Letter From Zanzibar

MPH student Kadesha Thomas

First Impressions

Zanzibar is beautiful -- a very lush, tropical island. It's amazing the sounds you hear when you sit silent for a moment: bizarre bird calls, donkeys kicking, cows mooing, and the man at the mosque calling everyone for prayer over the loud speaker. The Zanzibari people are predominantly Muslim, so there is prayer five times a day. All of the women are covered, and it's hard to find pork anywhere. There are even some hotels that wont give rooms to unmarried couples.

I definitely feel like a fish out of water. This is the most foreign of the foreign settings I've ever been in. Other than my skin tone, everything about me screams outsider. Plus, my Swahili is not all that great, but it's slowly improving. Luckily, most people speak some English. Occasionally, you'll see a group of white people, (usually from Europe) and everyone knows they're tourists. But the Zanzibari people stare at me and scratch their heads. The people I work with have told me that folks have come up to them wondering who I am, why I'm not covered and what is going on with my hair. When they find out I'm American they don't believe it until they hear me talk.

There is very little American influence here -- not one McDonald's, no malls, no Starbucks. (But of course, there's Coke. There's always Coke.) I've seen one or two pictures of 50 Cent or Tupac on the mainland. Queen Latifah is very popular on the mainland also, but most of the radio and television stations play local artists or artists from neighboring Kenya and Uganda.

Zanzibar is made up of two islands: Unguja and Pemba. I am staying on the larger of the two, Unguja, in a mid-rate hotel in the middle of Stone Town, the urban center. I've already eaten a variety of new foods and touched a donkey and a cow. It's very common to see a random donkey or cow on the street, so I had to make friends with them. My Tanzanian and Zanzibari colleagues could not believe that I had never touched a cow before. One guy asked, Well, how do you get milk? I explained that in the States milk comes from a cow somewhere down the line, but by the time it gets to us it has probably gone through several rounds of processing. And the cow might not even be a real cow.

The people here are VERY laid back and friendly. The male-female ratio has got to be like 20:1. Women are not a visible part of the social scene here. It's all men in the restaurants, bars, and sitting on the stoop. I can count on one hand how many young girls I've seen. I've been told that the women mostly stay at home while the men come to town to work. People here think its crazy that I am not married or looking to be married right now. One of my project mentors has told me that I should have a minimum of four children before I'm 30. Yeah, right.

The Zanzibari people are poor, meaning they don't have material excess like we do in the U.S. Sure, some basics are lacking (most people don't wear shoes or have hot water), but they are by no means starving and living in ravaged destitution quite contrary to a lot of the images we see of Africa. And remember, hakuna matata? [a Swahili phrase meaning "no worries"] That's the spirit of the people here -- very calm, peaceful and happy. I feel very safe.

Walking around at night is no problem (not that I do it too often, but still). The people have a laid-back peace and contentment about life. You couldn't beat an urgent reaction out of anyone. As a westerner, that can be a challenge to get used to, but you just get ready for Murphy's Law to go into effect and maintain patience. Also, the people here are very passive and gentle. Expressing frustration or being firm is taken very personally. Actually, it seems [people don't] openly express any strong emotions -- like you would never see a Zanzibari couple kissing or holding hands in public. These past few weeks have been great practice in tongue-biting and holding back tears. Thank God I keep a journal.

The Weather

It's either perfect, very hot or raining. It's winter so its not hot as hell, only perfect or very hot. Apparently, the rainy season has extended. It's supposed to end in May but it has rained several times a week since I got here. The first week it rained everyday. I think that adds to the tropical vibe of the island. Very relaxing.

The Food

If anyone tells you people in Zanzibar are starving, they're lying! All we do is eat. It's breakfast, tea/coffee and cake, lunch, tea and cake, dinner, tea and cake. The food is sooooo good. Hands down the best food I've ever had. I cant explain it. I haven't had one thing yet that wasnt incredibly good. Everything is so fresh and unprocessed. And the fruit is just...oh my goodness. I mean big plump mangos, super sweet pineapples the size of footballs, and seven different kinds of oranges plus a lot of fruits that I've never heard of. Outside of Stone Town, you can pretty much pick what you want off the tree and eat it. Food is very cheap. To go the market and to work, I ride the dolla-dolla, or local bus, which is more like the back of a pick-up truck. Luckily, I found a strip on the beach that I can run to keep things in check.

Health Issues

The biggest health issue here is malaria. Everyone I've talked to has had it at least once, but children are the most devastated by it. The other day I watched a 6-month old girl die of malaria and pneumonia. The mother brought her into the clinic and laid her on the table. The baby was limp and her eyes had rolled to the back of her head. Occasionally shed gasp and I thought that was a good sign, until one nurse said baby, expire. The nurses could not do anything so we all stood there watching this little girl taking her last breaths. I was choked up, ready to burst into tears. I was a bit shocked at how unmoved the nurses were. There was this thick sadness in the room, but no one cried. They wrapped the baby in fabric, placed her on the lower shelf of the T.V. stand and continued to see patients until the burial people came. The mom collapsed when she found out, but everyone in the hospital said this happens a lot. In fact, one of the people I am working with at the Ministry of Health said this is why the people have been resistant to family planning propaganda. Having children is a strong value and high expectation in this society. You can't tell women to limit the number of children they have or how often they have them because it's very likely that some will die before their first birthday.

I sleep under a mosquito net and make sure I spray myself with DEET everyday. I still get bitten a lot, but I havent gotten sick knock on wood. The documented HIV rate on the island is less than one percent, the same as the U.S. However, the nurses in the maternity home I've been working at think its considerably higher. One even estimated three in ten. Its over 10 percent on the mainland. Anemia and pneumonia are also big problems, especially for women. One of the nurses asked me if we have malaria in the U.S. I said no, we die from heart disease, stroke and cancer. So you die from food, she said. Yeah, pretty much.

What I'm Doing

I am assisting with research on a USAID-funded initiative called the Capacity Project. The Ministry of Health here asked for help assessing the strengths and weaknesses of its healthcare system with a particular focus on the workforce. My job is to shadow and interview doctors and nurses to get a snapshot of their typical workweek and find out the challenges of their jobs. Basically, there are not enough doctors and nurses here to fill the demand. Until the Ministry of Health can increase the workforce, they are looking to see what can be done in the meantime to help improve the overburdened health care workforce.

Giving Birth

I spent this passed week at Mwembeladu Maternity Hospital in the post-natal/gynecology clinic. Women come to the clinic for routine check-ups and for follow-up care seven days after giving birth. The most amazing thing I've done so far was witness two women give birth. I have never seen childbirth before. And in this setting it was far from the glamorous spectacle it is in the U.S. Up to three women can be giving birth in the same room at the same time. There are no cushions or pillows, no breathing techniques, no one holding the womens hands, no stirrups, no pain-relievers and no option for a C-section. It's just the woman, the nurses and eventually the baby. If there are no problems, the mom and baby go home four to eight hours after labor. If a C-section is needed, the woman takes a 10-minute cab ride to the islands only hospital. Did I mention that there were no drugs? The actual act of childbirth is beautiful and brutal.

Mothers Day should seriously be a federal holiday, meaning a Monday off. I had a front-row seat, so I could see everything. The two women were in labor side by side completely naked, lying on metal tables with nothing but a sheet of plastic underneath them to catch the fluids. One nurse is standing in front of the woman reaching in to pull the baby out, another nurse is standing over the woman pumping her forearm into the woman's abdomen to move it along.

I always thought women screamed and tore up pillows during labor, but these women were so calm. They cried and groaned of course, but no demons were exorcised. When the first baby was pulled out, it was limp and pale blue. I walked over to the scale and it was laying there, eyes half closed, not moving, breathing or crying. Asphyxia, you know asphyxia? the nurse asked me. I wanted to cry, vomit and collapse. I left the room because I didn't want the mom or the other woman in labor to see my reaction. A few minutes later the nurse called me back into the room and pointed to the baby girl who was now blinking and breathing. Alive, she said. By then the other woman had just started to push. Both of the women went home that night with healthy baby girls.

Other Activities:

Zanzibar is the land of spices, so I went on a tour of a local spice farm. It was great. This farm is 15 acres of exotic fruits and seasonings. I got to see the plants that pepper, vanilla and ylang ylang come from. And I got to taste them right off the trees. I have plenty of pictures to share. This access to all these incredible spices is why the food here is so good. There is also this area called Forodhani. It's a strip along the shore with different art and food vendors. I went out there one night and it was just a chill atmosphere. You can't beat shopping and eating in wonderful weather on the Indian Ocean. It's a beautiful spot, one of the places that make you say aaaaahhhhhhhh.