Dar Es Salaam from the air

Flying to the north part of Tanzania (the area where Mount Kilimanjaro and Serengeti are). Arusha is much different than Dar Es Salaam. Looking forward to a break from the City seeing more of the landscape.

This is a small part of Dar Es Salaam from the air. You can see the difference in the way communities are planned. Most areas not served by water, sewer and sometimes even power.

Buildings are made from concrete blocks. Roof material is often corrugated metal. To get around the city on foot, people walk to the highway and then travel up and down. No sidewalks, so the people are very close to cars as they pass by.

Dalla Dalla

The Tanzanians are very committed to their public transport. They crowd into Dalla Dalla's to get around the city (Called that because its costs a dollar..."dollar, dollar"). These buses are about the size of a Volkswagon van and often hold 12 people. There are a lot of them around. Factor in the heat, and that is a very sweaty bus.

Taxis are owner-operated here. They are their own small business. Taxis do not have meters - you negotiate a price before you set away on your travel.

Traffic in Dar Es Salaam is a nightmare. It can take hours to get across the city. Lots of pollution. In fact, in the urban district of Ilalla, respiratory infection is the number 2 health concern after malaria (HIV isn't even in the top 10).

So, if everyone is riding the bus, why is it so congested? Well, you must factor in all of the land cruisers and other SUV's. Mzungus like me prefer to ride alone in a huge SUV rather than on the bus. Similarly, as the middle class grows and the upper class prospers here, there is a corresponding increase in the number of people riding alone in big trucks and cruisers.

Yes, there is smog and yes, it sucks when you commute in the city and get stuck behind a diesel truck and have to breathe its exhaust.

Sterilization in a rural hospital surgical ward

As I see the things I see here, every so often I have what Tarantino reffered to as a moment of clarity. I mean, it hard to know what I can do personally, and what I can bring back to Canada in terms of initiatives. In fact, there are so many opportunities here that it can be overwhelming at times.

However, there are also moments when I know I am here for a reason and that I know I can leave a legacy going forward. Seeing the sterilization room at the Mkuranga District Hospital yesterday was one of those moments for me. I know exactly what I can do to help, I know exactly where the help is needed, and I know exactly who I can ask back home to help to make great things happen.

Laundry

Here we find hotel staff washing the linens for the facility. Sheets and towels are laundered by hand with simple soap and non-potable water. They are then left to air-dry.

Back home we use more specific detergents and hot air dryers for a reason. The removal of soil and the hot air serve to "sanitize" the linens. However, since that isn't an option here, the EHOs have a simple solution...white linens.

The EHO I was with asked that this hotel change all of their linens to white within one week. This way, it is possible for the inspector to be left with some kind of confidence that the sheets are being cleaned appropriately, Whereas a blue sheet may hide stains, white cannot.

The Goat on the roof

Call PETA. Someone left a goat on the roof of this building in Central Dar Es Salaam! Not sure if it is a pet or what. Man, the average temperature here in Dar is +33C. That goat must be sizzling.

Personally, I have liquified several shirts (and spoiled some great photos) with my excessive perspiration. Thank goodness Dennis Mazali's office has air conditioning! We are just a shade below the equator here, so the sun is both hot and dangerous. I put on SPF 50 and the sun still finds its way through.

Workplace / Occupational Health and Safety

For a Canadian visitng Tanzania, it is easy to spot the risks workers take. The safety precautions we enforce just do not exist here yet. When I worked for Alberta WH&S, seeing a man wearing no PPE, near the ledge of a building with no fall protection and jackhammering the very concrete floor he was standing on would have constituted an "imminent danger". That is not the case here.

Most urban buildings are constructed of concrete here. As they build a new storey, the fresh pads are supported by trees, not the steel scaffolds we would see back home. As Rob O'Neill might say, it could be argued that this kind of a scenario might not just be a workplace health concern, but moreso a public health matter. The rationale is that it is presumably unhealthy to have concrete fall on you while standing on the street below.

Occupational Health and Safety is on the radar here for EHOs. However, it will take a major cultural shift for the will of the public to choose safe worksites over urban development.

Dispensaries

Dispensaries are like a one-stop shop for the users of public health in Tanzania. Locals lack a way to get to a major centre, so dispensaries are created in the districts (both rural and urban) to make many important services accessible.




This dispensary was in a tiny village called Msorwa, which felt like it was a million miles from anywhere. The roads to get to this village are dirt and prone to wahsout in teh rainy seasons. Msorwa is a two-day bike ride to Dar Es Salaam and I saw many determined individuals making the trek.The goal for Tanzania is to have one EHO for every dispensary.

Bednets

Bednets are promoted as an effective physical barrier to mosquitoes - which transmit Malaria. The tricky part is getting people to use them routinely and properly. The Hati Punguzo program helps rural Tanzanians, who are limited in both means and finances, to aquire insecticide-laden bednetting at a reduced rate.

Expectant mothers who are seen by health offices are given a voucher for the program, which they then turn upon purchasing a new bednet. Maternal mortality rate is the target, and this is one of many programs that helps improve that statistic.

Proper use of netting is another thing. I was told a story of many thousands of bednets being given to the Tanzanian people from the Bush government. In many cases, instead of using the nets for mosquito protection, they were used to catch fish. It stands to reason. Being hungry is a lot more of an immediate concern than the chance I may get malaria.

The Catcher in the Rye

As I mentioned, on the flight over here I read Catcher in the Rye. When the cynical Holden Caulfield describes to his kid sister what would make him happiest in life he says:

I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody's around - nobody big, I mean - except me. And I'm standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff - I mean if they're running and they don't look where they're going I have to come out from somewhere and catch them. That's all I do all day. I'd just be the catcher in the rye and all. I know it's crazy, but that's the only thing I'd really like to be.

Catch of the day

While driving into work yesterday, imagine my delight upon seeing this shark in the trunk of a car (Likely heading to the fish market for sale). I had the chicken for lunch.

Lessons at the well

Here are 2 third-year EHO trainees from Mohambili University at Yombo primary school, teaching the school children two important lessons. One, how to effectively wash their hands. Two, how to sanitize the tap and look after the water supply.

So often we talk about teaching and promoting handwashing. What struck me was reflecting on what it would be like to learn that skill for the first time. Certainly we take that skill for granted in Canada.

I think I can relate a little bit though. Allow me to try to explain. In my hotel room bathroom, there is what appears to be a hose beside my toilet. Well, now that the local bacteria culture has taken up shop in my bowels and things aren't as solid as I am used to, I would love to learn how to use that hose device. However, as I clearly have no idea how to use that thing, there is no way I am going near it.

OK, bad analogy. But I do think that there is something to it. Putting a well, cistern and tap between the washrooms and the schoolhouses is a wonderful idea, but without education they just sit there (and are likely intimidating to use).

That is where Environmental health comes in.

Saturday Morning Breakfast

That is the Indian Ocean.

This was my view at breakfast this morning. When I was a kid, if you would have told me I would ever have swam in the Indian Ocean, I would have said 'you're crazy!'

My grandmother would have loved the coffee here. She always said she took her coffee strong, tall and black - like her men. You only need half a cup in the morning and you're good to go for the whole day. Amazing stuff.

Environmental Health in the news

What has been so amazing about the first few days here (work wise) is realizing that an EHO is an EHO, wherever you are. It has been the great leveller on this trip. We battle very similar obstacles in our work, and we are all colleagues - whether we are students, field EHO's, academics or working as an NGO.

I saw these newspaper clippings in the library at Mohambili University (where the EHO diploma training is done). Students have clipped out stories related to environmental health. I remember doing the same thing at Concordia, and, more recently, in the lunchroom at work. Sure the topics may vary a bit, but the work is strikingly similar and the pride in our job is universal.

Getting the messages across

One thing I have been very impressed with is the empowerment and education of women. You see it everywhere. Many public health advertisements are intended on educating women. These are examples of public health related educational messages posted outside a girls' school in Dar Es Salaam.

I have attached photos that obviously relate to education related to HIV/AIDS (prevalent here), but other murals and advertisements can be found around the City dealing with water, smoking, midwivery and more.

Ministry of Health

Have had meetings with the Chief EHO for Tanzania.

These buildings are four stories tall. No elevators. The Minister of Health has an office on the main floor. Environmental Health is on the third floor and near the stairs. I thought this wasn't half bad and showed that EHO's are relatively important.

PS - Eho's are called EHO's here

Yombo School

I accompanied local EHO students as they taught handwashing and use of the school water supply. I was mobbed by the schoolchildren as a result, which was amazing and humbling all at once. This was a great experience. The school is just outside central Dar Es Salaam, and located in a relatively poor area.

True Africa. They even sang for me, which was beautiful.

Fish Market

Its been a long time since I have done a food inspection. Maybe some of my colleagues can help me...is food preparation on the ground outside something we allow?

This scene was about 2 hours into my first day of work.....oh mama!

Funny story. I inhaled at this location and could feel all of that delicious swiss airline food trying to creep back out. luckily it stayed down. I sighed in relief as I didnt barf,

which caused another inhalation....and nearly another yak.

pole pole

Sorry it has taken me so long to post. More to come soon. Flights were great overall. Dennis Mazali and Stewart Petrie are looking after me very well. So far i've been to the fish market, Ministry of Health, the EHO University, and a primary school. I have great photos to post later on tonight.

I am in great health and loving this experience so far. Later.

PS - I did try the foot thing and it calmed me down nicely.

Sunrise in Zurich

Doing well. Went from Edmonton to Ottawa to Montreal to Zurich with no problemos. Here are the highlights so far:

- Swiss Keyboards are different. It took me forever to find the @ sign.
- Metal cutlery on the Swiss Airline...oh la la
- Got my bag searched in Zurich because I brought some Maple Syrup for my hosts
- Its true...in Europe, a danish is called a Vienna Bun

The sun is rising here in Zurich. Its a bit foggy too. Im reading Catcher in the Rye instead of studying Sawhili. Bad Jason.

From what I hear, the Swiss are meticulous about their knives and watches. Im going to investigate the duty free (I like to shop in the duty free shop)

Talk to you from Africa in about 12 hours or so.

I'm going to feel the rain down in Africa

Ah...Toto.

Mom and Dad,

By playing this record as many times as you did during my formative years, you have rendered me helpless to the fact that this song has been playing in my head for the last 6 months. Oh well, I forgive you and love you both. Ha ha.

Tonight, the song is ringing in my ears and has officially eclipsed "I want a hippopotamus for Christmas" as my least favourite song.

Welcome to the party, Pal!

As I look for ways to keep people interested in my blog, I thought I would start with sharing my anticipation for the long flight...which begins tomorrow morning.

Remember in the first Die Hard when Jon McLean is visibly nervous to be flying? The guy beside him, a seasoned traveler, offers him some tried and true advice...

"When you get to your destination, take your shoes and socks off, and rub your toes into the carpet".

Well, I hope my hosts have seen that movie, because after two days of flying and 10 hours of time change, I am certainly going to be looking to rub my bare feet somewhere soft, and seeing if that advice really works or not.


...this exchange has international incident written all over it!

I'll be on a plane in two weeks!

My flight goes from Edmonton to Montreal, then to Zurich (Switzerland) and finally on to Dar Es Salaam (Tanzania).

If any of you are fans of LOST like I am, you can imagine that I am grateful not to be flying on Oceanic or Ajira airways!