Way to go Mamas!

Pictured in the dining tent on the mountain are Dorathea, Karen, Secunda, Agnes and Anna, the Mamas, the HIV+ women who climbed Mount Kilimanjaro and the woman who gave them the opportunity. A big thank you to Karen for her go for it nothing can stop me living life to the fullest maximizing every moment in life attitude!

To read more about the clinic and working in Tanzania, visit Karen's blog and Jenn's blog of the trip and more:

www.sunoverkili.blogspot.com

www.carpenter-chardsintanzania.blogspot.com


Dr. Karen Yeates, who founded the clinic in Moshi, is working with an American Foundation to start a dialysis program in Moshi. Currently, there are no established programs of dialysis in Tanzania. There may be a hemodialysis program starting in Dar es salaam for patients who can pay the high amount required. Otherwise, patients will try to travel to Kenya or abroad to seek care. Most cannot afford it. Karen is working in partnership with the hospital in Moshi to help start the program at the consultant hospital and will provide temporary peritoneal dialysis for women and children. This will meet the needs of women who suffer from acute kidney failure as a result of post partum hemorrhage and children who get kidney failure from diarrheal disease; both conditions patients can usually recover their kidney function in time, if they receive supportive care with temporary dialysis. Patients will need to pay for this treatment but they are working to make the program affordable and sustainable from the outset so that it is more likely to survive and be successful.

Karen is a kidney specialist who had a big interest in public health and women's issues before she went to medical school. After she finished her medical training she did Nephrology as her subspecialty (after Internal Med) and then still had a burning desire to get public health training so she went to Harvard and did an MPH (masters in public health) and spent a few years developing her academic career at Queen's University mostly in research in health disparities and access to care. She studies access to kidney transplantation for Aboriginal People as a model for how minorities access technologically advanced health services. She felt a nice connection with working in Africa as much of what goes on here is about access to care. Karen first came to Tanzania in October 2006 as a vacation/logistical trip with her husband. She and her husband had signed on with CACHA as volunteers and were planning to spend six months in Tanzania with their family and they were going to work on various HIV projects for CACHA while here. Soon she was introduced to Mama Minde and they discussed her vision of starting a shelter for those women who access legal aid through her organization KWIECO (in Karen's blog). Karen and Mama Minde rented a building while in Moshi and eventually the Women's center was born! Karen's biggest drive after that was to establish some improved free health care and women centered health education for Pamoja Tunaweza clients and other women in the region. CACHA had already done 4 health caravans around the villages in the area and so Karen utilized their ideas and focussed it on women with CACHA's full support.

The first women's only caravan was April 2008 and you can read about that in www.sunoverkili.blogspot.com A small women's clinic is now open in the center and as it grows, the women residents will likely be shifted to a new location that is less public. An outreach business/microloan support program is run from the center now too and other outreach initiatives are being established.

In terms of health care access in Tanzania, the poverty is grinding and for poor women and their children it can be impossible to get adequate care and medicine let alone education about their bodies. HIV care is now free for those who access it. Some other pediatric programs are also covered. Many still end up paying for medicine that are supposed to be free and women must make a choice to eat or buy medicine, but that is slowly changing.

Supporting programs like this directly helps the local people. Giving millions of dollars to governments in Africa can be like throwing money away (hey why not just buy them their own private plane and build them a palace). Grass roots efforts at change work and donors who support grass roots efforts can be sure their money is going straight to the people who need it.

"To the Top" - Summit Day & Night Climbing to the Roof of Africa - Days5 & 6

Sunday & Monday, January 25 & 26, 2009

Arguably these days and nights prove to be the best and most challenging days of my life. I said I'd never do it again, but I've since forgotten. Kilimanjaro anyone?

As I transcribe this from my journal I can see signs of altitude issues in my entries, some of which are not making much sense. Our porters packed up camp at 3rd Cave and we all head to Kibo Hut for what will be the longest most challenging day yet.

Sandy, Jen, Tanya and I went up last and slowly, with the exception of Mama Minde who can be seen in the photo at 3rd Cave Camp climbing up. Tanya is not feeling well, but she made it to Kibo Hut to have her photo taken before being sent down the mountain with no hesitation while Alfred our head guide shouted to her guide “Pamoja! Pamoja! Pamoja! (Stay Together!)” This shook some of us up a bit, but we were reassured she was in good hands so we continued on with our day. I felt confident at this time that if we have Acute Mountain Sickness or worse, we would be taken down and taken care of. However, this was extremely scary for Tanya.

Tanya's Story - Opiates or Alcohol:

By opiates, I am referring to religion, the opiate of the masses. I must say I felt more comfortable being guided up the mountain by the bible quoting guides than I did by the guides that smelled of alcohol and were retching on the way up to the summit. Come to think of it I did not see them at the summit. The guides who prayed were a comfort during our most fearful moments on the mountain. Tanya was comforted by her guide who held her tight and prayed with her the whole way down the mountain when she didn’t know if she would survive a scary case of cerebral edema. The way down the mountain is not straight down, there are a few up hills along the way. Each time Tanya had to go uphill she could feel the pressure increase inside her head which is when she and her guide did the most praying and went as quickly as possible. When she arrived at Horombo Hut (the 13,000 foot camp) she had to sign a book to let them know why she was going down the mountain. In the far right column of the book she was to fill in her ‘status’. Just above her status was the status of the previous climber spelled out in big red letters . . . DIED! She asked the administrator at the hut if she was going to die as well and he responded back to her with a blank stare. Fortunately her guide was a man of prayer and that was comforting to her as the pressure went up in her head at the same time as they ran as quickly as possible (to minimize her increasing symptoms) up the small hills that are part of the descent. Tanya made it down the entire mountain in 6 hours. It took our group 12 hours of rapid walking. Happily Tanya made it back home to her family (2young children) safe and sound and is recovering well from her traumatic experience on the mountain. She is grateful to be alive.

We sat to have some well-earned hot drinks after 5 hours of walking at high altitude. Many of us have achy heads and nausea. Dinner is at 4 p.m. after which we will sleep until 10:30 p.m., have some tea and biscuits and begin our ascent to the summit.

Our confidence is tested when a dead body of a Japanese climber is brought through camp in a sleeping bag. Rumor has it he was asked to turn around and go down, but he proceeded to the summit and died on the descent while coughing up blood (sounds like pulmonary edema). The porters and guides usually wear big smiles, but they are looking somber and some of them are holding hands.

At this time I wish I’d taken my massage therapist up on her offer of bringing some sage to burn. It could be a comfort to cleanse the mountain of death and fear before we go up. Prayers were being said by the Mamas in their tents who decided to err on the side of caution and not attempt the summit and the porters were also praying.

I said my nightly prayer of gratitude once again, for all of us and tried to remember the serenity prayer in my fuzzy brain state:

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this sinful world
as it is, not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him
Forever in the next.
Amen.
--Reinhold Niebuhr

After tea it began to lightly snow. The Gods of weather were with us the whole way up the mountain and continued to be as the snow creasted a light dust of white that made the climb that much more majestic as it sparkled by the light of our headlamps. Jill and I decided to get up at 10:30 p.m. for tea prepared to summit. Jill has some mild symptoms of altitude sickness (tinnitus) and was taking benadryl for an allergic reaction to what we think is something she is eating. She made a wise decision to err on the side of caution and chose to turn around and go back to camp. Rich, one of the porters who was given an opportunity to work as an assistant guide for the night, took her back to our tent. I continued on with no symptoms of altitude sickness, just fear of death, but I planted my poles firmly into the ground and told myself it was not much different than being at the top of Whistler and put one foot in front of the other. It was pitch black with plenty of stars in the sky, but no moon to light the way, only our headlamps.

Jen is Karen's right hand person and she had been bringing up the rear making sure Tanya was taken down safely and now she did the same thing for Gary as he turned around and went back to his tent. She had a feeling she needed to check on him and sure enough he was experiencing AMS and was taken down to Horombo Hut at 13,000 feet in the night to improve his condition.

We walked slowly up steep rocky switchbacks throughout the night. As I was bringing up the rear with a few other women I found Zoe sitting by herself on a rock crying by the edge of the trail. She reassured me she was feeling well, but needed water and didn’t know where her pack was and she has become separated from her guide and Kashini. A guide, who was helping me out and smelled of alcohol and was retching on the way up wanted to continue upwards, but I asked him to wait while we found Kashini, Zoe’s pack and another guide to bring up the rear. While we waited we found Melissa and Hillary. I put the retching alcohol smelling guide in front, us girls in between and another guide behind us and we tried to stick together. “Pamoja! Pamoja! Pamoja! We need to stick together” I told the guides. At this point I had run out of water since I was sharing my water supply with the guides who had no water. Kash & Melissa were both too nauseous to drink anything, so I gratefully took their water bottles and continued to share with the guides. I felt it was the only thing keeping me for developing altitude sickness and it was keeping a headache at bay.

Zoe only told me later that she was hallucinating – she was seeing hands by the side of the trail and poking her poles in them only to find they were not real. I think I would have sent her down if she told me that on the mountain. She seemed to have her wits about her though as she asked when the sun would be coming up. I checked my watch at that time and it was about 5:30 a.m. The sun began to rise in the distance and the sky was starting to brighten. Shortly after we were at Gilman’s Point on the crater ridge. From there we could see inside the crater and the ridge all around it. We were up above the clouds standing on the roof of Africa. It was unbelievably challenging to get to this point and Penina and Steve, who were there, chose to go down. Hillary and I were also talking about going down from here when along came Alfred, our head guide, with his usual chattering at a rapid clip telling us to get going up to the summit quickly quickly. No more time for pictures, time to get going. He reassured us it was not far, but once we got on the trail and saw the light in the distance and met others returning back from the summit we realized it was yet another 2 hours of slow gradual uphill walking. Two more hours seemed almost impossible, but Alfred kept us going with his seemingly endless amount of energy (did he have an oxygen tank in his pocket?). Nothing was alive except the humans on the crater rim and it was -22 C. It was colder with the wind and oxygen levels were 40% of normal. We could all feel it. Kash was stoically pushing forward and not looking back , focused only on making it to the summit no matter what.

At the summit we fumbled around for our cameras and Rich appeared with a Canadian flag for photos. I am amazed he got back up after taking Jill down. He had no gloves with him so I gave him my fleece gloves that I was wearing inside my down mittens. I was grateful for Alfred’s presence to help everyone get down. I made my way with Rich along the crater rim to Gilman’s point and was completely astonished at the number of steep switchbacks ahead of us that we had only come up a few hours before in the dark. I asked if there was a faster way down, but no, we had to go slowly through the switchbacks. Later, we came to some scree and I happily sat back on my heels, leaned into the mountain and slid down the scree. I came down from the summit in 1.5 hours and it took 8 hours to go up!

Rich offered to give me back my fleece gloves, but I told him to keep them and was inspired at that point to give all of my gear away since the porters seemed poorly outfitted for the climb, some of them wearing sweatshirts for warmth and flip flops on their feet. Luckily I waited ‘til we got to the bottom of the mountain since it was cold and wet on our way down. Once we got down I gave all my gear to Abbas to give to the porter’s association. I also gave Rich my water bottle (since he didn’t have one) with $20.00 US stuffed in the lid. I also stuffed a $20.00 bill in the porter’s pocket who carried my back pack + another 20 kg. on his head up the mountain in flip flops. I also gave my poles to a guide when he put his hands on them and asked for them and gave another porter a deck of cards with $20.00 stuffed into them. When we got down to the base of the mountain we went to a hotel with the guides and porters to celebrate. The porters stayed on one side of the room while we were on the other and we were discouraged from interacting with them. We could all sense the desperation in the room while Karen carefully counted out $6000.00 worth of tips for the porters and handed all the money out individually with a thank you and a hug to ensure that they all received their fare share. It seems few are above corruption and this is the only way to ensure fair pay.

When we arrived at the back at Kibo Hut after the summit, I decided I would never do anything like that again. It was extremely grueling and I’d rather give birth to 3 children in a row than do that again, however, I have since forgotten and I’d be game for another climb!

14 of us did not make it to the summit for a variety of reasons, but 19 of us did. They say fully 60% of people who attempt Kili do not summit so our stats beat the average.

Mama Minde made it to Kibo Hut. Her guide brought her down to Horombo Hut at 13,000 feet, but the rest of the trail is so bumpy that a group of porters decided to carry her down in a stretcher the rest of the way.

The first person to summit was Nini, our 62 year old retired nurse volunteer from Ottawa! She is pictured with Kash and Zoe on our descent with Kili in the background.

All of the HIV+ women made it to Kibo Hut which is a grueling climb in and of itself – congratulations to them all. They are role models for all of the women in Tanzania, particularly those who find themselves testing positive for HIV. This shows that an HIV positive test is not a death sentence, but it can even open doors to new opportunities. I don’t think any of the women ever dreamed they would be climbing Kilimanjaro and have their stories told on film.

In total 130 of us were on the mountain for 7 days.

Climbing to the Roof of Africa - Day 4

Saturday, January 24th, 2009, Acclimatization Day

We are a large group of about 90 people which is one of the reasons Dr. Karen Yeates has chosen the Rongai Route for us. The other routes are busier, but on this route we only see three other small climbing parties and there is enough space for us to set up camp for all of us and all of the porters. It seems appropriate that we are taking the road less travelled since how many groups bring four HIV+ women from Tanzania with them on the mountain. Abbas is the overseer of our whole trip. Karen has hired him to coordinate our travels. He is one of the most calm, compassionate peaceful men I have ever met. The night I taught yoga he began to demonstrate his mastery of yoga, easily pressing up into a handstand and more. Alfred was our head guide who kept us organized and on ‘German time’ as he called it. I tell Abbas he has the patience of an elephant. It is not easy keeping 30 women organized and heading in one direction at the same time on a mountain.

Seeing the dry riverbeds as we climbed today is more than a little disturbing. One can’t help but think this used to be drinking water for people at the base of the mountain. If you have ever seen a wide fast flowing glacier fed river as I have seen in British Columbia and Alberta, picture those river beds dry. It is a sad sight. Climate change has caused most of the glaciers on Kilimanjaro to melt and the permanent snow cover on the mountain is only at the very top now. I can’t help but wonder if there will be enough drinking water for the people that live around the mountain in the years to come. Water is sustenance and that is very apparent to us as we are told to drink at least 2 liters of water a day on the mountain. It is very dry up here and water helps us to acclimatize and keep altitude sickness at bay. Once nausea sets in (a symptom of mild altitude sickness) it is difficult to stay hydrated and the spiral of altitude sickness easily continues.

The center of one of the round-a-bouts that leads into the town of Moshi has several water fountains where people in Moshi and the surrounding towns can fill containers of water. In the center of the fountains is a statue presiding over the water, protecting the supply. It is a stature of a soldier with a rifle and in large letters underneath him is written "WATER FOR LIFE".

As I climb I hear Jacob Dylan’s words singing in my head . . ‘Got my window open wide . . . cause I know something good this way comes.”

We are all experiencing varying degrees of altitude sickness, mostly mild and some worse than others. Many of us are taking Diamox to help us acclimatize to the altitude and it leaves are fingers and toes vibrating from the inside out.
Training on the stadium steps has really paid off for Jill and I as our legs feel strong and I like to think the ‘breath holding’ Sandy and I were practicing prior to the trip may also be paying off.

Today we climbed to the Outward Bound hut which is the equivalent elevation of Kibo Hut. It stresses our bodies to produce more red blood cells before our actual climb to the summit tomorrow. Kibo Hut is the camp from which we will attempt the summit on Day 5 if we are not experiencing signs of altitude sickness. When Mama Minde was in her 20’s she climbed to the Outward Bound hut with a group of classmates during a 3 week long Outward Bound course. She really doesn’t remember much of it except that it was a lot of fun. She seems to be doing well – her strong spirit will get her to Kibo Hut tomorrow.

We set out on a 6 hour journey up to the Outward Bound hut which was set up by people in Munich, Germany. School groups are led up to the hut to build strength, endurance, confidence and teamwork and to test their limits. Mama Minde walked up for 1.5 hours today to help with acclimatization.

Dorothea and Secunda made it all the way to the hut and back down before many of us. Agnes and Anna did not make it all the way to the hut, but they are feeling strong and are happy to attempt Kibo Hut tomorrow.

Each of us has issues that we need to deal with and set aside for the summit tomorrow, some are real physical signs of altitude sickness and much of it is fear of what might be. Most of us are feeling strong and feel that we can do it together since we have so much support - Pamoja!

Climbing to the Roof of Africa - Day 3

Friday, January 23, 2009

This is the first day we climb above the tree line and we will really begin to feel the altitude and the lack of oxygen that comes with it.

I began the climb at the back of the pack of 30 of us, walking with the mamas, the last group to leave camp with the exception of the porters. We quickly caught up to Mama Minde whose legs and back were aching. She missed yoga yesterday, arriving at camp after dusk again after walking for 11 hours, so Melissa and I stopped on the mountain to give her legs and back a massage with Sandy’s homeopathic cream for aches and pains. Pole pole (slow) walking gets us to the top and she is practicing that. Her spirit will get her to the top.This whole climb is reminding me of the story of the tortoise and the hare – slow and steady wins the race. We were climbing with Abbas and whenever we experienced shortness of breath he suggested we stop and catch our breath, returning our breathing to normal before continuing to ascend.
We continued on past Mama Minde and attempted some meditative silent walking, but we are a chatty group of women and we could not go for any more than 10 minutes without talking. The meditative walking will come at higher altitudes when, with less oxygen, talking while walking will become impossible.

There has been a lot going on since the first day we arrived in Moshi – each day and night being different and not knowing what is going on which can be a challenge for those of us that lead very predictable lives. I am finding the predictable routine on the mountain and being cared for by the men (our guides and porters) very comforting.

All the Tanzanians have a strong sense of where they are from, they can tell you which village and tribe they are from and the name of their chief. A porter asked me one day how many tribes we have in Canada – two I suppose french and English!

This morning Agnes Mtambo, who is Chagga, from Kenya, tripped on her bootlace and broke her wrist. It could have been much worse. But, her inner strength which is attributed to her Chagga heritage has her persevering through the discomfort and inconvenience and continuing to attempt to push to the summit. The equipment and clothing seem elaborate and complicated for all of us to deal with, but I can only begin to imagine what it much be like if you have lived in a warm climate all your life and never really had to wear shoes or a jacket. Fortunately for Agnes she is surrounded by no less than 7 female doctors all of whom have checked out her wrist and decided it is mostly like broken. It is nicely wrapped and her guides can assist her with packing and climbing while she rests the wrist and takes some mild pain killers. Agnes has faced bigger challenges in her life than a broken wrist on Mount Kilimanjaro.

Originally the climb up Rongai was to be female only and we would meet the men at the top, but who are we kidding, in Africa mountain guiding is men’s work and we are surrounded my men, so we have embraced the two men from Canada, Jason and Gary, who have been working with us at the clinic and they are climbing with us up the Rongai Route.
Most of us have decided to take Diamox for prevention of altitude sickness. It makes our fingers and toes tingle. Tanya is also experiencing tingling and numbness of her lips and over the next couple of days it spreads to the rest of her face. We did not realize at the time that she was experiencing early symptoms of cerebral edema.

Our bodies are already working to make more red blood cells to provide much needed oxygen to our tissues as we climb.

Dorothea, Penina and Secunda are pictured on the mountain with the Kibo peak in the background.

Agnes, Dorothea, Anna and Secunda are all HIV+ and doing will on ARVs. Secunda has a 12 year old son who is HIV + and nearing the end of his life, he may only live for another year. Secunda was diagnosed with HIV when she gave birth to him. The women are from a village in Moshi called Rau and they are having fun speaking their native tongue with Alfred.

Secunda is an HIV counsellor at Pamoja Tunaweza. She has been through the HIV counselling training program and counsels all the patients that come in for an HIV test before and after. Precounselling involves telling people that if they are negative they need to come back for another test in 3 months since the test measures antibodies and it takes time for the antibodies to appear after exposure so the initial test can be negative with a positive three months later. If the patients are HIV positive they go to CTC for more testing and to the Mawenzi Government Hospital for ARV meds. Patients line up for three or four hours to receive their medicine. The HIV+ women are doing well, but they are anxious. Most of us have never been on a mountain before, let alone a mountain at high altitude. My own experience on the mountain helps me keep me calm as I experience the sensations of breathing less oxygen. I use my climbing poles to press into the mountain and imagine I’m climbing or skiing on a mountain in B.C.

As I write this is it is 1 p.m. and the porters are putting our delicious lunch together. We can hear the busy shouting of their voices.

We are at 3rd cave tonight. We are at 3800 meters (12,000 feet). We have about 7000 feet or 2000 meters to climb to get to the top. We will sleep at this camp for two nights and spend tomorrow climbing up to about 5000 meters and back down to camp to stress our bodies and tell our bodies to make more red blood cells. This is our acclimatization camp.

Again I taught another yoga class. Many people are feeling anxious as our bodies produce hormones that help with the altitude and make us anxious. I once again taught a very spiritual class that helped us ground into the power of the mountain, take our fear away and open our chests and shoulders to open the door of our hearts to let the spirit that is all around us on the mountain fill us. We also practiced the universal breath connection. “As you breathe in imagine the universe is exhaling and as you breathe out imagine the universe is inhaling and share in that which connects us, our breathe, our life force, our universal energetic connection”.
We also ended the class with a rule from Karen’s book of RULES FOR LIFE that was very applicable to the challenges ahead of us and a blessing for us all: "Thank you God for this incredible opportunity to climb this mountain. May joy, love, peace and compassion be part of the lives of all of us, all of Tanzania and all of Africa. May we all be healing and may be all be healed."

Mama Minde made it into camp around 3 p.m. today and the porters sang beautiful a Capella to welcome her. We got a few welcome drops of rain this afternoon (it is so dry), but the sun is shining again as it does each day.

There are many strong women on the mountain, Hillary Tenenhouse, is one of them, she has had a rough few years in her life with sickness and now she is healthy and she celebrated her birthday today on the mountain, very much alive and well and enjoying the moment.

Climbing to the Roof of Africa - Day 2

Today is Thursday, January 22, 2009.

We walked four hours to camp today at second cave on Kilimanjaro 'journey' in Swahili. It was a slow (pole pole), steady uphill climb. When we see our porters we say “pole Kaka” which means SORRY brother, or I feel for you brother, or we are one and they respond with asante sana (thank you very much). Their language is teaching me to be more compassionate!

The weather today is incredible. It is sunny and warm and our clothes are drying after yesterday's rain.
Breakfast is amazing. Fresh fruit, eggs and toast. We have warm soup at midday and evening meal and today it was served with fresh cilantro. We enjoyed fresh vegetables, chicken, potatoes rice and beans, all cooked over a small camp stove in a tent.

Ironically many of the women that come to the clinic are suffering from violence at the hands of men, but here in the mountain all of us (including the HIV+ women who have suffered from gender inequality) are being cared for by men who are carrying our equipment up the mountain, setting up camp each day and cooking warm nutritious meals for us each day – more dichotomies in Africa. When I asked Samson how he feels about the HIV+ women climbing the mountain he thinks it is a good thing for women to climb. HIV+ men have climbed and it is time for women to do the same. Women need more equality in Tanzania and this is a step in the right direction.

Mama Minde is climbing with us. She has her own personal porter because she is going pole pole (more slowly than the rest of us). Kashini (a strong fit 18 year old girl who dreams of being in the Olympics one day representing Canada in the javelin throw event) could climb the mountain quickly, but she spent the first two days climbing with Mama Minde and enjoying her company. She said Mama Minde reminds her of her grandmother. She encouraged Mama Minde to take more steps (up to 40) before stopping for a break so they could get to camp before dark, but Mama Minde still came into camp after dusk each day after 12 hours of slow uphill walking. She was aclimatizing better than the rest of us at that pace. We hope that one day Kash can say she climbed Kilimanjaro with the Prime Minister of Tanzania, Elizabeth Minde.

As we climb we can see pinnalces and snow on Mawenzi, the second peak on Kilimanjaro, it reminds me of Black Tusk in Garibaldi Provincial Park in B.C., except Mawenzi cannot be climbed because the rock it too loose. The main peak of Kili, taht we will summit is called Kibo. The top is called Uhuru, which means 'freedom' in Swahili. We are climbing for the freedom of all women in Tanzania. The photo is of Kashini and Agnes Mtambo, one of the HIV+ women climbing as a representative of all women whose lives have been touched by HIV.

I am also reminded of the mountain meadows in B.C. coastal mountains as we climb through mountain meadows today.

I taught yoga on the mountain today. That’s the first time I have taught a class at altitude. It was not a real physical class, but more of a spiritual class with all of us grounding into the mountain to absorb the power and energy of the mountain to give us strength and confidence to climb and we reached up and opened our hearts to bring the energy of one of the most spiritual places on earth into our hearts.

Climbing to the Roof of Africa - Day 1

There are so many stories to tell and the road less travelled is a story unto itself. Who knew one of the scariest parts of our climb would be the bumpy 3 hour bus ride on the dirt road to the Rongai Route that very few climbers take. The beginning of the Rongai Route is located near the Kenyan/Tanzanian border. Penina was sitting in front of me on the bus ride. She is the Clinical Assistant at the Pamoja Tunaweza Center, training to be a doctor. She manages health problems of the women at the center and runs HIV tests and does HIV counselling. Penina leads classes for local school girls to educate them on what HIV is, how it is transmitted and how to prevent it. Penina was getting very nervous on the bus ride. We both had a window seat and it seemed at any moment we could get a flat tire or go off the road. We held hands for support during the most precarious parts of the ride.

After the wild bus ride we arrived safely at our destination: the trail head of the Rongai Route. Karen Yeates chose this route because we are a very large group and she knew we could have the trail almost completely to ourselves. From the trail head we can look out over Kenya to a mountain range and a crater in the distance - an incredible sight. Many porters were lined up hoping to be chosen to perform the arduous task of carrying our gear up the mountain.

According to www.roughguides.com Tanzania's best asset is its people: friendly, welcoming, unassumingly proud and yet reserved – you'll be treated with uncommon warmth and courtesy wherever you go, and genuine friendships are easily made. We experienced this throughout our trip, but particularly when we were so unbelievably well-cared for by the porters and guides on the mountain thanks to Bushmen Expeditions.

Working as a porter is a very tough job. They have little money for gear and often arrive inadequately outfitted for the climb. One of the porters was wearing flip flops and a T-shirt and sweatshirt for warmth. In order to get this low paying and challenging job they need money for transportation to the trail head and money to bribe the guides who will choose them. It seems almost comical now that we spent a lot of time this morning weighing our bags to keep them under 15 kilograms since the porters climb with our backpacks and an equal amount of weight on their heads and shoulders. They do not get much food to eat and they work so hard. We could not climb the mountain without their assistance. Some of the porters smell of alcohol (a preclimb celebratory drink perhaps?) and look poor and worn out, but very happy to have work.

With only our day packs on our backs, the porters pass us on the trail as we make our way through flowering fields of potatoes and banana trees. We hiked through some light afternoon showers which washed some of the dust off of us and we arrived at our first campsite just after dusk. We were not prepared to set up our tents in the dark, but set up quickly with the help of our porters, guides and a small group of Germans who had already set up camp and had flashlights to help us out. We had a cozy first night inside our tents at camp 1 where there was still plenty of oxygen to breathe which was apparent by the lush vegetation surrounding us. The background noise on this night was much the same as the others to come, once we were settled into our tents we could hear the melodious chatter in Swahili of the porters preparing for the next day, relaxing and socializing now that we were taken care of. It reminds me of motherhood - take care of the little ones and then take care of yourself - I felt like I was being mothered - it was a welcoming feeling.

One of our guides is Samson Lauwo. He climbs the mountain 3x/month and has been working as a guide for 9 years. He is the grandson of Yohani Kinyala Lauwo who was only eighteen years old when he became the first guide to lead a westerner up Mount Kilimanjaro in 1889. Samson's grandfather was chosen because he was a hunter who spent much of his time on the mountain and knew it well. The mountain was much harder to climb because there was not enough equipment and was lots of snow from 4000feet. People used to sleep in caves, but this is no longer allowed since some porters were killed when a cave collapsed and porters have died from hypothermia, so they must sleep in tents. In 2006 when two women from Colorado were climbing Kili, they saw the deaths of porters on the moutain first hand and decided to do something to help prevent future deaths and they formed The Porters Association in Moshi. Porters can now get assistance with equipment for the climb. Unfortunately a lot of porters don’t know about the association, but with time word will spread. If porters are able to move up to work as assistant guides, they learn about the ecosystems on the mountain, how to perform a rescue and how to summit. Most porters do not summit.

According to Samson, in the Chagga language, Kilimanjaro is known as Kilemakyaro pronounced chalem charo which translates as 'Impossible Safari' Much of what is known about the mountain has come from western writers, but Samson wants people to know the Chagga people know first hand all about the mountain.

When Samson's grandfather turned 100 years old, Tanzania National Parks gave him a home and recognized his accomplishments over his lifetime with a plaque at the trail head. Samson's grandfather died at the age of 125 in 1996. He had several wives and one of them recently died and was honored with funeral service with 1000s in attendance.

Last week the second wife of his grandfather died. Now is a good time to tell you about funerals in Tanzania. The bodies are not preserved so when someone dies, the funeral and burial takes place the next day. Anyone who has had any contact with the individual attends the funeral to send the spirit off to a good place. The women stand on one side, the men on the other and they sing in a lovely call and response fashion to and with each other. It is a full day of sending off the spirit of the decesased. Tanzanians have a strong faith that the spirit is going to a a better place of love and they will all be together one day so this is not a sad day. Samson’s great great grandfathers wife’s funeral was attended by 1000's and everyone views the body. All things come to a complete stop for funeral attendance - meetings are cancelled, clinics are closed - you get the picture.

Samson is one of ten children, but now in his family people are becoming educated and family planning is taking place. Samson has one wife and 2 children. Samson said this makes it easier for women to inherit property when there are not so many wives and it improves the lives of women and children. This makes it easier for all the children to be cared for and loved as well.

Last day at the Pamoja Tunaweza Women's Center

There are physicians and nurses from varying specialties including nephrology, emergency medicine, pediatrics, anesthesia and more along with occupational therapists, medical students and residents, all of whom have seen 100's of patients this week, each patient worthy of a story. One doctor found it funny when a patient described burning upon urination as 'feeling like hot peppers when I pee'.

Another HIV+ woman came to the clinic today crying with a sick and fussy baby. She had been told by the hospital to stop breastfeeding and her baby was now on antibiotics and drinking watered down cow milk. There are dramatic differences here in Africa between babies who are breastfed and babies who are not. Not being breastfed is a death sentence for a baby here in Africa and the mothers know it.

In www.sunoverkili.blogspot.com there is a photo of a newborn baby wrapped in a red blanket. His mom came to the last caravan and gave birth. She was HIV positive. Her husband had been drinking and beating her and she was depressed. It took her four days of staying at the clinic to finally tell Agnes that she had a toddler she had left at home on his own. When Agnes went to the woman's home they found the toddler lying in a bed covered in his own feces and emaciated. He was brought back to the clinic, cleaned up, fed and loved and within a few days he was happy and healthy. The baby died at 3 weeks of age, but the mother and the toddler received assistance from the center and mom now has a job and they are doing well and living in peace.

A teenage orphan came to the shelter looking for residence. She was also working as a translator this week. She was HIV+, but chose not to take ARV (anti-retroviral) medications because she thought God was going to cure her of her illness. She requested to stay at the clinic for a year while she completed her studies and wrote her exams that would get her into a boarding school. This seemed like a good plan, except for the fact that without ARVs she would not survive long enough to carry it out.

We have all been moved to tears this week and at times overwhelmed by the suffering around us. The only way for the lives of the Tanzanians to improve is through education, followed by a decrease in the practice of polygamy, followed by a decrease in population that allows parents time and means to look after their children and a consistent breastfeeding policy that encourages all mothers to breastfeed their babies and put the theory to the test that babies of HIV+ mothers who are breastfed may develop a lifetime immunity to the disease.

Empowerment: During the caravan week, 20 women were identified as candidates for Ivan's business program to help them become financially independent so they can find their own shelter for their families, feed their children and send their children to school. In a culture where men value having multiples wives (i.e. 4) and many children by each wife (i.e. 4 again), resulting in 16 children per family, it is not surprising that women find themselves in a situation of primary provider for their families.

Dialo's story: Dialo is a reggae musician who has spent 3 years in prison in South Africa for a crime he did not commit. He is working as a translator for us on the caravan along with over 20 other Tanzanians. Dialo knows first hand the struggles of the young men of his generation. The young men are led to believe that if they do well in school and work hard they can lift themselves out of poverty, but the reality is that there are few opportunities available for work and leaving the country is almost impossible. Dialo feels men are unfairly blamed for the violence and oppression of women because the men know no other way, they are raised to be violent and oppress women. There is a 'jail' here in Moshi for young children. If parents are having difficulty controlling their child they have the option of sending them to 'jail' where they are beaten and lo and behold they come home and don't give their parents any more trouble, but it perpetuates the cycle of violence. Dialo is interested in working with young boys to help break the cycle of violence by educating them on alternative ways of behavior. Kashini and I were both familiar with the 'Challenge Program' from North America and suggested he may want to begin a 'Challenge Program' in Moshi.

This was a sad day for some of us. This was the day that Milley's father picked her up to take her home. Ritika, a family practice resident from Toronto and Damon, a medical student from Vancouver, said a tearful goodbye to Milley as she said "I love you all and I want to stay". Milley's family brought gifts for Amy who had been looking after Milley during the caravan week.

On the last day of clinic as we were cleaning up and packing medical supplies, a duffel bag full of toys and trinkets from Canada was found. Sandy brought it out and she was immediately swarmed by children and some adults.

This was a sad day for some of us. This was the day that Milley's father picked her up to take her home. Ritika, a family practice resident from Toronto and Damon, a medical student from Vancouver, said a tearful goodbye to Milley as she said "I love you all and I want to stay". Milley's family brought gifts for Amy who had been looking after Milley during the caravan week. It made us feel grateful for the opportunity to climb the mountain together and grateful for the freedom that we have to come and go from any country in the world at anytime and know that we can go back home to our western lives and our families.

Although some people don't have enough food to eat, a roof over their heads or access to clean water, cell phones are plentiful and most of the advertising one sees on the streets are from a few cell phone companies. People may not have access to medical care, but it seems almost everyone has a cell phone.

There are so many contrasts. There are unbelievably beautiful fabrics, works of art and colorful and delicious tasting fresh fruits and vegetables. There is awe inspiring landscape and wildlife and yet so much tragedy, illness, loss and poverty. There is also joyous music and grateful happy people who seem to be strongly connected to one another, and yet there are also outcasts, some with HIV, but we are here to show that people with HIV can live normal lives, in fact, they can climb Kilimanjaro. We can eat with them and we will not get HIV, we can provide health care for them and we will not get HIV, we can climb the mountain and camp with them and we will not get HIV. We can live and work with them and we will not get HIV.

This evening we are packing our bags for the climb. We have been anticipating this moment for many weeks . . . the time to depart is finally here!

The T.V. is on in the background while we are getting ready to go. It's surreal watching 'Usher' speak at Obama's inauguration commenting on Michele Obama's gown . . . the dichotomies continue. Each of us are creating our own personal history by climbing to the roof of Africa while watching history in the making on T.V. Happiness and hope abounds in Africa as a result of Obama's inauguration.

Packing light for the climb is a challenge for some of us. Given our current situation the sayings "Less is more" and "Live simply so that others may simply live" seems particularly appropriate.

The mountain we have faced over the past week has been offering knowledge, empowerment, healing and hope at the women's center through the medical caravan. Now it's time for the real mountain which will also offer hope and healing to the women with HIV, strengthening them from within. I found this quote on an Internet blog: "The mountain will try to kill you." This seems a little over dramatized, but nearly 35 people die on the mountain each year (around 15 tourists and 20 porters). It is something to be taken seriously and knowledge of symptoms of High Altitude Mountain Sickness is crucial.

If you are reading this blog and planning to go to Africa, bring a bank card with you! I was told not to bring one because it's difficult to access money and if you do you can be robbed outside the ATM. Robbery outside ATMs happens at home and I still use them, so I don't know what I was thinking when I didn't bring one. It turns out we need another $100.00 to tip the porters since we need more porters than we originally planned for. The porters make $6.00/day on the mountain plus tips so I have no problem tipping extra, but I don't have any more cash - the porters and I thank you for the loan Rachel!

Pamoja Tunaweza Women's Center - Clinic Day 5

It is now January 20th, 2009, our last clinic day in Moshi and the Obama's inauguration day. We watched a bit of the swearing in ceremony on the television at the B & B in the evening. It felt like a celebration that the whole world could enjoy. I don't think any of us will forget watching this from a country where the majority of people are poor, lack access to education, clean water and enough food to eat. Here in Africa it is a common sight to see women with their heads wrapped in scarves and it was a beautiful sight to see these woman represented by an African American woman front and center at the inauguration.

The clinic is primarily for women, but if men come they are not turned away. Today a man came who was HIV+ and his wife had died from HIV. He had three children with him for testing who were gratefully all negative. He was looking for assistance for himself and his children. Like all HIV+ patients he was referred to the government hospital (Mawenzi Hospital) for follow up. Charmaine, one of our doctors, wanted to do something for this family to make their lives easier and to give the children a chance at a better life, but Agnes was reluctant. Charmaine made the case that the cente is about gender equality and we should not discriminate. Agnes decided the center will help pay for school for his children and some food for the children. He will come back to the clinic in February for follow-up. All children have access to education in Moshi and they are required to go to school, however, $265.00/year is required to pay for books so many children are unable to attend.

There are many subtleties in the swahili language that are not present in the English language. It is a language of humility and politeness. For example there are different ways of greeting people depending on their age. When greeting an older person it is appropriate to say "Shikamo papa or Shikamo mama". The man in the photo is 97 years old and of course he was greeted with "Shikamo papa" as a sign of respect.

Milley is a 13 year old girl who is staying with us this week. Amy, our logistics coordinator) is taking good care of her. She is well educated and she has a bright spark in her eyes and she is always smiling. Her parents came to the clinic in the spring of 2008. They have 3 children, all well educated and well cared for. They asked Amy to adopt Milley and take her back to Canada to give her a better life. Her family lives ina poor community called Himo Town adn although they protect their daughtes, rape is common adn opportunites for the future are limited. However, the adoption process would take at least 2 years and cost >$20,000.00 and Amy hopes that by that time if Milley keeps up her studies she can go to Canada as an exchange student. Milley wants to work in a bank when she grows up.

Looking out the second floor window of the clinic I see many people walking and riding bikes. There is no such thing as obesity here. People gets lots of exercise just going about their day walking or riding a bike and eating fresh local foods. We also walked most places or took a taxi if it was too far to walk. If the locals go a far distance they take public transportation also know as the daladala which is a Japanese van that is always bulging with people (and some animals). Periodically throughout our work days, a large truck (about the size of a garbage truck in North America) drives by at high speed with the driver honking the horn as it drives by. Upon questioning, it turns out these trucks are filled with prisoners on the way to jail. The truck cannot stop because the prisoners may attempt escape and they will be shot if they do.

The Village of Shimbwe - Health Caravan Day 4

Set in the foothills of Mount Kilimanjaro the bus ride to Shimbwe offered stunning views of the mountain we would be climbing soon. 100's of people are already waiting to see a doctor when we arrive in the village. We have rented the facilities of the local church in Shimbwe to run the caravan. I was running HIV tests today and the second one I ran was positive which really caught me off guard and I was crying. The patient received counselling and follow-up, however, it was still a bit shocking. Steve, a medical student from Tanzania, was nearby and I asked him how he maintains his composure with so much sadness around him. He agreed "it is very sad" and he found himself crying over a sad situation yesterday. Steve and Karen became friends when he helped her with Malinga, her adopted son. When Karen first brought Malinga from his orphanage to Moshi (en route to Canada), Karen was struggling with helping Malinga deal with his new surroundings, a new mother etc. and Steve spent some time with Malinga and was a huge help. He is a kind-hearted man who will make a compassionate physician. He plans to climb Kilimanjaro with us as the assistant for our camera man, Gary Kibbins, who is helping to film the documentary of the journey of the Tanzanian women with HIV. The film will be called "The Women and the Mountain".

Today we met an impressive young woman from Norway. Evelyn is a social worker who has been living in Tanzania for a year helping build schools and works with a local NGO (non-governmental organization) called Mnjeni, that helps poor people from the area of Shimbwe to access transportation for health care. Evelyn has a good grasp of the local language and helped us organize the crowd of patients in Shimbwe today.

A man came to the clinic with vitilago feeling very self-conscious. The pigment he had left on his skin made him look like he had eyeliner on and a goatee pencilled on his fact . Unfortunately there is not much we can do for him and I can only begin to image the stigma he faces in his community.

One woman came today with four children looking to escape her violent home. Her husband beats her every time he drinks. Her home is peaceful until he consumes alcohol.

The pharmacy is busy every day of clinic and it was particularly busy in Shimbwe filling 1500 scripts that day.

Many people come to the clinic complaining of 'pain pain' - their whole body aches. They work hard digging in the earth to plant food for their family and carry goods on their heads so it is not surprising that their bodies are sore and tired. It seemed we could have used a massage therapist at the clinic. A chiropractor from Canada joined one of the past health caravans and he worked long days helping deal with all the aches and pains.

After a long day in Shimbwe, we went back to Moshi for dinner and experienced and there and the power was down in the town. We went out to an a Italian/Indian restaurant for dinner that was no affected by the power failure since they cook their food over fire.

When we first arrived in the town of Moshi we were told it is a wealthy town which was hard to believe, but after being in Shimbwe we now understand. It is wealthy by African standards because many Europeans, Canadians and Americans (aka Mzungus which is a term used in East Africa for a white person) have set up missions here and brought their mzungu dollars with them to share with the community. The tap water in Moshi is 'safe' to drink thanks to a combined effort between the Tanzanian government and several European countries, primarily Dutch. The Catholic church has a large presence in Moshi and there are many western style restaurants.

The contrast between those of use who have come to the clinic to work and those that come for help is stark. Today a woman came for HIV testing. She has 5 children, no husband and no family. When I attempted to give her an HIV test I was unable to get any blood. She was hungry and dehydrated and she had a baby attached to her, fortunately breastfeeding. We pulled her aside and gave her a meal and some water. I was unable to eat my own meal in front of her so I gave her my lunch which she prechewed and shared with her baby. Half of the day is gone and there are still >100 people lined up waiting in the hot sun to see a western doctor.
There is so much poverty and illness, at times it seems hopeless, but then we look at the smiles on the faces of the people around us and the hope in their eyes and we too feel hopeful. Even the HIV+ patients are happy when they realize there is hope for them.
On his 90th birthday Nelson Mandela said the only regret he had looking back on his life is that he did not see the HIV epidemic coming and was unable to prevent it. He wished he had done more. While we are here, counselling, educating, testing and treating for HIV and raising money for the center so the work continues, I feel we are working for Nelson Mandela, one of the greatest human beings to walk the earth.

Ngorongoro Crater and Lake Manyara

After 3 days of work we headed out into some African wild spaces for the weekend. While driving from Moshi to Arusha and then onto our safari destination zebras crossed the road - a typical sight! We then came across bushes in the middle of the road laid out at evenly spaced intervals seemingly all about the same size. This is what they use to warn of an accident or obstruction in the road up ahead to warn drivers to slow down - very creative.

We were in a jeep for two solid days since one cannot get out of the jeep on safari because of the potential dangers that the wild animals pose (remember that before you schedule a 10 day safari!) Two days was just right. The crater (or caldera as it is accurately called) is impressive at 350,000 square kilometers. We saw zebra, gazelle, ostrich, birds galore, a rhino, a pride of lions, 2 lone male bull elephants, wildebeests, water buffalo, antelope, a cheetah, hippos, a mama warthog with her 4 babies happily twirling their tails and playing in the dust and what little mud they could find at the end of the dry season. The rainy season begins at the end of January and as a result it was very dry when we visited on January 16th. The acacia trees are quite a sight with weaver bird nests hanging from their branches.

Sheets of rain came in while we were in the crater and it was such a good feeling to see the dust go down, the air cool off and the caldera receive much needed water.

At the end of our safari in the Ngorongoro Crater, we visited a Masai Village at the cost of $150.00 for the group of us. It was a rather highly contrived visit. The Masai used to live in the crater, but they are no longer allowed to live there. They still graze their cattle in and around the crater, but elephant poachers (looking for tusks) were dressing up as Masai so as not to be caught. One of the most beautiful sights that I saw were the Masai children herding their goats and the adults herding their cattle. They walk tall and proud through the fields using their spears for walking sticks and protection from wild animals if necessary. They wear blue blankets to symbolize marriage and red if they are not married. The Masai live in keeping with nature. They seem to leave a very light footprint on the earth, with the exception of taking many wives and having many children, but this ensures survival of the tribe. The main source of Masai nutrition comes from the milk and blood of cows that they store in calabashes (gourds). They are used by the tourism industry to promote visits to Africa, but the government is trying to urbanize them so their lifestyle will be no more. Having learned through history about the native indians and the havoc wreaked on them by trying to turn them into Europeans, it is surprising to me the lessons learned from these past mistakes are not used here and that the Masai way of life is not being protected for as long as it is able to exist (with the exception of female genital mutilation). There are so many dichotomies in Tanzania and the way of life of the Masai being lost at the same time as it is being used to promote tourism is just one of them.

The feet photo are from the majestic looking Masai woman who came to the clinic one day. She is wearing the typical Masai sandal made of recycled rubber tire.

Our safari on Sunday, January 19th was in Lake Manyara. The water level of the lake is very low and the whole Savannah is hot and dry. When the rains come they will be very welcome here. Our guides tell us the best time to safari is in February when the wildebeests migrate and have their babies. It brings all wildlife out. Today we saw giraffes, impala, zebras and flamingos at a HOT spring, impala, gazelles and many beautiful birds.

Third Clinic Day

The clinic was busy today. Half of our group went to the village of Shimbwe and had a very busy day with no break. We saw > 100 people at Pamoja Tunaweza for eye exams, HIV test, tylenol and deworming meds.

People go from being helpless with an HIV+ test to empowered with knowledge of prevention and treatment. HIV does not have to be the death sentence that many people here think it is.

I saw a mom today who was tandem nursing her baby and toddler, a common practice in Africa and not unheard of in North America. She came to the clinic with grandma and two healthy children. She had been experiencing the pain of thrush on her nipples for 4 months! Nothing was going to stop her from breastfeeding her babies. We were able to give her some meds to help clear it up. It was so nice to see happy, healthy breastfed children in contrast to sickly fussy nonbreastfed babes. It was also great to see her have the much-needed support of her own mother with her.

Second Clinic Day

It was another quiet day at the clinic (by CACHA medical caravan standards). I had an opportunity to connect with Marissa who has lived and worked in an orphanage in Dar es Salaam. It is the same orphanage that Karen and Roman have adopted their son Malinga from. I heard there are over 300 orphanages in Moshi and since Dar is a bigger city I can only begin to imagine how many orphanages are there. I gave Marissa some artwork and photos from my daughter's 4th grade class, to give to the children at the orphanage in Dar. She plans to send me photos and artwork from the children at the orphanage who attend a Waldorf school, which typically has an art, music and language based curriculum with an emphasis on creativity. The school also has a firm policy of no physical punishment of it students. A philosophy that is rare in Tanzania where children are still brutally punished by teachers for discretions committed in the classroom.

Local optometrists are working at the clinic this week and word has gotten out. Many people are coming to the clinic requesting eye exams. One woman came requesting an eye exam who had an inconsolable baby with her. I watched her and wondered why she was not breastfeeding her little one which would have consoled him instantly. I asked her if she needed some assistance and she asked for water for her baby. She also asked for money for cows milk since she had been feeding water and cows milk. This is a sad situation that results when women do not breastfeed their babies in Africa. I brought her into the clinic and since her baby was 5 months old we began to feed him bananas which he was capable of chewing and swallowing and he ate them voraciously. She was set up with 3 cans of powdered artificial milk which ought to last her 3 months if her baby lives that long (where will she get clean water?) and she can come back to the clinic for more. She was happy and grateful. She too had a sad story to tell. Her lover gave her a baby and HIV. He also gave another woman HIV and a baby and the other woman is dying. The mom is on ARVs and so she has a chance at living. When she was diagnosed with HIV she was told to stop breastfeeding. Unfortunately the data from the International Lactation Consultants Association (ILCA) demonstrates (from well published studies in well respected medical journals i.e. The Lancet for one) that HIV transmission through breastmilk is extremely low and infant mortality is lower if babies are breastfed here in Africa. But, the WHO (World Health Organization) has recently changed its position on HIV positive moms and they are now told not to breastfeed. Over the course of the next week we saw two more HIV+ moms who were told not to breastfeed, with sick, malnourished babies . . . a sad controversial issue in Africa.

Three little girls visiting from Victoria, British Columbia are working at the clinic with their mothers. They have been happily helping count pills for the pharmacy, which fills upwards of 1500 prescriptions/day. Hannah had asked to come on this trip with me - next time! They and their travelling mothers have been thoroughly enjoying their experience in Moshi. I particularly enjoyed connecting with these laid back moms from the West Coast. Fiona is a family doctor, Rita is a writer and Stephanie previously ran the CACHA orphan program at the district hospital in Kilemma. Stephanie and her husband and three children have spent a year or more working and living in Tanzania. Stephanie has returned this January to arrange payment of school fees for many of the vulnerable children in the orphan program. She is here for a month. She brought along two of her good friends who we were lucky to acquire as volunteers while Steph was off visiting headmasters at the local school on the slopes of Kilimanjaro.

The Pamoja Tunaweza Women's Center and Caravan

The Story of Agnes

The photos show the cooks making chapatis over a fire. We ate fresh local foods every day. Each day while walking to the clinic we saw women dressed in colorful clothes carrying food on their heads home to their families. Bananas grow everywhere and they are a staple in the Tanzanian diet. The women that cook our amazingly delicious and nutritious lunches each day are HIV positive and have received assistance from the clinic to get back on their feet. They are paid a small stipend to cook for us. They have children and grandchildren to support and they hope to make 10,000 Tanzanian shillings/day, which is approximately $8.00 US/day. I asked to take their photos and agreed I would send them copies. They have very little and appreciate receiving anything in the mail. Their address is: Pamoja Tunaweza Women's Center, Peace Park, Box 8483, Moshi, Tanzania.

Agnes(on the mountain)kindly shared her story with me one day when we went to the local farmers market. Agnes Mtambo is the administrator of the Pamoja Tunaweza Women’s center and her story of HIV is one of pain and triumph, the pain part being a a typical story for an HIV+ woman. Almost ten years ago she had visited her gynecologist because she was having difficulty conceiving her second child. At this visit she had a routine HIV test and the test came back positive. When she went home to tell her husband, she was beaten and her husband left and told his family she was dead. Her own family lived in another town. For a year or so she was able to support herself and her young daughter, but eventually she moved to Moshi, Tanzania for work. She became very ill with AIDS (the disease caused by HIV) and eventually her sister came from South Africa and brought her back to South Africa for medical care. Agnes would have died in Tanzania at that time as there was very little HIV infrastructure and it was difficult to access to HIV medication. The stigma around HIV was very difficult to overcome for Agnes but she constantly fights against it and works to educate other HIV positive women to stand proud and protect their rights as women living ‘positively’. Now, she is in good health on ARV medications (and plans to climb the mountain with us!) and her daughter is HIV-. When she eventually returned to Moshi, her husband's family were shocked to see her alive. She has since been in contact with her own family and has helped her sister, who is also HIV+, to be empowered and live a good life.

Another similar story was told to me by a woman who has 7 children at home. When she came home with an HIV+ test result her husband beat her and kicked her out on the street. She spent 3 months at the Pamoja Tunaweza Center getting on ARV meds and finding work. She now lives with her mother. Her husband has got down on his knees asking her to come back home to help him raise the children, but she is reluctant since like so many women in Tanzania she may find herself facing regular beatings again.

We asked all of the women who come to the clinic what their home life is like and it is such a relief and it also seemed the exception to hear “I live in peace”. Women with violent home lives are the norm and the Women's Center can only help them when they have exhausted all other avenues to create a peaceful marriage or to leave their husbands. One women had been facing beatings for 12 years and her father-in-law had been protecting her from her husband, but her father-in-law had recently died and the beatings were getting worse. She had gone to her own family to no avail so she had come to the center with the hopes that we could help her find work so she could live independently from her husband and raise her two children in peace. She is a good candidate for Ivan's business course.

The Pamoja Tunaweza Women's Center serves many purposes, one of which is to identify strong candidates for a business program. Ivan Esmeral, a volunteer from Montreal who is affiliated with the runs a local business program for women called 'NIWE' which translates to 'Let Me Be Me'. Ivan plans to help some women who have taken the program open a bakery making a Portuguese bread that is popular in Mozambique, but not sold in Moshi. It is a bread made with cornmeal, flour and water that stays fresh for long periods of time. Coincidentally, Sandy’s mother-in-law makes this bread on a regular basis in a trough just the way it has been made in Portugal for generations.
75 people at the clinic the first day is a quiet day by CACHA medical caravan standards. It was quiet because we decided not to advertise on the radio as we had in the spring of 2008 because 1000’s of people had to be turned away and there is no worse job in the clinic than working the gate and telling sick people they have to go home and cannot be seen by a doctor. So, rather than advertise, Karen chose to let the caravan days be spread by word of mouth, however, we can handle up to 400 patients/day. So, a little advertising was done in town and the next few days were busier.

We can see the mountain from the veranda of the B& B where 15 of us working at the clinic are staying. Each morning we wake to the sounds of roosters crowing & dogs happily barking. Life moves at a slow pace here. Most people walk everywhere so the streets are full of people. It makes for a sociable life. I have been joking that there is no words in Swahili for yesterday or tomorrow since people naturally live in the moment. They do not plan ahead and do not spend time anticipating a crisis, but live in the moment and deal with stuff when it happens. Ah, the key to a low stress life, but chaos often results (c'est la vie)!.