CROSSING TANZANIA

Chap 3  

Truck Stop!

  What makes eating breakfast so unique in in a little roadside “café” in the middle of Tanzania. Well besides the ambiance, then there are these 4 ft. tall crane like birds that have wingspan of 6 feet. They are famous garbage eaters. They are in most towns and cities in East Africa and provide a great public health service. They will eat and clean up most anything. But they are really really ugly. I don’t know what they are called but they are accepted to the point that no one seems to notice them and they are not afraid of people. They just sort of mingle in with the crowd, not too close, they always have an exit. They are like dogs, accepted, as long as they behave.  And because they will eat anything, digestible or not, they are sorta like vacuum cleaners. This might be something you saw on the Flintstones. Betty directing this 4 foot bird -  vacuum by holding its tail feathers.  I donna know.

civic minded public health worker

  Breakfast is hot tea and and ugali, sort of a simple flour based cream of wheat. It’s a national staple. Millions of East African kids have grown up on ugali. I am famished and although ugali might be good ( and safe) I’m not totally buying into the local cuisine here….yet. After I wolf the ugali down I think, what is the safest and best thing?  So I go up to the gas grill which is in front and order Yahi mbili kupika sana ( 2 eggs cooked well), like really well!   Like, Al Carbon,  like kill everyone of those parasites, bacteria whatever. Nuke it!. It is delicious. Now I’m ready for a day on the road.

  We head west to Dodoma, the capital of Tanzania. Dodoma is a bit like Brasilia, a capital made by political compromise, in a non-threatening geographic location. I remember learning about Brasilia in 7th grade, a modern brand new city built in the jungles of Brazil.  So too Dodoma but I’m not so sure is quite as striking as Brasilia.  Anyway, there are no superhighway loops around this new city, no superhighway at all. We drive through the middle of town and keep moving. The middle of Tanzania is dry and empty.  Not jungle just open and dry. For some reason out here, in the middle of nowhere, there are more police then in Dar. We are stopped several times in small townships by roadblocks made of a long wooden pole ( just the pole) and policemen in white uniforms. They have radar guns! Dennis has been very speed conscientious so I assume he knows about these speed traps. They are pretty much always the same. Except these cops don’t have souped up police cruisers, they are on foot. The policeman comes out from under the shade of a tree, saunters over, asks for papers, looks at the windshield where in Tanzania you display your insurance sticker instead your inspection sticker. Think about what that means. Then he or she walks around the truck, never looks inside the back but ALWAYS  stops and looks at me. They usually start in Swahili. I can go about 2 sentences before they know that I DON’T know Swahili . Then they might try a little English or just stare. I have never been asked for a passport or any ID. Maybe this region, wherever we are, is trying to break the mystique of the African truck driver.

  We ride on, the day is endless. I suspect we are in the middle of Tanzania, I don’t know of any large towns, much less cities between us and Rulenge.  I can’t see the speedometer but Dennis says we are doing a 80 km/hr.  at max( 48mph). then we have to slow to 50 km/hr in townships. There are occasional giant trucks that pass us, busses of all shapes, sizes and states of disrepair.  The most common vehicles ate pikipiki’s ( motor cycles) and bicycles, then dalidali , little mini vans that are just small buses that are never empty, always overstuffed with people, animals and cargo inside and out.  We pull into a cross roads with a cluster of low buildings with corrugated tin roofs and home made brick walls or even just canvas walls. I think we are all ready for a break. And so does my bladder. We have been on the go since 6. Any town or village out here has 2 things, almost requirements, to make it spot on some map. First there is the universal Coke a Cola sign and then either Vodacom or Airtel (cellphones) signs. Lacking these signs you are officially not an anything (Adrian’s 1^st Law). Get these signs in your village and your on the map……assuming there is a map.

   By 10 pm we are all beat, I have bloodshot eyes and I’m sure Dennis does too. We coming into in a good size town and I hear Elami say “’lory semama” (Truck stop). Dennis and Elami never go 10 minutes with out some conversation in fast Swahili, which I can never understand. But I get this: we are stopping for the night. It has been a 16 hour day and I feel run over….. by a truck.

It may be 10 and it’s a Tuesday night and I don’t know where we are but this place is rocking. There is music and lights (glaring in my weary eyes).  OK it’s not Vegas but there’s a lot of action here. Trucks are moving in and out, there is a bar and restaurant. We head for the food. I order fried rice and vegetables and a Castle light beer (my usual go to, safe meal when in strange places). Dennis and Elami order food no alcohol. There is a 10 to 1 male to female ratio here and I’m trying not to be too obvious about my taking in what’s going on.  I have arrived!  This is the real thing, a real African truck stop in the middle of nowhere.  A perfect place to break laws, hang out and move the Black Economy. When I say Black Economy I’m not talking color here but I am talking roots, as in underground, the invisible, the black market, the under the table economy.  I don’t know the size or significance of the Black Economy in East Africa but it can’t be small. Economist estimate if the calculated world GDP  (about $80 trillion USD) included the world Black Economy then the world GDP would be 15% higher then currently measured (you can do the math). That is probably an underestimate if you consider the Internet and the dark net.  Any open street market in East Africa is not reporting taxes.  There is no sales tax here. And although I don’t see it I know there are things for sale here, which are illegal, and nobody is reporting these transactions to the Tanzanian IRS…if it even exists.  I wolf down my dinner knock off the beer and am fading. As much as I would like to see what’s going on next door I really just want to go back to sleep, even if it is in the truck. Dennis and Elami are blood shot beat and weary. As I scope out the crowd everyone looks the same. These drivers work long killer days on the road. I’m not sure anybody is up for anything here except food and rest.  I’m also realizing I’m the only white guy in the room, sometimes I forget that. What that means is I often draw a crowd, at least a lot of stares and nobody is going to do anything overt with me around. Actually I don’t know what I was really expecting. Like maybe I would see Osama bin Laden and Joseph Cony sitting in a corner having a beer?

      We walk out and head toward the truck but Dennis and Elami direct me towards a gate. They say (I think) that I need a hotel( Unahitaji hoteli). I’m not sure what they mean. But I it sounds like “meerikani hotel” We open a 6 foot high metal gate, cross a courtyard, go around a building…. Now I’m getting nervous…… and come to another courtyard. It’s now close to midnight and we are far from the road, far from the truck…..I do trust these guys… “salamu sana” says Elami. We come to a door, Dennis opens it up and we are at the Mocray Hotel.

What is this, is it safe? is it a brothel? Dennis yells something and a big man comes up from behind the desk, obviously just sleeping. They chat is Swahili, he looks at me and says: “ hello, welcome to the hotel” in perfect accent free English!  Dennis points to the clerk and says”Meerikani menaja”. The clerk looks at me and says ”hi, I’m Jackson, I’m not American but I went to school at Murray State.

Your friends want you to get a good night sleep”.  I’m speechless. The Mocray Hotel is clean, a little skankey but the thought of real bed is too good, I must be dreaming. Dennis and Elami head back to the truck where, I am finding, they always sleep.  We agree to meet at 6:00am. A night at the Mocray Hotel is 5,000 TzS, about $2.50 USD.  Jackson leads me to my room, outside and to the right. I’m still a little on guard and now I’m totally alone in some back street of a town I don’t even know the name of. Jackson tells me his real name is Milaki, he owns the hotel with his family. I have a million questions and its such a joy to speak American. But I am also asleep on my feet. I warn myself to be awake, be sharp but somehow I sense all is OK.

  My room….. small, one twin bed, mosquito net, no big holes, bathroom and “shower” are one and the same….best to use toilet( eastern) first then take a shower. Always smart to wear sandals in the shower, one small window, no view (who cares), sheets are clean!  I take a quick shower; try to get  the Tanzanian road dust off, hop into bed after I put my extra t - shirt on over the pillow. I can take bedbug bites but will not tolerate lice very well.  Final thought of the day as my head hits the pillow: what if Dennis and Elami left me here? ……wherever I am.

CROSSING TANZANIA CHAP2

11/18/15 or 18/11/15:  Crossing Tanzania    Chap 2 

   In Dar, as in the rest of Tanzania, the hottest part of the day seems  to happen much later in the day then in New England. Maybe its because we are just below the equator.  But as the afternoon continues and, if it stays sunny, it just keeps getting hotter. No afternoon sea breeze like in my home town.

By 3 oclock  the temperature was still taking off; almost unbearable in the sun.  Anyone who can, black or white, is out of the sun in the shade. We had made good progress by then. The truck was full. The  workers were finishing up putting boxes and equipment we couln’t bring  to Rulenge back into container.  We were all were soaked but the workers were all still going strong. They were in a good mood. I think I had paid them well and I let then have their pick of Vermont style winter, and summer gear. It was the price of doing business.  Lets get real here. Most of these clothes belonged to priests who left their stuff in Vt. And most of it had been in boxes for years. As far as I knew nobody from Tz. had made a special trip or even called , or maybe written, to see if their stuff was safe or ever coming back.  Meanwhile I had made at least 50 international phone calls over the last 16 months to get us to this stage. And, I had just flown in here from Mwanza to get the truck “ in gear” and get it moving to its destination at the other end of Tanzania: Rulenge. Of course my interest was the hospital equipment, especially hospital beds that were promised to Rulenge Hospital more them 16 months before.

     Rulenge  Hospital is  deep in the bush near the Berundi and Rwandian borders. To put into perspective you have to understand Tanzania. The best way to do that is to think east to west. The east is flat, hot, populated and contributes probably 2/3 of the country’s GDP. As you head west the  elevation rises, the temperature drops, the poverty goes up and the population goes down.  The village of Rulenge is as far west as you can go in Tanzania. And so by the above description it is very poor and believe me it looks it. The hospital servicing the Rulenge region is as poor as its people and…. it looks it.  With the exception of the  new solar panels you might think its still 1975.

   So I might as well furnish you with the backround of this story. I run a very small NGO  called The Sandy Christman Foundation ( SCF) . Our mission is “to make things better” I know that’s simplistic but that’s the idea. We are small, and we can only know simple because simple is cheap…usually. The Sandy Christman Foundation is no threat to Bill and Melinda Gates. We will not wipe out Malaria. But we are in the action. And the site of action is in Rulenge and western Tanzania, a region known as Kagera. Pick a poor developing country , like Tanzania, go to its poorest, least developed region and you’ll find yourself in Kagera. There may be worse places on earth but the need here is true.  I know, I’ve been coming here seven years. Plus it’s relatively safe. I don’t know about you but I’m not planning on getting to the Gaza strip or Syria in my lifetime.

   Our project is to deliver Hospital equipment to the Rulenge Hospital. We have a 40 foot shipping contained stuffed with donated medical equipment and clothing from a catholic parish in south central Vermont. This is the second container from this parish. The last one didn’t go so well and ended up at the wrong hospital in Kagera. Still a success but a little off target. The SCF partially funded that project. You think you’d learn from mistakes  but no, that didn’t happen. For this 2^nd shipping container the SCF funded the whole thing, 100%. And it hasn’t gone so well. We are now 16 months behind schedule. The container is safe  but its in Dar es Salaam, probably1000 miles away from Rulenge. And its been sitting there since June 2014.

……………………………….

Monday 11/2/15:  the truck is stuffed, we are soaked and instead of calling it a day the truck driver says we should go now.  My 2 new friends are Dennis, the driver and Elami who is sort of the co pilot.  They aren’t crazy about me coming with them but I have told them that the equipment is mine and I’ve waited 16 months to get to this stage and I want to see it delivered.  Of course they didn’t understand that. They speak to Fr. Florence. They want to know if me, the mzungu, is ready, capable, sure I want  to travel with them. I think they don’t want to be responsible for me. Some rapid Swahili goes back and forth. Dennis is definitely the in charge guy. He has been checking me out all day….. and I  have been checking him out. Its sort of bilateral. I’m not completely sure I trust Dennis and Elami  after all they are truck drivers…African truck drivers at that. They have a big job, drive across Tanznaia.  Now they might have to baby sit a mzungu.  They are from Rulenge and I’m quite certain they have never spent any time with a white man ….maybe a white priest  but never a white “Meerikani”.

       Dennis has the truck running, I run to get my pack, climb up into the cab throw  my pack onto the cot behind the seats and we are ready . Its 4:30 pm I’m in a the 30 foot truck, 2 African truck drivers and we are off on a 3 day  safari across Tanznia. Dennis and Elami speak “yes, no”, “good bad” “ Michael Jackson! “( big grin) English. I speak Swahili like a 3 year old. Or maybe more like  Johnny Weismuller in the original Tarzan movies….. “ me go you” (prepositions are so difficult sometimes). There are no maps, no GPS and no air conditioning and I’m psyched to get some breeze into the stifling hot cab. As we pull out of the Caritas compound the metal gate slides closed behind us and we enter into the great Dar es Salaam  evening rush hour. For the next 2 hrs we creep through a chaotic, anything goes traffic jam. Cars, trucks, motor cylcles/scooters, bicycles are everywhere. Curbs, lanes, the other side of the road, the rare traffic light : none of it matters. The goal is the go forward. In the long stand stills hawkers are in the traffic to sell anything.  At one point 3 motor cycle guys pull up next to us, climb up on Dennis’ step and theres rapid bad Swahili. They are scary and demanding something. Elami reaches over from the middle seat locks my door just as another guys is climbing up to my door pulling on the  handle. We haven’t gone  5 km and we are being raided.!   Dennis accelerates the truck forward, opens his door to shake the guy off the door. It works! They are off the truck and disappear. But only for a minute.  Soon there are 3 motocycles weaving through the lanes next to us  and  then driving right in front of us.  Dennis threatens to run them down. Lots of yelling, screaming, gestures.  The fuck you, middle finger seems to transcend all language barriers.  I’m waiting for a gun to appear. Dennis has his window down yelling as the motorcycles buzz around us between lanes like angry bees. Its still light but I'm getting freaked out about how this is going to go down….especially when its dark. Suddenly  Dennis turns left  at the last second as we enter a big intersection we are moving but not fast. The cycles have gone straight but I’m sure they will be back. I look at Elami, he smiles ….….”bandits”.   Great ! Bandits in downtown Dar es Salaam at rush hour.

Around 2 pm

  Dennis and Elami are laughing and yaking in hi speed Swahili. They seem to think it over. Just another pesky rush hour problem: people trying to hijack your truck.  Big smiles and gestures, like locker room post game bragging, reliving the tense moments.  Who are these guys? And who were those guys?

   We are picking up some speed and facing less bottlenecks. The rush hour is winding down as we head straight into a setting sun. I don’t know where we are but I do know we have to go west so things are really starting to look up. Another big bonus it’s starting to cool down.

    A few words about African truck drivers.  Not to be compared with the big belly, big belt buckle big semi driving American brothers. Africa moves on trucks. The only way to get goods from China and India to the African interior is by truck.  And the drivers of these trucks are small, caffeinated,  dex./ meth. drapped, bloodshot eye, road warriors. These guys work in a world with few regulations and drive some of the worst roads in the word.  African truck drivers are know to singlehandedly have been a major contributor to the spread of HIV/ AIDS through out Africa in the 90’s and earlier this mellenium. Like mosquitoes are vectors of Malaria, African truckers, roaming across Africa have been vectors of HIV/AIDS. African truck stops are the stuff of lore. You may not find a Hampton Inn there but you can find, drugs sex and just about any communicatable disease you can name at truck stops. Truck drivers have money and truck stops have lots of ways for men on the move to spend it, one night at time ….and best of all, be gone in the morning. Contraband including people and guns are carried by trucks across borders thru countries that have small budgets for law enforcement.  Hey, it’s a job.

     As we left the last of the Dar suburbs behind, the speed picked up, the temperature went down and we headed west into the African night. We didn’t exactly have friendly chatter but the 3 of us seemed to be settling into our places. Despite my efforts to let Elami sit by the window he seemed pretty adamant to stay sitting on the middle consule  or lean of the cot behind the seats. 

  We are driving a Fuso Fighter Truck. Made by Mitzubishi for this part of the world with the driver on the right. I don’t know where this truck was made but it’s a tough mother. The roads here are bad but at least paved. Where we are going it will only be worse. In the dark we drive by small and medium villages and enter more and more stretches of bush. I cant get the story from Dennis and Elami about the 3 motorcyclist who just tried to kill us. It just gets them amped up and they start laughing like the whole thing was entertaining.

   Music is just as internationally understood as the middle  finger. We can barely talk but we do know what fuck you means ( laughter) and we can all dance in our seats  as I play “Don’t stop til you get enough “ on my iphone.  I think we were really speeding when I played “Happy” by  Pherrell Williams.  Repeated that one a few times. 

    By 10pm I’m falling asleep and hope that Dennis isn’t.  We are in the middle on nowhere and I’m starting to think about where we will sleep and  wondering about those African Truck stops. Our original goal was Didoma  ( the Capital) but the rush hour traffic has shattered that plan. I’m really unsure about what these guys do at night and knowing everybody has been working all day I try to verbalize a question.  “Lala wapi usiko”.  no answer. “ Je lala wapi usiko?” ( hey, where sleep tonight?) .   Elami has got my drift, I dunno, may be my New York accent is throwing them off.

He and Dennis have a mystery dialog and I think the answer is “ we don’t know”. We drive on. I sleep and nod. Sometime after 12:30 Dennis is slowing down and we are in some small town.  Just a bunch of one story buildings with corrugated metal roofs. We pull into a big lot full of parked trucks.  There are very few lights and most light is from parked trucks.  Dennis is hunting, creeping the big truck in low gear. We stop talk to a few guys ( truckers), do a 3 point turn head out and parallel park on the shoulder.  I’m dying to get out, stretch and pee. Elami follows me towards some tall grass, we both pee.  I am dirty, sweaty hungry and tired.  Its dark and very quiet. If this is an infamous African truck stop than I’m going to have come up with a new theory on the spread of AIDs.

 There is no food, no music, no bar and I haven’t seen any prostitutes in the headlights.  We head back to the truck. Elami says  ( I think) : “lala hapa  sasa, sawa?”  ( we sleep here OK?”)  We are going to sleep in the truck?”   Right here?  I think the answer is “ndyio”(yes).  Well sure, the 3 of us in the cab tonight? Not to be a wimp I say “nzuri” ( fine ).  Yeah I’m up for anything you guys do…I’m no white Meerikani wimp…I can sleep in the truck… No big deal… sure I do this all time,  we always sleep in the tuck back in the US.

   So it’s settled. I would like to brush my teeth, buy a mosquito net, find some deet, maybe a pillow?  WIMP!  We sleep in the truck. This is my first night ever in Africa without a mosquito neat. Luckily its pretty cool now  and we keep the windows mostly rolled up. I’m in my very light weight rain coat.  Comfortable. Feet up on the dashboard, Not exactly stretched out but in for the night. Dennis is curled up in the drivers seat and Elami has grabbed the cot, which is really just a board to store stuff on.  Before I pass out I hope these guys sleep soundly because I am told that I snore loudly.

  I wake up about every 15 minutes through the night tortured by the seat, the cramped sleeping space and the simple fact that trucks are not made for sleeping. My 2 truck mates seem very content.  By 5:30 we are all up and out in the bush in the dark and then back in the truck. Dennis is ready to roll. I am looking for breakfast and dreaming of Denny’s. It’s a quiet early morning, not much talk, I think we are just trying to put in the miles.  The first village we come to I’m psyched to stop eat and hit the choo. But it’s too early and none of the roadside “cafes’ are open. Another hour and we reach a real town. Dennis pulls over we all get out and head to a place to eat.  A place to eat. Sounds simple enough. But we are heading to a place you would not want your local board of health to even look at much less think about approving a license.  And as for the choo…..well believe it or not I might have seen worse….once. There is no privacy in small villages, rarely doors and no “western toilets”. Anyway, when I come out I wash my hands in a communal bucket with a well used bare of soap while most of the locals check me out. The only mzungu in town and everybody knows my bowel habits. Great!

    I come to the table on the dirt floor and find Dennis and Elami have ordered and paid for my breakfast ( more on breakfast later)  Hey, I think I’m getting some street cred with these guys!

When It All Goes Wrong, You Can't Win For Trying

11/11/15

WHEN IT ALL GOES WRONG, YOU CAN'T WIN FOR TRYING

 ......its really just adaption to your environment otherwise you could go nuts here.

Adapt, accept, chill or be manic swimming against a tide of overwhelming obstacles. For example…. 

     Patricia is 30 y.o. women I was asked to see. She was extremely weak, getting worse and looked like she was going to die. She had a diagnosis of  chronic Congestive Heart Failure (CHF) felt to be from Mitral  Valve Regurgitation. If  that was true then some of the blood entering her left ventricle would go backwards into the left atrium when her left ventricle contracted or squeezed.  As things got worse and the valve got more leaky or regurgitant some of the blood going back to her left atrium would go farther backwards into her lungs. In time, Patricia’s lungs would get overloaded with blood, the blood pressure in her lungs would increase and fluid would be pushed into her lung tissues and the air sacks in her lungs. When severe, her lungs would fill up full of fluid, as if she was drowning and she would be very short of breath. If you listened with a stethoscope you would hear all that fluid in her lungs.  This is called left heart failure because the defect, in this case, mitral valve regurgitation, was on the left side of her heart.

  But when I examined Patricia, her lungs sounded fine, not wet or full of fluid. She was a little short of breath but I think that was from her being anemic. Looking at Patricia and examining her it was overtly obvious that she was full of fluid but the fluid was not in her lungs it was in her abdomen and her whole lower body. Her legs were like elephant legs. Her belly was gigantic and when I palpated her liver it was huge, probably full of fluid. Blood was trying to get into her heart but couldn’t. It’s like trying to get onto the interstate in Los Angeles, traffic was all backed up at the entrance.  In contrast to left heart failure where fluid backs up in your lungs Patricia had right heart failure because of some defect on the right side of the heart. When I listened to her heart she had a big murmur. It sounded like her Tricuspid valve was where the leak was, not her mitral valve. When I examined her neck the neck veins were distended, full of blood, even when she was sitting straight up. The traffic (blood) was backing up all over Los Angeles, like at rush hour. There’s a reason they call Congestive heart failure.

    Because of gravity, most of the blood settled in her lower extremities, then her belly, then her liver. If she stood on her head it would back up into her brain.  It was impossible to tell with out an echocardiogram, if indeed the problem was her Tricuspid Valve or some congenital defect. But what I did know was that we had the wrong diagnosis.  Patricia had right heart failure not left heart failure. She was not receiving the right medications and to be honest: none of this made any difference.  The right treatment does not exist here and even if it did Patricia and the hospital couldn’t afford it.

    But, we could make her more comfortable and maybe, if we all got lucky, she could get home.  We used 1970’s technology, I gave her big doses of diuretics, and over several days we drained 4 liters of fluid from her abdomen by placing a plastic needle through her abdominal wall. This is somewhat dangerous and of questionable value but she improved over a period of a week. I even thought about using rotating tourniquets, you’ll have to Google that one but it was desperate clinical maneuver from the 1960’s. But I’m not sure that has ever been proven to work. I calculated Patricia needed to lose at least 15 kg. to get near to her  ideal weight of about 55 kg.  We checked her weight daily ( a big deal here).  Slowly over 10 days, as her weight dropped, she got moderately better.  Then she disappeared.

     She and her family (her bedside assistants) “ absconded” one night, probably to home.  This is how it is here. The family not the doctor, not the nurses, decide when to leave, and it’s often at night. The decision is economic. Maybe they had run out of money. Maybe it was time to go home and plant crops, a time when every able body person is needed to work the fields cut out of the jungle.  I don’t know where they lived but it was far away in the bush. There is no follow up appointment, no letter to a local clinic or practioner.  Worst of all Patricia will run out of meds, get worse and die… or  maybe come back here…..if the economics are right.

   So, here’s point. The practice of medicine here is acute care. Get Malaria, have a baby, get bit by a snake. We can do that. But if you have a chronic condition that requires longterm medication, as in life long, you may be outta luck. In the best situation (the developed world) Patricia would need daily medications, follow up and ongoing management. Optimally, she might benefit from surgery.  Here that is impossible. In the developed world most medical care is chronic care medicine. Our medical industrial complex thrives on diseases we can’t cure but instead are treatable with long term care. Renal failure with dialysis, diabetes and its complications rheumatoid arthritis, heart disease and maybe someday cancer are all chronic care, common and often very profitable diseases in the developed world. Here, it is simply out of reach. Patricia’s family knows that, maybe not in so many words, but they know enough to make the decision they made: Stay and try to make Patricia better or be poor and starving next harvest season. That is real world decision making and there is no more real world then the developing world.