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  • Farmers participating in our workshop to review their contracts and the upcoming seasons activities
  • Sarun, our Country Program Director
  • The delicious lunch the ladies prepared for us
  • Bride getting her hair done; as Phanat was the cousin of the bride, we got to get made up with the wedding party :)
  • Coast line

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Paths that lead us to tomorrow

I know it has been too long when I try the password entry until I get a sign that says ‘too many attempts, try again later’.IMG_1474

I know the life I live in the US goes on around me, invisibly, like I have stepped outside of a circle into a parallel universe.

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Lights over Bangkok

I try to keep up. I try to stay connected. But it’s hard…

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I mean, come on, look what I’m working with here! When was the last time you saw printer paper this ancient? Let alone for an airplane ticket…

And sometimes that’s a good thing.

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Living and working so far from my closest friends and family can be draining on everyone, but to fully immerse myself into a new environment, I have to get lost. At least a little bit.

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The past month has been hectic. Hot. Humid. Noisy. Full of papers. Data. Interviews. Emails. Stifled grumbles. Laughter. Tears.

Sometimes I just need some space to breathe.

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Orchids in the Bangkok airport

Remember… this is a country with 165 million people squeezed into the land size of the state of Georgia.

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My work has been going well. I am continually learning and expanding upon the skills I had only just begun to develop in the past year. The diabetic retinopathy trial I spoke about last time is up and running, and we finalized a draft report mapping all nutrition intervention taking place countrywide. My main focus has been on developing and revising a research project from which I will gain the data for my thesis paper. I finalized my research question a few weeks ago: How does gender awareness and nutrition training influence health seeking behavior among women in Nilphamari, Bangladesh? I conducted preliminary interviews last week to trial my interview guide and I will be returning to conduct interviews with women, their husbands, and their mothers-in-law to gain qualitative data to support and add robustness to the quantitative data being collected. I am also developing questions to be incorporated into the end of project survey to work towards answering my research question.

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Now that my interview guide has been revised and the participant selection has been set, I will travel back to Nilphamari for a full week of interviews starting from Sunday. Traveling in the northern region of the country is interesting: a gorgeously serene landscape dotted with farmers tending rice and jute fields and dusty roads leading into the green abyss. But beneath that beauty is the dichotomy of a deeply rooted tradition. A tradition into which women conform and accept. Why wouldn’t they? They have never known anything else.

IMG_3215You see, traditionally in Bangladeshi culture a woman is permitted very limited access to the world outside of her home. Much of the country has changed and developed; however, you still see this is every day life.

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For example, one of the first observations I made here back in May was the abundance of men compared to women out on the streets, in the markets, shops… everywhere. In rural, more conservative areas, this is amplified even more. Women are housewives. They clean and cook and take care of the children. That is what they were born into this life for.

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Once they get married (by law not until the age of 18 but in rural areas sometimes as young as 14 or 15) they move from their parents house into the house of their in-laws, quickly shifting them to the bottom of the pecking order.

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This is why the work we are doing here is so important. Empowering women while simultaneously encouraging their husbands and mothers-in-law to give them a voice in the home, in the community, is vital to their becoming strong, independent, and healthy.

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Quite simply, they just need encouragement to realize they have a voice at all.

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Outside of work life has been equally as busy. I was hired for a consultancy for a week in Cambodia, so I flew over there for nine days. It was lovely to see friends in a place that feels so familiar.

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Then for the fourth of July I just had to attend the annual embassy cookout. There was no John Deere tractor like in the Phnom Penh bash a few years back, but there was a Bangla cover band in leapord print tights singing sultry love songs from the 80s.

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My time here is going by shockingly quickly. Next week I will be in the field conducting interviews, then in Nepal for a week to take some much needed down time. The following week I will be back to the Dhaka office for a week before wrapping things up and heading back over to Phnom Penh for another week of work. My only concern right now is that I am going to come stumbling off the plane in NC in mid-August, eye glazed, head bobbing for the first days of class!

And before I forget- Ramadan Kareem! The month of Ramadan began today so a shift in daily activities and the pattern of schedules changes as the whole country fasts during daylight hours until Eid al-Fitr on August 6th. So happy I will be missing the Eid al-Adha though… ‘feast of the sacrifice’ where the streets literally run with blood…

So much to learn so little time!

A Sight to See

It’s only been two weeks and I already can’t remember the date I arrived… I actually had to look at the calendar just now. May 22nd. I arrived on May 22nd. It is quite possible that I am losing my mind, but more likely (hopefully) that I have just been so busy that it feels like I have been here for at least a month.

Last week I was just getting my bearings and adjusting my sight to the new environment and surroundings; much like stepping into the glaring sun on a hot day, feeling a bit disoriented at first, needing to steady myself while my vision comes to and thinking, ‘well that was strange, let’s get on with things’.

It seems that traveling has made me at least somewhat adaptable as I jumped right into work on Sunday morning and haven’t stopped since (well, aside from a few lazy mornings sitting by the pool). After learning that my project was de-funded by 90%, I jumped into three new projects simultaneously. I haven’t drowned yet, but let’s see.

The first is a mapping project of all nutrition interventions countrywide. Luckily my role in this project is overseeing the staff entering data and answering questions they may have. I reorganized their database so that each project is easily transferable into mapping software. Hopefully they will be done at the end of the week and we can start developing the maps.

As I have indicated to some already, going back to the mindset of being an intern can be challenging at moments, but at the same time I have a good deal of autonomy and ability to provide input into the projects we are working on. And on days when work seems like no fun or I am feeling frustrated, having the chai-wallah come to my desk at 3pm always makes me smile. Who doesn’t love a personalized (milk and one spoon of sugar, please) cup of chai? As a side note, for some reason I can’t get out of my mind that I feel the term ‘chai-wallah’ is demeaning. To get over my fear of being insensitive, I may now refer to myself as a ‘health-wallah’ (even though, according to wikipedia, ‘punka-wallah’ sounds much cooler- the servant who keeps the fan going on hot nights- something to work on for next year).

The second project I am working on is a randomized control trial for diabetic retinopathy. We are randomizing patients to one of two types of health education tracks to determine if intensive case management improves adherence to attending follow-up appointments. I am currently writing from my hotel room in Chittagong Province where we work with a large eye infirmary, the location of our randomized control trial. I won’t go into the details but there are some barriers to starting the trial; hopefully we can start data collection early next week. Luckily, I was finally able to start taking some photographs.

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Our data collectors interview patients using an electronic questionnaire.

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Our health educator counseling a patient on dietary and exercise habits to reduce the likelihood of diabetes related complications.

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Eye examinations

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To make my travel to the field more diverse, I requested that we do a community visit this afternoon with a patient from the hospital.  These are from a slum in the surrounding area of Chittagong City.

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Her papers say 48, but our guess is that she is in her sixties. Diabetes and a bad case of gangrene that rendered her disabled have taken their toll either way. I learned that it is common in Bangladesh (as it was in Cambodia) for women to tel people they are younger than they really are.

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Hard at work studying.

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There were lots of children and adults milling around both inside and out of the house during our visit. As I understand it, in Bangladesh homes are organized into Baris. One Bari is occupied by an extended family under one sort of ‘master of the house’. Once a woman gets married, she goes to live with her husband’s family (for which a dowry is paid, as the bride is ‘gaining’ the man; therefore her family must provide money/cows/gifts to the grooms family for basically taking their burden/daughter), and they start their own family. For the work I do we look to effect behavior change not only among these women/mothers, but the husbands and mothers-in-law as well. The husband and mother-in-law are the primary decision makers in the household, especially when it comes to the health and nutrition of young mothers and their children. When these practices are detrimental to health, everyone suffers, so working with all members of the family is key.

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Young girl carrying baby. While this girl is still too young to be married or to bear children, early marriage is all too common in Bangladesh. The legal age of marriage has been set to 18, but this is virtually impossible to enforce. Another reason why maternal and infant health remains such an issue in this country.

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The third and ultimately most exciting project I am working on is still in it’s stages of development, but we have a household food security program within which we are pilot testing a gender awareness curriculum. I will be conducting some qualitative research in a few weeks to determine preliminary effectiveness of this curriculum and to determine if it will be feasible to include some more maternal and child health related outcomes to our randomized control trial and end-line evaluation. This project is now what I am hoping will ultimately become my thesis.

Overall the heat, pollution, and chaotic streets can be overwhelming, but I truly am enjoying my time here. I am especially looking forward to the opportunity to travel outside of urban areas to see the countryside a bit- I imagine the rural areas to be a lovely, cool place with fresh air and serene nights. Until then I’ll remain constantly amazing at the sheer volume of activity going on around me!

Welcome to Dhaka!

After a long 25 hours of traveling from Boston — Washington DC — Dubai — Dhaka (whew!) I arrived in Bangladesh! From experience I have learned that from the moment you pass through the security check until you emerge from customs into the sunlight of a new environment, slipping into a state of semi-consciousness is the only way to sanely survive the hours of perpetual movement. The world of airports is very much a parallel universe that obeys no rules of time and space.

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Flying into Dubai- where is the city in this sea of sand?

Often traveling feels like entering a time machine from the US, moving within a sanitized world of duty free shopping, spirits, coffee, and an endless sea of seats and walkways, and landing into… well, in this case, chaos.

If I may be so cliché as to quote my guidebook (which I recommend all travelers carry with them despite how long they will be somewhere or how familiar they may already be with the environment. I often wonder what new sights I would come across if I picked up a guide book for my own home state…), the first paragraph I read about my temporary home for the next three months, the capital city of Dhaka:

Dhaka is more than just a city; it’s a giant whirlpool that sucks in anything and anyone that comes within its furious grasp. Around and around it sends them, like some wildly spinning fairground ride bursting with energy. Millions of individual pursuits constantly churn together into a frenzy of collective activity- an urban melting pot forever bubbling over.

I can’t quite decide if the Lonely Planet writers are trying to entice or discourage visitors… either way Bangladesh does not have a bustling tourist industry.

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First glimpses of the city on my ride from the airport. I smile as I think about the fresh air and breeze the gentleman deciding to ride on top of the bus versus inside must be enjoying.

I am staying at a guest house for the first few days, allowing me to adjust to the time difference while enjoying some home cooked meals.

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First meal in Dhaka. Bangladeshi food is similar to what we think of in the US as Indian food. I say this, “what we think of as Indian food”, because I have already been informed by multiple people that a large percentage of Indian restaurants in the US are actually owned by Bangladeshi families. Marketing a restaurant as Bangladeshi would just not be as successful as marketing as Indian.

As described above the city of Dhaka is a bustling, chaotic flow of humanity. On top of the constant activity it is monsoon season. Today I decided to walk to a nearby coffee shop and quickly realized that, aside from the constant state of traffic jam, there is lots and lots of mud.

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On my afternoon outing I considered taking a rickshaw (once I have a better grasp on the environment and feel more comfortable taking my camera out I can take some photos of the various modes of transportation here… for now you will have to do with Google and the few images I capture here and there with my phone), but for a reason that I still don’t understand decided that walking would give me a better sense of my location. Well, after meandering for about 45 minutes I succumbed to the beckoning of a rickshaw driver. First, note that streets are not marked so the only indication of where you are standing is by the house addresses, luckily clearly marked by placards outside of each gate. Street and house numbers, however, are not ordered and therefore don’t provide a grid to follow to your destination. Therefore, when I say I meandered around, I really was doing just that. While the rickshaw got my feet out of the mud and provided a nice breeze in the balmy, so-humid-it-is-constantly-on-the-brink-of-raining weather, the driver also did not know where I was trying to go. Patience and a smile, after 45 minutes of more meandering, stopping for the driver (cyclist?) to ask security guards directions, more meandering, more stopping, attracting five or six men to give their input as to where we were going, more meandering, gathering another crowd, and ultimately a boy jogging along while the rickshaw followed, finally delivered me to the café where you can find me now. Success! Should I have taken up the offer to call a driver from my office to drive me anywhere I wanted for the afternoon? Nah.

Glimps of the bustling roads from the cafe window.

Glimpse of the bustling roads from the second floor cafe window.

As a side note, for every woman you see approximately 100-200 men. (Remember, this is a country of 165 million people in an area roughly the size of the US state of Georgia) All of the staff in the guest house and restaurants and taxi/rickshaw/car/bus drivers… that I have come across so far are men. There are a few reasons for this and I will have a better, more balanced understanding the longer I am here, but from research over the past few months this public appearance of imbalance is in part due to the culture of purdah. Purdah is the restricted movement of women outside of the house. The practice of purdah is most common in Muslim and South Asian countries (both categories of which Bangladesh belongs to). However, the practice of veiling and/or socially excluding women stemmed from tradition in the Middle East among many religious groups before the founding of Islam. Therefore, purdah was incorporated into Islam based on regional practice versus emerging from Islam.

So I arrived in the country on Wednesday evening and now it is Saturday evening- what have I been doing? Thursday morning  and early afternoon I cycled between eating, sleeping, and email. I was rescued from my third nap of the day by my supervisor who brought me to join with her and two other young women I will be working with for coffee. After learning that just a few days prior the budget for the research project I was going to be leading was cut by 90% (just comical, really), we discussed two other ongoing projects that I will work on, including the oversight of research being conducted in the southern province of Chittagong and the mapping of a nutrition program (with my shiny new GIS- geographic information systems- skills, of course with which I had already mapped out my prior research project area and distribution points. Good practice…!). I am looking forward to the work, especially to venture out of the city to see our project sites.

After coffee I met up with a friend of a friend, a Bangladeshi who went to undergraduate in the US, for dinner and a comedy show- a very enjoyable evening (of course outside of being pointed out to provide one of the comedians with 90% of his jokes as I was 1) the only white person in the room, 2) the only American, and 3) had arrived in the country just 26 hours prior– luckily his jokes were hysterical, even to me, and he had plenty of context as he lived in the US for 20 years).

Friday was a busy day; I accompanied two of the women I had coffee with on Thursday to the large city New Market- a market quite comparable to the large indoor/outdoor markets in Thailand and Cambodia, just with 10 times the number of people. It was great to follow them around and get a feel for where to find things (well, no, of course I could never retrace our steps to, for example, the great fabric stall we found tucked away among the thousands of shops in the market).

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Bursting with color and texture

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Remember, Bangladesh is the second largest exporter of textiles globally, so you really can find anything in these markets. I also appreciated the keen perception of one of my colleagues in recognizing when, as she so aptly put it, were feeling a bit harried and needed to stop for a drink and snack. After a rousing, sweaty few hours at the market we went over to an upscale clothing shop where I found a few salwar kameez. In Bangladesh, more than anywhere else I have lived, the women wear traditional clothing. Therefore, to best fit in and avoid overheating, both Bangladeshi and foreign women alike wear traditional clothing; luckily, some of them are super cute. Luckily I brought some clothing that will be perfectly appropriate for my time here, but a slight overhaul of my wardrobe for the time being will be necessary. And I have picked out pieces that I can easily pull of wearing back at home with jeans.

After a long day of shopping we made the necessary beeline to one of the girl’s houses to make smoothies and coffee before I headed back to the guest house. Tomorrow, Sunday, is my first day of work (the work week calendar of Sunday through Thursday follows the Muslim prayer calendar).

To leave you with something interesting, the largest NGO (non-governmental organization) in the world is Bangladeshi! www.brac.net

So here we are again…

… exactly two years later and another adventure in front of us. Let me reuse (reduce, reuse, recycle- this should apply to words as well as material goods, right?) my introduction for the blog so newcomers and longtime followers alike can be refreshed:

Msafara wa amani means journey of peace in Kiswahili. Peace is something we should all strive for in our daily endeavors. Dr. Abdul Said of American University once said that we need to replace all violent language in our vocabulary, beginning with the simplest of phrases. He said, for example, that we must always try to, instead of killing two birds with one stone, feed two birds with one hand. This beautiful saying stuck with me and has led me to understand more fully the impact that even violent language can have on one’s mindset and actions.

As I travel, I hope to learn the intricacies of what is required to bring peace, be it mental or physical, to the people I work with. Here you will find pictures and stories of my work abroad, beginning with my time living in Cambodia.  By learning about new cultures and educating others, we can bring awareness to the global issues that affect us all, ultimately leading to a peaceful, cooperative global community.

With this mindset at the forefront of my endeavors, I now embark on a new journey: Bangladesh. As a country with a population of just over 160 million in the land area approximately the size of Georgia, Bangladesh is a challenging environment to work within. I am trying to go in with little expectations for what I will face, but I am sure I will be swept into all that is South Asia. And I can’t wait.

See you in Dhaka.

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The Sleepy Town at the Base of Mount Meru: Arusha, Tanzania

Flying into Arusha was one of the most exhilarating experiences, or at least the highlight of my trek from Phnom Penh through Bangkok and Nairobi. Peering out the window of our small plane I could see the red clay earth that I had left almost exactly three years earlier. Powerful feelings of nostalgia welled up inside me, and then it happened: Mount Kilimanjaro. I could have stepped out of my window and landed softly in the powdery snow. Gazing from just above the peaks down the rocky slopes was breathtaking. A gorgeous entrance into a country swelling with traditions, rituals, biodiversity, abundance, mirrored by drought, poverty, corruption: Tanzania.

I immersed myself in work starting with field visits to our projects in the Central Zone, focused in the Singida and Iramba districts. While I was involved in fascinating work on malaria prevention and developing other health care initiatives in Cambodia, Tanzania has been more of a learning experience as I have not worked in the agricultural sector before. Our program here, in brief, works with small hold farmers to promote the cultivation of Jatropha Curacas, a woody shrub that is grow around homesteads for protection and privacy. Aside from conducting trainings and assisting in the formation of farmer groups, we link these farmers with a private company that provides contracts to purchase all of the Jatropha seeds produced per season. These seeds are pressed to extract the oil to make soap (Jatropha is a traditional medicinal plant in Tanzania that is believed to have curative effects for fungal infections). The remaining seed cake is combined with other agricultural residues such as rice husks, coffee bean shells, etc. and processed to create pellets. These pellets are then used as the fuel source for a clean burning cookstove that we have partnered with another local private company to develop and sell. My part in all of this is to help support program development and activities, liaise with potential donors and partners, and develop concepts for expansion into the health sector.

Below are some photos taken during our week of monitoring activities in the Central Zone.

Farmers participating in our workshop to review their contracts and the upcoming seasons activities

Child at a water pump near one of our partner farmer's fields

One of our lead farmers

Water catchment pit; part of our project for the easy irrigation of crops

The most exciting part of going into the field (aside from getting away from dusty cities and interacting with the people you are working for) is that you never know what to expect. I was taking photos of a family (above) when the father said to me please, take a photo in that window, pointing to a home 20 meters from where we were standing. Approaching the window I realized that there were six or seven women standing inside. Then I saw this:

Born just moments before

Umbilical cord still attached

Giving thanks to the woman who just delivered this child on a bed of animal hides in the middle of rural Tanzania, no professional medical assistance, no drugs…

Moments like this put life into perspective.

As seems to be tradition, with mixed feelings I accepted to receive a second namesake in my short 25 years. Never do you feel more undeserving.

These sack gardens can utilize dirty wash water by pouring the water through the top sieve of plant matter and rocks. It allows homes with even the most limited space and water availability to grow vegetables.

Selling solar lighting

Farm land at dusk

Moon above the land

The sudden darkness envelopes you in a womb of warmth and connection with the earth.

Back at the office we have been busy making soap for research trials that will test the efficacy of Jatropha oil soap in treating fungal infections.

Stirring the raw ingredients to create a thick liquid for soap making

Pouring the soap into molds to harden

Happy New Year!

The following week I traveled to Koh Kong Province for work and was able to stay on for a long weekend to celebrate the new year :)

The first stop, after meetings in Koh Kong town, was monitoring the malaria activities and to meet with the director of the health center on Koh Sdach.

Sarun, our Country Program Director

Chanda, our wonderful driver

Ice Crates from Thailand

Ice crushing machine

A fisherman fixing his net

Pristine coastline

Then a mangrove forest and surrounding beaches.

Safari World!

Tigers jumping through rings of fire!

Ostriches... if I haven't mentioned it before, I really don't like ostriches....

Beautiful birds

Flamingoes

Crocodiles!

And if you thought it couldn’t get any more exciting……

Parrots riding bicycles!!

So adorable!

They even raced :)

And a scooter!

And then... Orangutans riding bicycles!

This is what you have become, Batman?

Boxing match

Medics and all!

I'm not sure that this is a good idea....

And finally, the beautiful Tatai Waterfall!

Everyone was relaxing, picnicking, and swimming under the falls... a really lovely day.

Welcome, 2012!

A Holiday in Cambodia

I was fortunate enough to be surrounded by friends for the holidays in Cambodia, making the time fun and memorable. On Christmas Eve I joined with my good friend Patricia to lunch with the lovely girls we met on Silk Island back in July. On Christmas I spent the afternoon picnicking at Kirirum National Park, enjoying the serene environment and natural landscape. I then returned that evening to Phnom Penh to host a dinner with Patricia.

Christmas Eve Lunch on Silk Island

The delicious lunch the ladies prepared for us

Preparing lunch

Beautiful girls!

Do you remember this baby from a few months back? Well she is still as adorable as ever!

Mural on the wall of a temple displaying hell- always, apparently, displayed behind the Buddha, at the back of the temple where it is not easily visible.

If I climb the tree, I wonder where I will end up...

Our Christmas Eve lunch party

View of Phnom Penh at sunset as we cross the Mekong

 Christmas Day: An Afternoon at Kirirum

Excited for the trip!

Being bombarded by flower sellers

Veary modeling the flowers

Christmas Dinner

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