a vida continua

It's been several months since i last wrote. I think the last time i wrote i was in a particularly “blue” state feeling like i was losing the daily battle on many fronts.

Well life goes on. Here in Mozambique people often say “A luta continua” (The struggle continues) and life here (like everywhere) continues to throw curve balls but life is going on and

In June I had the opportunity to go to Uganda for an internaitonal meeting on HIV. Uganda is known as the “Pearl of Africa” and clearly earns its reputation with its rich music and culture, friendly people, and green lush landscape. The meeting also was a good opportunity to hear about what successes and challenges other countries are facing in scaling up the response to HIV. And now that i've been in this field for 4+ years now, it was also a good opportunity to catch up and network with friends and colleagues in other countries.

I am (finally) a bit more settled now. My worldly belongings arrived from Malawi in late June (more than a year after I had packed them away) but just in the last month, I have finally finished painting all the rooms, hanging pictures on the wall, and it finally feels like home. For the first time in a long time, i have my belongings from all the chapters of my life (Morocco, travels when i was living in the States, Malawi) all in the same place. Which is nice. And while I have a lovely home, it is the first time I have lived on my own and this remains something I am still trying to get used to.

One of the highlights of these past months has been the visit of my cousins from Indiana. I met Wayne, Joanne, Ellen and Dean first for a few days in a game park in South Africa, where we had fun tracking rhinos, Wayne discovered morning coffee tastes much better when you put alcohol in it, and we had lots of fun catching up with old stories, etc. And they then came and hung with me in Maputo for a couple of days where we hung around the house, explored the city, introduced them to Mozambican prawns and beer, and we even spent a day in a local community building houses through Habitat for Humanity, which i think was one of the most meaningful days for us all.

I do feel like I've settled in socially here. I have a good core group of friends, many of whom i see almost daily, and many of whom have become close confidants, colleagues, running mates, and mates on weekend adventures.

And work continues as well. I do feel like i am battling what I think I should be doing and want to do (e.g. Working with Ministry of Health and national systems) versus what I am required to do (in particular a lot of reporting for internal US Government use) but trying to find the balance, get what i need to done, and still have enough time left to do the fun (and important) stuff.
I'm working on a couple of projects right now that I both enjoy and feel are important, monitoring and evaluation systems for persons getting HIV tested, for pregnant mothers to prevent HIV transmission to newborn infants, and persons on HIV care and treatment. We are also trying to get a national study up and running among groups at higher risk for HIV (including sex workers, long-distance truck drivers) to better understand issues related to HIV for these specific populations as well as to learn how programs might be best tailored to be responsive and effective with these populations.

So life goes on day by day. I was back in Malawi this past week for a meeting but also was able to catch up with friends, who noted that I seem “calmer” and more at peace now than i did when things always seemed a bit frantic in Malawi. There are still days where lots of little things get me down (e.g. Someone decided to steal all the mirrors from my car yesterday when it was parked in the street.) And perhaps most importantly, each day I am trying to actively seek out the little things that make life beautiful, for example the two birds who have perched on my door right now and are keeping me company.

So life goes on, I'm learning how to live and breathe through the downs and discover the little gems in life that keep us going and moving forward.

In search of the silver lining

Life anywhere has its ups and downs and when people talk about moving to a different life (be it a new job, state, or country) there's often the initial honeymoon and then 6-9 months later, a “dip.”

The last couple of months have been a bit of “dip” for me.

There are not any major things but instead a stream of continuous stressors that has started to wear me down...my things STILL not yet shipped from Malawi...countless car problems including a breakdown in Joburg that grounded my car for a week followed by an accident one week later that has left my car still out of commission...a heavier workload than I would like which is leaving me tired for little beyond work...back problems and chronic headaches which have taken a cut into my running (and my mental health).

But it seems like the cloudy days of life have also forced me to see the glimpses of sunshine or silver lining that i might have otherwise missed. The kind gestures of people in my life here in Mozambique and back in the States that have helped to pick me up when I could no longer see the sunshine for the clouds...the Thelma and Louise adventure with my friend Dennis who made the 9 hour trek with me to Joburg by bus to collect my repaired car...my sister and parents who have stepped in and helped backstop me from the states when my house closing, tax time, and other “life” issues were all hitting at the same time...my colleague who drove me all one afternoon to get groceries and who let me camp out and borrow their internet connection when i was feeling otherwise alone and isolated (and without transportation.)

Last week I felt the accumlation of things was hitting a breaking point. This week things are better. I know there is still quite some time before I'm out of the whole and feeling more “settled” here. But at least I know I've got good company on this crazy adventure called life, be the days filled with clouds, there is usually still some silver lining to be found.

Postcards from Malawi

Lil Jo...Dinner at Chipi's...Chipi at 16

And lovely Lucy as a new loyal mom (7 puppies!)

Malawi: The Feeling of Familiarity

I went back to my former home in Malawi over Easter for a short holiday. It's the first time I have been back or seen many people since I left early last June.

When I lived in Malawi and happened to be travelling, I always knew I was going home when I got on the plane at Joburg airport and recognized several faces from the small community in Lilongwe aboard the plane. At first when I got on the plane this time, I looked around with anticipation, seeking out a familiar face which I did not find. But halfway through the flight, on my way to the bathroom, I recognized the face of my friend and former colleagues, Sam Phiri, director of the Lighthouse clinic that I had worked closely with in Malawi. I was going “home.”

Though some of the people and sights have changed somewhat since I left, it was also nice to be in a place so familiar.

My dear loyal dog, Lucy, who now stays with my friends Anne and Andreas, immediately recognized me when we drove in and gave me a big kiss on the cheek. Lucy is now the hardworking and loving mom of 7 puppies, now 2 months old, that she had with Ashanti, the dog of my friends Anne and Andreas. Lucy is still as gentle as ever, with kids, with the puppies, and still loved accompanying me on morning runs through the bush.

I spent a day or so at the Lighthouse clinic with whom I had worked and it was so nice walking into the morning staff meeting and seeing so many familiar faces and seeing the growth that has happened in the organization since I left. Malawi continues to be making positive steps in its response to HIV, with now more than 150,000 patients started on treatment. Many of the key public-health focused technical advisors who have been working with or at the Ministry are starting to transition out of Malawi so we will hopefully see Malawi continue in a similar path once these advisors leave.

I saw Chipi several times who is now nearing his 16th birthday. When he answered the phone, I at first didn't recognize his voice as it has changed considerably in the last year. He is now very much a teenager: during the first half hour I saw him, he answered every one of my questions in a mono syllabic answer, “yeah,” “Man” “Cool.” At dinner at his house one night however, the more familiar , younger theatrical side of Chipi emerged for a short while when he did a short theatrical performance for us. His health appears okay, he is still actively in care but at the same time still does appear quite skinny and continues to struggle with health issues.

I did not do much in Malawi, besides visiting with friends, sleeping, running with Lucy, but was refreshed by the many familiar sights and times: the lush green rolling hills as Malawi quickly approaches harvest time, Anne's homemade yogurt for breakfast, topped with passion fruit picked from the garden, beautiful African sunsets, the warm, gentle soul of Malawians that continues to touch my heart.

Homeless or Homeful?

One of the most difficult questions is where do you live? Or most specifically where is your home address?

Just this last weekend, I have (finally!) moved into the house assigned to me by CDC where I will be living the duration of my time in Mozambique. It's very good to finally be in a place that I can make my own. More on my new house below, back to my different “homes.”

So where is my home now? Or really where are my homes?

If you'd ask me where I've been living more recently, I'd answer that in my first 8 months in Mozambique, I have spent 3 months in 3 different hotels in Maputo and the remaining 5 months subletting a room in an apartment in the center of Maputo.

If you ask me where I'm from, or where my home in the States is, I'd say that my home base in the States continues to be my parents' place (thanks mom and dad) though I know they are happy to see all their garage space open up as I finally move some of my stuff out, some to Mozambique, others to more permanent storage.

If you ask the question from a legal or tax perspective, I'd answer Nevada. Since the length of my time overseas meant that I was no longer a State resident of California, I needed to find/declare a state tax home now that I am directly working for the US Government. So my official state tax home is in Baker Nevada (no state income taxes in Nevada) in care of some old Peace Corps friends.

And to complicate the question yet further, I have also been fortunate enough recently to take advantage of low interest rates and the plunge in the California housing market, and so have just closed on the purchase of my first house, a cute small 2 bed-room house in Rancho Santa Margarita, minutes away from my sister Julie's house. (My parents and sister and fabulous real estate agent, my “village”, deserve lots of credit deserve tremendous thanks for helping me to pull this off from a distant, from the initial screening of houses, the enormous volume of paperwork of offers, counter offers, and closing, the housing inspection, and preparation of the house to rent out.

Homeless or homefull? Yes to both. It's been a bit unsettling to have been “on the road” for the past 10 months since I left Malawi but am grateful for all the many places I can now call home.

P.S. On my new home: the wait for my new home in Maputo appears to have paid off, I'm just moving into a lovely house, just north of Maputo. The US Ggovernment typically finds houses that would be suitable for families, so in my case, I have a much bigger house than I “need” (3 BR, 4.5 bath, an office, lovely living space, a nice garden and even a pool.) I'm still waiting on the crate of my life belongings which will has been in Malawi the last 10 months but will hopefully be making its journey to its new home soon. Lots of work here still to make this “mine” (gardening, painting, etc) and hopefully can then further “fill” the house with guests and visitors to truly make it my home.

Turmoil and Healing in Maputo

I was out of town, doing site visits in the north of Mozambique, early last week when we first heard news that the prices of public transport in Maputo had risen, quickly setting off a wave of civil unrest in the capital. Within hours, Maputo quickly changed from the vibrant and peaceful city it usually is to one of confusion and chaos.

Despite pockets of economic growth in Maputo, Mozambique continues to be one of the poorest countries in the world, with nearly half the population living on less than a dollar a day. Salaries of civil servants remain unbearably low (e.g. A nurse at a health center makes approximately $80/month). The price of a ride on a “chapa”, the local type of mini-bus that constitutes the form of available form of public transportation for the vast majority of Mozambicans, is only 5 metacaix (approximately $0.20 US) each way, yet, given the level of poverty of many people, and the distances that many people have to travel from home to workplace, transportation is a major cost for many citizens. A recent study of union workers in Maputo estimated that workers spent approximately 35% of their monthly income on transporation.

So an increase in fares by 50% is a significant hit to people. Within hours, roadblocks were set up all over the city. Police responded with force and the people fought back. Many people were injured, a few even killed, in the process. My Portuguese tutor, Malate, was stuck in a road block for more than 12 hours and his car was damaged in the unrest.

Things have calmed down this week, the government is working with the transportation sector to identify a solution. They have set this weekend as a deadline.

Please keep Mozambique in your thoughts and prayers. The daily struggle of Mozambicans continues. People are speaking out in the way that they know how to. The government is trying to respond but there are no easy solutions.

As an American, we are protected from this, being kept safe within the confines of our community yet on some level, also feeling quite separated from teh lives and struggles of people here.

Please have hope for Mozambique and the struggles of this country.

Hot Springs and Rafting in Swaziland

Last weekend, a friend celebrated her 30th birthday and a whole crew (~30 people!) headed off to nearby Swaziland for a weekend.


The Swazi border is only an hour away, and Swaziland being a relatively small country, it's easy to reach the center in about 3 hours.


Swazi is a beautiful and hilly oasis away from the heat and city of Maputo. Most of the country is rural and the country is full of places to hike, mountain bike, and other outdoors activities. And it's very green and lush, in a very un-African way (some call it the Scotland of Africa.).


We spent Friday night at a natural hot springs, soaking in the pool (while having beer and pizza.) Saturday, we spent the day on the Great Usuthu River, white water rafting. I've been white water rafting before in West Virginia and Zambia but this was the first time I'd been in small boats (two person rubber rafts, necessary to navigate the narrow passageways through the reeds and sharp turns in the rapids.) The ride was beautiful, most of the water was calm in relatively shallow water, with some challenging (3 1/2-4 grade) rapids throughout, all set in a beautiful lush green valley. Children were playing in the water along the shoreline, women were doing laundry, and luckily we saw no crocodiles!

Becoming an "official" American

Now more than 5 months after arriving, I was ecstatic to learn this week that I will now be considered an “official” American here in Mozambique.

The ways people are hired and contracted through the US Government are incredibly complex and have included countless forms and paperwork, getting both a full medical and security clearance, taking a course (in Atlanta) on “Preparing to Work Overseas” (mostly security related), and countless emails, phone calls, etc almost on a daily basis. This has meant that while the paperwork was being processed, I was still under a temporary contract and not able to settle in here more fully.
My final clearance came through this week which means I should be transitioning over from my temporary contract to the direct CDC contract in the next couple of weeks.

Now as an “official” American in the eyes of the CDC and US Embassy here, I can finally...move into more permanent housing...all my things (which are still in storage in Malawi) can be shipped to Mozambique...I can purchase a car...and I can get a visa that no longer requires me to go to the border each month.

Needless to say this is some of the best news I've had and am happy that the end is in sight!

lessons for 2008

The end of 2007 was filled with friends visiting for Christmas, sun and sand-filled days at the beach near Tofo, several hours north of Maputo, and a string of parties and year end parties.

At the same time, in December, living, working, and playing in Mozambique felt like more “work” than it every has before. Continued problems with my contract (still on temporary contract), negotiating a morass of bureaucracy at work, related to borrowing a friend's car to travel of the holidays, etc have been slowly cracking away my eggshell of happiness here. Things which seem like they should be relatively simple and straightforward to take care of end up taking a lot of time and energy to address.

For example, when we were up near Tofo for Christmas, my friend Roger and I went into town on day to restock on food. This was intended to be a short, simple, and fun excursion.

We managed to sort out some things, finding a nice variety of fresh fruits and vegetables in the market. Fuel on the other hand was another matter. The town of Inhambane (the provincial capital) had run out of fuel due to the influx of tourists over the holidays. Roger and I drove to Tofo (half hour away) but they too were running out. I had less than quarter of a tank left so worried we would get stuck with no petrol (no AAA here so something generally to be avoided!) After trips to several ATMs (all the cash in Inhambane had run out as well), we did manage to fill up the tank and arrive safely back, but the day during our holiday left me feeling like i needed another vacation!

At the same time, we did some diving while in Tofo. Christmas morning was a particularly good dive. Diving in the ocean (as opposed to fresh water) one quickly notices the strong effect of the ebb and flow of the currents, which were particularly strong that morning. Every couple seconds, the tides would pull you 4-6 feet forward, 4-6 back. The immediate reaction is to fight the tides, to swim against the tides, we were often in small caves or underwater crevices with fragile coral as well as potentially dangerous marine life (e.g. scorpionfish) on both sides. One quickly finds however that the tides are much stronger than any of my kicking and that fighting the currents only made me tiring.

At the same time, at one point, I began to resist the fighting, just breathe and let myself go through the ebb and flow, giving a quick kick when the current was pushing my forward. When I did this, I realized I could stay in control, I would not bump into the coral or anything else, and I could swim through it all.

This lesson seems important for my life above water as well. Life in Mozambique continues to pose daily challenges but I'm trying to not fight it, take a deep breath, and perhaps give a good kick i feel the current is moving in my direction.

And both under and above the water, if I do learn to “go with the flow” as it were, the life will bring me some beautiful experiences and moments. One of the highlights from the diving was getting to snorkel on Christmas morning with two different whale sharks, a somewhat rare but beautiful graceful and awe-inspiring animals I've ever seen.

bringing in 2008, baixa style

Maputo literally closes down and goes to sleep over the holidays. The majority of expats and even Mozambicans often return home, visit families, or go otherwise on holiday during a 2-4 week period over the holidays, leaving Maputo literally a ghost town. Not only is the office empty, but many restaurants, theaters, clubs, (much of the social life of Maputo) disappears.

Given this, it seemed like I might be in for a quiet New Years. In all honesty, New Year's has never been one of my favorite holidays but I was determined to do something that would at least keep me up past 10! But friend Claire, literally one of the few friends still in Maputo, made a plan to enjoy New Year's together.

After making a stop at a warm and lively party at one of my colleague's house from Ministry of Health, Claire and I headed down to the Baixa, the old part of town down by the sea. Each year, the Cordoso Hotel, perched upon a cliff overlooking the Baixa, holds a fireworks display at midnight. Tickets for the big event at the hotel are quite expensive so the masses instead turn out on the streets in the Baixa just underneath the hotel.

Claire and I arrived about 11:40 and the scene was already wildly animated and frenetic. Cars lined both sides of the road and were wedged into the median strip. So many small fireworks were already being set up by spectators, we were not sure if midnight had already arrived or not. We had seen fireworks for sale all day on New Years along side of the road and let's just say that there are many fewer restrictions and safety precautions with fireworks in Mozambique than one would find in the US.

We climbed up on top of the roofrack of the Landrover that my friend had lent to me while he's back in the States, opened up a bottle of champagne, and took in all the energy. Around us hundreds if not thousands of Maputanese joined in the celebration. Many were Maputo's large Indian/south-east Asian community. Entire families were there, young children, teenagers, adults, grandparents, in a range of traditional dress from countries of origin that included the very conservative (hajib) to more provocative. Music was pumping out of the cars, people were dancing, and midnight buffets were being set up on the trunks of many cars. By midnight, the sky was alive with lights, sound and color in every direction. On one hand it was beautiful and energetic and so alive, while at the same time, when i closed my eyes, I could for the first time imagine what it must have been like to be in Maputo during the civil war, with the whizzing, screaming, and exploding bursts of sound coming from every direction.

Safety precautions around fireworks were minimal to non-existent. Young kids were setting off large fireworks in the middle of the street with lit cigarettes and lighters with cars driving by (or at times cars driving over lit fireworks.) We could see fireworks being set from the balconies of apartments up the hill. We were waiting for a firework to go off in someone's hand or for an explosion to go off in one of the nearby crowds. My friend Claire is a nurse who has worked in Africa for many years and in many intense situations (including Sudan, Burundi, and Congo) and so was half-prepared to respond to any health emergencies that happened (we had the ice coolers and towels from the champagne bottle.)

The fireworks on the street continued on well past the official show was finished. The families in the cars next to us offered us fried pastries and warm wishes at midnight. By 1, we started to head home, but the party would clearly continue for hours. Families were still sitting around tables outside celebrating, kids dancing, and couple lingered around together. Clearly 2008 was off to a good start in Mozambique.

Standard Setting in Nairobi, December 07

After a nice albeit brief personal and work visit in the States, I landed back in Africa for a meeting in Nairobi on Standards in Health Information sponsored by WHO and including a number of countries in Africa. I was joined by a number of colleagues from Mozambique, including the Ministry of Health, a public hospital in Maputo that is one of the first to implement an integrated electronic information system, and staff and students from one of the major universities in Mozambique who are working with the Ministry of Health on information systems.

Information systems in health care is an area where I have been increasingly working, first in Malawi, and now in Mozambique, as local governments and implementing organizations try to set up systems where patient information can be better documented thereby improving the quality of care as well as setting up systems to monitor what is happening at the local, regional, and national level (e.g. how many patients are accessing ARV therapy.)

The challenges to doing this--and especially doing this well--in Africa are great. Health care workers are in dire numbers (Malawi had about 1 doctor for every 100,000 persons and Mozambique has equally staggering rates, compared to about 1 doctor for every 300 patients in America.) Much of clinical care rests on health care workers who are less trained, in fewer numbers, and with fewer resources (e.g. anything from dependable electricity and running water to drugs). And many of the typical tools for such systems (sophisticated IT systems, communications infrastructure) are non-existant or non-reliable in Africa. Many computers hit the "computer graveyard" within their first year of deployment, "dying" from lack of virus protection, misuse, and the elements (dust, heat, moisture).

Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems. Perhaps the most noteworthy piece is the role of collaboration across developers.
Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems.

Perhaps the most noteworthy piece is the role of collaboration across developers. Whereas software and systems development is often a competitive process with developers fighting for dollars and recognition, the meetings was full of ideas and learning being shared across individuals and teams, projects and countries. Though the needs remain extraordinary, there are small glimmers of initial success of appropriate and feasible information systems being developed and implemented, all with the aim of improving health information for persons in Africa and other less resourced countries. Most importantly, a community is starting to grow that is actively dialoguing and sharing what's working and what's not is being shared.

In these crowds, I am always humbled by the expertise and knowledge of those around me.

Though I do not necessarily speak the same language of software, hardware, communications standards, etc, there are clearly many lessons that are learned.

That as much as we can, we should not be trying to reinvent the wheel every time.

That we should continue to find ways to foster collaboration and communication as collaboration results in a better, more applicable, more scalable product (i sat and watched a group of developers try and debug a system for a while, each offering ideas, input, and other constructive criticism on how to make it better).

That sometimes working 80% is good enough to get going and start trying it rather than waiting until things are perfect.

And finally when something is working, trying to standardize and share those products, ideas, etc, can ultimately help us all move forward.