Tuesday, January 25, 2011

Overheard in Monrovia

"Do we need to buy more ramen for the mice? I don't want them branching out and eating other stuff."

-- Nate, at our old flat

Me (in Uganda, to our friend's driver): Are we north or south of the Equator?
Driver (c.k.a. Mugabe): We are east.

To be continued...I've had a crazy week.

Monday, January 17, 2011

Adventures in Tropical Medicine: Giardia

Those of you who have been following the saga of our health here in Liberia will know that I've been diagnosed with malaria seven times and with typhoid four times in the last 20 months. This high incidence of deadly tropical disease seems exaggerated, even to me. Symptomatically, I've felt achy, tired, apathetic and, well...not very happy. But I haven't been ravaged by tropical fevers, left shattered and shaking in my bed by alternating feelings of hot and cold, and truth be told, when I get sick I actually gain weight despite eating almost nothing--figure that one out. Suffice to say that at the beginning of my holiday, the only thing I wanted was medical certainty. What the hell was going on?

In times like these, I fall back on my East African heritage and think of one word: Saio.

Saio is a doctor at Nairobi Hospital, where he's been practicing tropical medicine for decades. He has his own dedicated lab, understands if you only have a few hours to spend in his office, and will make it his mission to figure out what's bothering you without wasting your time. The first thing I did when I knew we were passing through Nairobi was make an appointment.

Now, because Saio is an internationally-respected tropical medicine specialist and people come to see him from across Africa, I'm just going to write what he said. If you live in Liberia, or were just wondering what the hell was going on with all the "malaria," here's what's up:

• If you are taking malarone, it is virtually impossible to get malaria.

• The labs in Liberia, at least the ones we've been going to, breezily hand out false positive diagnoses because a) on the off chance that you do have malaria and they can't see it, they don't want to kill an expat and b) they may not know exactly what they're doing.

That was all very reassuring, as were the absence of malaria or salmonella (the genus that includes typhoid) antibodies in our systems. This means that neither of us has had either tropical fever for the last four months or so, and maybe even longer. Since I've never been full-blown symptomatic for malaria and was just getting tested because I had a little fever or felt like crap, I'm not sure I've ever had it. But anyway, it gets better.

What we did have, Saio told us, was giardia. Lots of lots of the little buggers, one of which you can see above. Doesn't it look like it's smiling? Those aren't eyes, those are suction cups. Giaridia bacteria live in the first meter of your intestinal tract, which is where you absorb most of your essential nutrients. No wonder we've been feeling so tired.

It gets more interesting: giardia is easy to find in stool tests if it's in it's active, just-infected stage, but once it goes chronic after a week or so, only the old and dead bacteria are excreted. After passing through the full length of the intestines, there's not much left for a test to find, so while my active giardia was easily picked up in a lab test, Nate's chronic giardia came up test negative. What to do? Well, if you're Saio, you invent your own test--a giardia DNA probe that tests blood, for which Nate scored a resounding positive. After 18 months of exhaustion, random fevers and general physical malaise, problem solved--all symptoms of chronic giardia, which doesn't even have to give you the shits.

Saio also pioneered a new treatment, as present-day giardia is resistant to flagyl. For two days, at 6 pm, you take two 400 mg tablets of Zentel, which prompts the bacteria's suction cups to loose their adhesive powers. Then, before you go to sleep, you kill the fuckers with four 500 mg tablets of Fasigyn. Two nights of this, when you absolutely must not drink alcohol, and you're all clear--until you get re-infected.
Giardia is one of the most common intestinal populations you can have and it's everywhere, but particularly in areas where there is poor--try non-existent--sanitation. According to Saio's lecture, which came complete with photocopied handouts and articles to read up on, giardia can live for weeks and even months in open pit latrines or anywhere there's shit on the ground. All it takes is for a fly to land on that shit and then on your food, and you're infected. Of course, the common transmission routes of poorly-washed hands is also a major culprit.

Suffice to say, we're pretty sure we'll need to take this treatment every so often. But at least it's not malaria.

Tuesday, January 11, 2011

Adventures in African Cooking: Pandora's Palm Butter

I am blessed with a wide and varied circle of wonderful friends, many of whom "happen" to be magical in the kitchen. Pandora is one of those people, and one Saturday morning, I invited her to the Tides kitchen to come and cook a Liberian specialty: palm butter.

You should know two things about Pandora. One, she is a powerhouse of positive energy. Two, the woman can cook. Her palm butter soup with fufu is Liberian comfort food at its best. She has her own Monrovia-based catering business, Pandora's Basket, and I highly recommend checking it out.

Most recipes for palm butter soup assume you're cooking in the west and can buy canned palm butter at an African foods specialty store. Here's how to make it...

How to Make Liberian Palm Butter

1. Buy bright, sunburst-colored palm nuts fresh from the market. They should be colorful and firm, without bruised or blemished skin. You'll want at least 4 cups to make approximately the same volume of palm butter for soup.

2. Rinse the palm nuts, cover them with plenty of water and set them on a low simmer uncovered. Boil them gently for about 20 to 30 minutes, or until the flesh around the kernel is very soft when you stick a fork in it.

3. Drain the water and let them cool just a little.

4. Buy, borrow or make yourself an extremely large mortar and pestle. The ones here in West Africa can hold about four liters and the pestle is a long wooden pole large enough to look like you could use if for scaffolding. If you don't have your own massive one, you can easily make do with a large plastic bucket or bowl and the bottom of a wine bottle. At Tides, we have our own but it still needs to be "cured" by placing it in a dying fire to seal up the wood, or so I'm told. We usually go downstairs to Johennsen Street and ask one of our neighbors to borrow one, then make sure to return it the next day.

5. Place your mortar and pestle in a clean spot on the floor, placing it on a towel so that it doesn't slip or skid. Then add some of the boiled palm kernels, by this time slightly cooled, and start mashing in regular, rhythmic motion. Your goal is to separate the fruit around the palm nut from the harder palm kernel--what palm oil is made from. Do this in batches until you've

6. Palm butter is made from the soaked liquid of the nut's fruit, so the next step is to soak the mashed up palm nuts in hot water to help extract the butter. We're going to strain this mixture, but first we want to get all the goodness out. Put all your mashed palm kernels in a large metal bowl (or several, if you're working in bulk). Pour enough hot water over it to cover generously, and stir gently to encourage the palm nuts to give up all their juice. Once the water is tepid enough to put your hands in, work the palm kernel fibers between your fingers, rubbing gently. Once you're coaxed all the nectar from your palm kernels, strain the mixture and send the palm fibers to the compost heap.

7. Congratulations! The thick amber liquid you're left with is palm butter and perfect for that palm butter soup recipe you've been wanting to try... Enjoy!

Monday, January 3, 2011

The Mama Liberia photo shoot

Thanks to the generosity of the U.S. Ambassador's Self-Help Fund, the Women's Sewing Co-op has funding for a website which we plan to launch in early 2011. As part of the marketing effort, we enlisted the help of a brilliantly talented photographer friend. The Co-op photos she took last year helped launch the group's international sales, and I'm thrilled she was able to work with us again.

Here are some teasers from the shoot. As you can see, the women enjoyed themselves.