31 October 2009

A (Brief) Encounter With Malaria

Yesterday, I thought I had malaria. Fever, headache, diarrhea, extreme fatigue. Like most people I know in Dar es Salaam, I quit taking malaria prophylaxis almost as soon as I arrived—I didn't want to hassle with it and malaria prevalence is low in the city, at about 4 percent.

A friend ran out to the local pharmacy and got me some Coartem and oral rehydration salts. It was surreal—this is the stuff I had read and wrote about in Washington, and here I was having to use it. (Side note: the “orange”-flavored ORT tastes like death.)

But I still didn’t know if I actually had malaria. I wondered: should I just start taking Coartem, and treat myself presumptively, as some friends had done? It was tempting—going to the clinic would take too much time and cost too much money. Plus, I'd been there twice recently for my ankle and didn't want to start feeling like a "regular."

But I wanted to know for sure, so I decided to go to another, better stocked pharmacy nestled in a shopping mall in an expat enclave by the bay and pick up a rapid diagnostic test, or RDT. These handy little things, I knew from having read about them back in Washington, were easy and relatively cheap and could tell me in minutes whether or not I had malaria. Voila.

The South African-manufactured RDTs cost about 25,000 shillings (or about $19) for five tests. (Like the Coartem, which cost 16,000 shillings for a full adult dose, it is prohibitively expensive for most Tanzanians.) I went home and assembled the pieces on the kitchen table: lancet, pipette, alcohol swab, and the test device/strip. Then I realized: the buffer was missing. So I called the taxi driver back and went back to the pharmacy, where they apologized and gave me some buffer.

Round two. I assembled the parts, and my friend sat down to help me administer the test. He pricked my finger, but hardly any blood came out—the lancet was dull. We took another lancet and pricked another finger. More blood this time. He took the tiny plastic pipette and tried, as the directions instructed, to suck up enough blood to drip into the test device. But the pipette wasn't sucking anything—it merely moved the blood around on my fingertip. We kept trying for about ten minutes and gave up.

Now the chances that I have malaria are low. More likely it is some nasty parasite. But the lesson is: getting things like RDTs on the shelves is one thing. Getting them to work (even under the best of circumstances) is another.

*Tanzania has made huge strides in malaria control (see Paul Smithson's Down But not Out: The Impact of Malaria Control in Tanzania), but it is still the leading cause of illness in the country. Next year, the Affordable Medicines Facility-malaria will launch in Tanzania, which will subsidize the cost of effective malaria drugs such as Coartem, making them affordable for average Tanzanians.

30 October 2009


Some friends and I took the Thursday afternoon ferry to Zanzibar, that iconic spice island off the coast of Dar es Salaam. It dropped us at Stone Town, where we spent the evening winding through narrow alley ways and dark corners. The city is a sweep of minarets, latticed walls, the call to prayer, candles flickering in the dark, the crescent moon, fishing boats moored off the beach, the sharp white curve of the dhow sails, like arrows in the glittering blue water.

From Stone Town we headed east, to the small beach town of Paje, where we did the usual things—laid in the sun, took long walks, went kite surfing, read books drowsily in the shade. And then we collected ourselves for an evening out.

Now, economic development, if it’s working, can bring great things like jobs, roads, and schools, but it can also brings not-so-great things, such as drunken tourists at beach bars. Let me say up front that my friends and I were of course NOT those kinds of tourists—sunburnt and dehydrated, smelling of mosquito repellent, drinking Pina Coladas. Of course not.

After dinner and dancing, the guys decided to shoot some pool. Their opponents: Maasai warriors. No really. (The Maasai lost.)

20 October 2009

A Robbery

There’s a moment, when you’re being robbed, when you still have hold of what is yours, and then, in a blurry flash, it slips out of your grasp, and you watch as the all the things that enable you to function, work, communicate, are taken further and further away until they are gone.

I had just left Epi d’Or cafe, an expat watering hole as cool and lovely as a garden, where I’d met a friend for lunch. She’d offered me a lift home, but I said no thanks. I’d walk. I packed up my bag—it held my computer, wallet, phone, a digital recorder and some papers and notebooks—paid the bill and set out.

Ten minutes into my walk and I was wishing I’d taken the ride—my bag felt like an anchor on my shoulder, and I’d forgotten to apply sunscreen. The road was quiet, and with each step I heard the crunch and crackle of dirt, rock and broken glass beneath my flip flops. I passed a man standing idly beside some concrete blocks. Crows squawked and scavenged among a pile of trash. Beneath the shade of a tree, a woman lifted her baby on her back.

Then a car is beside me, so close that the passenger door brushes against my skirt. A violent jerk and I’m on the ground. I look up. A man with sunglasses is staring back at me, expressionless. Then I get it: he has my bag in his hand. He is trying to steal my things. I clutch the strap fiercely. The car accelerates, dragging me along the road until I let go and watch them speed away.


Coughing, choking…dripping snot and tears…blood on my hands and face. Passerbys gather around awkwardly. Pole, they say. Pole sana. Poor girl. We are sorry for you. I feel seasick…my head is full of water…like everything is dissolving.

My first thought is: I have nothing. What am I going to do?


You must go to the police, someone tells me. I’d just finished canceling my credit cards and visiting the doctor, and all I wanted to do was sleep. But she was right. I had information: a witness took down the license plate number and make and model.

So a friend drove me to the Oyster Bay police station, across the road from the U.S. Embassy—the one they built after the original was bombed in 1998. It is a fortified compound of Soviet-style gray buildings (USAID is housed there too), with carefully mowed lawns, security guards and electrified wiring along the perimeter. Across Old Bagamoyo Road, the police station is crumbling and shabby, with a small dirt parking lot and scores of people milling about while boys play football on a field opposite the entrance.

I limped up to the outdoor counter where a uniformed man was writing in a ledger. He gave me a sideways glance and grinned while I told him what happened. I didn’t understand why he was smiling.

He called another officer over to write the incident report. “What did you lose?” the young man asked. He regarded my friend and I with mild annoyance.

“A computer,” I said.

C-o-m-p-u-t-e-r he wrote.

In between each question, he would pause to scratch his chin or flip through the newspaper. Someone would yell to him and he would wave hello and have a chat. I felt helpless, about to explode.

“The computer is how much?” he asked.

“One thousand five hundred U.S. dollars.”

O-n-e t-h-o-u-s-a-n-d f-i-v-e- h-u-n-d-r-e-d he wrote.

We went through each stolen item—the whole thing took about an hour—and he took a scrap of newspaper and carefully added up the total.

“One thousand eight hundred,” he said. His eyes were vacant.

Yes, I said, yes: I lost almost two thousand dollars, have a sprained ankle and some cuts and you don’t even give a damn.


Every year there are wildfires in California, where I grew up. One year they burned some expensive homes in the swanky neighborhoods in the hills around Los Angeles. No one was hurt but several homes were destroyed. Friends and I joked about it—those poor rich people, we would say. Geez, one of their mansions burned down. What a pity.

Of course we weren’t happy it had happened, but it was hard to feel sorry for them when they had so much, including, we assumed, insurance. We laughed because we thought: it’s an awful thing but they will be fine.


Everyone I talk to has an explanation.

—Crime is getting worse here, I tell you, a Tanzanian woman says. Worse, by the week. Be careful. Don’t walk outside. Try not to carry any bags.

—Well, these are poor people you know, someone else says, and poor people are sometimes driven to do this sort of thing.

—Poor? But they had a car! says another.

—Right, don’t be fooled. This is a business. There are networks; it’s organized. Kids in the compounds, some grow up and go into crime, others don’t. Who knows why?

—It is because there are no jobs in Dar es Salaam that young men turn to crime, says another. The donors should quit with their capacity building nonsense and build roads so there will be investment. If there are jobs this kind of thing will not happen!

—But the donors tried infrastructure and it didn’t work. Money was lost, things were not maintained. The problem is corruption. And the police? They are just as corrupt as everyone else.

—But the police are paid nothing, what do you expect? They probably don’t even make $2,000 in a year—what you lost in one day.

—You should feel lucky, it could have been worse. At least the police wrote up a report—you’re in Dar, so that’s not bad. And you weren’t hurt badly. It could have been so much worse….

There are a hundred ways to wonder at circumstance.


The morning after the robbery, I walk down a dirt road towards a taxi stand. I’m carrying only a notebook with a little cash in it, which I keep clutched in my hands beneath a scarf. My arms are crossed as I walk, like a locked gate.

There are, as usual, people hanging around on the side of the road, chatting with street side vendors, walking along on their way somewhere, or just sitting, letting the morning pass. To me, it all looks like danger. But these people didn’t steal from you, I remind myself. They are not going to steal from you. I keep walking.

Then I hear footsteps behind me and I turn in a panic to see three men walking towards me quickly—at least it seemed quickly. I feel terrible, guilty, as I cross to the other side of the street and watch them as they pass. Tears well up in my eyes—and I feel angry. And afraid.

14 October 2009

Behavior Change

Night comes early in Dar. The sky is midnight blue in the moonlight, and from where I was sitting, on a rooftop Ethiopian restaurtant off Migombani Street, I could see cluster of palm trees sway gently in the cool night air.

I was having dinner with my new friend, Cristina Broker. Cristina is a 28-year-old Boston native who arrived in Dar five months ago to work for Population Services International (PSI). In between bites of beef tibs, she told me about a social marketing campaign she and her colleagues are creating to help promote condom use and discourage concurrent sexual partners—one of the things helping to spread HIV in many African countries, including Tanzania. The campaign will spread messages, via radio, television and in print, that will encourage Tanzanians to engage in less risky sexual behavior by reminding them that it is in their personal, social and economic interest to do so.

It was the first time Cristina and I had had a chance to really talk one on one since meeting, so we covered the usual range of topics: work, where we are from, where we studied, what we miss about home, how long we plan on staying, and: Guys. I told her about a relationship I'm trying to wean myself off of and she told me about a similar situation in her own life. There was a lot of laughing and shaking our heads. We know what is best for us. We understand what it costs to keep on down the same road. But changing your behavior—even when you know it is in your interest—is hard.

05 October 2009


I strolled up to the taxi stand in front of the Seacliff Hotel armed with the knowledge that a ride from the tip of the peninsula to the center of town should cost no more than 8,000 shillings. In a nearby café a South African named Denise, who has lived in Dar with her businessman husband for nearly a decade, gave me the scoop on taxis, tipping and good restaurants.

Up until this point, every time I’d get in a cab it was like the lottery: I tried to play but I knew I was going to lose. My first day alone I spent US$50 in taxi fare – for one day. A good sense of the exchange rate can help, but as with many African capitals, Dar is expensive, and you need insider information. And confidence.

It was about 1 p.m. and the afternoon sun was beating down on us like a spotlight, radiating heat. I approached in my flip flops and sunglasses; five drivers leaned against a wall and stared back at me.

“You need a taxi?” One of them came forward.

I squinted against the sun and nodded.

“Fifteen thousand,” he said.

“Seven,” I said. We stared at each other like river boat gamblers.

He took a deep drag on his cigarette and shook his head: “Mnazi Moja is far, seven kilometers. Ten.”

“No, eight.”

He laughed. “No, no. No less than ten. That’s the rate, no less.”

Now normally I would have said: "Okay great thanks, let’s go, and sorry for being such a pain." But I was emboldened with the knowledge of what this ride should cost, so I persisted: “Eight.”

One of the other men who had been sitting, listening in the shadows, suddenly spoke up: "What’s one or two thousand shillings to you?”


At dinner some friends were talking about the obsession some expats have with not living in the "expat bubble" (i.e., trying to avoid $3,000/month apartments and full-time drivers and expense accounts). The reason it’s important to them, my friends said, is partly because they want to experience whatever is the most authentic Tanzania, and they are pretty sure the expat bubble is not it. But it is also important -- to try to live with a little less rather than a little more -- because most Tanzanians they meet are astronomically poorer than they are. And the discrepancy is uncomfortable.


Eventually the driver agreed to 8,000 tsh. When we got in the car the gas tank was empty, so we stopped for petrol: 5,000 tsh. It barely moved the petrol indicator.

On the way we ran into some traffic on Ali Hassan Mwinyi Road. I had a bag in my lap with a computer, wallet and camera inside. Our windows were rolled down because of the heat, but when he noticed me clutch my bag as some men walked close by selling things, Michael, the driver, whose name I now knew, rolled up the windows and told me not to worry -- he turned on the air conditioning.

I asked him, with a sort of panic almost, to turn it off.

02 October 2009

On the Indian Ocean

The Indian Ocean looks a lot like the Pacific, except there are patches of bright teal and aquamarine cutting through the deep gray blue. It’s windy out, and there are white caps dotting the surface of the water, and way out, near the horizon, some tankers are passing by or parked…I can’t tell which.

I took a cab from Mbezi Beach in the north of Dar to the Seacliff Hotel way out at the tip of a peninsula where expats and tourists hang out. The ride over was an assault of sound and smell – traffic jams, horns honking, the smell of exhaust, of smoke from burning trash on the side of the road, and bodies, sweat. Inside the hotel, it’s quiet and cool and lazy. Some men on break from a conference smoke a cigarette and talk quietly. A gardener takes a break from trimming a hedge.

When people ask, I’ve been telling them that I work for the World Bank (which I do, on a short-term contract). Now in Bob Zoellick's dreams, the average response probably goes something like this: ah, yes, the World Bank! You work to alleviate poverty around the globe!

But in my one day's worth of experience, the response has been more like: Oh, nice, they have lots of money. One guy, Job, a young Dar native, said exactly that, and another fellow who works at the Seacliff, launched into a very detailed description of a safari scheme he's been dreaming up and asked if I could help him find financing. Maybe I should just tell people I’m a writer.

01 October 2009

Waiting at Heathrow

Heathrow is one of those weird places where everything and nothing is happening all at the same time. The buzz, clatter, motion, sound--people waiting in line for sandwiches, the BBC blaring across a gigantic screen, voices on cell phones, ladies at the duty free counter, families with strollers, four story high walls of windows, and outside, planes ascending into the gray spatter of rain.

I'd hoped to do some shopping while I waited (nine hours) for my flight, but unless you can afford Fendi and Aramani, forget it. The only thing I bought were two cappuccinos, some internet time, and a salad. Then I found a place to set down all my stuff, and I did what everybody does: I waited. While the din of Heathrow swirled around me like a tornado, I watched passerbys, stared off into space, and enjoyed that jittery delight of being on my way somewhere.