Update on Bushie's Mosquito Nets

400 insecticide-impregnated mosquito nets have been purchased and are en-route to Quelimane!!!

Lugela...my love

Let me begin by saying that I’m writing this from the confines of my room in Lugela, which consists of a bed, a mosquito net, and a lantern on a small end table. Yep, pretty much heaven. Amy and I are staying in a thatched hut tonight. We have two bedrooms, a small living room, and an outdoor bathroom. Mud walls, straw roof, a single light bulb that runs off of a generator, and two candles for when the generator não e funcionada. And the generator is turned off, so I’m typing by lantern light.

The conversation through the paper thin wall between our rooms in our thatched hut:
Amy: 10 bucks says you got malaria last night.
me: yeah, my caffeine withdrawal headache this morning was probably my malaria prodrome.
Amy: I hope you die a slow death
me: I hope the scabies burrow out of your skin tonight
Amy: I love you
me: I love you too. Goodnight

So, we made it out of Mocuba without any further incident. We packed the truck with workers heading to Lugela, and we were off. It was actually a rainy and slightly chilly day. About an hour into our trip, we drove down a dirt road with thatched huts on either side. Welcome to Lugela! No phones. No electricity. No running water. It was beautiful! Rolling hills with a misty, rainy fog. Chickens, goats and ducks a-plenty.

They dropped us off at the training session we were to attend. Basically, there is a group of HIV+ people in Lugela who are in the process of creating a formal organization of people living with HIV, with the purpose of implementing HIV education programs, promoting prevention, and assisting orphans and widows who have lost family members to HIV/AIDS. Amy and I basically observed and networked with people.

After the meeting we headed to our residence for the night. It’s beautiful! And tonight was the first time since arriving here that my body has felt warm water. The outdoor bathroom came equipped with a double bucket bath…one bucket with cold water, the other steaming hot. So I grabbed my towel, lit a candle, and walked around back to our little tiki hut-esque bathroom. It was glorious! The night was silent except for the pleasant chirping of crickets. The air was chilly. The water was warm. And when I returned, there was a plate of chicken, rice, and shima (flour boiled in water) on our table. I could get used to this.

The Incredible Hulk

First night in the districts. Amy and I got settled in at our little pensão in Mocuba. For the first time in who knows how long, we had our own rooms. When we first arrived in Quelimane, we shared a bed at Michelle’s. Then we shared a bed at Mónica’s. For a brief time we had our own rooms at our dependencia, but since we’ve been house sitting, we’ve gone back to sharing a bed. And sharing a bed is not without problems, mostly involving Amy accusing me of steeling the covers, touching her with my toes, and infringing on her personal space. No joke, it’s like the episode of Brady Bunch where they draw a line down the middle of the room because they can’t share. Amy’s totally the line drawer.

I think we were both looking forward to having our own bed to sprawl out on tonight. So we got settled in our rooms, worked on our presentation for a while, and then decided to grab some dindin at the little restaurant attached to the pensão. After dinner we went back to Amy’s room to get a bit more work done…and that’s when the fun began. She couldn’t open her door. This is nothing new for Amy. She perpetually has problems unlocking and opening doors. So naturally, I told her to step aside and let the professional have a go at it.

“You’ve just got to put your shoulder into it,” I told her, as I put all my weight into that door. And much to our surprise, I had opened it….and ripped the door off the wall. The deadbolt was still in the bolted position, and I managed to rip a large chunk of wood off the wall which contained the hole thingy where the door latches shut. We stood there in silent disbelief for a moment. Then I began hysterically laughing, partially because I thought that if I laughed, I’d have less of a chance of getting a knuckle sandwich from Amy. Luckily, she found it equally hilarious and I still have all my teeth.

What can I say? Sometimes I underestimate my own strength. Well, I call it strength. Amy calls it being stubborn. Maybe I’m a little of that too.

So here we are now, sitting Indian style on my bed, eating coconut flavored cookies and listening to “trouble” by Ray Lamontagne, and working on our presentation that we need to give this Friday.

There goes our night of sprawling out in our own beds.

Sink or Swim

Today, Amy and I went to the clinic in Inhassunge for the first time. We hopped a boat across the Rio de Bons Sinais and landed at Aquapesca, the camarão (shrimp) farm across the way. From there, a truck drove us down a dirt road for about an hour. We passed through fields of mandioca, coconuts and little huts with thatched roofs, and finally arrived at the clinic. It was quite a sight. A compound of buildings with people lined up all around, waiting to be seen by either Mónica (the doctora), the nurses, the pharmacists, or technicos de medicina (medical technicians).

We walked through the crowd to quickly take a look at the urgent consults. The first patient we saw was a newborn with an imperforate anus. So this little man was born perfectly fine, except that his digestive tract failed to make a little hole at the end so he can poo. Mónica informed his mom that they'd need to come with us to Quelimane at the end of the day so a surgeon could fix him. Next, we saw a little boy, probably about 8 years old, who had a condyloma. While walking through the courtyard to set up shop in Mónica's office, a man approached us to say hello and wish us a good day. Mónica knew him very well. She later informed us that both he and his wife are HIV+, although his disease is more advanced, requiring him to take anti-retrovirals. His wife's condition is not as bad right now, so she hasn't been started on meds. The problem that Mónica is having with him is that he doesn't understand why he has medicine and his wife doesn't. So he's been giving his medication to his wife...which is making his condition worse.

Throughout the day, we saw about 12 HIV+ patients, 4 of them having run of the mill TB to boot. But another 3 had MDR TB (multi-drug resistant tuberculosis). We had a really sad situation with a 15 year old girl who came in with her mom and was just diagnosed with HIV (her reason for seeking medical attention was that her skin was itchy and bumpy). She weighed 80lbs, was jaundiced, and had sex twice last year--the only time in her life. As of today, she has HIV, TB, and potentially hepatitis. We saw another man who was diagnosed with Kaposi's Sarcoma at another health center, although it looked more like osteomyelitis. We also saw a little baby who had a bad reaction to Niverapine (an anti-retroviral)...his face is covered with a bumpy rash. Watching Mónica interact with patients is a thing of beauty and deserves to be the topic of another story.

During a short break, Amy and I toured the facilities. We walked through the pediatric ward which consisted of 8 beds. We met one girl who I thought looked to be about 8 years old. Turns out she's 18. Amy and I then chatted with an older woman who was holding an extremely malnourished boy who we thought was about 6 months old. He is actually 3 years old. Eye opening to say the least.

There is also a pulmonary ward with half a dozen beds, a general medicine ward, a maternity area, and a men's health area. There's a building for HIV counseling, an area for the pharmacy, and a building off to the side that functions as the morgue.

Towards the end of the day, a man popped in to Mónica's office and gave us coconuts with the tops chopped off, so we could drink the water.--sidenote: unripe coconuts have a thin layer of soft meat and are chalk-full of water. ripe coconuts have the thick, drier meat with less liquid.

At the end of the day we packed into the truck and headed back to the dock. Mónica, the driver, the woman with her newborn, and two other women sat inside the truck. Amy and I piled into the flatbed with 7 other people. Mind you, the flatbed on the FGH trucks are about half the size of what you get with the Silverado. So Amy and I made new friends as we bounced down the road. Just your average day in Inhassunge I suppose.

The monkey on my back

So, Amy and I have wanted for nothing since arriving in Quelimane. In fact, we've probably put on a kilo or two. But every so often there is a diet coke shortage. There is a regular coke factory in Maputo, so bottles of regular pop are always available. But "coke light," as they call it here, is imported...and a hot commodity. There has been a coke light shortage for the past 2 weeks. At first I drank spar-berry pop. But spar-berry pop is something that needs to be consumed in moderation. A little too sugary to be my go-to drink. This evening, Amy and I discovered that the coke light truck has arrived in our little town, so naturally we celebrated the only way we know how: bought a crapton of diet coke and drank it like we were chain-smoking cigarettes. I imagine the empregado at Ty's house will arrive tomorrow morning to find us passed out on the floor in an aspartame-induced coma, surrounded by empty cans.

Shock Value

I think cavemen knew what they were doing when they grilled their food over a camp fire...they had fire back then, right? Anyway, Amy and I purchased a double burner hot plate 3 days ago. In the world of kitchens, this is the equivalent of a double-wide trailer. It's no penthouse, but it's real nice! We brought it home, I plugged it in, and it worked. Perfect. So the next day I went to boil a pot of water to pour into our water filter. This was a momentous occasion. Not only was I trying out the new hot plate, but I was also using our new pot and water filter.

First, as the pan heated up, it began shaking and vibrating like an earthquake. Then I noticed water leaking out of the side of the pan at the point where the screw attaches the handle. No problem...I just won't use the top 2 inches of the pan. But then I decided that it would be a good idea to touch the base of the hot plate, just to make sure it didn't get dangerously hot and would be safe to have little kids (or Amy) be around it. Upon carefully placing the tips of my fingers on the side of the frame, something shocking happened. I completed the circuit. A sizable amount of electricity surged up my arm. And if that wasn't wretched enough, the crummy thing stopped working about 2 minutes later! It's broken! Our brand new double wide!

I've decided that it's probably best to opt for a grelha e carvão (grill and charcoal). After all, I was the grill-master at 1011 State Street.

Amy + webcam = a dangerous combination

Let me paint this picture for you...Amy and I are house sitting for one of the FGH workers for the next 2 weeks. She has internet. Last night, as I sat in bed reading, I heard a peculiar noise coming from the room with internet. Amy was belting out "circle of life," from Lion King. Then I hear her screaming, "Can you hear me? I can see you! Can you see me? Flip me the bird if you can hear me. Do I look like a crypt, wearing this blue bandanna?" Yep, she got her webcam to work on skype and was chatting with her dad and sister. Next thing I know, she has moved the camera back and has cleared a space to make room to demonstrate her African dance moves for her family. She asked me to join in...which resulted in me nearly getting kneed in the face.

Work update: We are done with Portuguese class and starting our projects. Had a long day of meetings on Friday concerning our protocols, worked for a bit this weekend, and are continuing to get things straightened out with the ethics committee and whatnot this week. At a meeting this morning, I found out that Gonhane, the secondary clinic near Inhassunge (which just opened three weeks ago), has 120 new positives...about 90% of which involve people with CD4 counts less than 50. After being diagnosed, approximately 22% of these people didn't return to the clinic to receive their medication.

African Tooth Fairy

Best thing I’ve heard in a while came from Amarra, the 6 year old daughter of Stacy, the nurse practitioner who runs the clinic in Namacurra. Amarra just lost one of her front teeth. Sitting next to her at dinner, I asked her if the tooth fairy had ever visited her. She states very matter-of-factly, “yes, but last time it took 3 days for the tooth fairy to take my tooth, because her wings kept getting caught in my mosquito net. So I had to put my tooth on a table.”

Also, I need to post a clarification of the previous posting about the bug in my room. A certain someone in Djibouti has brought to my attention that it was more than a brief girlish shriek that I made when i saw the demon bug. He called me a liar and insists that I post a clarification of this statement. So, here it goes...I didn't briefly scream. I may have screamed and hyperventilated for 5-10 minutes. There! You happy?!

Snail Mail

Amy and I have had a few requests for mailing information. The mail isn't exactly "reliable" so the best thing to do if sending mail to us, is to send it to the FGH office in Maputo. Then they'll carry it up here when someone is traveling from Maputo to Quelimane. Also, don't mail anything of value, like electronics or pieces of pretty jewelry that you're dieing to give to us.

FGH
Avenida Maguiguana N32
Maputo, Mozambique
CP604

The Green Hills of Africa

What an inspiring day! Yesterday we woke up at the butt-crack of dawn and headed to the border of Mozambique and Malawi to renew our VISAs. First of all, the sunrise here is just as awe-inspiring as the sunset. Secondly, Hemingway wasn't joking when he wrote, "The Green Hills of Africa." It was amazing. The terrain changed from the palm tree-clad city of Quelimane, to fields of mandioca, papaya, and pineapples. Then came the rolling hills and the brisk weather of the western plateau, around the Alto Molocue area. Blue skies, red dirt road, chickens, people on bikes and working in the fields, thatched huts, and an excellent music selection that I was jamming to.

If ever driving through the green hills of Africa, here are my suggestions for the perfect music mix:
1. Into the mystic--Van Morrison
2. The boy in the bubble--Paul Simon
3. Catch the wind--Donovan
4. You're gonna make me lonesome when you go--Dylan
5. Nothing but flowers--Talking Heads

On another more clinical note, Inhassunge (the clinic where Amy and I are going to do the majority of our projects) had 2 cases of leprosy last week. And also, we've learned a bit about ritual scarification, which is an interesting cultural practice in this area of Mozambique, especially Inhassunge. Sort of like tattooing, but the women are the only ones who have it done as a coming of age ritual, and it is often done with unclean instruments and can be a vector for transmitting HIV. More to come on that later...

Bugs and Birds

Last night, as I was preparing for bed in my dark room (trying to curtail energy costs and make Al Gore proud), I saw a dark shadow move across the wall...about the size of my hand, fingers included. It wasn't moving like a lizard, so I flipped on the light to see what it was. It was either some form of beetle or cockroach. After the initial shock and a brief girlish scream, it met its maker.

At 5:30am, I awoke to the sound of someone raking or sweeping outside my back window. When I realized that I couldn't fall back asleep, I got up and looked out back to see a dozen chickens grazing outside my window. They belong to the people who live behind us. Oh, Africa...

Tomorrow Amy and I are leaving bright and early to venture to the Malawi border with one of FGH's drivers. We need to renew our VISAs, and apparently you have to travel to the border to do so. We're pretty pumped to see the country by car, and will most likely have to spend tomorrow night in Malawi. If you don't hear from either of us in 3-4 days, it's safe to assume we've been deported.

our house is a very very very fine house

Although I’m beginning to get used to the concept of sharing my home with giant wall-crawling lizards, I still can’t help but let out a shriek whenever I turn a corner and see one of those unholy beasts scurry across the room. Like spiders, they are good in theory because they eat bugs. Unlike spiders, they can be the size of a small cat. The air conditioner lodged in my wall provides the perfect conduit for these little creatures to venture in from the great outdoors. (yeah, our new house has a couple a/c boxes. fancy shmancy!) But one creature that is not welcome in our new home are those nasty little hopping spiders. 3 of them met their maker today. Hopefully the 4th escaped and will tell his friends to set up shop in someone else’s home.

The overhead light in the bathroom is slightly dysfunctional. It flickers on and off in a strobe light type fashion, and I’m a little concerned about having a seizure whilst brushing my teeth, so we’ve opted not to use it. Consequently, Amy looked like she was going spelunking while she got ready for bed. She walked into my room brushing her teeth and wearing a headlamp—picture to be posted soon.

We’ve managed to borrow two mattresses from people at FGH, and we have them on the ground, lying on top of straw mats. I just need to get a couple bamboo poles to fashion a frame that I can use to drape my mosquito net over my bed. Africa has done wonders for my creativity! After 3 stifling years of med school, I’m reconnecting with my childhood skills of fort-building; turning empty rolls of t.p. and wrapping paper into swords, telescopes, and fishing poles; smooshing the chairs together in the living room to play “boat” (Remember that Hannah? We always made Elliott be the fish). I’m fairly certain that I can turn coconut shells into lamp shades. And we’ve already got a couple capulannas for curtains. I’ve devised a method for washing our clothes in a giant bucket. And after a long day, when I come home all hot and dirty, there’s nothing better than a cold shower! (no hot water) What else could a girl want?!

Amy and I christened our new place by sitting in our giant hallway/front room (which by the way is perfect for doing cartwheels) eating pizza, drinking red pop, and watching “Little Women” on our computer. Pretty nice way to spend an evening, eh?!

Yesterday was the last day of 3 days of FGH meetings. Our days were packed with listening to people speak about various aspects of the organization and how the clinics are running. All of this, mind you, was in Portuguese. I now have about 10 pages of vocab that I scribbled down furiously during the talks. A recurring theme of the meeting was that Amy and I were labeled as “fearless,” as a result of our lack of inhibition when it comes to speaking Portuguese. Now, let’s be very clear. Not once were we told that we spoke well…we just dazzled people with our ability to embarrass ourselves without caring. I’m giving us an A for effort.

Following the meeting, there was a big party in Dr. Paulo’s backyard (where we have African dance class). There were about 10 people who formed a drum circle and just went to town all night. So we danced around the drum circle under the palm trees and the beautiful African sky, and they played and chanted. It was all very magical and surreal.