The Very Lost Tribesman

13th September 2010

Video with 1 note

Trying again to post our short film in an easier format.

4th May 2010

Video

PARIS _ Pictured above is the tartare de veau pastry appetizer from Petrus, a Michelin 1-star spot on the Rue de Villiers, side-by-side with the millefeuille de vanille for desert. Needless to say, it is not the kind of thing you find in Moshi, and you certainly wouldn’t eat raw beef there if you did. It cost me enough Euros to rescue Greece. I don’t care. It was worth it. It is the sort of the thing you dream about in Africa, and if you thought about it too much might make you feel too guilty to eat. Anticipating such a problem, I resolved not to think about it.

So, recipe for exploding your own brain: live for four months in a small city in rural East Africa, slowly growing accustomed to muddy roads, ubiquitous incompetence and dysfunction, and a diet of rice, beans and the occasional scrawny chicken. Then, eat dinner with your wife on a Wednesday, drive to the airport and board a plane for Paris, arriving before lunch the next day.

The last four days have been a multi-sensory overload. So many things you notice. Sirens. The sound of a place where the police actually respond to things, rather than just sitting around a checkpoints while the world cracks up around them. A place where it can rain, and yet life goes on. Mirabilu dictu! Pavement! You nearly weep with joy at the most seemingly trivial example of functioning infrastructure. Nor even one mosquito to bother me in sidewalk cafes, on any one of the average 5.2 meals I have been eating per day. And yes, you do wonder how it’s possible that two countries on the same planet at the same time could provide such utterly and almost unimaginably different experiences to their citizens. I am further than ever from answering that question, though I am certainly glad to now be gathering data and observations vis-à-vis the European side of the issue.

As promised, this will not devolve into another European travel blog, as the world has enough of those. I will note for the record the rediscovered joys stated above, plus a few others: fat, neigbhorhood cafes with a cup of cofee and a newspaper, Vivaldi’s Four Seasons at the Sainte Chappelle, a jazz band on the Left Bank, the Impressionists at the Musee d’Orsay, the smell of the fromageries, a rainy weekday afternoon movie, confit de canard, drug stores.

I will also commend to anyone the experience of stepping out from your life to travel alone for a few weeks. It is of course not always feasible, and probably won’t be for me again anytime soon. But happily it is feasible for me now, and that’s exactly why I did it. Time is the ultimate depreciating asset, so it is irrational not to spend it.

As for the alone part, it isn’t for everyone, and I wasn’t sure it would be for me. And in a few weeks that might prove the case. Certainly, I was sorry Maria had to stay behind and work in Africa, as everything is always more interesting and fun when she is there to laugh at it with me. That said, there is something delightful in being answerable to know one, simply strolling wherever you wish around the city, stopping to eat when you feel like it and going as fast or as slow as you like. It was definitely a good call to start my month of travels with an extended stay in one spot. Now comes a bit more travel - to Prague tonight, then Vienna and across Bavaria and eventually to Munich, where I fly to the U.K. to meet my family. I promise to post occasional entries if I think of anything interesting to say — and equally important not to post if I do not.

29th April 2010

Video

Some safari photos from Lake Manyara, Tanzania.

24th April 2010

Video

On medicine in the country-side and hard-hitting police work in Moshi…..

In a place with such enormous medical challenge, and so many people dying of preventable causes, palliative care is understandably not a priority. Why invest resources in helping people die more comfortably when you might be able to keep them from dying at all? And yet, why shouldn’t it be? In any setting, you could always devote more resources to preventing death than to managing it. If there is a moral case for doing that in the first world, why not the third? If you can’t keep people from dying, they should be made as comfortable as possible.

These photos come from our visit yesterday with Dr. Yesiah Meru on a USAID-funded palliative care project in a very poor, very rural area between Moshi and the town of Machame, where they are based. I was journalistically curious and it fit in nicely with Maria’s interest in finding ways to help front-line health workers offer rudimentary mental health services. If ever there were a good target population for depression, this would be it.

We visited about a half-dozen homes over the course of the morning, spread across a few villages that were poor even by the standards we have gotten accustomed to. Despite all the recent rains, it was clear this area has not received nearly as much of it as the foothills visible just a few miles away; the earth is slightly muddy but still cracked and hard.

In fact, not all of our visits were really palliative; clearly that is one focus of this project, but it also visits people in a range of circumstances. Our first stop (first photo) was actually a bereavement visit, to pay respects to the families of people they have worked with who have passed away. The hosts were the parents of a 42-year-old woman who passed away just three weeks ago. As our jeep pulled up, the father, mother, a brother and a few scattered children — the family structure wasn’t entirely clear but at least one belonged to the recently deceased woman — gathered a few plastic stools and pushed them against the outside wall of their home in a line to capture the sliver of shade under the hot sun for their guests. A bell clanged away from the neck of a scrawny cow, while a few chickens and tiny goats wandered around the courtyard and in and out of the house, a crackly radio playing folk and gospel songs in the background.

This couple was very dignified but had looks of truly deep sadness etched into their faces. The little boy looked totally lost. The father had a white patch of hair and wore a pair of old, crooked glasses, jean shorts and plastic sandals. He and his wife reported they had seven children; four have now died. The latest story was somewhat murky to me in the translation. The general cause was HIV but the immediate one less clear. She had been receiving some anti-retroviral treatment, but did not receive her diagnosis until the case was quite advanced. Whether or not she was properly taking the daily drug regimen is unclear. Virtually all of the 1200 patients in the project have HIV, though a few older patients have other conditions like terminal cancer (which is rarely identified here. One reason is people don’t live long enough to develop cancer, or if they do it simply is never diagnosed).

In any case, death certificates are rare and autopsies non-existent, so it often isn’t clear exactly, though HIV is typically a contributing factor. Reports that AIDS has somehow been cured in Africa are sadly mistaken; people still die from it all the time.

Dr. Meru and two social workers, Deograsisu Mrosso and and Elly Meena, respectfully asked how they were faring and checked on some of the other children in the home who had been left with a package of school uniforms and rudimentary supplies. The brother led everyone in a long prayer. Then we walked through a muddy patch of vegetables and into a clearing where the daughter is buried in a shallow mound of dirt with a white cross, with some fresh bows and ribbons dropped on top. Dr. Meru asked several times if I had any questions for them, but it felt very intrusive. I only asked their daughter’s name: Janet Samuel.

We next visited several patients: a bed-ridden elderly woman in her home who claimed, almost (but perhaps not totally) impossibly, to have been born in 1896 and remember World War I as a young adult here (basically, very few people in Tanzania older than about 40 know precisely when they were born, and exaggeration is very common. Still, who knows?). She is cared for her in her home by her son. We spoke a bit about how rare it is in the United States for family members to take care of elderly relatives in their own homes. This seemed to confirm everyone’s worst opinions about life in the United States. Another woman we visited, tired-looking but smiling, is HIV-positive, but hopefully not a palliative case as she is receiving anti-retrovirals. The treatment distribution, and the drugs themselves, are substantially more effective than just a few years ago, Dr. Meru told me. Still, there are enormous challenges; people simply don’t have the few cents to take the bus into treatment centers. More and more clinics are sending vans into the villages to distribute drugs directly.

Our final stop was an elderly woman with a leg injury. She lives with her extended family but sits all day on the ground under the shade of a small propped-up thatch-roof structure that doubles as their kitchen, with a small fire pit next to her. She has no cane, wheelchair, or access to rehabilitation. A depression diagnosis could be made visually, from 20 feet away. The program has access to handful of pain medications (no opiates) and other drugs (an anti-worm medicine) it is able to distribute; getting a basic (and available here) anti-depressant like amitriptyline added to the list would seem like a worthwhile project.

On the public bus home, we became real visitors to Africa; somebody snatched Maria’s wallet. One looks back on these things and always things “if only we’d……“ Gotten off the bus one stop early instead of heading into town for lunch. Not taken the seat. Taken a purse with a zipper. Maria is beating herself up over letting it happen and what she might have done differently in the chaotic moment when she realized it was gone, when everyone was disembarking the bus and several people around her knew what had happened but refused to point out which person had done it or do anything about it (I was at the front and didn’t realize what had happened until it was too late). Personally, I wish she’d just started shouting really loudly and causing a commotion, but I think it was actually a lesson learned at a pretty modest price. We got away pretty easy - she had about $35 in the wallet, and one credit card to cancel, and is so angry hopefully she will be super careful in the future (if we ever taken another public bus… a big “if,” considering our limited experience). Since you can’t use credit cards anywhere here, we didn’t worry much about that. But I think I understand why she is so upset about it; it isn’t losing the money but your faith in people around you who don’t speak up to stop something. You come to a place and try to help do some good and now this. The experience seemed to take on the burden of all her frustrations over all the obstacles here that have made her work difficult and frustrating.

We decided somewhat irrationally to go to the police station, which is right next to the bus depot. We stood for around 10 minutes while functionaries ignored us. Then, a friendly, English-speaking man took us to a desk where he and another officer began filling out forms. And more forms. They wrote down the missing contents. All sorts of irrelevant information, on various pieces of paper. Her religion? Really? We tried to explain that we just thought they should know what had happened might want to talk to the bus driver and door attendant, who were probably still at the bus station (and, in my opinion, were in on the theft, since they refused to stop the bus and contributed to the commotion). They know their regular passengers, and while the wallet was certainly gone it wouldn’t hurt for them to see the police showing some interest in petty crime on buses.

Ha! So naïve. Then filled in the boxes. One section that was not be filled in had to be x-ed out, but with perfect lines, so they got out a ruler to make sure the lines they drew through one section of the form were perfectly straight. This from a country so obsessed with procedure and paperwork that across the street from the police station sit a stand of three or four stalls where people literally sell rubber stamps.

Then they took us to an upstairs office By now I had concluded our efforts to be good citizens and report the crime were completely misguided. More forms. Finally a woman starts filling out a receipt. Maria notices first and ask what the receipt is for. She informs it’s 500 Tanzanian shillings (about 37 cents) for the privilege of receiving a form confirming our items have been stolen. And here, a streak of what I frankly consider pretty heroic patience during three-plus months in Tanzania comes to a crashing halt. I commence a volcanic eruption that threatens European air travel. An f-bomb drops quietly beneath my breath. More loudly: “Let me get this straight. You want US to pay YOU to report a theft?”

The man seems genuinely surprised at my surprise. It is for the form, he says. Why do we need a form, I ask. What good does it do us? So you can be reimbursed. By whom? The government of Tanzania? He suggests this form will be necessary to collect reimbursement from our insurance company. I struggle not to laugh at the thought of an alternate universe where this would be covered, but only if accompanied by a 5-page report with stamps on it. I explain once again the reason we came: to report the theft in case you wish to try to actually do something about it. Slightly calmer now, I tell him we have absolutely no intention of paying and he can keep the report; sorry for the misunderstanding and to take up his time. Maria makes the obvious point: I just had my wallet stolen. What am I supposed to pay you with?

Our refusal flummoxes him, and he insists we go downstairs. He relays the story to his corpulent supervisor, who asks where we are from and he says he just spent six months in America at an FBI training college. “So at this FBI training college,” I am tempted to ask, “do they advise you to handle theft investigations by filling out endless forms, or actually going to the scene of the crime and talking to people, at the very least to fly the departmental flag?” Probably wisely, I restrain myself. With a dramatic flare, he removes 500 TS from his own pocket and pays the fee. I regret not insisting he take the money back, but eventually we just thank him and take our report, and head home. Now you are a real visitor to Africa, I tell Maria.

Final update: the Almond family arrived in Africa late last night, on a cloud of homespun West Virginia wisdom courtesy of KLM. They came five days later than planned due to the volcano (insert in-law volcano joke here), bearing 130 pounds of medical supplies, cookies and other sundries. Chacha, our driver, was I think a little overwhelmed by two delirious West Virginians talking constantly about their home state during the ride home from the airport. They are still asleep as I write (11 a.m.) and tomorrow we depart on a two-day safari. Wednesday night I depart for Paris. At that time the blog may fade away as I don’t think people care as much about some guy touring through Europe. If it persists, the new emphasis will probably tend toward cuisine, as that will be the unrelenting focus of my trip. So be forewarned: good-bye development issues, public health, education, and African political analysis. Hello European food porn.

22nd April 2010

Video

Mtakuja revisited, and more on language and learning.

In seven days I will be in Paris, come hell or high ash, reversing the rice, beans and scrawny chicken diet of the last three months in one bold cholesterol-laden swoop. I have been looking forward to the R&R for a while now, though it is nice to be leaving at a time when I don’t feel desperate to escape. Walking around Moshi yesterday, I had the satisfying realization that I finally feel pretty comfortable here, certainly in comparison to my wide-eyed, completely freaked-out state when I first arrived. I’m gla I won’t be staying here forever but I see that it is possible for people to live happily and in relative comfort here for an extended period, and that I could do so if I had to. And now that I have had that realization, I am happy to escape for a month of traveling in Europe before returning here in June for a few weeks, followed by a long safari with my friend Dave Scott — of approximately 50 who promised to visit, he alone will actually do so — and finally home to the USA in July.

— I returned to Mtakuja this week (some photos above), the village I wrote about in an earlier post where a Dutch NGO is experimenting with a comprehensive approach to try to lift an extremely poor village of about 4,500 out of poverty. It is a small-scale version of the approach getting a great deal of (sometimes critical) attention from the Millennium Villages project. Joris, the outgoing project leader, and his wife Sarah were kind enough to let me spend some time with them and ask a lot of annoying questions.

 Mtakuja is substantially greener than when I was there a few weeks ago. Last year, the rains (and harvest) failed entirely and after 22 months with almost no water the place looked terrible. But after solid rains the last few weeks it was noticeably greener. Work is proceeding in the common field the project is helping to organize and irrigate, with villagers working to clear the land. Tanesco, the power company, is slowly starting to put up electrical poles to connect the field to the grid, much to Joris’s satisfaction. That will enable pumps to run, tapping groundwater from boreholes reaching down 100 meters or so into the dry earth. We visited a local agricultural training center, where the lead farmers are receiving two weeks of training in both crop management and leadership. We sat in briefly on one of their classes, an incongruous site of about a dozen or so roughly-clad Tanzanian farmers sat around a table in what could have been an MBA classroom, with an engaging teacher working through a Powerpoint about leadership techniques.

Out back are fields where the students get hands-on agricultural lessons. Zablon, a retired Tanzanian government agriculture official who has been hired by the project to work with the farmers, told me there is a whole body of knowledge he is trying to convey to them to improve the chances of the fields in the irrigation project being productive. Some are quite simple: local farmers, he says, almost always spread their maize plants too far apart in a misguided effort to give each plant more nutrients. In fact the optimal yield comes from putting more plants closer together. That information alone, he says, could double production. Overall, he thinks the village could improve its maize yield by a factor of four, which would be an essential building block for transforming the village economy. More maize would set in motion of a virtuous cycle where there is enough cash for low-level investment and savings to protect against future shocks, and to make the irrigation project financially self-sustaining. It’s a useful reminder: someday, perhaps, industry and a service economy will help lift Tanzania into prosperity. But that will be decades away under any conceivable scenario. First it has to rise out of extreme poverty, and that will be all about agriculture (if I have learned one useful thing about poverty here, it is that there really is an important quantitative and qualitative difference between an income of $300 a year and $1200. In the former you are utterly stuck; with the latter you may well be moving in the right direction)

But there are also large obstacles, from the saltiness of the soil to the novelty of the experience for the villagers and the unforeseen, unintended consequences of changing the economic dynamics (broken as they are) of the village. Still, it is the only conceivable way forward. The village of Chakarini, next to Mtakuja (and the location of the training center) has had more advanced irrigation for about a decade, and for that reason alone is more noticeably developed, with better-quality buildings visible along its roads. Some Chakarini farmers have even bought plots in Mtakjua. And the main determinant of success, Joris, Gebert (his successor) and Zablon insist, will be involvement of the villagers themselves. Several years ago, the Japanese poured development dollars into the area to try to build up rice farming, but did it mostly on their own, and the system broke down soon after they left. A giant rice refinery they left behind now runs at about 10 percent capacity. To their credit, the three have made community involvement the cornerstone of everything they do. The interesting question to me isn’t whether money can lift a village like Mtakuja out of poverty, but whether it can be done without someone like Joris on the ground in every single village. On the one hand, it’s a little patronizing to think that’s what’s needed — a Westerner with an MBA. But it isn’t the MBA that matters: It’s that Joris speaks fluent Swahili, has gotten to know and earn the trust of all the village leaders and many of the villagers themselves. He is determined to involve them in every aspect and says it is better for the community to try something as a group and fail than for him to do it himself and make it work, because it will stop working after he leaves. His most useful tool is patience.

“When we are done with our first phase in 2013, we’ll measure,” Joris told me. “I have no doubt we’ll show significant progress. But what matters is after. If you come back in 2020 or 2025, is this place better off than surrounding villages? What is going on on the ground? Are there local coordinators in the village? Are they truly involving the community?” If not, he says, there will be no permanent good. So I’m not sure the question is whether enough money can be raised to test comprehensive development on the Sachs model. If this project costs $250,000 a year for 5,000 people, that adds up to roughly $1 billion a year for a similar level of commitment to 20 million people living in extreme poverty - a lot but not impossible. The more limiting factor seems to be the number of Jorises in the world — people who speak the local language and have the patience (which I would certainly lack, as would I think many save-the-world types of the kind who might be applying to work in Millennium villages) to make community involvement such a high priority that they would prefer to fail than to create something unsustainable. And people who do not become cynical. This seems like one of Joris’ more extraordinary accomplishments — that he has largely, if not quite entirely, avoided the deep cynicism that affects so many ex-pats here. They are probably more cynical even than me, since I started with a reservoir. They are idealists who came to solve problems and hit a wall, and their disappointment is acute. Joris, by contrast, seems endowed with extraordinary patience. Still, he leaves next month after two years, returning with his family to New York (interestingly, he will be working for Millennium Villages). His successor, Gebert, is in place, but will have to get to know everyone himself and build up the level of trust it has taken Joris a while to accumulate, as well as fully master Swahili. -

— In the afternoon, I tagged along with Joris’ lovely wife Sarah, who visits one of the local secondary schools once a week for an effort at some health education and communication-skills building. It was the latest of several glimpses I’ve gotten of secondary education in Tanzania and it wasn’t terribly encouraging. The school has a few advantages — some new buildings under construction with support from TPC (the sugar plantation) but the classrooms still have dirt floors and gaping holes in the walls instead of windows, where wind and rain and dust blow in. When it rains, Sarah says, the noise of water falling on the metal roof is so loud students can barely hear their teachers.

The school is exceptionally crowded. On paper, at least — on the scheduled posted on the wall of the office of the headmistress — it has an ambitious and disciplined daily schedule running from 7 a.m. until after 4, with work on Saturdays, too. But transportation is a huge problem. Because the cachement area is so large, many students don’t arrive until 9 or 9:30. Many walk for miles; needless to say there is no school bus system here. It’s hard to see how students who miss the first two hours of school every day could possibly stay on track. Sarah has been working with a group of high-school aged girls on health issues. Among her activities has been trying to help them identify adults they can trust and approach with problems. It’s clear, she says, they don’t trust the teachers or the school counselor (who is just a teacher with a full teaching load). Her training is to encourage and direct students toward outside resources, to push them to seek help when they need it. Here, the whole premise breaks down; there are no outside resources. They are basically on their own.

We sat under the tree with a group of strong students selected for her once-a-week class. Recently, she had them write a play about HIV and perform it for the other students in hopes of spreading some of the lessons more widely. As they worked on songs (a subsequent assignment) a group of boys passed us walking back and forth to a patch of banana trees on the school grounds. They are required to tend the banana patch, not as a pedagogical exercise, a la a Berkeley elementary school’s organic farm, but to supply the teachers with food to supplement their admittedly meager salaries. Students also handle the groudskeeping, sweeping the grass around the school buildings clear with machetes, among other tasks. I did pass the classroom of one teacher that left me encouraged, at least initially. He was a smiling and engaging young man and was teaching chemistry by bringing laughing students up to the front of room to grasp arms in different formations imitating molecules. But it was hard to hold the attention of the class because there were dozens, perhaps hundreds of students milling around loudly outside. It was hard to tell, and I didn’t want to interrupt to confirm, but the likely explanation is that this was “extra time” during the school day and he was teaching the students who pay additional fees for supplemental instruction. Outside, those who could not afford the extra fees were left to kill time. Supposedly all the “essentials” are covered tuition-free and the extra payments are for supplemental lessons. But it is widespread practice to nudge the more essential material into the extra class time to try to drum up business for the teacher.

I told Sarah that the students, at least, seemed heroically well-behaved compared to American ones, but she wasn’t able to summon much good will on that front either; a major reason, she says, is that corporal punishment and humiliation are widespread. That makes for fairly docile, well-behaved children, perhaps, but it comes with a price. None of those issues, however, were the most discouraging. They are all difficult, but potentially solvable and improvable over time.

But there is one absolutely central aspect to education in Tanzania that seems fundamentally broken, to enormous consequence: the language issue, which I have written about before. In secondary school, instruction switches to English, but neither the teachers nor the students are prepared for it. Teachers read from textbooks in English then essentially translate into Swahili (probably poorly). The students Sarah is teaching have some of the best English in the school but even theirs is mixed and they obviously are not at a level where they are prepared to fully learn in English. Sarah reports they do poorly on national exams partly because the questions are more open-ended, and the best most students can hope for is a kind of learning by rote memorization that is not, ultimately, terrible effective for exam preparation or useful in real life. Creativity is not a priority, a problem that seems to poison the workforce of the entire country. Tanzania benefited enormously from the emergence of Swahili as a national second language, which helped unite the country and spare it many of the problems of its neighbors. But, sadly, it is now paying a big price. In other places, it is easier for English to emerge as a de facto national second or even first language. Here, it seems obvious to me the country would be much better off instructing through secondary school in Swahili and complementing it with intensive English instruction. Then at least the students might master the concepts of subjects like chemistry and then, hopefully, learn enough English by studying it intensively for an hour two each day to eventually apply those concepts in English. That is how countries, such as Holland, for instance, end up with well-educated citizens who also speak good English. But Tanzania doubled down on its policy of switching instruction to English. It believes English is the language of global commercie and its route to prosperity. Perhaps. Also, there are few secondary teaching materials available in Swahili. But what else matters if the students don’t master any of the material. Students in Japan don’t learn English very well but they learn a curriculum and have a chance to study English; that seems like a much better outcome. It is very difficult to see a strong way forward for a country where, on a widespread basis, teachers and students cannot understand what it is they are supposed to be teaching and learning. —-

Finally, an update from Rwanda, and not an encouraging one:: Kagame has arrested his main rival for the presidential election (http://bit.ly/a6n6pO ). He appears to have no chance of losing the election so this does not bode well for his understanding of how important this sort of thing is. For all his virtues, he is persuaded he alone is the savior of the country and that the outside world has done so badly by Rwanda it has no moral authority to criticize him. It will be interesting to see if he is still a global media darling in five years.