Tanzania Week 4: (Or How I learned to Love Korogwe)

So, uh, Korogwe is not bad. Not bad at all.

In fact, I think I actually like it better. I feel more at home here, tucked betwixt the lush Usambara Mountains, than I did in Tanga.

Home. Let’s start with that. My current domicile is known as ENRECA house, named after the project that most of its past, and current, occupants were either working on or adjacent to in Korogwe. Currently, I’m the only person who is here consistently through the week. The metaphorical revolving door that is ENRECA house’s large lightly rusted metal gate sees many a NIMR employee or co-conspirator who lives most if not all of their life outside of Korogwe. My most consistent temporary housemate, Masaka, stays here Tuesday through Thursday. He is a soft-spoken man with a proclivity for reassuring head nods. Monday he drives directly to NIMR-Korogwe to attend to the lab’s accounting needs and by Friday evening he is on his way back to his family. Even when he does stay here, he is always gone when I come out for breakfast and always returns after I have retired to my bedroom. I have also befriended a Danish girl at NIMR who is working towards her bachelor’s degree in Copenhagen. She apparently has lived in ENRECA house, has left ENRECA house, and now will move back into ENRECA house next week. I didn’t ask too many questions.

My cutest house-mate. She is only mildly terrified of me now that I let her play with my phone.

Now to the permanent residents: mother, father, two sisters, and two grandchildren. Because I’m a mildly terrible person, I only remember the star of the show’s name, Winnie. Mostly, this is because she speaks the best English and therefore was always sent as the house envoy to ask me questions, and now I’ve been here too long to ask names without making it awkward. She is 24, though honestly I would’ve believed her if she had said 15 or 30, and punctuates the end of almost every conversation with a forceful thumbs up. At first, I mostly kept to myself in my room if I was in the house and not eating. However, on my second or third day there, Winnie invited me back outside to the courtyard between the guesthouse and the family house. Here, her sister cooked our delicious dinners between lines of drying sheets and clothes under the watchful gaze of her mother. Here, Winnie’s one and a half year old niece clung to the shirt of her 3 or 4 year old sister. Here, Winnie played music and sang and danced with her mother and niece before forcing me to join in. I spent the rest of that night playing with the kids, and I still have the bug-bites to prove it.

The night before I was to move to Korogwe, Nick and I had a wonderful encounter in our room with a Tanzanian Giant Tailless Whip Scorpion (Google at your own risk). By the time I was stepping over its Raid soaked and shoe sole marked carcass the next morning, I was thinking maybe it was time for a change. The car ride to Korogwe felt even shorter this time around, as Dr. Lusingu and I spent the entire time excitedly chatting with a representative from GlaxoSmithKlein (GSK), all the while managing to fit in stops at two local dispensaries (community health clinics) and a roadside restaurant for lunch. She resembles what I believe Dolores Umbridge would be like if she was pleasant, South African, and had a thing for puppies.

The NIMR Korogwe Lab

Coincidentally, Nick also had to be in Korogwe for the day to discuss some pertinent data for his research, though he traveled there with someone else. So after our first (and most likely his only) day at the office, we caught a ride to ENRECA house with one of the NIMR drivers. We asked him, Ali, if he would do us the honor of giving a mini-tour of Korogwe before taking us back, to which he happily obliged. He showed us the best grocery-store-esque kiosk he knew of for our shopping needs before making a bee-line for a strip of bars and restaurants. His reasoning? “I know how much Americans like to drink, and now you’ll know where to find me after work too!” Along the way home we stumbled upon a bar he had never seen before, so went to take a quick look. Nick made a friend very quickly as a woman sauntered over to us to declare how much she “wanted to play with the mzungu (white person).” On learning that I was also American and did not speak Swahili, she offered to teach me something that I didn’t understand because she switched from English back to Kiswahili midsentence, but I didn’t stick around long enough to find out. Whatever it was, Ali seemed rather unhappy as we left about not getting the same offer.

With the GSK representative and monitors for the malaria vaccine trials occupying most of the staffs’ time this week, I did my best to create a research proposal that we could work with on my own. Eventually Edwin, a public health and qualitative research expert, and Dr. Lusingu had a chance go over my work, after which I received a word document riddled with comments and corrections and some homework to read. By Friday I had draft round 2 turned in. The study focus is getting smaller, I’ve already cut out health workers and may have to make a choice between traditional healers and community members, but I’m assured it is for the best of the project. I’m curious to see what comments come of this iteration.

One perk of the hectic schedule my supervisors had this week was the time it gave me for a visit to Lutindi Mental Hospital. Lutindi was founded in 1896 by German missionaries, making it the oldest mental hospital in East Africa. It is perched high in the Usambara’s, overlooking the many dips and bumps of Korogwe District. Visiting its local referral clinic in Korogwe and making the trip to the actual hospital seemed only right as I construct my report on Tanzania’s Mental Health System. Ali drove Tesha, a field worker who will be assisting me in my data collection later on, and I up the winding mountain roads that lead to Lutindi’s gates. We passed a significant amount of people carrying on with their lives in the mountains, far more than I was expecting at least. There were children in school uniforms, little shops selling wares, and women washing clothes at all different heights of our trek.

Half way there

I didn’t notice how nervous Ali and Tesha were until we got out of the car. After volunteering in Camden, New Jersey and at St. Elizabeth’s Psychiatric Hospital in DC, working with a variety of people who used drugs and/or were living with mental illness while interning at HIPS DC, as well doing clinical hours at Holy Cross Hospital for a Clinical Neuropsychology class, being around people with a variety of mental, neurological, or substance related illnesses was kind of normal at this point. I hadn’t considered what they must have been thinking. I’ve seen how bad the stigma around mental health can get in the US and amongst my family members from Ethiopia, so I can only imagine what they thought they were walking into. It probably didn’t help that as soon as we walked into the area where all the male patients were relaxing or eating around 30 of them jumped up and surrounded us in their rush to meet the new visitors. By the time we left though, Ali and Tesha were relaxed and joking all the way out of the gate. It seemed the visit had effectively humanized one of the most demonized groups in the world, and I was happy that I wasn’t the only one who got something out of the trip.

Now, there were a lot of things I could say about Lutindi, but here are some of the more salient points:

· Lutinidi has 120 beds, meaning that at any given time they have 120 patients and must reject any one else who seeks to be admitted there.

· They, like most of Tanzanian’s healthcare system and especially the mental health system, have a severe human resources issue. The staff consisted of 1 neuropsychiatrist, 3 mental health nurses, and 37 other assorted staff, mostly dedicated to things like maintenance, cooking, etc.

· There is a lot of green and open space for patients to relax in, though some opted to stay inside instead.

· There were many opportunities to learn skills such as masonry, woodcraft, weaving and farming. This seemed to give a lot of Lutindi’s residents something to a do, a sense of purpose, or a marketable skill if they left. Some of the people I met were very proud of their work, and showed me animal stalls they had already built as well as the cement foundation they were currently laying for another project.

· The neuropsychiatrist seemed to be an incredibly kind and patient man. He had no qualms showing us around even though we came unexpectedly, and all of the patients seemed to have very positive relationships with him.

· Lutindi has prison style isolation cells that uncooperative patients are sometimes sedated and locked in. I had a very hard time reconciling that the man I had seen interacting with all these patients so gently all day was also a man who saw no problem with this practice.

· In comparison to the general population I had met, especially in Korogwe, the patients at Lutindi seemed to be significantly better at speaking English (one even knew some Amharic) and had relatively high education levels. It would be interesting to look into what effects education or socioeconomic level had on ability to reach this level of care.

· Somehow, someway, the people I met there were able to observe that I was American or from some other English speaking country immediately, before I was able to say or do anything other than come within visual contact. Everywhere else I had been native people assumed I was Tanzanian or from another Swahili speaking East African country and proceeded as such. Not here.

Hopefully this time next week, I will be telling you about my finally approved research proposal and how pretty Zanzibar is. If not, I’m sure the ensuing explanation will be just as interesting.

As Dr. Liese once told me (a week ago while I was freaking out about Korogwe):

“Never a dull moment in Africa”.