My job in Zanzibar

I have gotten a lot of questions about my job in Zanzibar, and, for the longest time the only answer I could offer was, "I dunno." I knew my job had to do with malaria. And I would have to have good writing skills to do my job well. Both are true. Thankfully, there is a lot more to it. Here was the latest description I offered to a friend (admittedly, with a broader audience in mind since I figured I would actually post this answer):

Background:

• Malaria has nearly been eliminated in Zanzibar (reaching historically low prevalences).
• Pregnant woman, especially during their first two pregnancies, are particularly susceptible to malaria sequestering in the placenta.
• Blood tests of peripheral parasitemia (peripheral = in the blood circulating around the whole body, parasitemia = the parasites that cause malaria) do not reveal the presence of placental parasitemia, but peripheral blood tests are the only ones that are systematically done to monitor malaria rates in Zanzibar and elsewhere.
• In areas of stable, high rates of malaria transmission (which it what Zanzibar was a few years ago), it is recommended by the WHO that all women receive a particular chemoprophylactic (chemo- = chemical, prophylactic = preventative) regimen called IPTp = Intermittent Preventive Treatment in pregnancy using a combination drug called SP = sulphadoxine-pyrimethamine. One dose of SP is given once after quickening, and then a second dose a month after the first dose; a third dose is recommended for HIV-positive mothers (of which there are relatively few in Zanzibar). However, no recommendations have been set for areas with historically high transmission rates but where those rates have been significantly reduced.

Our study:

• After pregnant women who have NOT received even one dose of SP as a part of IPTp give birth, but before the placenta is discarded by the medical staff, we will take a small blood sample from the placenta and check for parasitemia. This will help us judge the prevalence of placental parasitemia among women who do not receive IPTp, and therefore help us judge what the prevalence would be in the population if IPTp were not recommended for all pregnant women.
• We will try to use this data along with a cost-benefit analysis to inform a decision as to whether IPTp should be continued as a general prophylactic method to keep malaria rates down.

My job:

• Design the study (there was already a basic design in place; I am fiddling with details, doing sample size calculations, etc)
• Get ethical clearance
• Design data collection tools
• That kind of stuff.

And, thus far, I love my job.

Oceans & Zanzibari Men

This is one of the common beach scenes here in Zanzibar - made for cameras.
What I find funny/sad is this:

Just about the same scene, but now with a child playing happily in the water by a sewage pipe. It is the bump of cement tiles behind the girl that marks the pipe. There is no political statement I am trying to make; just the observation that I edited the sewage bit out without even thinking about it.

On another note, at this precise moment, I find Zanzibar to be socially exhausting. I smile too much in a culture of demure women and, I guess, cheerless foreigners. People follow me to talk with me, and openly cite my smile as the reason. Case in point, a guy on his bike changed directions to follow me to this beach, engaging me in useless conversation, and is now apparently waiting silently nearby for me to finish what I am doing. I did nothing except have a happy thought in his general vicinity to earn this attention. This one isn't even a salesman. Other times that I am overwhelmed by this culture is when everyone who sees me offers and expects a minimum of two greetings. That is actually every minute on the street, but sometimes it strikes me more acutely. In a whole other category of socially wearing interactions, I have managed to earn myself three thoroughly unwelcome and anti-elicited marriage proposals/ expressions of nuptial intent. It makes me miss China's unapologetic, quiet stares, not to mention the taboos that made me, as an absurdly tall woman, completely undatable. But I do love the lime-soaked corn on the cob and fresh coconuts here, and the learning process is fun for the most part. As I started writing about this whole topic, my mind was unhappily focused on things that really don't dominate my mind most of the time. Most of the time I am enjoying myself so thoroughly that the exuberance in my smile has the opportunity to get me into trouble.

Most useful phrase of the day: hapana, bwana.

= no, mister.