Wednesday, March 24, 2010

Playing catch-up (The past three weeks have flown by)

Summary of the past few weeks/happenings in Mwanza up to and including March 21st...:
-Joke’s trial is up and running, with all 153 patients!
-We've been responsible to deliver the yoghurt to the hospital and making sure the Mamas know how much of the probiotic and non-probiotic yoghurt they are to be making!
-Steph has sometimes been at Sekou-Toure Hospital helping with the yogurt packaging and distributing it to the women.
-I have been doing quality control at NIMR. There have been multiple frustrating days, where things just don’t go my way: the fusidic acid plates not working, unexpected contamination like yeast and potentially E. coli. Lots of waiting around. These are precarious times, when we don’t know if the yoghurt quality is up to snuff for the trial (ie. meeting the standards we have set in order to yield adequate differentiation in the results).
- We are still trying to organize the finalization of packaging/labeling for the yoghurt for the Mamas. We will be traveling to Nairobi, Kenya next week to pick up the packaging ("juice-box" or "milk-carton" style), and then we can start mass-distribution of the yogurt to local restaurants, markets, shops, orphanages etc.
-TWG received their grant from this years’ Mwanza Charity Ball 2009!! Yay. There are many good ways for money they received to be spent! We have 1, 987, 450 Tsh (almost 2, 000 dollars!). This money can be used to support the 125 people living with HIV/AIDS in the community who were being subsidized for their yoghurt. Many have not been receiving it for over a month now because there was no funding to support them!!!!
-We’re in the process of applying to the SCF grant (for small and medium enterprises within Tanzania’s food industry) and the Global Fund for Women (American organization that supports projects run by women internationally).


Recap of my birthday week :)!
On Monday, Steph was feeling ill and stayed in all day. I did a much-needed grocery shopping trip to Lavena supermarket and somehow ended up spending about 60 dollars on groceries (all imported foods are super expensive here, in contrast to the market where fruits and veggies are a steal).

On Tuesday, we worked at the apartment with Esther, on editing documents and proposals for grants. I did some reading (I’ve been reading a lot for pleasure here, and it feels so good to have the freedom to). Later in the evening, we were invited to Joke’s place for home-made pizza! Really yummy, one with pineapple pieces and another with grilled eggplant! Then, we stayed late to watch a movie. Joke and Major had a few travel guides on Tanzania and Zanzibar, so I was eagerly digging into them, looking into a Safari at Serengeti National Park and a trip to Stone Town in Zanzibar.

On Wednesday, I went into NIMR and check on some plates. It wasn’t a very eventful day. I can sum it up with some gram-stain tests and microscope work, really.

On Thursday, Steph, Esther, and I took a taxi to St. Augustine’s University. We met with the Vice Chancellor (who had been out of office). We reiterated our ideas for student interns from Canada to be “matched” with students from equivalent programs at SAUT (social sciences, business) or Bugando (health sciences).

On Friday, Steph and I baked a chocolate cake for my birthday! We even made chocolate icing (lots of Blue Bandi margarine…) and even found rose-shaped decorations at Lavena market! Later that night, we went to Villa Park for early birthday celebrations!

On Saturday (finally my birthday!), we went to the local market in the morning to purchase the food to cook our big, buffet-style dinner. We had the mamas’ help with making rice, pasta, deep-fried potato and green bananas, chapatti, green beans, and cabbage with carrots and peppers. We cooked literally ALL day long. We had our home-made cake and fruit kabobs with pineapple and grapes for dessert. After some champagne toasts, and speech from Esther, Joke drove us to Tunza for the beach party they were hosting, complete with a DJ right on the beach. We ended up having a late night at Villa Park, which was rockin’ til’ the sun came up. Africans sure can shake it. Even the young girls were far better dancers than us white girls will ever be haha.

On Sunday, I did some reading and finished up one of the books I was working on reading, called Zanzibar :). It’s great to have the rooftop of our apartment building to have some privacy away from onlookers from the street. There’s also a great view of sunrises and sunsets from the roof. I always find myself feeling guilty when I look around and see the mud huts and tin-roofed buildings all crammed together in the hills. Thinking of where people so near-by don’t have access to electricity and clean water like we do, I feel guilty living in this paradox. They don’t have a stove; they use charcoal burners and brass pots. They don’t have beds or couches with cushions to sleep on; they sleep on straw mats on the hard ground.

On Monday, Esther dropped by the apartment and we were informed that Hassan’s baby nephew had passed away that morning!!!! Puice stopped by the apartment after the funeral. Steph and I were asking how the baby died (he was less than two years old), but noone could give us a definite answer. Esther said it might have been malaria “or something”, as if the whole ordeal was quite common and nothing out of the ordinary. I was shocked and wanted to know exactly what had happened and why his condition could not be cured. This little baby had been running around our house the previous week and smiling, playing, and eating with us. We were told he was in Sekou-Toure Hospital and then Bugando Hospital. The family is Muslim, so the boy was buried the same day, but Esther says that the mortuary at Bugando is always overflowing with bodies that there's no room in the "fridge" for them. I said I wanted to visit and she said "yes, it's possible, but you might get nightmares"...We carried on business as per usual on Monday, but I was feeling a little stirred up by the whole ordeal. I went to NIMR and Sekou-Toure to help out Joke, while Esther and Steph went with Esther to the packaging company. Joke and I went for lunch at Kulianas. Later, we skipped out on yoga at Tunza and decided to bake! We had some rotting bananas that Esther was convincing us to throw away, but we decided to use them up by baking banana muffins!

On Tuesday, we visited Hassan’s house (also Pendo and Margaret) and were introduced to the rest of his family. We gave our sincerest apologies (Pole sana sana!!!) and we were offered to sit down (Karibu kiti!!) and stay a while. We were given kitanges to cover ourselves with (tradition for mourning). We stayed and chatted, took some photos, and ate some fresh pineapple! We walked from there directly to NIMR for quality control and found some unexpected contaminants, such as yeast and potentially E. coli, which was a little scary. Joke is worried about using the contaminated yoghurt, (even though the lab tech was not 100% sure it was E. coli) so she told the nurses that they may have to throw it out. The nurses said that if they throw it out, “God will punish them” and that they should distribute it throughout the hospital to people who have shown interest in it, but could not be included in the study. I think she kind of missed the point that the yogurt could make people sick!!!

On Wednesday, we went back to NIMR to check on the quality control. On my walk home, I purchased another Kanga and some henna dye. We went to the packaging/labeling company again to inquire about maybe traveling to Nairobi, Kenya. Because it was St. Patrick’s Day, we went to the Yacht Club (near Talapia) which is operated by an Irish man. We ate dinner and a couple drinks to celebrate, but nothing too crazy. Not many people celebrate the holiday here, but there were two birthdays that evening too, so lots of food and cake to go around!

On Thursday, we had Mama Joyce and Esther prepare a speech and we filmed a video for the upcoming event in Canada called “In the Market for Western Heads East”. We're in the process of uploading it to youtube now. I finished editing the SCF grant for Esther and we added the budget proposed for the packaging/labeling from Nairobi.

On Friday, Steph was already up when I woke up and she explained that she had been sick all night and wasn’t sure if it was from something she ate, or malaria again. She couldn’t eat or drink anything without throwing up, so it was obvious she needed to spend the day in bed. We cancelled our plans of going to Nyomongholo to check up on the cows (heard they are not being fed and watered enough) and Mtoni Secondary School. I collected yogurt from the kitchen and went to Sekou-Toure to meet Joke. We went to NIMR and we plated three different types of MARA milk to see if an E. coli contaminant was coming from one pack or if a whole batch may have been contaminated. We won’t be able to check the results until Monday, so it’s a bit of a precarious situation. We went for lunch at Kuiliana’s for pizza. The place was chock-full of other mzungus who I hadn’t seen before. After going back home to check on Steph, we decided to take her to the hospital for a blood test. The results indicated that she did indeed have malaria- this time three ring. Very sick! So, we went home to spend the night in. We received an email from Canada stating that we have to get the quality control of the yoghurt up to required standards, or they will not be paying for the yoghurt and the trial will have to end. Seriously, despite consequences to the mamas, the women enrolled in the study, the students involved etc. the trial could just end!!! We’re carrying on and working harder than ever to keep this study going!!!

On Saturday, Steph was feeling a lot better. Also, the sun has been shining all week. AMAZING, amidst the supposed rainy season!! Steph’s relaxing inside today because she’s feeling dizzy and weak still, so I’m going to work on some proposal editing, write some emails, get some fruit at the market, and do some photo-blogging :) Some days you just gotta take ‘er easy, or you’ll get worn-out and drained during the week. Hassan and I went to the big market and it was really bustling. On the way we saw goats running around the streets blocking cars from passing haha. There were some surprising sights at the market, like rows of suitcases on the ground, knives lying on tarps for sale (just out there in the open were anyone could grab them!!).

On Sunday, we were trying to go to Forever Angel’s Orphanage, but the contact number for Amy (owner/founder from the UK), and until we got in touch with the organization, we decided to postpone our visit to Tuesday. I can’t wait to see the kids! Amy and Ben have a really amazing organization set up where they take in orphaned and abandoned children, or children whose families are unable to support them. Many of the children have been dropped off at the gates of the orphanage and left there! Some children come in really bad shape, malnourished and diseased, literally on the verge of death. The orphanage accepts lots of volunteers and hires employees experienced in education, child development etc. They operate programs for feeding, schooling, arts/crafts etc. for all the children and I’m hoping to get the chance to help out for the next few months! Mama Asha’s daughter and son ended up coming by our apartment and we found some treasures in the dresser drawer labeled “stuff for children” haha (skipping-rope, coloring books, stickers, noise makers, and a puzzle etc.). Later, Salome also popped in for a bit. Then, Aisak, Mohammed, their friend who didn’t speak any English, and Puice came and we had some fun with silly photo-taking, dancing and music, fashion shows with our kangas, and eye-brow plucking because the boys were curious as to what tweezers were (we may have also done some makeovers with mascara and lip gloss…hahah). We have a busy week coming up so Kwa Heri!!! Usiku Mwema!!

Miscellaneous
-I started running in town this week every morning, trying to establish some routine. I find myself dodging people, bikes, cars, dala-dalas, and pike-pikes!!! It’s also difficult with my ipod in because I know lots of people are probably saying Mambo! When I run by, but I can’t hear them, so I hope they don’t think I’m being rude!! It’s also extremely hot here, even early in the morning.
-“Street children” are always coming up to our car when we are in the city center. They congregate where tourists come, near hotels and markets. It’s a major issue in most African capitals, towns, and urban centers. I’ve had several encounters while stopped at traffic lights or in a traffic jam where they try to wash the windshield of our car with a dirty rag and swarm the windows. They hold their hand to their mouths and moan how hungry they are. It’s sad to see them in their dusty, ragged clothing, sucking on little plastic bags full of ice water. I know they’re hungry-evidently suffering from malnutrition and ill-health. One of the boys even had a huge, jagged scar on his forehead, shoddily stitched together; Joke says he was hit by a car while trying to beg for money :S
-We’ve been warned about the dangerous, precarious nature of pike-pikes (motor-bikes) and dala-dalas (van buses), but we’ve bee taking our chances and using them because they’re so much cheaper than taxis.
-Mama Joyce called me “Mama Giraffe” this week hahah…She says it’s because I’m so much taller than her daughter who is about18 years old too. Stunted growth is really common here because malnourishment is wide-spread. Our friend Hassan is also19 (a few months older than me), and I was so skeptical that he was lying at first, to the point where he brought his birth certificate to prove that he was born in 1990 haha.
-Joke informed us that a thief who tried stealing from the local shop near her house was caught and burned to death!!! Just burned, right there, in the open, in front of a mass crowd of people. I’m not sure what he stole, wether it was as little as a piece of food or as much as thousands of Tsh. Either way, public forms of punishment here shock me to no end.
-They BURN garbage here. And they also burn bags and bags full of leaves and grass to make lumps of coal for fuel.
-When driving home from SAUT, Esther pointed out the place where dead bodies are burned into ashes. She asked us whether our families at home buried the dead or burnt them.
-I can’t stop thinking about Hassan’s little baby nephew who passed away this week. It just makes me feel ill. I get this pit in my stomach, this empty feeling in my chest. I wonder how many poor children die due to poor medical systems in the developing world. I wonder how many people suffer just so we in our rich countries can live the lifestyle we so wish.
-Seeing children taking care of children (seven year olds carrying one year olds) is another mind-boggling thing to me. Children here are going to school, cooking, cleaning, AND taking care of their younger siblings!! It’s as though they have the same responsibilities as “adults” at home do. It’s inspiring that they can do all these chores, yet still be cheerful, playful children!
-Sometimes I get the feeling that I’m intruding on other peoples’ lives here. I want to take as many photos as possible of all the sites here in Mwanza because they are so foreign to me. But then I think, this is just every-day life for these people. I don’t think I’d want pictures taken of me either. A couple people have taken pictures of me with their cell-phones, so at least you take a few, you give some back??

Wednesday, March 3, 2010

WEEK 5 IN MWANZA (The Medical Research Begins!)

A SUMMARY OF WEEK 5 HIGHLIGHTS (if you're too lazy to read the whole post):
-We have packaging and label design for it. Now, we have found a company to print the label onto the packages!!! Once that’s all done we can expand our selling market!
-Joke’s clinical trial has begun!! 150 HIV+ women, half taking probiotic yoghurt, half taking non-probiotic yoghurt, for 30 days, everyday, 125 mL servings. On the first and last day a simple blood test with a finger prick (to calculate viral load) and then vaginal samples with a pipette (to test for Bacterial Vaginosis, condition which makes women more susceptible to STIs, and the transmission of HIV from mother to child). We advertised by putting up posters and distributing pamphlets around Mabatini and at Sekou-Toure hospital. (Seeking women >18, HIV+, taking ARVs, no allergies to milk etc.)

On Monday we went to NIMR (National Institute of Medical Research, Mwanza) to get our lab space arranged for Joke’s trial which was set to start on Saturday. We finally got the chance to speak with Dr. Changalucha (Senior Scientist in NIMR). I stopped in the hall to look at the research posters, many of them describing works in rural areas of Tanzania, studies dealing with access to antiretroviral treatment. Most of them were carried out by the London School of Hygiene and Tropical Medicine (Jamie, a past intern, is actually doing her Masters there, and working as a nutritionist in Malawi at the moment).
Later that afternoon, we went to various stationary and printing companies in town (there are SO many little hole-in-the-wall shops that do printing and photocopying. We looked at a couple shops that carried sticker-type labels on sheets that we could stick into a printer and imprint the Fiti-brand label. We have the final label designed on the computer and put on USB, or “flash” as they call it here.

On Tuesday morning we returned to NIMR to talk with George, the lab-tech, after receiving the heads up from Dr. Changalucha to go ahead with the work we requested space for. We were shown some of the lab equipment and I felt as though we had gone back in time, the lab was not heavily equipped with supplies like in Canada. The autocalve machine (for sterilizing, through application of high heat and pressure) was ANCIENT (It looked to be from pre-historic times compared to the one I had used at Lawson Research Centre back in London). They had a fridge and two incubators (kept at 37°C) that we have access to use for storage of yoghurt samples and agar plates. Later that afternoon, the final company we tried turned out to give us the best deal as long as we printed in mass amounts! This company was originally going to print us water-proof labels (much better than the paper ones we were looking into), but then once we described the packaging, they informed us we could print the label directly on the plastic surface of the bags! Packaging has been a huge hurdle the mamas needed to overcome, so we were very pleased with the results of the day!! Joke dropped off the posters and pamphlets she had printed outlining her trial and we told her we would put them up in the yoghurt kitchen the next day to advertise for patients.

On Wednesday morning we walked to the kitchen to count the number of packages we had. The labeling company told us we could get a much cheaper price if we printed out 5,000 bags, for example. Turns out we have over 10,000 bags! Of course, when I went to pull the box out from under a pile of old file folders and papers, a couple mice scurried away (terrified me!!) and when we opened up the box it was infested by ants and what looked like cockroach (hey, I didn’t look to closely at it!). There were probably about 1,000 bags that were ruined, shredded and chewed through by mice (they’ve been sitting in an open box in a neglected corner of the kitchen for some time now, when they thought the sealer was broken…) We dumped the contents of the bag outside, and luckily there was a large lag, completely sealed that had untouched packs of plastic bags, each containing 100 packages, so it made it easy to count. Now we know we can get a cheap deal for the labeling, so we’re ecstatic!
Later that afternoon we went to the local market to re-stock on fruits and vegetables. One vendor we were purchasing cucumbers from proposed to me haha, and although I rejected his offer, he gave me an extra cucumber and a green pepper free of charge (only to be eaten by me, I was informed by Esther haha). Then, Joke picked us up to go try out an aerobics class at Family Fitness. It turned out to be a small, mirrored room, humid with the stench of sweat. We paid for a step class, which I am terrible at because it’s all about coordination and following the pattern of motions of the instructor, but he was going soo quickly and I always found myself unsynchronized with everyone else! Once we got home we bought “chips” (like an omelet with fried potatoes in it) from the street vendor.

On Thursday we stopped by the kitchen to collect samples of “probiotic” and “nonprobiotic” yoghurt to be tested. We arrived at NIMR with a big suitcase full of lab materials, including an endless supply of plates, a micropipette, agar and MRS broth powder, an anaerobic chamber and anaerobic packets that release carbon dioxide etc. Lots of nerdy things, really…It turned out to be a long day at the lab, as we had to make a large number of agar plates to last the entire length of the trial (For quality control three times a week). We ran into a few problems, like the weigh scale not working, but we worked around it by walking over to another part of the lab to do our measurements. After mixing the agar solution according to the recipe, we needed to keep it in the autoclave machine, and then cool it. The actual process of diluting the yoghurt samples and plating was really quick and then they were placed in an incubator in an anaerobic chamber.

On Friday, when I returned to NIMR to check on the plates, there was bacterial growth on both plates! Yikes! This isn’t what was supposed to happen. The non-probiotic sample should not have indicated any presence of GR-1, if it was in fact probiotic. We decided that there was evidently a slip-up in the procedure, so we decided that on Saturday the women would have their tests, but not be given yoghurt, until a new batch was made that would could test just to be sure to not have faulty data. We will have to delay and start distribution on Tuesday now, just to be safe!

On Saturday we went to Sekou-Toure Hospital early in the morning to help out Joke. We had cake and sodas for the patients enduring the long waits, because there was only one nurse and one doctor to perform the tests. There was also another woman who was helping the women fill in applications and sign consent forms. The patients received 3000 Tsh for that day (the tests are a little invasive, so we figured they need some incentive to come in), and they will generally receive 2000 Tsh for each time they come to pick up yoghurt, to cover traveling costs. In the end, there were 35 women who showed up for the initial tests. A few men also showed up, even though it clearly specified “women” on the posters, and unfortunately they had to be turned away. They all brought little cards with their medical histories, and I noticed they also displayed CD4 counts. More women are set to come on Monday for more tests, and some women who had initially signed up did not show up today so hopefully they will come in on Monday. The study is called a “30-day trial”, but it is expected to last a few months because not all patients start consuming yoghurt at the scheduled start date, and there will be more and more women joining in the future.

On Sunday we headed to the kitchen to oversee the entire process of making yoghurt and ensuring that the “non-probiotic” yoghurt truly is non-probiotic this time. We think that last time it was contaminated wither by using the same spoon to stir both containers, or by inoculating the new milk with a spoonful of probiotic yoghurt as a “starter culture”. After boiling the milk and stirring constantly, it was separated into to separate containers and placed in a cold-water bath. After cooling, the probiotic milk was added to one container, and Mara Milk (local yoghurt that we purchased at the convenience store) was added and then it was sealed and placed in a warm water bath to be incubated.
After this was finished at midday, we went home and headed straight to Talapia for Major’s (Joke’s boyfriend’s) birthday celebrations on the boat! For lunch, there was a whole goat roasting on a spit over hot coals, potato salad and a salad with a tomato and red onion base, EVERYTHING eaten with our hands. Joke also made some amazing breads in her bread-maker and banana muffins! Some of the guys had a couple fishing rods out, trying to catch some fish, but the attempts were unsuccessful haha. We ended up getting stuck in the eye of a storm, and the waves started getting choppier and the rain poured down in sheets, while we tried covering up with a gigantic orange tarp. Just as we started rolling back the tarp, thinking the rains had stopped, a new bout of showers would fall from the sky haha. It was a really fun outting, even if we were freezing, our lips were purpled and teeth chattering, in our clothes soggy and sticking to our skins.

Random/Misc/Hilarity:
-I had to buy some shampoo/conditioner, and I noticed some at Zagaluu, the convenience store across the street from us. The packaging looked to be Dove, but once you looked closer at the translations it says things like “for sexy, slippery hair need lots of drinking water”…"For god filled hair colr"..."water water is smooth smooth, soft and soft, and bright bright". Interesting translation hahah.
-We noticed a man at NIMR and also man in Mlango Moja (the area we live in) walking on his hands (with flip flops on) and dragging his feet; it looked like a strenuous effort to lug his crippled body down the street, and I thought in Canada this man would without a doubt be in a wheel-chair.
-We’ve started cooking our own ugali (using maize and cassava flour), a staple in Tanzanian meals. It’s rolled up into a ball with the hands and dipped into a sauce with okra, tomato, and onions. It’s delicious!!
-Whenever we wear our African-print Kangas, everyone compliments us “ume pendeza!!”…and they say we look like “African women” haha. Esther never wears Kangas and wears more modern, city clothes. She says that only “Mamas” wear the Kangas and Kitanges (similar to sarongs).