, many filled feet-deep with water. This is due to neighbors, who lack access to running water, tapping the pipelines these homeowners paid to install. Walking through the neighborhood we’d pass one room homes with children, parents, and grandparents sitting outside; burning trash heaps dotted with plastic water bottles; and children splashing happily in ditches of dirty water. In the distance we could see smoke rising from a massive cement factory. The dichotomies between rich and poor were always on our minds.

One of the first Swahili phrases we learned was “pole, pole” or slowly, slowly. We had to try to let go of our American attachment to everything being on time. Every morning, sometime between 7:30 and 9 am, a bus would slowly wind its way over the uneven, dusty roads to pick us up from our homes and carry us to school. There were seats for 24 people, but with the bus driver and his assistants we had about 35, so things quickly got up close and personal!

While we stayed in Tegeta, we had class at IMTU (im-two – they don’t spell out their acronyms). The administrators and students at the International Medical Technological University were very welcoming, and we had a large top-floor classroom with lots of fans and not too much sun, so we were very comfortable. There was a café downstairs that served chipsi mayai (introduced to visitors as “chips in my eye,” this is a heart-clenching concoction of French fries with fried egg served at stands all over Tanzania). There was also an informal Indian restaurant where we were sometimes able to arrange delicious lunches.

IMTU students complete a five-year medical program, followed by a year-long internship, before officially becoming doctors. There is only approximately one doctor per 138,000 people in Tanzania. Because doctors are not very well-paid in Tanzania and facilities often aren’t well-equipped, many doctors end up choosing to move abroad for work. We wondered about what could be done to prevent this “brain drain.”

Our faculty and guest lectures covered topics from “The Impact of Structural Adjustment Policies and Foreign Aid on Health Care Delivery in Tanzania” to “Under and Over Nutrition: Malnutrition and Obesity.” We also crowded back onto the bus for a number of site visits. Our first week there, we went to The Village Museum. Villagers from around the country come to this museum to build an example of their traditional homes, so foreigners and city-dwellers can see how the 70% of the population in more rural areas lives. The day we visited, some women from one of the villages were doing a dance performance to drum music and they saw Anna dancing in her seat so one of the women dragged her up to join in. She couldn’t quite get the steps down, and then the guys gave it a try without much more success. We had lots of fun embarrassing ourselves!

The next week we visited PASADA – an NGO that provides holistic treatment services for over 35,000 HIV/AIDS patients in Dar Es Salaam. The day we were there, they were holding a clinic for children. It was hard to reconcile all of the shy, smiling faces we passed and the scampering games being played in the courtyard, with the disease raging inside them. There was one little boy wearing a t-shirt that said “Forgotten Heroes” on the back. There were parents carrying babies – some looked exhausted, some sad, others resigned. We met three little girls, unrelated but so attached they seemed like sisters, who had all lost their parents to AIDS. One of them was very outgoing and eagerly asked and answered questions through or coordinator Mamma Anna. They had taken the day off from school for check-ups and to get more medicine. They were dressed in the faded, tattered satin dresses that we often saw and wondered about - they looked like they might once have been worn by flower girls in American weddings. They were very excited to take pictures with some of us.

PASADA attempts to address the social, psychological and economic, as well as health impacts of HIV/AIDS. All of their services are provided free of charge. They’ve been providing ARVs since 2004. They have an orphans program that supports over 7,000 children and provides assistance for extended family care. They have a network of lawyers, judges and police they collaborate with to ensure legal rights are met. They have community education programs that attempt to reduce stigma and promote VCT – Voluntary Counseling and Testing. They also have a microfinance program for women with HIV. We were very impressed by the extent and quality of PASADA’s work, and at the same time we wondered about the hundreds of other organizations trying to do similar work with much less funding and fewer resources (PASADA has an annual income of ~$4 million from numerous funds and foundations). They set the standard for treatment services in Dar, but some of us were frustrated that as a Catholic-affiliated organization they are not sanctioned to do most forms of prevention work.

Another day we divided into two groups to visit two small towns a little further outside of Dar and looked at drinking water quality and availability. There was one central water tap where women could bring buckets to be filled for a good price, but at the clinic they told us many people still find it more convenient to collect water from wells closer to their homes. They tell people to boil this water but many can’t afford the fuel or don’t think it’s necessary. The staff said they regularly treat water-borne diseases. We continued walking and a young mother doing the wash invited us into her backyard to look at her well. She said the well had been dug ten years before. Beneath the makeshift cover was a hand-dug well maybe ten-feet deep with a barrel casing put inside to keep the earth from collapsing in. A grandmother greeted us with “Karibu” or “Welcome” and showed us another similar set up. It seemed that many families had managed to save up the ~$20 it cost to have one of these shallow wells constructed behind their homes.

In addition to our intensive academic schedule we managed to fit in a number of non-intellectual activities. Valentine’s Day weekend, we organized a group trip to Zanzibar – a tropical island paradise a two-hour ferry ride northeast of Dar. At the Red Monkey Hotel in Jambiani we lazed beneath umbrellas looking out at the turquoise water, and at low-tide people walked out half a mile to watch women collecting seaweed and take a dip where the ocean floor started to drop down again. At sunset we watched children playing soccer on the beach and then wandered upstairs for dinner – featuring octopus caught just hours before. The small, tranquil resorts full of tourists from all corners of the globe that lined the beach were in sharp contrast to the crumbling, rocky road just behind, lined with stark, weathered homes and villagers sitting out front, staring at us somewhat wearily.

A few days after we returned from Zanzibar we departed to Ifakara – a remote agricultural community in the southern center of the country. About six hours in, the pavement ended and we began slowly maneuvering over 100 km of rutted red-dirt road. Maybe halfway through, there was an inexplicable stretch of pavement that gave us a short reprieve (one student said simply, “I love infrastructure”), but after that we didn’t hit another even surface until we reached the town. That twelve-hour journey left us thoroughly jostled.

During our week there, we were able to walk and bike almost everywhere – a refreshing break from the crowded bus rides. The weather was also much cooler, and there were a number of intense rainbursts and thunderstorms. We had classes at the Ifakara Health Institute – a Swiss organization that has a long history of providing public health services to the surrounding area. Their facility was an oasis of green lawns and flowering trees, whitewashed buildings, air conditioning, wireless Internet, and even a pool to dip our feet in! We also took advantage of the neighboring St. Francis Hospital. We toured the premises and met with health staff of several different wards. The group was housed in three different guesthouses around town that exposed us to more rural living. We battled with an army of unique insects we hadn’t encountered before. The chicken we ate for dinner one night had been wandering around the courtyard just hours before. A power outage lasted all day and into the evening, and the generator stubbornly refused to work.

We had one weekend there, and most of the group hired a few trucks to visit some national parks in the area. On Saturday we made our way back up the red dirt road to Udzungwa National Park to climb Sanje Falls – a relatively short (maybe 2 miles) but very steep path up to an amazing lookout and series of three waterfalls. The final was the tallest and most resounding, with an intense downpour of water. We took an exhilarating dip in the turbulent, chilly pool underneath. Before dawn on Sunday, the group was up and surprisingly energetic – eager to set off on a safari in Mikumi National Park. We packed into four trucks and as the sun rose, our cameras were already clicking – trying to capture herds of zebra and giraffes. As we wound our way through the park, we came thrillingly close to elephants, wildebeest, warthogs, water buffalo, and hippos. There were also many brightly colored birds.

Monday morning started with a downpour and some worried glances. It was time for the group to tackle our main academic activity in Ifakara - the case studies. Armed with a multitude of health questions and bicycles rented for a mere 75 cents a day, the class set out in groups of four to seven to learn more about specific topics, which included traditional healing, pediatric malnutrition, maternal health, infectious disease, local agriculture, and water quality and accessibility. Students pursued a variety of research methods including interviews with hospital patients, trudging through rice fields with farmers, and impromptu conversations with people at local water pumps. The experience gave us a taste of the realities of rural health in Tanzania. Many people still turn to traditional healers for treatment, but while traditional healers will advise follow-ups at the hospital and admit there are some cases too serious for them to address (such as AIDS), the doctors at the hospital don’t have the same view of healers as medical counterparts. Malnutrition contributes to susceptibility to a whole range of other diseases. Because of the household and agricultural burdens on women, many don’t breastfeed for adequate periods of time. Some mothers mistake distended stomachs for weight gain. Changing precipitation patterns and increasing intensity and duration of flooding is impacting food security and the spread of infectious diseases such as malaria.

After finishing the case studies and giving presentations, we traveled back to Dar to spend our last four days in Tegeta. Time slipped by too quickly with packing, a Thank You dinner for homestay families, and country papers due. Even though everyone was distracted and overwhelmed by our imminent departure, one final guest lecturer managed to captivate the entire class. Mr. Tundu Antiphas Lissu, a renowned lawyer, spoke about his direct experience with the social, economic, and environmental impacts of the gold mining industry. He asked us to consider what globalization means for people dependent on natural resources for their livelihoods. Tanzania is the third largest producer of gold in Africa, but the country only receives 3% of the revenues. The Mining Policy Framework the government agreed to a decade ago allows complete transferability of profits, favorable tax conditions for multinational corporations, and a glaring lack of labor or environmental standards. Mining is the number one source of industrial pollution. Pools of toxic sludge leach into soil, aquifers and rivers. The “wash out” required after blasting is incredibly water intensive. Cancerous diseases have emerged that were previously unknown, and there has been a precipitous rise in miscarriages and stillbirths, but when communities try to protest, many people are arrested on spurious charges. Mr. Lissu has helped free over 350 people. The class kept him there long after his lecture was over asking him questions.

Just two days later, we all took off in separate directions. Six students and one professor managed to summit Mt. Kilimanjaro. Others made their way into the Ngorogoro Crater and then wound through Serengeti National Park, catching glimpses of leopards reclining in trees and lions mating. Seven students traveled to Ethiopia with Elias, who is from Addis Ababa, and got a whirlwind tour of his hometown. Another group went back to Zanzibar and spent a few days in Stone Town – a maze of narrow alleys full of ornate, carved wooden doors and peeling blue and green shutters – before heading back to the beach. A few stayed on in Tegeta with Mamma Anna and spent more time exploring Dar. As with all vacations, the week passed too quickly, and we soon found ourselves at the airport, ready (to varying degrees) to make our way a little further around the globe to Viet Nam.

-IHP Health & Community, Track 2, March 2009

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Credits: 16

Duration: Spring, 16 weeks

Program Sites:
USA, Argentina, South Africa, Vietnam

Prerequisites: None. Coursework in public health, anthropology, biology, or related field recommended. Learn More...

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