Tanzania Travels

Tanzania Travels Honored

2007-08-17T15:42:00.000-04:00

I am happy to report that African health issues are getting some national recognition. The National Association of Black Journalists awarded the Tanzania Travels blog a "Salute to Excellence Award" in the category of New Media-Best Commentary last weekend.

There were a number of prominent media players also being honored that night including retired CNN anchor Bernard Shaw, NBC president Steve Capus, and former Los Angeles Times editor Dean Baquet. Hopefully, the timing of this award coinciding with their honors will spark continued dialogue in the media of dire health issues in Africa and other developing countries.

Thank you for your support!

Technorati Tags: NABJ, Salute to Excellence, New Media, blogs, blogging, awards

Congo Rapes: "Unforgivable"

2006-05-31T17:44:00.000-04:00

Today I read (and watched) with much dismay a story CNN broke about the raping of women and girls in Congo by uniformed military. The reports say the soldiers from one ethnic group were systematically raping women of another with the intent of destroying their reproductive capabilities.

Some were girls just 8 years old, raped in front of their mothers and fathers for days at a time. The raping is another indicator of how powerless and undervalued women are in some parts of Africa. These women were raped and tortured (some used knives to rape their victims) but not killed. Maybe it is because it is often worse in this culture to live with the stigma of being a rape victim and the emotional scars of surviving. Imagine raising a child born as a result of rape and hating yourself and that child as one women explained. Or feeling worthless as another woman noted.

The health toll of HIV is exacerbated by these inhumane acts as the reality is there is a high risk that these women could have contracted this fatal disease from their attackers. Women with HIV in Africa as previously noted, are often thrown out of their families and treated as outcasts.

It is hard to conceive that President Joseph Kabila, or any president, could be totally oblivious to this. He says this is "unforgivable." But a more unforgivable act would be to continue to let the offenders go unpunished as noted by Amnesty International.

Related Topics: Global Report: AIDS at a Crossroads

Technorati Tags: Sudan, rape, HIV, Africa, human rights

The Final Frontier: Jetlag

2006-05-29T09:16:00.000-04:00

The first thing I did when I got home was take a hot shower. I called my parents but other than that wanted to be left alone to decompress. I was just too wiped out to go into conversation; too wiped out to go anywhere; and too wiped out to even eat.

I attempted to stay up to write and unpack but lost the battle after about two hours. I felt sick with sleep -- a bit nauseated and drunk with fatigue. The jet lag was compounded by the serious sleep debt accumulated while in Africa. So instead of trying to adjust by staying up until bedtime in my current time zone, I didn't fight it and slept the rest of the night.

Experts say sleep problems tend to be more common when people travel from west to east as it is more difficult to advance than to delay sleep time. However, for me, I am hardest hit traveling from east to west. I saw a story about jet lag on CNN as I was packing up in my hotel room on my last day in Tanzania.

The expert said that for every hour of time difference you travel, it takes that number of days to recover from jetlag. My track record has been the number of days I am away is the number of days it requires to recover. So I anticipate it will take me at least a week and a half to get back to a normal sleep schedule.

My first full day back, I woke up at 5:30 a.m. (early by my standards). By 7 a.m I had suited up to work out, made a light breakfast, and watched some news. By 9 a.m., I got hit again with uncontrollable sleep (before I got to the gym). I woke up around 11:30 a.m., still moving like a zombie. By this point, I was famished and mustered up enough energy to eat and get some groceries for my bare pantry -- and of course take my Malarone.

I had given up on the dream of making it to the gym. By 4:30 p.m., I felt the urge to crawl back in bed where I fielded a few calls. I vaguely remember my dad calling; I think I fell asleep on him. By 6 p.m. I was out like a light and nothing could rouse me. My bed has never felt so good! I slept through a series of other calls. I felt like a brick wall was laying on my body, leaving it immobile, and the sleep mimiced the heavy, good sleep that you get while under anesthesia (this would continue for another week or so).

Some tips to help with jet lag include: Avoiding excess caffeine, alcohol, and tobacco; avoiding social isolation; practicing good sleep habits right away; taking a one-hour walk first thing in the morning; limiting sleep to no more than two hours immediately after arrival; drinking plenty of fluids to avoid dehydration; and controlling naps while in flight to your destination.

Melatonin has worked for some people but not for me in the past. Melatonin is a hormone the body naturally produces at night and is thought to help initiate sleep. Melatonin supplements have been available in health food stores for quite awhile, but they are not FDA-approved, so their purity and safety are not known. A recent study from the University of Alberta has shown that melatonin supplements may not actually be as effective as once thought.

Related Topics: Summer Travel, Tips for the International Traveler

Technorati Tags: jet lag, travel tips

America at Last

2006-05-29T09:07:00.000-04:00

At 7:30 a.m. we arrived at JFK in on a rainy, cold, New York City day. I deboarded groggy and stiff but excited to have completed my long voyage safe and sound. Still, I had another two-hour flight to Atlanta. My flight was scheduled for 10:45 a.m. but the plane never arrived because it got struck by lightening. By now, I was quite irritable with fatigue as the flight was delayed two hours (while they tried to repair the plane) before they told us what happened. After some debate with several rather useless (groggy attitude kicking in) airline representatives, I ended up taking on the painful task of arranging to reclaim all of my baggage and catching a cab to La Guardia. The thought of waiting another three hours for a flight at JFK was unbearable in my state of hunger and fatigue. After 20 hours of flying, all you want to do is get home to your bed.

During my cab ride home once in Atlanta, I felt a familiar feeling taking hold: jet lag. It is like you are awake but know that a wave of unavoidable sleep is lurking beneath the surface. I turned my head to look out of the window and another feeling overwhelmed me: one of sadness and guilt.

I thought about the neighborhoods I passed along the expressway that people say are depressed and thought about what I had seen in Tanzania. I knew that even poverty here is eons better by comparison. I thought about all of the luxuries we have in America yet we always complain about wanting more. Here a hot shower, clean water, smooth pavement, access to medical treatment, and no malaria-infected mosquitoes are all things I never thought of as being luxuries -- just basics. I guess the word basic is relative.

While Tanzania has its challenges, I never feared for my safety. There were beautiful places like Arusha and Zanzibar, like most countries, there are a few people who are very well off, and the people were kind and cheerful in spite of their hardships. Again, these people are proud and smart, they just need some help -- a lot of it.

Related Topics: Top 10 Causes of Death Worldwide, AIDS Taking on a Female Face

Technorati Tags: jet lag, Tanzania, Africa

Heading Home: 20 Hours and Counting

2006-05-25T07:48:00.000-04:00

I think it's fair to say we are all exhausted. I couldn't even process the idea of another 20-hour plane ride. Nobody honestly wanted to talk about it. I packed my arsenal for the ride: aspirin, decongestants, Malarone, toothbrush, and socks. I drank a lot of water to start out hydrated, polishing off the bottles I had brought with me so not to have to lug them back.

My experience in Africa, and other undeveloped nations, just makes me feel that safe drinking water should not be wasted. This thought shows me, I am already noticing the changes in my 'charmed' American mindset.

I sat on the plane next to my colleague, John, an editor from Miami. He is still tackling his sinus issues, so I shared my decongestants with him and emphasized the need for them while flying. John manages international coverage for the Herald and has an enviable wealth of global experiences.

Despite his intriguing tales, I realized when I embarrassed myself by falling asleep on him midconversation that the flight home was all about paying back the heavy sleep debt we all had accumulated. Sleep debt is the number of hours of sleep your body requires to function well but has not been getting. Eventually, however, one needs to make up for that lost sleep in order to get back on track. On this trip, it is fair to say, I owe a lot. When I looked back from my seat, which was in the front of the plane, I saw everyone was passed out.

The time change in flight also made me paranoid that I would forget to take my Malarone. Each way, we lost a day traveling, but I know how important it is to continue taking the malaria prophylaxis. I must still take Malarone for seven days after I get back. In my delirium, I tried to calculate the proper time to take it based on when I took it in Tanzania, but I was probably off. You are supposed to set your watch to the time zone of your destination to start the process of adjusting. Clearly, that was not an option for me since I never found a battery for my watch.

The first 5.5 hours from Tanzania to Dubai were fine. I may have slept an hour or so. But the 14.5-hour flight to New York City was a wash. As much as I tried to fight going to sleep, even to watch a movie, I kept losing the battle. I woke up to drink water and for restroom breaks (which I hoped counted for my walking requirement). John and I did manage to get in a few good conversations, but I don't know that I've ever been this wiped out.

By the way, I managed not to get one mosquito bite. Night, night.

Related Topics: Bringing Home Illness From Overseas, Sleep and Travel

Technorati Tags: jet lag, sleep debt, travel tips

Funding the Fight

2006-05-24T15:26:00.000-04:00

The question usually arises about how money for the top 3 killers of the world -- HIV/AIDS, tuberculosis (TB), and malaria -- gets distributed and where it comes from.

I have noticed several posts on this blog about what one can do to change things for the better. I've felt perplexed by the same question at times after seeing so much poverty and feeling so helpless on this trip.

As with many things in life much of the solution to getting a grip on malaria and AIDS boils down to sufficient resources. The financial piece has a big impact on why malaria and the other 'big 2' have yet to be eradicated in Africa. In my discussions with Louis, I asked him to explain to me what the Global Fund is that he speaks about so often. Louis, who is with Global Health Advocates, is also board member for the malaria section of the Global Fund and has first-hand experience with it.

The Global Fund is probably a little-known entity to many Americans. It is a war chest of money that was established by Kofi Annan and the United Nations to increase the resources to fight AIDS, TB, and malaria -- the world's most devastating diseases -- and to direct those resources to areas of greatest need.

In a nutshell, the fund consists of donor countries and recipient countries. The U.S., naturally, is one of the donor countries. The fund supplements money already in place for these causes in recipient countries. Recipient countries write grants to apply for funds, then the proposals are reviewed through an independent review process. Once granted, the recipient country is given the freedom to use the money to implement/supplement programs according to its needs.

While most people I've spoken to seem to think the Global Fund is a great vehicle to help, clearly there is much still to be done in terms of fighting malaria, HIV/AIDS, and TB, and more money needed to get control of these diseases. That is apparent by the number of people who are still dying.

Louis has expressed numerous times that it would take a mere $3 billion a year, each year, for 10 years to wipe out malaria worldwide. For the average person that may seem like an exorbitant amount of money. But in reality it is quite small compared with other governmental expenditures. Currently, the U.S. national debt clock shows the country is at $8 trillion. The war in Iraq will soon exceed $300 billion, according to recent news reports. That is the U.S.' share alone.

The dispersement of Global Fund money is broken down into 'rounds.' The current funding round is No. 5. The total amount of money approved for all five rounds so far is U.S. $ 4.3 billion over two years to support programs for the 'big 3' in 128 countries. The shortfall of funding to eradicate these diseases is glaring when looking at the need (Louis' estimate) vs. what is available. Between round 4 and 5, the funding has been cut dramatically for both HIV and malaria.

From my viewpoint, the heart of the problem with funding the fight does not seem to stem from a lack of financial ability, but more from a lack of it being a priority in the eyes of empowered nations.

The issues with funding form a complex web compounded by politics, race, gender, and economic empowerment. Africa has long been overlooked, partially, from what the experts on our travels have said, because it does not bear the economic fruit other continents do and sadly because of race.

Louis echoes a sentiment that I have heard from experts -- black and nonblack -- both in America and Africa, "Nobody cares about poor, black babies in Africa," he says. "Every time a child dies here [from malaria], it is because we could not get $2.40 to the mother."

I and the other journalists on the trip have discussed the reality that malaria's devastation in Africa is often a hard sell to newsroom managers in the States, and HIV across the board is going under the radar, too, with more advancements in treatment. I think that maybe it isn't that citizens of the developed world (who can make a difference) don't care about these topics, I think it is more likely that they don't know to.

More to come on funding...

Related Topics: The Global Fund: Fighting Malaria in Niger, World Health Organization: Global Malaria Programme

Technorati Tags: theglobalfund, fight malaria, africa

Bono Speaks Out on African Health

2006-05-22T17:05:00.000-04:00

Today I was happy to see that Bono is spreading the word on malaria and the two other major killers in Africa, TB and HIV. Read more about his journey through Africa here

Related Sites

The ONE Campaign

Reuter's blog: Bono in Africa

Flickr Set: Bono's Africa Trip

Technorati Tags: U2, Music, AIDS, Africa, health, González, poverty, Live8, entertainment

Ignorance Is Not Always Bliss: Mollelian's Story

2006-05-18T08:28:00.000-04:00

One of the most glaring examples of ignorance and the need for education, came to light while at a village where Artemisia, the plant used for Artemisinin-based Combination Therapies (ACT) for malaria drugs, is being farmed. This is where I, and my colleague, Bob, a CBS news radio reporter, interviewed, Mollelian, a young woman living in the village.

We asked Mollelian about malaria to obtain a general sense about her knowledge. Women are the first line of defense so if the woman in the house is lost, then the children's health is in serious jeopardy.

She says that even now she is sick with a headache and a temperature. She says she has no money to buy nets and doesn't know where to get them. We ask her how she gets treatment. She says that she gets treatment at a clinic. But we find that she buys most of her drugs at a local ducha (neighborhood corner store) and it may just be aspirin. The translator explains to us that when people get prescriptions, most are written in English so many people in rural parts don't understand what the prescription is for. Mollelian can't read or write any language. In addition to Swahili, educated Tanzanians learn English at a young age.

We ask Mollelian if she had any kids. "Yes, 2," she tells the translator. We asked if she had any that died from malaria. She said no. After some time passed and more questioning it turns out she had two children die "at child birth." Louis comments that it is likely that the kids died from malaria. We have found during our travels that many people in the villages don't know that 'fever' is malaria and mistake symptoms of malaria for other things. Then we ask her if she knows how you get malaria. "You get it from close contact from people who are sick." For the record, malaria is only transmitted by mosquitoes, not human-to-human contact.

I thought about asking Mollelian about HIV, but I sensed from our conversation that she wouldn't know much - if anything - about that either. However, she did get one thing right, she knows what the Artemisia plants being grown in her backyard are for. Ironic that it is a cure that is right outside her door and one she may never be able to afford.

Related Topics: Spotlight on HIV/AIDS in Females, HIV and AIDS in the 21st Century

Technorati Tags: malaria, Africa, Tanzania, artemisia, ACT therapy

Gender Inequality: Striking a Balance

2006-05-18T08:20:00.000-04:00

I could not leave Africa without addressing the important role women play in society. The topic of the impact of gender inequality and health care is a topic I could write about all day. Women are the care takers, the home base, the back bone of family life, much like in the U.S. -- and they are responsible for getting health care for the kids.

Unfortunately, the gender inequality that persists in the culture in Tanzania and other African countries still reflects a devaluation of women that is far greater than in the U.S. I had heard about how women are the last to get medicine in the household since the man is the breadwinner; that they can be thrown out of their homes if they admit they have HIV because stigma is so strong both in Tanzania and Zanzibar; have fewer sexual rights within a relationship; and are often overlooked in terms of getting an education -- a decision made by a man, their father. While here, I thought it was important to find out first hand from the women who live this life.

I asked Ritha, a WHO malaria professional and part of our team, about her experience as a woman growing up in Tanzania. We talked while in transit to a village in Arusha. She says her tribe was more progressive than some others. Her father always thought it was important for her to get an education and saw to that happening. She adds that she and her husband share decision making in her home as well. While there are a number of women like Ritha, particularly in the city, sadly, I would guess she's the exception. Again, most Tanzanians live in the rural parts of the country, where access to everything is just scarcer and mindsets less progressive. Ritha does say that the government is trying intervene and things are slowly changing regarding elevating the girl child more and emphasizing giving her more rights.

After our visit to the clinic, where we saw the malaria ward in Arusha, the female NABJ fellows discussed a situation that baffled us. One of the women explained to us through our translator that she had to beg and beg her husband for the money to go get treatment. Finally the woman said she won him over with her 'womanly' ways.

Men control the money and make the final decisions generally. Gender inequality plays a major role as to why women are so left behind in terms of health care. Much of it boils down to lack of education and therefore lack of empowerment and control over their destinies. When I've asked women here if they feel oppressed (by American standards), I don't think many of them have the knowledge or exposure to even understand what that means. They don't realize what is out there in the greater world. I've asked the question in many ways and have received the same responses.

Louis weighs in on this issue, saying tackling ignorance is a way of empowering people. "The only way we're going to see a massive change is through education. And formalizing education and perhaps making it required for families to send their girls to school," he explains. Then we discuss some girls we met in Arusha. They explained that they didn't have $.50 USD to get to school (what they needed for one year) because their father didn't think it was a priority or didn't have the money.

"I think the problem is finding financial resources to make this happen and making this a high priority," Louis adds. Compound this with throughout Africa, most of the decisions made within countries are made by men. Women rarely a part of the political process at high levels.

This lack of empowerment is also one reason that women are the highest risk group for HIV in Africa, just as black women are in America. Louis explains that some of the customs and practices culturally completely "victimize" women so empowerment is important dealing with the HIV crisis in Africa.

As noted in my entry Reconciling With Reality, women are the last to get antiretroviral drugs, carry the strongest stigma and have the most to lose if they are diagnosed with AIDS and reveal their status, and have fewer means to be self-sufficient. Women often contract the disease from their husbands who are frequently away for months at a time working. During this time they may have affairs with prostitutes without condoms and then transmit HIV to their wives. In rural areas, often times access to condoms is scarce even if a man or woman knows to use them, Louis says.

Stigma is a very big issue with women. Particularly in Muslim countries, such as Zanzibar, it is even more difficult for women to come forward. In addition to more funding, access, and education, cultural attitudes play a major part in combating HIV. It seems the same systematic problems that need fixing for AIDS will also be needed to bring malaria to its knees. As Americans, we are no stranger to the impact of stigma.

Related Topics: AIDS Taking On a Female Face, WebMD Women's Health Center

Technorati Tags: AIDS, HIV, women's health, Africa, Tanzania

Arusha: The People

2006-05-17T10:07:00.000-04:00

Ursa River Village Children

Maasai woman standing outside her home in small village in Arusha.

Zanzibar: A Glimmer of Hope

2006-05-15T17:49:00.000-04:00

If there is a silver lining during this trip, we found it on the tropical island of Zanzibar. It is low season so the island is rather quiet as far as tourists, but the beauty of the desolate coast is breathtaking. Not only is it aesthetically an oasis in the desert, but it is a model of what can happen in terms of turning a health crisis around when the proper precautions, education, funding, and government commitment are in place. Other countries have looked at Zanzibar's programs as a roadmap to wiping out malaria in other countries in Africa.

We visited the east coast of Zanzibar after meeting with the country's president Amani Abeid Karume. We stopped at a poor village in the midst of a popular touristy section called Jambiani. The natives greeted us with song and dance. They are singing for good reason. Malaria has practically been eradicated in their community -- and on the island as a whole.

All of them have nets, access to care and drugs, subsidized funding for medication, and have been educated about malaria prevention and treatment, spraying is also in force. The endless pot holes (which serve as breeding grounds for mosquitoes) and standing water -- aren't quite as bad as they are in Tanzania, either.

In Tanzania, the standing water is literally everywhere. I am here at the end of the rainy season. Once it ends the mosquitoes will have an opportunity to breed in the stillness of the leftover puddles and come out in another month or so in full force.

Zanzibar is a predominately Muslim country of 1 million people. It is a 15-minute plane ride from the mainland of Tanzania. The poverty outside of the powdery white sand that borders the Indian Ocean is similar to Dar Es Salaam. These people also have their struggles, but Louis emphatically notes that the success here is a prime example of what is possible when the government is committed to this problem and has proper funding: Malaria can be eradicated and babies do not have to continue to die.

This cheerful community of 5,000 had an infection rate of more than 100% in 1997. This means that not only did every single person in their village get malaria each year, but some got it more than once. They have not had a confirmed case since October 2005. The infection rate is now down to less than 1% per year. It is common for people, including the U.N. Tanzanian officials traveling with us, to get malaria 2-3 times a year.

The president acknowledged in his meeting with us that HIV is a devastating problem in Africa -- still -- but malaria must be conquered alongside of it. Both together are crippling the African continent.

One note: While Zanzibar is a model for malaria, there is still much to be done for women regarding HIV and gender equality, which will be noted in a separate entry.

Related Topics: Malaria Vaccines in Development, WebMD Inteview: Doctors Without Borders

Technorati Tags: zanzibar, malaria education, poverty

Emergency Medicine

2006-05-15T17:44:00.000-04:00

We are near the end of our time in Tanzania and it seems people keep getting sick. First Thursday, then Friday, I noticed different people were missing from the group. Stephanie, a reporter from Philadelphia, had started feeling really sick in Zanzibar, and she looked really bad and was rather quiet which is a stark contrast to her vibrant personality.

When we got back to Dar, I was told that she was off to see a doctor. And John, an editor from Miami, disappeared on Friday. Both went to the doctor for infections. Stephanie had an infection in her leg and John had a sinus infection. One of the U.N. officials from Tanzania was kind enough to take them to her doc. Luckily nothing was seriously wrong, and the U.N. was able to make arrangements for their care.

Traveling overseas, especially to developing countries, can be scary because of the unknowns if there is indeed an illness that requires a doctor's care. I always fear that the care will not be up to the same standards as it is in the U.S. A friend of mine who went to Kenya for a summer, advised me to bring syringes and needles in case I needed a shot.

I had read to take this precaution in some travel prep reading, too. I would've never thought of that, but HIV is rampant in Africa so I seriously considered it but ran out of time to get them. You basically need a doctor to prescribe them and you should carry a doctor's note, too, so they don't get confiscated in transit. I think both of my teammates were satisfied with their care however, and they are recovering nicely.

For this trip I actually took out traveler's insurance via American Express in case something went wrong. I figured Africa was too far away to get caught off guard without additional protection. Most employer health insurers either don't cover treatment abroad or make you foot the bill up front. If you are hospitalized or require emergency transport back to the states it can cost thousands of dollars.

Among other items, my plan covers emergency transport for me or for a family member if someone needs to come to me, also emergency evacuation, all medical care, and if I died it would cover transport of my remains. The fees are based on the length of time and coverage in dollar amounts you desire.

There are plenty of plans online to shop for traveler's insurance; a friend of mine actually recommended American Express to me since I am a cardholder and so is he. If nothing else, I certainly had peace of mind knowing if something went wrong, I was covered.

I am feeling fine now other than a constant runny nose, which seems to be a universal symptom of the group at this point.

Related Topics: Travelers' Insurance: Buying Online, Bringing Home Illness From Overseas

Technorati Tags: travel, travel insurance

Wednesday/Thursday: Montezuma's Revenge Strikes Again

2006-05-12T08:55:00.000-04:00

I noticed on Wednesday night during my return from Arusha to Dar Es Salaam that my stomach felt slightly queasy. It subsided but it was enough to send a red flag, then I thought, 'Naww, this is just all in my head.'

After a very late night of travel and filing stories about Keith and Erv's fate with traveler's diarrhea, I prepared for bed at 3 a.m. I got back to my hotel room and knew immediately that I had been hit. Curses! Then I reached immediately for the Cipro.

I sensed the impending squirming in my stomach that would have a very bad end result and braced for the worst: the toilet marathon. Though having traveler's diarrhea is a nightmare, it was the timing of it that bothered me most. In three hours I was set to board a plane for the infamous island of Zanzibar. I had anticipated this part of my visit most. I feared this would sideline me as flashbacks of London and my bout there filled my head.

I was hopeful since Keith nor Erv experienced vomiting so I thought if I could control the diarrhea and nip the bacteria in the bud with Cipro, I could manage. NOTE: Africa, or at least Tanzania, is no place to have this problem on the road. The 'toilets' especially outside of Dar Es Salaam consist of a hole in the ground, a bucket of water with a cup, and a hose. I'm still trying to figure out exactly how this works but for either gender it means squatting over the hole -- which can vary in size. There normally isn't any toilet paper, so it's a good idea to tote your own.

At 4 a.m. I text paged a doctor friend of mine in the states who reminded me about the Imodium AD. I had totally forgotten. I miraculously found the strength to get up with an hour of sleep (in between potty breaks) to get on the plane. I was sick but felt better than when I was when in London, probably because of the Cipro. I actually made it through the day without incident despite the intense nausea. I attempted to use a restroom but there was always an issue at each stop -- the flush wasn't operational or the hole in the ground issue. Even at the president's mansion on the main floor, there was a real toilet but no running water to flush. Thank goodness for Imodium AD.

Related Topics: Travelers' Health Kit, Food and Water Precautions

Wednesday: Don't Forget Us

2006-05-10T21:02:00.000-04:00

Standing water in animal foot prints and holes in the muddy roads are havens for mosquito breeding. This is the rainy season, so puddles are plentiful right now. That was all too apparent at a village where an elderly woman invited me into her two-room home to talk.

The village has a rice paddy farm - a mosquito magnet. And there are puddles, big and small, everywhere - right outside the doors to their tiny dwellings. I walked gingerly trying to avoid getting muddier, and then I thought to reapply the DEET as it was near dusk and malaria-carrying mosquitoes mostly bite at night.

She talked about how she had bed nets, but I saw those were old and tattered. She said she could not afford to buy more on her $11-a-month income. That is what she earns with two jobs; her full-time farming job, then her side job of making jewelry. A widow of 15-years, she is raising her kids and several grandkids on that amount and emphasizes to my translator that she lives hand to mouth. She says fortunately, there is a clinic nearby where she can get free malaria meds for the kids. The grandbaby in her arms has already had it twice. It is common for Africans to get malaria several times a year if they survive it.

Later, as I started to leave the village, the woman stopped me. "One moment, I need to grab my translator," I said, gesturing because I knew she didn't understand me. The woman told the translator that she wanted to give me her blessings and that she liked me. Then she insisted on inviting me in her home again, mud-caked shoes and all tracking on her clean floor.

It was there that she presented me with a lovely, handmade beaded necklace. A gift. I thanked her and wished her well and told her I would not forget her. Then the translator said that she wished me safe travels, was praying for me, and that I should not only remember her but more so her children and grandchildren because she has lived her life. She hugged me and asked me to remember her story so that the world will know about the tragedy that is happening here.

Admittedly, I was a bit choked up as she looked me gently in the eye with her pleas. The Africans I've met are smart, proud, and want things to get better, they just need some help.

Related Topics: More than 10 Million Child Deaths Per Year, Preventing Infections During Travel

Technorati Tags: africa, tanzania, malaria

Wednesday: Malaria - A Half Billion Cases a Year - Why We Should Care

2006-05-10T17:50:00.000-04:00

My nausea has subsided for the most part from the Malarone. My mother sent me a very mother-like email telling me to make sure I remember to take my malaria drugs as 'I forget things like that' sometimes.

But my paranoia, which has been compounded by the infectious disease specialist reports, will ensure that I do not. Putting up that mosquito net was a chore since there was none already in the room and no hooks already set up to hang my own. Giorgina couldn't believe that a nice hotel wouldn't have them. When I called the front desk, they said they had sprayed, but I already had learned that's not enough.

A global health expert, Louis, joined the group last evening from Britain. He is smart and displays a rare passion about health issues but particularly malaria. He works for Global Health Advocates and is here to give us an objective view to weigh against what we hear from the politicians and other organizations.

Malaria's seriousness is something I'm realizing much of the world outside of Africa is rather clueless about. Today, after we flew from the main city of Dar Es Salaam to rural Arusha, I sat on our minibus and chatted with Louis about HIV and malaria. For now, I'll talk about the shocking details of malaria.

Malaria is the biggest killer throughout sub-Suharan Africa (except for Mozambique and South Africa) for all people -- even more so than HIV.
Every 30 seconds one child dies on this continent from it. And half a billion people a year contract it. There are several reasons - which are primarily economic.

Louis notes that it only costs around $2.40 U.S. dollars per incident here to treat malaria with the new combination ACT drugs, but subsidy funding falls short in terms of making the drugs available to everyone who needs them. He says $3 billion dollars a year for at least 10 years could eradicate malaria in the world.

Tanzanians have become resistant to older drugs that were cheap and once available over the counter, and that $2.40 is a steep price for most here to afford. A decent wage is $150 a month. Minimum wage is $70 a month, and many fall below that it seems.

There is no prophylaxis treatment here. After all, you can't take malaria drugs forever. If you get malaria, you just get treated, that is if you have the knowledge to know you have it, can walk up to 22 kilometers to a clinic with your sick kid, that clinic actually has the drugs, and you can then afford them. Combine that with there is one doctor for as many as 30,000 Tanzanians, so you are likely to be hard pressed to find one to treat you.

Malaria is highly curable when caught early, but many Tanzanians may make very little so a $6 insecticide-treated mosquito net or a round of malaria drugs are needs that will continue to take a back seat without government subsidizing and a lot of education.

Besides this being a health crisis and global moral issue, I turn to Louis who is sitting in the seat behind me as we bump along to our hotel and ask, 'Why should Americans care that all of these Africans are dying?' People at home never think about this problem since it is not their problem. Then, he explained a phenomenon I'd never heard of: traveler's malaria.

When people get malaria, he explains, they develop the parasites in their blood, which make them sick. Malaria is sneaky; you may not get the associated flu-like symptoms for weeks or months after being bitten. (Misdiagnosis is a common reason for malaria death in the U.S. and it is important to take all of the pills including post-vacation even if you feel OK).

With increased travel to Africa and other malarious countries, there is an increased risk that travelers will get malaria and then may be bitten by a 'healthy' mosquito while in transit. The 'healthy' mosquito can pick up the malaria parasite and then transfer it to someone else in original host's airport back home. Bam! The infection spreads stateside. With better control of malaria in Africa, there is less chance for transcontinental spread.

Related Topics: West Nile Virus and Insect-Borne Disease, Malaria: What Increases Your Risk

Wednesday: Arusha - Montezuma's Revenge Strikes

2006-05-10T17:45:00.000-04:00

This is our second day in Arusha. Last night I noticed one of our campers was missing at the dinner table. Then today while we were back out in the field -- a different one was missing. I later learned that Keith, a photojournalist from Atlanta, and Erv, a newspaper reporter from Pittsburgh had been hit with Montezuma's revenge. Erv spent the entire day at the hotel. When he resurfaced after a day in the field, I saw him creep gingerly to the bus that was taking us to the airport for our return trip to Dar Es Salaam. He and Keith both experienced fever, nausea, and chills -- but both were seemingly over the hump. Keith took the antibiotic Cipro and offered one to Erv.

A year or so ago, I was visited by this demon while on a day trip in London. One meal was all it took. Before I could get back on the train to Paris, I vomited in customs. It was one of the most miserable times of my life. The rocky train ride compounded my relentless nausea and the constant diarrhea was a double whammy. I was in bed the entire next day and part of the following one. I literally could not get up -- except when I had to pull myself to the bathroom. Luckily, my mom was there to nurse me back to health. Unfortunately, I didn't think to bring Cipro to Europe, but it does show bacterial infections like this can strike anywhere in the world.

Doctors often recommend you bring Cipro when you travel out of the country just in case. It is taken 2 times a day for 3 days on average and should clear things up and get you going. Traveler's diarrhea is caused by common bacteria including E. coli. People usually contract the bacteria from contaminated drinking water. Tourists traveling to tropical places -- including Mexico, Asia, Africa, and South America -- are among those at high risk. Some ways to avoid bad bacteria: pass on ice, tap water, salads, fruits that don't have peelable skin, food that has been sitting out in the sun, and unpasteurized dairy products.

Symptoms include: diarrhea; abdominal cramps; mild to severe dehydration; general lack of energy, nausea, and vomiting; fever, vomiting, and stools with blood or mucus. These symptoms indicate you have serious diarrhea, which is more likely to lead to problems with dehydration.

Dehydration may alter the effect of any medications being taken, such as oral contraceptives or antimalarials. It's important to drink lots of fluid.

Hopefully, Erv won't feel too bad on the plane ride back tonight.

Me? I am feeling OK. I think allergies have taken hold so I am sniffling quite a bit but my sore throat has subsided.

Related Topics: Travelers' Advisory, Travel Health

Technorati Tags: montezuma's revenge, travel risks, travel health

Sweet Dreams of Sleep

2006-05-10T17:44:00.000-04:00

My first two nights in Tanzania I realized a few things: The food is actually pretty good, so no bonus pounds will likely be lost; despite the vast malaria problem, there are many places with open airways, including hotels; and I can't sleep when I need to. Then I thought how will I work out? After all, it is way too easy to pack on pounds on the road, whether traveling for work or vacation. In addition, it's just too painful to start working out again after a 10-day break.

I heard a few people mention going running, but that's not my thing. Then another journalist suggested doing stairs at our hotel. I however, thought to bring a jump rope, jog bra, shorts, and shoes. By Tuesday, I realized that I needed something to get my circulation going since there was no gym available at our hotel. Jumping rope is a great, portable exercise. While I work out at my gym several times a week, I haven't jumped rope in years.

After a long day in the field, I suited up in my hotel room, pumped up my iPod, and went for it. After a few clumsy steps, I caught a rhythm and reminisced of my school girl days on the playground. Suddenly, I started feeling winded -- really winded -- that part I don't remember from my childhood. So in between jumping I did sit-ups and squats. This way, I got an interval workout and didn't have to stop completely. I also jumped at fast, medium, and slow speeds to mix it up. Elastic bands are also great portable items for toning. Somehow, after, I sweated it out for the duration of one reggae CD and showered, I did feel more energetic.

However there is one more issue: sleep.

I have traveled abroad on several occasions and usually have the opposite problem -- not being able to stay awake. Somehow the drowsiness hits me here when least expected and least ideal -- during the numerous meetings we've had with prominent Tanzanian health officials.

During our breaks, I will drink coffee to avoid embarrassing myself with my untimely bouts of jetlag. Then I am fine. It's a fate that all of us are struggling with on this trip. You can see people fighting the demon of droopy eyes around the room. Normally we joke with each other at the end of the day about who got caught. The caffeine boost is great, that is until it is time to go to bed. I am not a coffee craver. I avoid caffeine normally so one strong cup can keep me up for the entire day and evening.

Sunday, I was up until 1 a.m. working on my reports and planning for the next day. Monday, I tossed anxiously under my-not-so glam mosquito net until 2 a.m. and then started text paging friends out of boredom.

Perhaps anxiety is part of the reason for my restlessness. The net makes me a bit claustrophobic and just being in a strange environment is a factor, too. I've read it helps to bring familiar things with you when you travel, such as photos of your family, music you like, etc. to make your new surroundings more comfortable.

I think part of my sleeplessness also stems from my paranoia that I will oversleep. I have yet to see a clock in my hotel rooms. My watch is dead, so I must rely on my cell phone, which didn't convert to Tanzania time. So I must ponder how the 7-hour time difference adds up to when I need to get up.

I concede, I am a journalist, not a mathematician. In my delirium of fatigue and brain drain Sunday night, I set my cell phone alarm an hour too early. Trust me, the difference between 6 a.m. and 7 a.m. makes a profound difference when you are sleep deprived. Now, I've decided to switch to tea in order to decrease the caffeine, and tomorrow, I will succumb to Tylenol P.M.

Related Topics: WebMD Video: Travel Without Injury

Technorati Tags: travel, insomnia, jet lag

Sunday: Tanzania...Reconciling With Reality

2006-05-08T09:53:00.000-04:00

Generations dead. I was on the continent where millions have died from HIV/AIDS before they even had a chance at life. The average Tanzanian rarely has a chance to die from heart disease because they simply don't live long enough. The HIV death numbers are presented to Americans in cold, black print. But seeing the faces is chilling. Coming to Africa I think is something you can't really describe but it is my duty to try.

Whereas I am just beginning my mission to report on this epidemic here, I instantly knew I wasn't in Kansas anymore when I stepped outside of the airport. We piled into our UN buses, passing poor Tanzanians sitting and standing about in the hot, humid air, and I wondered how many of these people are dying right now from HIV? How many know? And how many are able to do something about it?

As we rode to our hotel -- exhausted -- we passed broken sidewalks, run down buildings much in need of painting, barefoot kids, pools of dirty, standing water from lack of proper drainage (ie mosquito haven), and people cooking food on make-shift grills on the street. Then one of our U.N. escorts told us, 'This is downtown Dar Es Salaam.' Admittedly, I was in shock and awe that this was a major, downtown city. I've been to third-world countries before, such as Jamaica, but this -- my heart sank.

It is important to have an image of this type of poverty, because it is a major factor in the complex picture of HIV across Africa. Women have it particularly hard. Gender inequality exists even in the U.S. surely but not to this gravity. Women here are secondary to get health care consideration in the household if only one person can get treated. Even with lifesaving mosquito nets, the experts in N.Y. said they are last to get them because if any one person in the house is going to get them, it will be the man. The same goes with HIV drugs, which are prohibitively expensive to most. The economy can't afford to pay doctors and nurses so there is a shortage to treat patients even if they could afford treatment. We were told during our U.N. briefing 90% of medical students in Tanzania go elsewhere to practice.

"Is HIV top of mind for people in Tanzania? We hear about the problem in Africa all the time in the states but is it real to the people living here day to day?" I casually asked a UNICEF representitive as we had coffee later before our welcome dinner.

"Yes, but it is a very complex issue," she replied.

Giorgina is a native Tanzanian. She says one of the major hurdles is stigma. She says that people can be thrown out of their families and become social outcasts if they admit they have HIV. For women, we know they depend heavily on men to support them and their kids.

So what happens? People don't tell and then continue to have unprotected sex. Spouses don't even tell each other. Condom use is high among youths, she notes. They get the message. Married women, however, are virtually powerless when it comes to asking their husband to start using condoms if they wanted them to, or they just trust their husbands are faithful. But there are many cases, unfortunately, when the spouse is not.

There are other reasons people don't disclose their status, Giorgina continues. She says maybe 50,000 people out of half a million in Dar will get vital antiretrovirals. So what is the use in being labeled an outcast if you won't get the necessary treatment anyway?

I know now just after this short chat that there are many faces to HIV, which is why this has been such a hard problem to solve. I have my work cut out for me.

Related Topics: CDC: Everyone to get HIV test

Technorati Tags: AIDS, HIV, Tanzania, Africa

Dubai: Achy but Almost There

2006-05-08T09:20:00.000-04:00

At NYC Airport

Dubai Airport

Free at last! We made it to Dubai. Fourteen hours and 3 meals later, we had our first break in the Middle Eastern city that gleamed with prosperity. Dubai is clearly a jewel in the desert. It has all of the modern amenities of the West, just looking at a glance, in its sprawling airport filled with mind-boggling gold treasures, expensive body creams, and good cell phone service among an array of other goodies for eager travelers. We sat at the airport 2 hours before anticipating the next segment of our trip: Tanzania, our final destination.

The time difference hit me like a Mack truck on the 5-hour flight to Tanzania: I slept the entire way and roused only to quickly down the meal they served fearing there was no telling when I would eat next. I felt worried when I woke up for good that I hadn't walked and had not had but one small container of water. I ached, too, -- knees, hips, and neck -- as these seats were smaller and tighter than the jumbo jet we had coasted on to Dubai. Once they announced our descent I raced to the one working bathroom to spray on mosquito repellent. Already the malaria paranoia had started to set in. Once on the ground, it became quickly apparent the glimmer and comfort of Dubai was, economically, a lifetime away.

Technorati Tags: dubai, jet lag

Saturday: The Voyage Begins

2006-05-07T16:06:00.000-04:00

I began my groggy 20-hour voyage to Tanzania at 6 a.m. ET from New York's JFK airport: 14 hours to Dubai, 5 more to Dar Es Salaam. During the cab ride from Manhattan, I thought about how I'd manage physically and emotionally for such a long ride -- the longest flight I've been on. Fortunately, we were laying over in Dubai, so I thought that would help break it up. I had dressed warm, but in layers: jeans, tank top, long sleeved shirt, a cardigan, with running shoes -- and socks, a must-have. "Cherie, what are you taking?" Synadene, one of the NABJ fellows from Memphis asked as she saw me popping a series of pills in the back seat.

"Aspirin, I responded," looking away from the others that were to follow.

"For circulation?" she asked.

"Yes, it is to help prevent deep vein thrombosis, (blood clots that can form from sitting too long). I'm also taking some decongestants. I once developed eustachian tube disorder on a flight once and my ENT doctor recommended taking them before flying from now on. I couldn't clear my ears for weeks when I had it."

Synadene along with another fellow from Philadelphia, Stephanie, are flying internationally for the first time. It is interesting watching them as a result. I've tried to share with these 2 and the entire group while we were in between meetings with the U.N. infectious disease specialists some health tips.

Besides the normal walking and drinking water regularly, and avoiding alcohol, I thought to myself how will I cope mentally? I get edgy being in one place too long. An hour of church, and I'm impatiently checking my watch. My thoughts drifted away for a moment to the slight nausea that had seeped into my sensitive stomach. I started the Malarone for malaria protection last night. Something just felt different about me today when I woke up. Synadene offered me a banana in the cab, which seemed to help a little but then I thought, 'Wow, this is just day 1 of taking this drug and I'm already feeling it.' She is taking doxycycline but isn't having any problems. The side effects just vary from person to person.

To try to alleviate my nagging anxiety about being in the air so long (I am also afraid of heights), I shopped around for distractions during the 2 hours we had before our flight once we checked in. Two magazines, a crossword book, a Wall Street Journal, and I already had a travel journal novel and my iPod fully loaded.

The watch in my battery died this morning -- major bummer work wise -- but this will help me lose track of the time. I didn't actually want to know how long the flight was but during our briefing at the U.N. someone spoiled my ignorant bliss. Passing the time goes faster when you just don't know, I've found.

Despite my sincerest efforts, I couldn't start living on Tanzania time when I got on the plane; they are 7 hours ahead so I should've stayed up for at least 5 hours. Instead, I drank some water, snuggled up with a blanket, and almost immediately lost the battle with sleep shortly after take-off...and moved onward to dreams of what I am set to accomplish.

Technorati Tags: tanzania, air travel, malaria

Packing and Tales of a Mosquito Magnet

2006-05-04T20:52:00.000-04:00

Today, I am putting the finishing touches on my packing. Hand on hip, standing perplexed over the scattered mess on my tan, Berber carpet in my bedroom, I think about how to pack up my life for 10 days in these two suitcases for this place a million miles away.

A big part of that is preparing for the war against malaria-infected mosquitoes: Stocking up on mosquito repellant with DEET, reviewing instructions for Malarone, and looking at the list of dos and do nots. Do not wear dark clothing; do not use fragrances and scented lotions and soaps; and do not eat bananas because mosquitoes like them. Well, I admit, a good friend who traveled extensively in South America told me the last tip. I am not sure if it is medical fact, but it cannot hurt. Do wear long sleeves; do remember to put repellent even between your toes; and bring a bed net to keep the blood suckers out at night. I admit my comfortable American lifestyle has me a bit weirded out about sleeping under the net. It's one more thing in the bag that I do not want to pack but dare not leave.

I once created a headline for a feature story on WebMD called, "Are You a Mosquito Magnet?" because in summer, I was the kid covered with the pink calamine lotion dots. Still, I am a mosquito delicacy.

Last night I spent my time spraying my clothes with permethrin, a suggestion by the travel clinic nurse. This solution kills mosquitoes before they can bite through your clothes. The fumes and drippy mess on the floor from drifting particles, again, drudged up thoughts I had at the travel clinic: Am I sure about this? Quickly, I shook it off. 'Don't be a worry wart,' I told myself. It takes at least two hours for permethrin to dry so don't wait until the last minute. The effects last for two weeks, so I should be good to go. I am also carrying an extra bottle to spray my linens once I am on the ground in Tanzania.

While I am also heavily armed for allergy annoyances, stomach upset, and gut-wrenching diarrhea, malaria is a condition that Americans are privileged to not have to think about during their daily lives. In Tanzania, however, malaria is the No. 1 killer of children. In, fact, Tanzania has one of the highest infant mortality rates in the world. The infant mortality rate for kids under age 1 was 98 deaths per 1,000 births in 2005 compared with 6.9 per 1,000 births here in the U.S. -- according to the CDC. Sadly, the average life expectancy in general is around the youthful age of 44. The side effects of the malaria drugs are often enough to make people bail during the course of treatment. Friends' descriptions of their nausea from these drugs make my stomach hurt. Admittedly, I am nervous that Malarone will be more foe than friend.

This fellowship is in honor of a budding American journalist, Akilah Amapindi, who traveled to Africa last year and died once back in the States on the last day of our national journalism convention in Atlanta. She did not take malaria pills because of a lack of insurance. By the time they figured out her diagnosis it was too late. The lesson learned: Malaria is real, and even though death from it here is rare, Americans are not immune.

My friend Leah lived in Tanzania for a summer two years ago. One last piece of advice she gave me when we spoke about my trip was to be sure to get treated for malaria while you are still in Africa. The doctors there see it all the time and have essentials to treat it. Most importantly, she says they recognize the symptoms easier because of its prevalence. Better to be a bit nauseous than the alternative.

Related Topics: Bringing Home Illness from Overseas, Travel Health: Before You Go

Technorati Tags: Tanzania, malaria, mosquito repellant, travel overseas

Tanzania Prep -- The World of Vaccinations

2006-05-04T09:15:00.000-04:00

Malaria, typhoid fever, yellow fever: As I embark on my journey to Tanzania the bravest spirit can't help but think about the possibility of contracting all of the diseases that plague Africans daily that Americans may never think about in a lifetime. But as the world gets smaller with the lure of international travel, these diseases are feeling closer to home.

I am traveling to Tanzania as part of a health fellowship sponsored by the UN and the National Association of Black Journalists. I found out nearly two weeks ago that I was selected along with a handful other fellows from the states; five more journalists will come from Europe. The first thing I could think of after my initial excitement was: What about shots?

Well what about them? I researched on the CDC's web site to find out what is recommended for Tanzania: hepatitis A and B, polio, typhoid fever, meningitis, rabies, tetanus, and yellow fever is required -- in addition an ample supply of malaria prophylaxis. I learned quickly appointments to get them are tough even when you beg, and there is a minimum two-week incubation period, for hepatitis A the incubation time is even longer. Suddenly a new feeling came over me: P-A-N-I-C. After much fretting and persistence, I finally landed an appointment -- precisely 14 days before departure at a travel clinic. After a 20-minute counseling session on the necessary vaccines, I settled on polio (I'd never received the booster as an adult), meningitis (was skeptical if I really needed that one), typhoid shot (instead of oral -- which requires taking pills over a series of days), and the yellow fever shot, as required. I didn't have enough time for the series of rabies shots, and I'd had the others for prior travel.

As the friendly nurse administered my shots, two in my left arm and two in my right, I watched a film on all of the millions of things that can make you sick while in Africa or other places, such as Asia or South America. This can be nerve wrecking to say the least and almost make you ask yourself if you are crazy to go.

Water is a serious hazard. "Don't drink any water that isn't boiled, bottled, or carbonated," the narrator cautioned in an ominous voice. Wipe condensation from cans before you sip from them and absolutely no ice. Don't even brush your teeth with tap water.

Then on to the warnings about food: Don't eat anything from street vendors because you don't know how sanitary the preparation is, no fruit unless you can peel it, no salad (again could've been washed with the water), stick to the nicer restaurants.

Then the video turned to a very serious subject: sexual protection against HIV. It's no secret that this fatal virus is wiping out generations of Africans, and I hope to find out more about its impact on women of color during my trip. As I saw the condoms appear on the screen it started to hit home: This is real enough to mention specifically to travelers. As the woman finished the injections, the ominous voice kept going but honestly I couldn't take hearing any more.

Then we turned to the discussion about malaria pills and prevention. I opted for a newer drug called Malarone. This supposedly doesn't have some of the intense nausea side effects of some of the others, such as doxycycline. It also doesn't cause weird dreams or potentially suicidal thoughts -- a side effect of Lariam. But of course there is a price, literally. For a 19-day supply to be taken before, during, and after my trip, the travel clinic was charging 6.50 a pill or $123.50. I found it's better to buy drugs and supplies outside of the clinic because they are cheaper. I ended up spending $105 on Malarone at Target. Nausea is one of the worst ailments for me so I sucked up the expense. Cipro is also recommended to take with you just in case you get a bacterial infection from the food or water. After getting food poisoning in London, it' s a torturous lesson that I won't forget again.

As I trotted out, prescriptions in hand and covered in Band-Aids, I faced another reality of traveling abroad: my bill. Unfortunately, insurance doesn't cover vaccines of this nature. For four shots I paid nearly $400 minus the cost of the Malarone. But as a health journalist I know it's better to be safe than sorry.

Related Topics: WebMD Video: Travel Without Injury, Spotlight on HIV/AIDS in Females