Zanzibar Mix - Street Food

We have become very fond of a well known street food in Dar-es-Salaam known as Zanzibar Mix. We had for Thanksgiving. It is a spicy soup with a  multitude of ingredients described below. We get it at a small open courtyard "restaurant" about 4 blocks away. We had some last night. I took pictures as I waited for my for my order to be filled. It's a nice look at a unique street food culture and how it is prepared. You always have to wait since the food is prepared and cooked right in front of you.

Finished product

There is always a line of people waiting no matter what time we arrive. They only sell Zanzibar Mix there. It is quite cheap, only TZS 2000 or $1.25 per bowl. One bowl is a nice light meal.

Stirring the bhajia  recipe prior to frying

The 'Mix' is a bowl of smooth and tangy flour-based sauce cooked with lemon and mango, with tiny cubes of potatoes in it, followed by crispy bhajias and fried mashed potatoes, a spoon of coconut chutney, a dash of red-hot chutney and a scoop of deep fried cassava or potato shavings sprinkled on top.

Forming the bhajias by hand

Dropping the mashed potatoes into hot boiling oil. Tanzanians use their hands with food, both in preparation and eating. The oil is very hot.

Frying mashed potatoes in front and the casava shavings in the back. The fry cooks are always in motion.

The proprietor fills the orders by doling out the soup in the big bowl and adding all the  fresh fried ingredients and requisite spices supplied by the cooks. He also interacts with all the customers and orders everyone around. He is the Dar version of the Soup Nazi.

The ingredients are flour, warm water, coconut milk, salt, grated raw mango, lemon juice, red chili powder, garlic past, chillies, potatoes and turmeric.

Thanksgiving, Chole Island Getaway and Whale Sharks

So how do you celebrate Thanksgiving in a country where there are no turkeys? We were fortunate enough to be invited to the local American Chamber of Commerce affiliate's celebration at a hotel on the water. In exchange for providing some volunteer services during the event we were able to get in free. It was a lovely evening. We had the opportunity to meet other ex-pats, specifically from the American business community in Dar. The dinner was a benefit for a Tanzanian elephant protection NGO. They are using trained spaniel dogs to sniff to contraband ivory amongst other activities. It was fascinating.

Thanksgiving Dinner and cocktails on the Coral Beach Hotel veranda

Working at the registration table greeting guests as they arrived

The grounds were very tasteful and the tent had AC!

There were about 300 guests. The food was good and the pie contest produced some notable desert.

The following weekend we had a three day retreat north of Dar in a hotel along the beach with all of our fellow GHSP volunteers from across Tanzania. Peace Corps called this training "IST" and everyone does it about 6 months into your deployment. It was good to see our fellow volunteers and catch up. We were joined by our counterparts from the hosting institutions as well as PC staff and Seed staff from the US. There were many educational sessions. It was time well spent.

During a lecture on multi-drug resistant TB

Laurel and her counterpart, Joel

Grace, one of my counterparts from Muhimbili, delivering a lecture on TB

Three days later we actually celebrated Thanksgiving at home with Zanzibar Mix, an all-in-one meal from our local roadside restaurant. It cost only $1.50 USD per bowl. We are increasingly sampling the roadside food in our neighborhood. Last week we discovered an ice cream store only 200 yards from our apartment.

The following weekend we travelled to Mafia Island. It's about a 30 minute flight from Dar. We flew on a prop plane that seats 12. We were interested in a weekend out of the city. Laurel had arranged for us to stay at Chole Mjini Lodge, a very unique destination that sits on an island in the middle of the Mafia Island nature preserve, an aquatic sanctuary that has some of the best scuba diving in East Africa.

Chole Mjini is a very unique property. It has no electricity nor running water and guests stay in one of 6 tree houses. It is the work of a couple who bailed on corporate life almost 20 years ago and created this property on the grounds of the former seat of government of the Mafia Island archipelago  when the Arabs and then the Germans ruled here about 100-200 years ago. It is very ecologically friendly out of necessity since the entire island lacks power. Proceeds from the lodge also helps fund a foundation which has brought schools, healthcare and jobs to the island's one thousand residents. I encourage you to read more about at Chole Mjini

Leaving Dar we were finally able to appreciate the tremendous sprawl that results from housing 4-5 million people in one and two story homes. It goes on for miles. 

The airport on Mafia Island was tiny, as was our plane.

After a 15 minute taxi ride across Mafia we boarded the dhow that serves as the ferry to take you across to Chole Mjini. We were glad to see the beer coming along with us.

The manicured paths at the lodge.

Our treehouse

The view from our upper balcony, the second story to the treehouse. I slept here at night and let the sea breeze keep me cool.

Another of the treehouses

So, how do you get a hot shower if there is no running water? You use this ingenious kerosine fired double walled fire tube which heats water on demand and is filled from a hidden cistern of water that is refilled daily. It works. Eco friendly tourism in action!

These are some of the ruins on the hotel property. We had a candlelight dinner here on our first night. 

The next morning we were off to go swim with the largest fish in the sea, the whale shark. They migrate through the underwater preserve yearly. They are massive but totally harmless as they are baleen feeders that only consume plankton. This is one of the attractions on Mafia. Chole Mjini operates its own operation on Mafia. We picked up several guests from other hotels and were joined by "Ben from Sweden" pictured here with me en route on the dhow.

There were about 10 of us and we searched for 2 hours to finally find one whale shark. Once you see them they stop the boat and off you go in snorkeling gear. The sharks swim back and froth through the plankton cloud so you just hang in the water and wait for them to come to you. They are beautiful animals. We had strict instructions on staying 6 feet away from them so as to not disturb them. They basically swim out of your way if you position yourself in their path.

Here we are in the water alongside another boatful of tourists.

This is the best picture I got. In the foreground you can see the rippled water. Immediately in front of this is a small patch of whale shark with the characteristic spots that scientists read like individual fingerprints to identify the animals. Chole Mjini has had a hand in facilitating research on these mysterious animals. They disappear for months at a time and are thought to go very deep to hibernate. No one really knows where they go but some stay resident in the park for the year and do not migrate. They just cannot be found.

Laurel walking back to the beach from our dhow after the excursion.

The next morning I was off to scuba dive in the pristine waters. This dhow picked me up at a high water pier and we had a fine time diving pretty shallow reefs. The dive master was my dive buddy and helped me get back in the swing of things after four years out of the water. The last diving I did was the Great Barrier Reef while visiting Laurel in Australia during her on her MSF assignment in Papua New Guinea.

Laurel stayed home that morning and read/relaxed.

That evening we (5 guests and the proprietors) sailed out to a sandy spit that is exposed by the low tide and had a evening beach party awaiting the sunset.

It did not disappoint.

On our way back from the sunset cruise/beach party.

 By now regular readers will be wondering "How is he going to work bats into this post?" It turns out Chole Island has a huge population of fruit bats that live there and fly to nearby Mafia every evening to eat fruit from the orchards. We toured the island the next day with a local guide and found hundreds roosting in the local trees in and around the village. It was our first chance to see them up close. We were very excited!

They are covered in yellow fur to our surprise. They fuss and fight with one another during the day periodically making screeching sounds and flying from one roost to another. It was fascinating to see them up close. I just wish I had brought binoculars!

Sign outside the old abandoned mosque built by the Arab traders who used Chole Island as a headquarters for their save trade.

Mosque ruins

The foundation associated with the hotel built a new health center thus providing the island's population with nurses and a doctor. This is a huge improvement since previously they had to take sick people to Mafia by ferry, a dicey trip with someone like a woman in labor.

Doctor's Room

The only motorized vehicle on the island, a motorcycle ambulance.

Local village house with typical mud and stick walls and frame.

The island's other claim to fame is its shipbuilders. They are widely acknowledged as being the premier dhow builders in East Africa. They make everything by hand. This boat was 30 feet long and took two men four months to build. It would sell for $4K USD we were told. Merchandise (coconuts and fish) from the island is sailed to Dar (a two day affair) and sold there.

The primary school for the island. The foundation provides tuition and board for the island's children to attend the secondary school on Mafia thus enabling the island's children to get a decent education. Most could not afford this luxury before the foundation began its funding. It is all part of the intricate partnership the lodge's owners have established with their neighbors. It is generally acknowledged as one of the most inventive and eco-friendly tourism partnerships in all of Africa. Kudos to the proprietors who have made this their life's work.

We have stayed at some pretty wild and memorable places on our travels but Chole Mjini stands out. It has to be near the top of the list of spectacular places I have seen in my lifetime. Kudos to my spouse for making this happen.

This is a stock photo from the web to give you an idea of the scale of whale sharks. The one we saw was not this big but it was still quite intimidating yet harmless. Having it swim by me 6 feet away on two occasions is an experience I will not forget.

Balcony Garden Update

Things were going great guns until about three weeks ago when the beans got some kind of blight from which they have not recovered. We were already fearing the consequences of their going three weeks without water during the looming Christmas vacation back in TN. My homemade watering system using aquarium tubing, valves and a water reservoir will sustain the healthy tomatoes and basil and mint but the speckled butter beans ( my pride and joy) are toast.

We have been surprised at how well this experiment has gone.

The speckled butter beans did not make it.

We are looking forward to the tomatoes though. Not bad for the resources we had for this project!

The Walk to Work - a short movie

This is the height of banality. Nonetheless, I had fun generating this using my iPhone's camera and a photo program that took pictures every 15 seconds. It goes by fast. Blogger is refusing to accept uploaded videos today for some reason so you will have to download the file from a file repository per the link.

The Walk to Work

Muhimbili National Hospital

Hospitals have always fascinated me. I grew up trailing my Dad around Marion County General Hospital. The uniforms, the smells and the sounds are forever embedded in my mind. Muhimbili National Hospital (MNH) has been a significant addition to my mental inventory of hospitals. It is THE national hospital of Tanzania, a country of over 40 M people. There are other at least four other large referral hospitals spread around TZ but Muhimbili occupies a unique place as the only national hospital.

"Welcome to Muhimbili National Hospital" that sits in the middle of the roundabout entrance to both MNH (to the right) and MUHAS (to the left)

There is a roundabout at the entrance to MNH and MUHAS that I walk through every day. It is also a bus (dala-dala) terminal and a taxi stand. It is an incredibly busy and chaotic place. After months I have begun to understand its rhythms. In the morning between 6 and 8 it is an absolute beehive of activity with thousands of people streaming in and out of MNH. Many people who work in our area of Dar (Upanga) come in from distant areas of Dar and get off the buses there to walk to their workplaces from this terminus. 

The Entrance to MNH and MUHAS at 7 AM

The activity level there is overwhelming most days. You see a huge cross section of Tanzanian society converging there every day. Most days it is crazy busy with people streaming in and out of the main gate to MNH to both seek care and take care of relatives on the wards. There are multiple businesses located there as well as a market for fruits and vegetables. Dala-dala hawkers are shouting out the destinations of their buses and people are everywhere.

Main Entrance to Covered Walkways at MNH

For many years Muhimbili National Hospital was the only place in Tanzania that trained doctors and nurses. It was and is the place complex cases landed. What distinguishes it currently is its nursing and medical staff. Other hospitals may have nicer facilities and may be more efficient at providing patient care but MNH has the specialist doctors and the expertise if any place in Tanzania does. Despite its limitations it remains a unique place and occupies a special place in the minds of most Tanzanians. They may love it or hate it but they know about it for sure and have an opinion about the place.

Overhead from Google Maps of the MNH campus

Medical training is a bit different in Tanzania and follows the British model generally. This was a British colony up until the early 1960's when Tanzania won its independence and their influence is still quite evident in many things. Students come to medical school straight from high school after they have done one advanced year and made the grade via a national testing system. The government tells you what your options are based on your past performance. If you are headed to professional school there are no choices except yes or no. Those directed to one profession may not cross over to another in general. It reflects the residual of the 20 year, post-independence Tanzanian socialist experiment.

Sign on the medical student dormitory by my office

First you must complete five years of medical school. Becoming a specialist is then a multi-year process with 6-7 years required post-medical school. You pay for this specialist education and are treated as a student and have classroom time and instruction as well as clinical duties. This is in contrast to the US where residents are paid but were historically worked like dogs. Frankly, the TZ residents do not work nearly as hard as US residents although that gap has closed some with recent limitations on resident work hours. The number of specialists (internist, surgeon, obstetrician, pediatrician) are limited and spots hare highly competitive. 

TZ Medical Super-Specialist Career Pathway (Nephrology in this example)

Most students need money for tuition and living expenses etc. The government "sponsors" you via a grant. It is not at all uncommon for a career to be halted for two years while you await sponsorship. Further specialization to become a cardiologist or pulmonologist etc. requires another 2 plus years. You are awarded a Master of Science degree with that and become a "super-specialist". Muhimbili is the only place in the country offering what we would call fellowships in the US. There are very few super-specialists in the country and most all of them are al Muhimbili. This is the only place where they are trained and the availability of such training is a very recent development in Tanzania.

My counterpart, Professor Magusi, lecturing to newly arrived third year medical students on the MNH campus

Families are responsible for feeding and bathing etc. their relatives daily. The hospital only provides a breakfast of corn meal porridge to its patients. Water, other food and any number of medical supplies that are not in stock are the responsibility of patient families.

Back of the kitchen where large vats of the corn porridge is prepared for patients

Increasingly patients must pay for advanced services such as imaging or unusual antibiotics or oxygen. Outside the hospital there are numerous pharmacies that provide everything from pills to IV fluids to central lines to TPN. If you cannot pay you simply do not get the treatment. Money is tight. A third of Tanzania exists below the poverty line locally and they tend to end up at MNH.

Prices for advanced imaging like CT etc. TZS 100,000 = $57. These are significant sums to the average Tanzanian. Many cannot come up with TZS 100,000. 

Typical walkway scene with family taking their hydrocephalic child to a clinic visit

Families stay outside the grounds and then come in several times a day for visitation. There is no hotel for family members. Patients from all across Tanzania may be in the hospital for months at a time. Family is hugely important to Tanzanians so someone must stay in Dar with the patient the entire time. Getting here from the distant corners of the country is a major undertaking for most (multi-day bus journey while sick) so they stay in the wards until tests come back etc. rather than return for the next phase of an evaluation as is common in the US.

On rounds with Professor Magusi, my counterpart

It is a huge, sprawling complex with five large multi-story (4) wards for OB and Women's Services, Medicine, Surgery, Pediatrics and a mixed services ward. There is also a psych hospital, a TB ward, a very busy Emergency Department and a huge facility called MOI which houses trauma (lots of that due to the proliferation of cheap motorcycles and unskilled young men who get chewed up on them), neurosurgery and orthopedics.

Typical large ward building and manicured grounds

Handwritten note on the walkway to the chapel on campus in the background warning TB patients to stay away. There is a mosque next door to it.

Patients waiting outside one of the outpatient clinics are MNH

Entrance to the Tuberculosis Ward

It is adjacent to MUHAS, the health sciences university to which Laurel and I are attached. Its campus dwarfs that of MUHAS in size. There are untold numbers of smaller speciality buildings which house things like HIV, TB, diabetes and other specialty services. Many are the spawn of past donor grants or the largess of the US PEPFAR program. There are a alliances with other international universities such as Harvard, UCSF, University of Bergen in Norway, the Karolinski Institute in Stockholm and various other universities from around the world.

Outside of an office building at MUHAS. Everything has wrought iron over windows and doors for security and theft deterrence.

It is a government facility and also serves as a major employer in Dar-es-Salaam, the business and governmental heart of Tanzania. It employs a small army of people including nurses, doctors, gardeners, aides, security, maintenance and housekeeping staff. Most significantly it has its own medical staff which is spirit from that of the academic faculty at MUHAS. They previously were all the same.

Incinerator with medical waste being sorted prior to burning. Little is thrown away if it can be re-purposed. All waste is sorted by hand to recover anything of value.

MNH outreach vehicle with Stop TB message

Covered walkways connect all the buildings and provide welcome shade at this time of year and will be invaluable during the rainy season to follow.

It is run by an Executive Director who is a governmental appointee and reports to a Board that is linked to the University of Dar-es-Salaam, Tanzania's premiere educational destination. It is ultimately overseen by the Ministry of Health whereas MUHAS, the university, is overseen by the Ministry of Education. This governance split came about over ten years ago and has resulted in increasing friction between the two entities over time.

Administrative Offices entrance on the second floor of the ED building

MUHAS is currently constructing a new university hospital for itself about 20 miles outside of downtown Dar that it intends to serve as a "teaching" hospital for the training of undergraduate nurses and doctors. Historically that has been the province of MNH. Speciality care will stay at MNH as I understand the plan. The new hospital has become "the straw that broke the camel's back" in terms of the relationship between MUHAS and MNH. MNH is starved for funding and the diversion of governmental monies to support the construction of a new hospital has been a bitter pill for MNH to swallow.

MUHAS Coat of Arms = Education, Treatment and Research

Artist rendering of new MUHAS hospital currently under construction at Mloganzila

Please note that these observations are not externally validated by anyone and represent my personal thoughts rather than those of the Peace Corps or Seed Global Health.