Jessica Brumbaugh BBH 390B

First Set of Field Notes

Field Note 1:May 18, 2017

Through The Media’s Glasses

An elderly women came into the office of Mr. Mafunsi and Mrs. Judith who,
according to a folder handed to Mrs. Judith, was albino and had lost her right arm to cancer.
Judith explained the situation stating that around the university was some poorer
communities and people would often walk through their office areas and request money.
All of us students started to look around trying to understand what was expected of us, if
we were expected to give money or not. Soon the women received most likely a total of
$20,000 Tz before leaving without a word. Discussion then of the stigmas against albino
Tanzania’s was discussed and informed of the occasional situations where such people or
children were used in witchcraft as sacrificial practices. Situations were sometimes albino
children may be stolen from families as babies or sold for a price. In an attempt to possibly
have our group understand better what she was discussing, Mrs. Judith paralleled it with
the news articles she had read earlier about the Penn State student who died recently at a
fraternity house. She mentioned how many media sites speculated this death to be a
ritualistic sacrifice. To which many of my colleagues and I were shocked to hear and
slightly embarrassed that that was the impression that was being made. Trying to
understand why there could be this assumption, I looked up news articles on the topic and
found many articles titling or describing the situation as “… a cruel hazing ritual.” Making it
understandable that such presumptions could be made.
This situation reminds me just how powerful the media has in relaying a story.
Especially one of another culture located thousands of miles away and passed along article
to article. How easy it would be to hear a story of a situation that took place in another
country, in a different culture and make assumptions based on the context of our own
culture and conclusions based on the way it is presented by the media.

Field Note 2: May 17, 2017

Traffic Accidents

Turning Left onto the road, the 14 person touring van was hit on the back right
bumper and hit by a vehicle attempting to pass around the bus but was forced from traffic
going the opposite direction to hit the van. Grimacing the driver of the van hopped out of
the van and walked behind the van and started to speak with the driver. He took pictures of
the vehicles and then they seemed to stand and converse for a while occasionally speaking
passionately but never visibly enraged or violent. It was then described that they did not
most likely have insurance to cover the cost of the damage but instead the gentleman who
caused the accident would need to pay at that moment for the cost of repairs to the van
driver. A few minutes late an older gentlemen drove up on a motorcycle and seemed to join
the conversations. A while later the drive of the tour van hopped back in and after briefly
pulling over started on the original path again. The situation brought to light the difference
between the American insurance system and the Tanzanian accident procedures. I was
very nervous during the situation expecting there to be some kind of physical altercation.
Many times in the States I have seen people become aggressive after accidents. I am not
Jessica Brumbaugh BBH 390B
First Set of Field Notes

aware of how much money was exchanged for the damage but I know that if I was in an
accident at home I would not, nor would my friends or family, have enough cash on them to
pay for damages. I was impressed by the cordialness and the peacefulness that was
displayed.
The accident is just a small glimpse of the intense driving situations I have been in.
According to the CDC, driving accidents are one of the leading causes of death for visiting
Americans. Just on May 6, 2017, outside of Arush, Tanzania, there was a bus of primary
school children that was speculated to have been speeding and crashed killing 32 children,
two teachers, and a driver. Between walking along the roads, in bijajis, or taxis I have been
in some heart racing situations.

Field Note 3: May 20, 2017

Cholera Outbreak

As we began our walk back from dinner to the hostel the group got caught in not just
rain but torrential down pour. In seconds, the streets began to flood and all care was tossed
in the wind as we franticly began to run home. Many of the other girls took off their shoes
as they ran. We ran past dumpsters, over flowing once with cats, now with water and
people secretly huddled in doorways. When we got back to the hotel we immediately
showered and washed our clothes and shoes. In April of 2016, a cholera outbreak occurred
during the rainy season of Zanzibar killing over 45 people and hospitalizing over 3,000
people. The clogged draining systems and poor hygiene lead to this outbreak according to
the WHO and the source was marked as the Forodhani Gardens only a few blocks from the
Tsaini Palace that we stayed. Experiencing first hand the flooding made the cholera
outbreak much more realistic and opened my eyes to how hard it would be to prevent such
an outbreak. You can’t see cholera but it is carried by water and the water was absolutely
everywhere not to mention anything that was hidden under the water can could have cut
the feet of those who took their shoes off allowing room for any bacteria in the water to
directly enter the body or the possibility of tetanus.

Field Note 4: May 20, 2017

The Christian Minority

While shopping in the small shops in Stonetown Zanzibar, I had a small

conversation with a merchant named Marko. The conversation of religion soon came up
and I found out he was Christian. Representing less than 5% of the Zanzibar population, I
asked what it was like and if it was peaceful or difficult to practice openly. He said that a
few years ago it was difficult and slightly scary. He gave the example of soldiers coming into
his shop and searching for food during Ramadan and having difficulty renting an apartment
because of his religion. He said that under the new president John Magufuli, who was
elected in 2015 and is a Christian, things have been peaceful between the religious groups
since. When I first was listening to Marko explain himself the fear seemed but miniscule,
however, after researching later, I found that in 2013 the priest to the St. Josephs Cathedral,
55 year-old Father Evarist Muchi, was shot to death when his car arrived at the entrance of
the cathedral. This cathedral just happened to be the cathedral I passed with the group
Jessica Brumbaugh BBH 390B
First Set of Field Notes

almost everyday as we walked to different parts of Stonetown. On Sunday morning we even

passed it and I saw each person being wanded with a metal detector and thought it was
strange but nothing really of it. I now can hypothesize that after their Priest was murdered
outside the church that precautions would be taken. This incident was not the only that
occurred in the few years prior to the new presidents election, including multiple other
assassinations and a few church burnings.

Field Note 5: May 24, 2017

Medical Tourists

The first round of rotations at the Muhimbili Hospital took my small group to the
oncology department. My two classmates and I were taken to the ward and introduced to a
physician that worked in the wing who was white skinned and had a European accent.
After telling her we were students and interested in shadowing someone and learning
about the ward she responded with a few questions of our length of stay. We said that our
rotations would be pretty quick, being only 2 or 3 days. She then responded with a few
statements about the shortness of the stay and how little we could be trained and that we
were essentially “medical tourists.” Eventually leaving us there after saying she had no time
for us. Rather surprised by her reaction and slightly flustered, the three of us left the wing
and eventually found our way to the inpatient schooling area for the rest of the day.
The title of medical tourist was a fear of mine while entering the fieldwork
experience and after reading many articles of other students falling into such a trap made
me worried that maybe it was actually occurring. The confrontation was in fact good to
have because it re-aligned my goals and inspiration for studying abroad in Tanzania with
the Global Heath Program and encourages analyzes of the actions taken thus far and the
future.
The reason I am in Tanzania is not to saves lives or even change anything at the
moment, but to observe, critic, analyze, learn. Unlike programs like Global Medical Brigades
that strive to bring healthcare to those in need of it, though highly unqualified to do even
the simplest things. My purpose in being here now is to learn and soak in as much
information as possible so that in the future, when I am a certified physician and working
with my patients domestic or abroad, I can understand better where they are coming from,
why they may be struggling with their medical issue, how to research deeper hypothesis.
This experience can bolster deeper passions for public health and policy for possible career
transitions into more public health oriented fields. The daily discussions and deeper
investigations into questions and theories set my team and I apart from being “medical
tourists.” I instead will have the information I need to change not only my future but also of
others.

Field Note 6: May 26, 2017

HIV Testing
Jessica Brumbaugh BBH 390B
First Set of Field Notes

My peer Vanessa and coordinator Alex and I were fortunate enough to be given an
informational session with Sister Ruth Selehe on the HIV testing and counseling that she
gave day to day in the clinic. She took us through each step in detailed process and then
reached a point where she asked if Vanessa or I had been tested. She was encouraging us to
be tested and Alex, though not encouraging us one way or the other, mentioned that
knowing our status was important. Stating that we should be tested if it were here or in the
States but it was our decision. Alex did mention that he was a certified CDC councilor and
could administer the test. With him and Ruth there I was confident in the safety of the
procedure and was actually excited to be tested. It was a unique learning opportunity. I am
comfortable and personally okay with sharing my status as negative for HIV.
Reflecting on the experience, a few unique points come to mind. The first being the
lack of privacy during the time that the test results were given. I was okay at the time with
my peer Vanessa being in the room but that was while I was under a strong belief that I
would be negative. This view may have changed if I had actually been positive and could
have been a regret afterwards. More importantly though was the fact that my peer Vanessa
was also tested in my presence and I was not aware of her comfortableness in having me be
there other than her lack of opposition to it.
Secondly, after recognizing the lack of confidentiality, I felt as if I should be upset if
many people new my status. As much as this is a right of mine to have confidentiality, I do
feel as if recognizing a, let us say theoretical positive result, would have perpetuated the
stigmas I had heard. There is a stigma that I should be concerned about revealing my
status. A director from the local Centre County had spoken to our class about the reality of
HIV/Aids in even our local community and the incorrect assumptions made about it. I
began to believe that my status would become more of a terrible secret that I would hold
verses a disease that I would have and therefore be something I should be upset with
others knowing. It brings to light the perpetuating stigmas that are not only held by
bystanders but the beholder themselves.
Thirdly, the steps taken after a theoretical positive result would include counseling
and registration. Thankfully Alex, has been trained as a counselor through the CDC and
would have been able to be there for me and walking me through different steps. For
registration, it is my understanding that I would need to be registered simply because I
took a test administered in Tanzania. However, if that would be communicated to the USA
or if it would be my right to retest or not to in the USA is unknown to me. I have inquired to
the AID.gov website email and am waiting a response.
In the end I am happy that I now know my status. If I could do it differently I would
have done it in the USA but I trusted the process and steps taken. After rotating in the
wards, I know that if I had been hospitalized for any other injury or disease I may have had
the opportunity to be tested and it would have been my right to take such a test. Especially
if it was something I was concerned about.

*I know that we have discussed this and if I had known that we should not have been tested
under the program, I would not have gone about it in this way.
Jessica Brumbaugh BBH 390B
First Set of Field Notes

Field Note 7: May 31, 2017

Lights Out

We were about half way through the urethra stricture single stage surgery, when
the power within the surgical room went out. There was a Senior doctor leading the
surgery with the help of the Senior Intern and Junior Intern, while the multiple
anesthesiologists and nurses squeezed past the 10 plus fourth year medical students and
four of us Penn State students in the room. The patient had received spinal anesthesia and
was awake during the surgery. The power had gone out a few times while I was at the
hostel and returned less than 2 minutes later, however, it had yet to occur in the hospital
until that point. When the power went out everyone in the room stopped moving and went
silent. The only sound was that of the monitor controlling the patients slow breathing.
Patiently waiting the minute or so for the power to come back, the surgeons had what
appeared as an unsurprised facial expression but slightly annoyed. The only machine that
continued to functions was the monitoring machine, which only occasionally worked being
the victim to glitching, while the cauterizing machine lay silent along with the fluids
vacuum.
The problem may have been a power surge or an outage, with backup generators
kicking in, but the 30-60 seconds the power was out felt like an eternity. The urethra
stricture surgery was not life threatening for a minute or so outage but open-heart surgery
or one more complex could have caused serious problems and complications. The calm
composure of the surgeons was encouraging to see. It was comforting to know that even
though there was an outage the monitoring machine continued to function and track the
patient’s vitals. However, extended outages could produce more serious problems for
patients especially those depending on machines to breath or pump their heart. Battery
powered machines could only last a certain period of time. I had known this was a realty
for many hospitals working in difficult settings but to be sitting in surgery and see the eyes
of a patient awake when the power goes out and twenty or so people highly skilled be able
to do nothing but wait was terrifying.

Field Note 8: June 10, 2017

Litter Bug

The small group of MUHAS nursing students and the three of us Penn States
students decided to take a small break from visiting the homes of the rural community
members of Mkoza to eat a snack. One of the nursing students was offered a small wrapped
granola bar but once they were done threw the wrapper on the ground. Quickly, my fellow
student Maddie picked up the wrapper and reminded the student of the importance of
putting trash in trashcans and not littering. The student laughed the situation away and we
moved on. The next day I was standing next to one of the community health members,
when they saw I had a wrapper in my side pocket of my backpack and motioned that I
should through it on the ground. I responded with a saying “No” and that I would wait for a
trash can. She said that it wasn’t a problem and tossed the wrapper on the ground. When I
picked it up shaking my head, she seemed very confused and asked “Why not?” I explained
Jessica Brumbaugh BBH 390B
First Set of Field Notes

that leaving the trash on the ground polluted the landscape and pointed to the near by plot
of land growing with maize and littered with large amounts of trash bags and wrappers.
What surprised me the most was not that leaving trash on the ground would be
common but that a nursing students from the urban city and focusing on health and a
community health worker, trained in public health, would be not only allowing it to happen
or doing it themselves but encouraging it. The reaction of laughter by the other nursing
students when the one was reminded of the importance of recycling made me believe that
they knew it was wrong but had done it anyway.
This is not the first time I have seen littering as a serious problem for developing
countries. I spent some time in a small town outside of Lima, Peru with a family restoration
center. One of the days I was there was a special community help day and all of the children
staying at the facility walked the few blocks around the campus picking up litter. The trash
in their town was much worse than what I have seen in the small rural Dodoma villages.
This may be because the diets in Lima contained a lot more packaged products were as the
Dodoma villages grow more of their own foods. Just the same though, thinking to recycle or
use trashcan was a difficult concept to practice.

Field Note 9: June 9, 2017

Connecting the Dots

Our small group in the Mkoze village had the opportunity to visit one of the local
primary schools and a secondary school. A surprising fact I learned about the schools was
their lack of facilities. This included their limited number of building space for the large
number of students but more surprising the few toilets that were available to the students.
For the secondary school there were 393 students and four toilets and for the primary
school 1028 students for only 8 toilets. That would be 98 children per toilet in the
secondary school and 129 students per toilet in the primary school. There is also no
running water source nor electricity for the primary or secondary schools. This provides
not only a lack of consumable water for the children but also no water source for flushing
the toilets or washing themselves. The schools explained that most often students will ask
neighboring homes or find local taps and pay them for a bucket of water for that day of
school. The students would rotate between the different standards to decide who would
bring water to school.
Nurses at the dispensary explained the process of going to the bathroom without
the western style toilets or toilet paper, emphasizing the importance of water to not only
help with cleaning a persons body during and after going but also for flushing the toilet.
The toilets of the schools were the style that had a trough sliding down to a hole. The nurse
explained that without washing the toilet before a person goes, the splashing of your own
waste can actually mix with that of the previous person and splash back on you. This causes
increased risk for UTIs (Urinary Track Infections). When asking the headmaster of the
primary school about common illnesses that affect her students, she explained that first
was malaria and second was UTIs. The sources of the UTI’s may have been from other
variables but having to share a toilet with at least 129 other students without proper
sanitation before, during, and after going could definitely be a plausible cause for such a
large number of cases.
Jessica Brumbaugh BBH 390B
First Set of Field Notes

Not only does the lack of water affect the health of the students but also starting
around the age of 12 years old girls begin to go through puberty. The primary school in
particular, includes children up to roughly the age of 14 years old. During the UNICEF
meeting, it was explained to us that unfortunately many girls do not go to school while they
have the period if there is no way or a very inconvenient way to clean properly themselves
or the type of cloth or padding to prevent excess bleeding. Thankfully there are split
bathrooms at each of the school but the lack of water located at the school could be a large
deterrent for many of the female students from attending or at least cause emotional stress.
Using water for the bathroom toilet is something that I have taken for granted and I
am looking forward to creating different interventions long term and short term to find
solutions applicable to the communities of Mkonze.

Field Note 10, June 9, 2017

Early Education

On the walls of the primary school teacher break room were posters expressing
initiatives for equal opportunity through gender. One handmade picture in particular had
two children running up steps hand in hand one male and the other female with the words,
“May our Gender not Divide.” The first thing that took my attention was the fact that the
poster along with many of the other posters, though usually not colored in but black and
white, were of white skinned children not black skinned, the opposite of the demographic
of the school. The reasons for this may be that the digital graphics copied were simply of
white children. Another could be that a foreign intervention, encouraging gender equality,
had provided materials only that of white children. I am curious of the affects that such
posters would have on the population of students and how receptive it was. I will make a
point however, that the school did have a female headmaster and actually more girls in the
school than boys.
The second point taken from the collection of posters was that of one focused on
female health. When asked about the programs within the primary school to help children
learn about reproductive health, the headmaster explained that there was general human
reproductive health lesson within the biology curriculum but that they also did other
lessons on female menstruation and pregnancy. When asked if males and females learned
about the health of both genders, she responded with “Yes.” This was very exciting to hear.
I personally believe that it is beneficial for children to learn about reproduction and safe
sex practices for both genders. In the United States I personally never had a health class
explaining the anatomy or proper sexual practices until I was 14 years old in 8th grade and
had already had my period for over three years and many of my friends sexually active. Not
to mention our school did not do coed health classes until high school. In the US, the
stigmas against female menstruation and how it is “gross” from especially the male gender
is poisonous. These stigmas branch across to other areas including breastfeeding. The
number of women openly breastfeeding in the general population of Tanzania is something
that cannot be counted because it is respected as natural and in most cases an affectionate
action for a child.
Jessica Brumbaugh BBH 390B
First Set of Field Notes

Field Note 12: June 11, 2017

Making Change in Healthcare

It was right after Sister Fidea Bimbo (Head Nurse) helped to deliver a healthy baby
girl when she explain to me that she followed her passion for nursing because of her own
personal struggle with breast cancer. That was the moment that she whipped out a plastic
boob explaining she had had a mastectomy two years prior to remove breast cancer. She
said that she had felt a bump and went to the doctors but was turned away not once but
twice before she demanded and scheduled herself a CT scan, which showed indeed tumors.
She then was able to find a doctor to help her with treatment. She was encouraged by her
other nursing colleagues to go to India for treatment as most people do with more serious
issues but Sister Fidea decided to stay in Tanzania for her surgery and chemotherapy
because her new doctor was trained in India herself. The cancer was successfully removed
from her left breast as far as she knows and has a second check up next week. She
explained that a friend of hers who lives in Georgia, USA sent her the plastic breast because
no such thing was available in Tanzania. This explained why the breast was caucasian
colored and not matching Sister Fidea’s skin color. Through it all and her experience
working in an American hospital for a few months, Sister Fidea intends on getting her
masters next year and then opening her own facility to specialize in women’s health, may it
be through pregnancy or breast cancer.
Sister Fidea knows where the health facilities could be in realms of sanitation and
machinery. She understands and has expressed her fear for her patients may they have a
complication in their pregnancy or delivery and the dispensaries inability to provide the
needed care. But yet she does what she can with what she has. She represents the constant
battle between not only the financial shortfalls but also skill war with the potential that
healthcare could be. The motivation that Sister Fidea shows in truly inspiring. She believes
that the financial shortage isn’t something she can change herself but she can affect the
knowledge she has and become the best nurse that she can be through more schooling.
Building her skills as a nurse also helps to prevent miss diagnoses like herself and her
struggles with breast cancer. The supply shortage, represented in Sister Fidea’s prosthetic
breast, is just the tip of the iceberg. There have been repeated times that I have seen people
with amputations, and no prosthetics. This observation may be just like Sister Fidea’s
situation where I simply didn’t notice the difference or could be representative of an
extreme shortage. This has many repercussions including reduced rehabilitation, quality of
life, and mental health. This was also seen when Alex took the initiative to make a
wheelchair for a young boy who what lived all of his life without any kind of structural
support.

Field Not 11: Jun 10, 2017

The Reality of Malaria
Jessica Brumbaugh BBH 390B
First Set of Field Notes

When I was shopping in Wal-Mart the morning before I left for Tanzania, I found it
humorous that the can of bug spray said it protected against malaria and Dengue Fever and
for once it was applicable. Malaria was a small fear of mine preparing for Tanzania because
of my history of being almost eaten alive by mosquitoes as a child, however, I could not
have been prepared for the “slap in the face” reality of malaria for the people of Tanzania.
The presence of mosquitoes was apparent as soon as I got to Dar es Salaam and saw them
flying around the room as I hid under my mosquito net. The more I spoke with locals
though it became clear that the prevalence of mosquitoes with malaria was much lower
considering the climate becoming dryer. But just two weeks into the fieldwork experience a
new friend of ours, Jacob, informed us that the reason he had been gone for a few days was
because he had contracted malaria. He said he knew he had acquired malaria once he
started having severe headaches, chills, and fatigue. That was the first time I had ever been
in contact with someone that had actually had malaria. A disease so foreign and distant was
suddenly right in front of me, representing the millions of people affected by malaria not
just in the world but in Sub-Sahara Africa.
The presence of malaria did not stop there. One week after the public health focused
program in the Mkonze village outside of Dodoma began, a new peer Hanifu requested
prayer after our soccer game because he feared he was coming down with malaria. I
remembered briefly the day before one of the other male nurses explaining that they didn’t
have mosquito nets but simply pulled their bed blankets over their heads. The local
dispensary and heads of the local primary and secondary schools also mentioned that
malaria was a key concern for the child population. I was able to shadow a nurse and first
hand meet someone who had lost three of her five children under the age of one to malaria.
The ability of each of the people I came in contact with to identify simple symptoms,
that if I had while in the states would have dismissed, was impressive. It is understandable
that they would more easily diagnose themselves but is a reality of the importance of
understanding the different kinds of diseases that affect a region of people. Especially as an
aspiring physician, understanding what a patient may be exposed to for proper diagnosis is
extremely important and different based on location. The importance of education for self-
diagnosis is also very important in such a prevalent and extremely dangerous disease and
appeared successful for the two cases I saw.

Field Note 12: June 12, 2017

Adjusting back

My rollercoaster of stress while on this fieldwork experience is actually a humorous

thing because the most stressed I would be so far started before I even took flight. I new I
was going to miss my next flight because of the delay on the runway and right then and
there I new I was going to have to start taking each problem as they came with a cool and
understanding attitude otherwise my eight hour flight ahead of me would be miserable.
There would be no reason in stressing out about things because eventually things would
get worked out (luggage being lost). This made the transition to “African Time” extremely
easy and almost comical when it drove my peers crazy. Adjusting to the differences in
Jessica Brumbaugh BBH 390B
First Set of Field Notes

amenities became just another day in the forest backpacking. Even the new foods became
comforting in comparison to my poor, bland diet at school. But coming home is going to be
different
First, I wont be going home, I will be going to Switzerland. This will include a whole
new culture, social expectations (Including family dynamics and expectations) greetings,
language, and new groups of people. My mother being there verses a large group of peers
my age and a close friend to confide in will alos shake things up. Second, after Switzerland I
will be starting back a work in State College and be driving back and forth from home. The
kind of inconsistence that drove me kind of crazy last summer, will come again.
“The Art of Coming Home” by Craig Storti provides insight and advice for allowing
me to adjust to my reentry to the United States. The first advice Storti gives is to write out
expectations of home and this note and my reflective paper later will hopefully do just that.
It will hopefully prepare me mentally for the dramatic shift that will occur on reentry. I had
a year of slow preparation through BBH 305 and BBH390A for initial culture shock so
hopefully I will be able to use Storti’s advice well.
I have had more experiences than many of my family members so I am used to the
jump they have for me to explain everything and my exhaustion not only of just speaking
put attempting to explain EVERYTHING. Storti encourages to take it slow to give
enthusiasm in smaller stories than attempting to explain it all and be patient with
questions. Also he encourages to acknowledge that life went on and exciting things may
have happened at home too and be intentional about asking about others as well.
Adjusting to the drop in what Storti refers to as “Celebrity status” is already
something I am anticipating being difficult. In a selfish way I enjoy being exotic and
different. I enjoy speaking Kgogo and creating instant joy across someone’s face. I enjoy
being viewed as beautiful just by a quick look or being in a van that instantly gets stairs and
waves as if we are in a parade. Something for me to help cope with this change while back
home is more of a personal reflective mechanism. Understanding that maybe my
“exoticness” will be less so may be true but my inner uniqueness and beauty still remains. I
am no less interesting or beautiful because I have returned home. Equally so my
perspective of others needs to reflect that as well. The peers around me and the friends I
meet for the first time back at school are no less intricate or unique as well. Maybe at a
surface level they are similar but just like the Iceburg Effect there are so many deeper
layers to a person.
I am nervous that my slow growth in Swahili will diminish but hopefully I can take
the Penn State Swahili class in the fall and maybe meet some people that have been to
Tanzania or Kenya and I can connect and bond with new peers over that common
connection. I also will take Storti’s advice and keep contact with my new nursing friends
and be able to transition our friendship from someone that is so close and personal to one
that is long distance.
My transition to Tanzania was a lot smoother than anticipated but I think the subtle
acceptance of the culture and embrace I initially gave it may make my reentry to the United
States harder than anticipated.