Saturday, December 24, 2005

Edu-Tourism 2006 Information session

To all Temple students and Philadelphians who love Jamaica and want to make a difference ... Get involved in a new student group that will be fundraising and traveling together to Kingston and the eastern parish of St. Thomas, Jamaica this coming late May to mid-June, 2006. We will work hard, do good and have fun. Enroll and earn six Temple University credits.

The time to start preparing for the trip is now! Our next information will be held on Monday, February 13 in the centrally-located seminar room 301 GLADFELTER HALL (6:00 to 7:00 pm information session; 7:00 to 8:00 pm fundraising and planning meeting). Food and drink will be provided.

As you prepare for this meeting, pertinent information can be found at our Temple University Edu-Tourism website.
And keep up to date on planning of the summer trip by joining The Edu-Tourism Jamaica Meetup Group, – contact Mike Dorn for more information.
Thanks as always for your interest and support. MD

Sunday, November 20, 2005

gosiame (goodbye) to Gabs

November 20, 2005
Dear Friends & Family:

My time in Botswana is coming to a close soon. The past 2 weeks have been busy, with busy weeks in the hospital and weekends exploring the wildlife and landscapes of Botswana and nearby.

Work at the hospital continues to be intense, with many sick patients, deaths of some of our patients (many younger than us—young doctors in our 20s and 30s hate to see patients die younger than us—but then doesn’t everyone?), but also with some nice saves. One woman I had feared would just get worse sat up on Tuesday and said, “I’m going home.” Only then did I appreciate how much better she was—from “death’s door” as it were—and we sent her home the next day. The wards demonstrate a phenomenon gone from American hospitals with their single and double rooms—patients helping each other. We had a 13 year old girl for 2 weeks, and she and the older women around her formed very sweet relationships, helping to get water, and just encouraging each others’ recovery.

I have been amusing my patients with Setswana, a little more each week. While a very kind young Motswana tutored me before my departure, I have struggled with how much to try to communicate in Setswana (the first language of most of my patients), or English (the official language of the country, which is familiar to most Batswana under 30, but quite variable in those who are older because schools were not universally available before the 1970s). I can say hello (dumela), please (ke kopa gore), thank you (ke a leboga), and basic greetings, and I have some medical vocabulary (madi for blood, mathata for problem, botlhoko for pain), but with only a few lessons and perhaps 20 hours to study, once I ask the question, what will I do with the answer? I think the main purpose of my attempts at Setswana is to express my respect for Botswana’s people and culture, and to offer an opening for them to share the ultimately personal and frightening symptoms that have brought them to medical care.

Last weekend I went with one of the others to Chobe National Park and Victoria Falls at the border of Zambia and Zimbabwe. Vic Falls is beautiful, but sad to see. The mighty Zambezie river which rushes over the rocks in Zambia to land in the gorge below is very dry, with a few small falls where a massive 1.7 km wall of water is meant to be. It is beautiful nonetheless, but one feels for the people and animals dependent on all that missing water.

The Chobe river in northern Botswana serves massive herds of elephants, hippos, antelope, and buffalo, and we got to see them in their natural glory.

This weekend I went to the edge of the Okavango Delta, where three of us stayed with a lovely Zimbabwean family who have worked in tourism all over Africa. They were extraordinary guides, and shared with us their local contingents of hippos, elephants, zebras, lions, giraffes, and a leopard with her little cub. Just breathtaking—you’ll have to see the pictures.

In a few days I return home. I have learned so many of the timeless lessons we all learn from travel. What is special about home, what is peculiar about home, and a tiny little bit about what it might be like to live another’s life…more on all this later.


Wednesday, November 09, 2005

Touring Southern Africa

This weekend Carla will be traveling north to visit the famed Chobe Wildlife Reserve. A region rich in the famed flora and fauna of Africa. We all look forward to her report upon her return!

One of the greatest natural wonders in Africa, the Falls of the Zambezi River, 5,400 feet wide, 320 feet deep. Named Victoria Falls after the English queen, by the explorer David Livingstone. The falls are not nearly this wet currently, as a result of 4 years of drought in the region. This stretch of the Zambezi River flows between the countries of Zambia and Zimbabwe.

Sunday, November 06, 2005

With another week gone, and a little more seasoned, medicine in Botswana is both more familiar and more extraordinary

November 6, 2005
Dear Friends and Family:

With another week gone, and a little more seasoned, medicine in Botswana is both more familiar and more extraordinary. The average age of my patients is mid-30s, with a few middle aged diabetics and elderly heart patients, and many young people admitted with HIV, meningitis, wasting syndrome, and coughs suspicious for TB, and often all of these. It’s not uncommon that I look at a patient, and only after looking at the chart do I appreciate how disease has aged them 10 or 20 years.

On the one hand, we don’t have all the tests we are used to back home (notably the CT scanner is broken and there are no MRIs; and the young patient we have with a bleed in her brain has to go to South Africa for further investigation since there is no place in the country to get an angiogram). On the other hand, we are finding we don’t need all of these tools for everyday diagnosis and treatment. Blood tests, ultrasounds, and other procedures we might otherwise do at home are passed in favor of empiric treatment for the most likely condition. Some of those tests really are redundant, and others simply confirm a suspicion. Sometimes we use them to decide between a number of different possibilities, but as often we are relatively certain before ordering the test.

One friend, John, before he left said that working here has made him more impressed with the amazing possibilities of trauma surgery, intensive care medicine, and the "good saves" of people with serious injuries and illnesses who we can return to normal lives. John also said his time here has also highlighted the ways that in the U.S. we sometimes lavish painful and expensive treatments on people who are obviously dying, and miss the opportunity to help patients and families come to terms with their deaths. I couldn’t agree more with both of John’s observations.

This practical approach to resource allocation is born of scarcity, but the fact that I can use my time and the hospital’s money doing what is possible instead of chasing rescue fantasies is reassuring. Our new medical student has observed that we don’t call "codes", as we do in the United States. Any patient not on hospice found pulseless in an American hospital will be subjected to a ritual of epinephrine, electric shocks, and chest compressions.

This is rarely helpful. In fact, outside of trauma situations in which a young person is bleeding and cardiac events in which a heart attack leads to a "shockable rhythm", patients who lose their pulse are usually quickly pronounced dead, subjected to another few days to weeks of intensive care only later to succumb, or are maintained in a "persistent vegetative state." This is not to say that we should not "do everything" for people with severe disabilities, but sometimes we prolong suffering without hope of improvement instead of prolonging meaningful life. Unlike at home, those with end-stage diseases are allowed to pass quietly.

There are frustrations: medications that would be useful, or even life-saving, which we are supposed to have, are mysteriously not in stock. Last week the laboratory computer system was down for 2 days, and lab results that take 1-2 hours at home, which can sometimes be had the same day at Marina, were held up in the queue. Supplies appear to back up at every level, with materials available from vendors, but not purchased; materials in the Ministry of Health’s central supplies, but not available at the flagship hospital, and items such as hand soap plentiful in the hospital stores but unavailable on the male medical ward…

On the weekend, we went away as we so often do, this time to the Khama Rhino Sanctuary in the center of the country, where we saw a few of Botswana’s remaining Rhinos (largely hunted to extinction for trophies and Chinese medicines), antelope of various kinds, wildebeests, hartebeests, zebras, and the "wild" painted dogs who are endangered.

Next week on to Victoria Falls and the Chobe Wildlife Reserve, where the largest groups of elephants and hippos in Botswana are to be found.

Sunday, October 30, 2005

It has been 10 days since I arrived in Africa

Dear Friends: It has been 10 days since I arrived in Africa. I left Philadelphia at 5:40 am for Atlanta, and waited 3 hours there for the next flight. The flight from Atlanta to Johannesburg, South Africa is the longest I have ever been on, 18 hours including an hour refueling in the Canary Islands. Then after another 3 hours in Johannesburg, it was an hour on a prop plane to Sir Seretse Khama International Airport in Gabarone, an unimposing one-story brick building with one gate.

I was picked up from the airport by Gill, a white Motswana (singular for Batswana, the name for the people of Botswana) who has lived most of her life here, with brief stays in the UK for training in her youth. She and one of the other residents brought me to the ICC flats, a gated community where Penn has rented two apartments for the rotating physicians and medical students who come to work at Princess Marina Hospital. The flats are largely expatriates, and when I asked about identification, I was told that the guards would know I lived there because I was white. "There aren't many of us here," explained the other doctor.

Marina is the largest hospital in the country, serving as a referral hospital for specialized services, and for opinions from specialists not available at the regional and local facilities. Nyangabgwe Hospital in Francistown (about 8 hours by car to the north) serves as the referral hospital for the northern part of the country. Many special services, including CT scans, and consultants such as oncologists, are only available at Marina or Nyangabgwe, and some such as neurosurgery, are only available at one of them. If patients need cardiac surgery (such as valve replacement for rheumatic heart disease), angiography, or other high-technology procedures, and they are citizens of Botswana, they are sent to private hospitals in neighboring South Africa and the government pays the bills. In practice, some referrals to Marina are for end-stage patients for 'further management,' and in my experience these patients are already dying on arrival, or for services such as blood transfusion or oxygen therapy, which are supposed to be available at all hospitals, but are often not because of short supplies. (In fact, last week Marina ran out of B-type blood for 2 days, and the previous week ran out of oxygen.)

All nurses are Batswana, but all doctors are foreigners or foreign-trained. Botswana has just opened its first medical school and now has students in the third year. For 40 years since independence in 1966, they have sent their bright young people to the US, the UK, the Netherlands, South Africa and elsewhere for medical education, but many do not return because of better conditions and higher pay where they train. Of the 500 would-be doctors sent abroad in the past 30 years or so, only about 100 have returned. And since only citizens can hold jobs in the Ministry of Health, many of the Motswana doctors are there, with others in private practice. Since patients are most likely to speak English if they are under 30, we often need translation from Setswana, either from a nurse or a Motswana doctor (in the male ward where they often have neither, it is sometimes the patient in the next bed). I have been taking lessons, and have only a minimal knowledge - I can ask if they are better, if it hurts here (pointing), and would they breathe deeply. More complex questions require translation, no so much because I can't ask the questions, but because I can't understand the answers. I quickly realized that when talking to a family who speaks only Setswana about a death, my job is simply to look sorry and ask the nurse if they have any questions. Delivering the news becomes her task, as my Setswana is simply not up to such a delicate task.

Princess Marina reminds me of many places I have seen or read about. First, it is a massive complex in the center of the capital, perhaps 20 buildings, perhaps more. The heart of the hospital complex is built on the pavilion style made so popular in the late nineteenth and early twentieth centuries by the work of Florence Nightengale. The separate single story ward buildings with open walkways between, which allow for maximum ventilation without any mechanical systems, which many of my colleagues assume to be eithepeculiaritycuiliarity or a colonial hold-over was actually the highest technology in tuberculosis prevention a century ago, and surely still serves this function at Marina, where conservatively a third to half of admissions to medicine have 'rule out TB' as at least one of their problems. We are very crowded in the medicine wards at Marina, with a female ward designed for 30 patients in five bays with 6 beds each bay frequently housing 10 patients on beds, 2 on mattresses on the floor, and one around the corner in the hallway. On Tuesday when my team was admitting, they just kept pushing the stretchers in despite the fact that there was no place for them to go. I think we must have peaked at about 75, and one could barely walk out of the ward around the traffic jam of sick patients.

Marina also reminds me of the nineteenth century hospitals of Paris and other major cities, including those in the US. But as a grand complex with open wards, and very sick and often dying patients, it is more like the charitable facilities that were run in the nineteenth century, where patients went only if they had nowhere else to go, and in which they expected care but cure was usually beyond them. Eighty-five percent of the patients admitted to Marina are HIV positive, with many admitted to medicine for end stage HIV/AIDS, cryptococcal meningitis, tuberculosis of the lungs, joints, and many other parts of the body. The population as a whole is more like 40 percent HIV positive, with a skew toward the young and working-age population (about 55-60% between 18 and 49). These are the highest documented rates in the world, but interested observers believe that the rate is actually similar in neighboring South Africa, Zimbabwae, and other nations, and that Zimbabwae is too chaotic to survey, and South Africa too deep in denial. "This virus is tearing us apart," said one of the administrators at Marina to me. The President and the country's leadership realize that they have to fight HIV.

At the same time, Marina sometimes has late twentieth century technology, including ultrasound, echocardiography, a CT scanner, lab testing, and medicines from penicillin to streptokinase (a clot-buster used to stop heart attacks in progress. Then again, there is no ciprofloxacin in the country, and my first week we ran out of most of the different kinds of IV fluids. The tuberculosis patients cough on each other, and on the staff (the nurses wear surgical masks, but apparently no one has told them they are useless for TB - the thicker kind that would offer some protection would be stifling in the un-air conditioned wards and 90+ degree heat).

There are some peculiarities to the use of invasive medical technologies in these conditions. I have long wondered whether hospitals that re-use needles are doing more harm or more good compared to nothing, traditional medicine, or simply refusing to use technologies that cannot be safely administered (then again, I wonder myself about use in any setting of dangerous drugs, especially many chemotherapies, transfusing blood products which could always be tainted, and many of the surgeries or CT scans we do routinely at home with risks of death, organ failure, infection, etc.).

But these academic doubts come to little when I look in the sunken eyes of a woman dying of overwhelming infection, and I will place an IV, administer drugs and oxygen, and tell her family that we are doing what we can. I had such a lady last week, and when I talked with her relatives, her brother said that he wondered if there could be more done with more resources. I looked him in the eye and said that I come from America, and with all of our machines, and medicines, there was nothing we would have done for her there that was not being done. I think that was a comfort - I hope so. I cannot always say that, but when asked, if it is true, I am glad to do so. She died that night.

I saw another patient that day, a lady whose liver had been replaced by cancer, and who was therefore in complete liver failure. When she got worse, I considered giving her a blood transfusion or a transfusion of blood plasma (to replace the clotting factors her body could no longer make). I knew this lady was going to die no matter what we did, and thought perhaps we could delay this by a few days, but no more. At home, we would have tried unless her family declined the care. Here I hesitated. As I told the Motswana physician with whom I work, I would have felt terribly guilty if someone came in later that day after a motor car accident, and died of bleeding because I had used that FFP on a lady who was going to die anyway. He agreed, and we did not give the plasma. She died about 15 minutes later.

While these resources are limited at home as well, they are not so constrained as to offer such direct consequences - usually at home it is about money, and neither patients nor physicians consider that a major factor in treatment decisions at the time of lifesaving treatments. I know we should sometimes be more realistic, and often push both families and the senior physicians to accept the inevitable, but it's a fine balance between accepting what you cannot change and giving up too early on someone who might make it (then again, these issues usually arise at home in patients who have cancer and are known to be terminal, and the argument is about how soon ...

Finally, the level of sickness, the frail, thin, wasted patients remind me of both so many famine relief campaigns and of the early AIDS epidemic in New York. In the mid-1980s, up to 30-50 percent of admissions to medicine beds at hospitals (distinct from surgery, OB/Gyn, and pediatrics beds) were for HIV related conditions. Here it is more. And the people who come in with TB and late-stage HIV can have sunken eyes, flat or sunken bellies, and arms as thin as 2 inches in diameter - if that. Some will recover, many will not. But Dr. Gluckman, one of our senior physicians, says no one should die without at least trying drugs for TB (and HIV if reasonable). After starting an ambitious national HIV treatment plan 2 years ago with assistance from the Gates Foundation and Merck, Princess Marina Hospital has the largest HIV clinic in the world in terms of people under outpatient HIV treatment. They have a multi-million dollar pediatric HIV project in partnership with Baylor University, and a major AIDS research complex associated with Harvard. On the one hand, we are all trying to help, but then again I feel a bit like a voyeur watching a train wreck (an image of vultures also comes to mind) but if I were not here, who would see that Sylvia got her amphotericin every day ...

All this is against a background of a dry but beautiful country, a small provincial capital city, friendly people (though as a white person in a majority black country, sometimes I feel like I am the animal they are looking at on Safari). Last weekend I took some time to recover from the jet lag. This week I ventured to the Main Mall downtown, which with its hand-painted signs, chaotic traffic and layout, street vendors, and yet high-tech services such as cell phones reminded me most of all of small and medium-sized cities in Mexico.

This weekend I, two other residents, and a medical student went to the Kalahari (Kgalgadi in Setswana (the English spelled it wrong again) to see wildlife and scenery. It was hot but not as bad as Gabs had been last week. We saw giraffes, antelope of various kinds (Gemsbok and Springbok in Setswana), vultures and other birds, and a few badgers. While lions have been seen in the Kgalgadi, this is the third year of drought, and there have been many areas burned either spontaneously or as fire breaks, so many of the animals have departed for better grazing elsewhere. Finally, we took a walk with a member of the San, who showed us how to make fire with two sticks, a small stone, and some dry grass, explained how they used the snakes, spiders, and worms to poison their arrow tips, and how they get water from the tubers in the ground.

Now back in Gabs for another week at Marina. I think on balance that the patients I see each day are better off that we are there, though the locals are working hard to teach us about the diseases they see most often, and how to treat many things without all the expensive tests we are used to.

More soon.

All my love,


p.s. Elise, it was in the 90s Farenheidt all week last week, and in the 80s this week, and no the Penn flats don't have AC. The hospital doesn't have AC, but also doesn't have chairs, more than 1 computer per ward, etc.

Sunday, October 23, 2005

first days in Botswana

Dear Mike: Gabarone reminds me of Leon, Mexico and other third-world cities I have seen. The expat cocoon here is quite dense: living in a gated community, restaurants that are predominantly white and foreign clientele, and a language barrier that is profound (despite an official language of English) between us and the elderly and poor because of availability of schooling in the past and present school fees.

The hospital is as expected, and reminds me quite a bit of what I have read about nineteenth- and early-twentieth century wards (11 patients to a cubicle, with the extra mattresses on the floor) and pavilion architecture (which I explained to a colleague yesterday was not about inefficiency but about TB prevention). The suffering of the people is certainly great, and borne with a dignity (resignation?) that is at once admirable and sad. I think I can be useful here, and have much to learn (and teach my colleagues gently).

The country is very warm and dry, as expected. The plant life are all desert species. We spent the weekend swimming, hiking, and at a fascinating party. The Motswana man who tried to pick up me and the medical student I was with (I had heard about this feature of African men...) acted physically wounded when he saw my wedding ring, and wanted to know why my husband let me come to Africa without him ...

But the Ugandans and Batswana I have met are also eager to dispel the myths they see in the international news, that "we are not animals." Carla

Thursday, October 20, 2005

safe in Botswana

Dear Friends: I have arrived safely in Gabarone, Botswana after a
cumulative 21 hours in the air and 6 hours at various airports. It is warm
and inviting here, and will be even more so after I have had a nap.

More soon ... Love, Carla

Tuesday, October 18, 2005

Heading to Botswana

Hi! I'm Carla Keirns, Mike Dorn's wife.
Tomorrow I leave for Gabarone, Botswana, where I will spend the next 5 weeks working in a hospital there.
For those who don't know it, Botswana is a country of about 2 million people in Southern Africa just north of South Africa and west of Zimbabwae. Its other bordering nations are Namibia and Gambia. The country of Botswana is predominantly Kalahari desert in the west, so most of the people live along the eastern edge of the country where there is enough water to live and raise cattle. Besides beef, the main export of Botswana is diamonds.
I'll send occasional posts about my activities there, and about things the larger world should know.


Friday, September 02, 2005

INFO: Relief for Katrina Victims with Special Needs

A clearinghouse with Katrina disaster relief information for people with
A colleague of mine, Penny Richards, offers her summary of blog discussion
and outreach to people with disabilities affected by Katrina,
UCP Greater New Orleans maintains a message board that is being used "to
share information with others on needs, whereabouts, etc."

Not that email or blogging are terribly efficient ways of offering
assistance. But they may provide us with some new ideas on how to

Hurricane Katrina response

See my comments to a post on the current state of disaster relief in New Orleans. Atmospheric scientist have noted that we now in an active hurricane cycle. So why wasn't our Homeland Security apparatus drilling for the South Coast's long-anticipated 'Big One' scenario? Scholars in the earth sciences and environmental engineers have long insisted that New Orleans was living on borrowed time. FEMA had already listed a major hurricane striking New Orleans as one of the top three most "likeliest, most catastrophic disasters facing this country."

The Survival of New Orleans blog

Instructive Background Reading
"Washing Away," special section in the New Orleans Times-Picayune, 2002.
Craig Colton, Unnatural Metropolis (Baton Rouge: Louisiana State University Press, 2005). See as well the interview with Colton in Wednesday's New York Times article "After Centuries of 'Controlling' Land, Gulf Learns Who's the Boss."
Mark Fischetti, "Drowning New Orleans," Scientific American, Oct 2001.
Todd Shallat, "In the Wake of Hurricane Betsy," in Craig Colton, ed., Transforming New Orleans and Its Environs (Pittsburgh: University of Pittsburgh Press, 2000).

Friday, July 08, 2005

Hurricane Dennis; from Dave

Wow - thanks for this news Kingsley. I am sharing this message with our
past trip participants. I'm glad you are still able to communicate with
Novella and Nelson. One wonders how much damage our friends on higher
ground in Hayfield and Bowden Pen must have seen.

Please keep us posted - a blessing that none of our groups were there to
experience this storm.

-----Original Message-----
From: kingsley keith []
Sent: Friday, July 08, 2005 6:21 PM
Subject: Hurricane Dennis; from Dave

Yallahs house is still intact and they have experienced very little
damage; however the roads from Kingston to Yallahs are impassable and we
won't be able to get there before next week.
I'll keep you posted

Thursday, July 07, 2005

hurricane dennis approaches jamaica

National Works Administration has just posted a news update that Yallahs Ford, known so well to participants on Edu-Tourism trips, is closed due to flooding. The Office of Disaster Preparedness and Emergency Management reports that the Airport Road is inundated, and communities in the Blue Mountains such as Hagley Gap, Epping Farm and Penlyn Castle are currently inaccessible by road. Of course, these communities can be difficult to reach under the best of weather conditions! Mike

wikipedia: 2005 london transport explosions

There is a new wikipedia entry for the '2005 london transport explosions.' Wikipedia entries are group edited - as the events unfold the entry will be modified in real time to reflect the unfolding coverage. As the story develops, pay attention to the haunting similarities with the 11 march 2004 madrid attacks.

a day for the history books, and the blogs

As with most mornings I turn to the television to help me wake up. As usual, when I turn on the TV, the first station to come up is CN-8. I noted that the Yoga Zone show was wrapping up with meditation. Pressing on the remote, the television flips to the station I viewed last night (still stored in its memory). The BBC World News - no coverage the G8 summit, just large white letters against a red backdrop across the bottom of the screen - the headline 'London Blasts.' I only got the briefest of discussions of the events before WXPN cut away from the BBC broadcast. Since then I have been following the news on NBC's Today Show before heading into the blog world to see if I could find any useful information that I could dig my teeth into. Remember that this coordinated terrorist attack is only one of so many important events taking place today: the opening of the G8 Summit at Gleneagles in Scotland is the second; and at the track of Hurricane Dennis as it sets its sights on the Eastern tip of Jamaica.

The situation is still confused, and eerily reminiscent of the election-oriented transportation attacks in Madrid last year. For those of you who wish to read eyewitness accounts of the events in London and Scotland, I recommend the GuardianUnlimited's NewsBlog which provides continually updates news on the myriad impacts. Apparently "the complete air of unreality" that has set in at the Gleneagles meeting. Guardian reporter Ewen MacAskill reports that "the summit, at least at this point, has been completely overshadowed." The world leaders continue to go through the motions of discussing climate change and debt relief, acting under the assumption that by breaking off the summit early will be seen as giving in to the terrorists. Prime Minister Blair is heading down to London to oversee relief there, but plans to come back to Scotland this evening. For obvious reason, the protests outside the resort have been somewhat muted today. Given the seriousness of topics on the G8 agenda this year, this coordinated attack in London is a real setback for all of us. A new cultural divide has emerged, and only time will tell whether the ripple effects of the London Transport Attack of July 7, 2005 will outstrip the coordinated Live 8 Concerts of July 2, 2005.

Update, 8:02 pm EDT
One London commuter's account of being trapped underground.
The camera phone shots of a young man who works in London's Financial District.

Wednesday, July 06, 2005

busy hurricane season

Keep our Jamaican friends in your thoughts as they watch another hurricane approach. Nelson and Novella are still in Yallahs and can share their impressions. It has been a wet summer so far, the busiest start ever to the hurricane season, with four named storms by July 5!

Coverage of so-to-be-Hurricane Dennis, from the Houston Chronicle

Jamaica now under Hurricane Watch, according to the Jamaica Gleaner

See also, cover story for the Jamaica Observer


Tuesday, July 05, 2005

novella's jamaican update

I received the following message from Novella on June 29, 2005. She describes the kind of impact that our group is making. I hope it inspires readers of this blog to consider joining us for future trips. Mike
June was wonderful, in terms of our work here. Mike will tell you about the first group. As for the second (we had a group of high school students, the CommuniTech Club from Gratz High School, 7 students and 3 adults), they worked with people in the local (Yallahs) high school -- students, teachers and community folks -- to teach them how to take computers apart and put them together again (in better shape, one hopes), diagnose problems with hardware/software, etc. People are beginning to talk about us "in the street" -- this kind of work just isn't done by others here. Typically, they donate computers which then languish the moment they develop one small problem, and that's that. To give you an example: we went to a Basic School and replaced their computer because they said the old one "wasn't working." When we tested it, we found that the switch in the back of the computer was turned off. Nothing else was wrong with it! You'll be pleased to know that I myself now know how to replace CD Roms, add RAM memory, etc., etc. It does give one a sense of greater competency. We've identified three high school students who'll be going around to the schools with us and checking all computers. And we finally have enough money from all the fundraising to transport the 80 odd computers we've accumulated, to include more schools in the program. Now that we have a bit more time, we'll be doing some of the planning, reaching out/PR, etc., work-- including the universities and Allan Lewis, who I think has been feeling left out; I think he'll be eager to get folks involved as well. And our villa/Center for Global Understanding is taking nice shape, as Mike will tell you. So maybe one of these days we can get a group of folks from the college (including you, of course) to come down and check things out!

Friday, July 01, 2005

In the cooperative spirit

As the Live 8 concert arrives in Philadelphia tomorrow, it may be worthwhile to update everyone on the activities of Edu-Tourism that endeavor to construct first-third world linkages and address difficult social problem. Edu-Tourism board member Nicola Shirley has been working with the fledgeling Women's Center in Morant Bay to explore micro-enterprise initiatives. One of the ideas that is moving forward is the creation of a sewing cooperative. Markets exist for fine fashions along the North Coast. These women are excited to learn and apply new skills in fashion design and sewing, but they don't currently have the necessary equipment. That is where next month's fundraiser comes in.

Morant Bay Sewing Cooperative's
Fashion Show Benefit for Teen Mothers
featuring Philadelphia designers

Date: Saturday, July 16th, 2005
Time: 6 p.m. - 11 p.m.
Where: Jamaican Jerk Hut, 1436 South St., Philadelphia
For more information, call Nicola Shirley (215) 545-0765 - office

Contact Nicola or Mike if you would like to purchase tickets in advance of the event.

- $15 advance
- $20 at the door

The funds we raise will go towards purchasing supplies and equipment which will be transported down to Jamaica later in the month of July.

Tuesday, June 21, 2005

Edu-Tourism / Sustainable Development June Meetup

This is going to be an informal meetup for folks who want to learn about Edu-Tourism's activities in Jamaica and to become involved in planning Philadelphia-based activities for the fall. Feature presentation (after it gets dark): Stephanie Black's excellent documentary Life and Debt, on Jamaican economy and society and the impacts of IMF/World Bank-sponsored structural adjustment.
Thursday, June 23, 2005 at 8:00 PM
Jamaican Jerk Hut1436 South Street Philadephia, PA 19146
215 545-8644
Info · Map/Directions

RSVP at our website!

Friday, June 17, 2005

time to congratulate our latest 'alumni'

Let me take the opportunity to welcome back a new group of students. This year's Jamaica course is going well - we are in the process of planning a final class session next week, probably at the Jamaica Jerk Hut. Katie Tanner, Kristen Hunter, Colleen Tomaszewski and Dan Savage spent the first half of the month in Jamaica, enjoying the hospitality of Novella and Nelson Keith and the staff at the new Center for Global Understanding in Yallahs. They were connected to our ongoing projects in women's students, disability studies, and instructional technology. I invite each of the students to post notes to this listserv describing their work and their findings before the July 4th weekend.

Again on this trip, students, teachers, and friends engaged in grueling recreational activities. On Sunday, June 5, the group awoke at 3:00 am to climb Blue Mountain Peak, arriving a little after noon to 360 degree views of Kingston, Yallahs and Portland from Jamaica's highest point. (I hope to be loading pictures of our feat to the Edu-Tourism Temple website shortly.) We are pleased to have been able to accomplish this feat before the arrival of the two tropical depressions that filled many of our subsequent days with clouds and heavy rains. Keep our Jamaican friends in your thoughts as the torrential rains continue today, June 17. When I spoke with her by phone yesterday, Iclyn Smith of 3D Projects informed me that two lives were lost in the parish yesterday due to flooding.

Readers of this blog will also be learning soon about more Edu-Tourism events to be held here in Philadelphia. This group of students returned with the goal of establishing a student board to advance ongoing projects and represent student views in Edu-Tourism board deliberations.

accessing computers in the formative years

Children are using computers at a increasingly early ages in the United States, according to a recent report from the National Center on Educational Statistics. One would like to see this pattern replicated in Jamaica, but we find that schools still lack the infrastructure and trained staff. Many of the basic schools now have one or two computers, but do not have a strategy for making the computer available to the kids. Our computer trainings helped to raise awareness and familiarity amongst teachers, and the free educational software that we provided goes a long way to promoting computer use. It is going to be great to see this program flourishing over the coming years. I will be staying in touch with Ms. Gordon, the Educational Officer for the Parish of St. Thomas, and Ms. Fraser of the White Horses Community Center so that we can learn more about the progress of these training sessions.

Wednesday, April 13, 2005

Tuesday, April 05, 2005

Getting computers into the hands of children

As our Edu-Tourism initiative places computers in Jamaica's basic schools, we are still aware of the gaps that exist at the primary school level. Non-profits and governments each have roles to play in filling this widening gap. With this in mind, it is heartening to learn of initiatives at MIT to manufacture inexpensive laptops that can be ordered in bulk and brought in by governments. AP coverage from

Wednesday, March 16, 2005

Linking North Philadelphia and Rural Jamaica

I'm happy to announce an initiative to bring students from the CommuniTech Club at Simon Gratz High School to the Parish of St. Thomas in June, 2005, where they would be installing a computer lab and conducting trainings in computer training and operation. Please consider lending your time and financial support to this important cultural/technological exchange.

Saturday, March 05, 2005

The Power of Numbers

Blogs, like other media, tend to amplify and reinforce viewpoints that have widespread acceptance. Many writers intend to dispel misconceptions, but few have the experience and the tools to do so. I regularly check out Ethan Zuckerman's weblog for insights like the one that he recently offered on African population statistics.

Thursday, March 03, 2005

Edu-Tourism Fundraising Walkathon

***Please put the following event in your calendars!***

Get friends, family, coworkers and community members to sponsor your involvement in the Edu-Tourism initiative. Follow this link for the cover letter and sponsorship form (PDF format),

Edu-Tourism Fundraising Walkathon
Location: Jamaica Jerk Hut, 1436 South Street, Philadelphia; Phone (215) 545-8644.

Date and Time
Walkathon 1:00 pm, Saturday, March 12, 2005.
Dinner 6:00 pm, Saturday, March 12, 2005.


Mike Dorn

Novella Keith

P.S.: For more on Jamaica Jerk Hut's contributions to the South Street West Business District and the local foods movement, see the recent write-up by university professor and local farmer Jonathan Michael Thomas.

Information on our Summer Session I course has been updated on the Temple University page,

Sunday, February 27, 2005

TU Summer Course in Jamaica - Info Session this Thurs. at Ritter Hall

Meet with Profs. Mike Dorn and Novella Keith in 303 Ritter Hall on Temple University’s main campus to learn more about an outstanding study abroad experience! Thursday, March 3 from 3:00 to 4:30 pm is the drop-in time to learn more about participating in the Temple University course Ed 321 (undergrad) and 621 (grad): International Service Learning and Community Development. This Summer Session I course provides students with an orientation to Jamaican history, culture and politics, and then hosts students in rural Jamaica where they work on sustainable development projects with our community partners. Participants also get to experience Jamaica's wonderful food, beautiful countryside and a few of the island's more famous tourist attractions. Updated information about the summer trip, prepared for Thursday's meeting, will soon be available on our Temple website,

Thanks, Mike

Thursday, January 27, 2005

Computer installation and training plans for Morant Bay/Yallahs

From: Novella Keith
To: Janice Steinberg
Cc: Mike Dorn
Subject: Edu-tourism information

Hi Jan,
hope you are enjoying the snow! Actually, I'm assuming that schools are closed today, but am not sure that's the case.

I have some information that hopefully you can use. sorry I didn't get it to you before, but I've been under pressure from some deadlines (and actually that work isn't finished yet, but I know I just shouldn't postpone this any longer)!

Let me know what's next.


All of the work of Edu-Tourism is concentrated in the parish of St.Thomas, which is one of the least developed and quite rural parishes, located in South Eastern Jamaica. There are 5 main towns. Yallahs, where our Center for Global Understanding is located (this is the Jamaican headquarters of Edu-Tourism, and where the students will be lodged) is the second largest, with only 12,000 inhabitants.

General information about Jamaica and St. Thomas Parish:
St.Thomas population, 92,000 (just to give you an idea, the population of Kingston, the capital city, is about 600,000 and total population of Jamaica is 2.7 million). Jamaica is in the middle range of Third World countries: Jamaica Gross Domestic Product is $3,700 per capita; life expectancy is 73.4 (male) and 77.5 (female). As is the case in all Third World countries, a large percentage of the population is young (30% is between 0 and 14 years). Jamaica has compulsory education to age 14, but many children, especially in rural areas, end their education before high school, at the equivalent of our 8th grade. I don't have the exact stats on that. Literacy rate in St.Thomas is thus lower than the Jamaica average -- 75% for St.Thomas versus 81% (male) and 89% (female) for the whole country. Yes, there are consistently more females in education than males (at the university level, about 70% are women). By some accounts, literacy rates are dropping, however. The government is currently focusing on improving the quality of education and level of literacy in primary schools. A recent report found that many students who enter primary school, especially from rural areas, are "not ready" (especially in the areas of auditory and visual discrimination). Courseware to assist with literacy and numeracy is needed and we are currently working to identify and secure appropriate software for "our" basic schools. If possible, we would like to include this item in our fundraising, as well as the cost of shipping about 60 computers (see below).

It is estimated that there are currently 150,000 Internet users in Jamaica. All government ministries have well developed sites. Local content is limited, especially for the rural areas, but growing. One of the national newspapers, The Jamaican Gleaner, has developed a "go-Jamaica" site ( that also has a local companion ( and includes information for every parish (http://www.go-StThomas. The main driving force behind the push for local content previously had been the tourist industry and agriculture. The National Library of Jamaica has a directory of recommended sites -- see There is also considerable emphasis on making computers available to the population in general, and putting computers in schools (Telecommunications Act of 2000).

Education and Technology Initiatives:
The UN has an ambitious program, Education for All, which wants to have all children in school and early childhood education available to all by the year 2015. Jamaica's educational policies are trying to follow that lead. So there is currently considerable emphasis on basic school education (3 to 6 year olds), which is widely available but involves some fees and costs (like for lunch) that are at times difficult to meet for very poor parents. The ratio of students to teachers in basic schools is 45-1 and only 22% of the teachers are trained.

An effort has been mounted by the government and private foundations to put a computer lab (about 15 computers) in every primary and secondary school in the country. The educational plan called for at least 60% of Jamaican schools to have computer labs of up to 30 computers each. I don't think those targets are close to being met. According to the most recent data, computers are available in 170 of the 250 High Schools throughout Jamaica. Again, rural areas are behind the capital city and tourist areas. There are currently no plans to put computers in basic schools, which is why we started from there. Most primary and secondary schools have access to the Internet, but this usually involves one single telephone line, with data transmission rates that vary from 14 Kbps to 56 Kbps. There is no broadband access in St.Thomas (again, it is available in Kingston and tourist areas only, though mostly to businesses). Thus access is a big problem. Access is often through the school library, which usually has only one or two terminals. Students are charged for time to access the Net, to help subsidize fees the school incurs. In remote areas, however, there is still no infrastructure for land telephone lines -- though cell phones are widely available and cell phone calls can be made to and from most of the country. Through a recent program, computers with internet access have also been put in all Parish libraries and branch libraries (there are at least two computers per library even in small rural villages. Fees will seem fairly low by our standards -- I seem to recall JA$50 (US$ 0.80) for half an hour; however, the daily rate for unskilled laborers in St.Thomas is about JA$600 -- so that will give you a better idea of cost). The library in Morant Bay, the capital city of St.Thomas Parish has about 8 computers; Yallahs library has about 4. When I was at the library, there were lots of students coming in after school using (and waiting for) the computers and the internet; most of them seemed of high school age. There are also Internet kiosks (or "cafes") in many Post Offices (a total of 60 post offices, in 2002). In St.Thomas parish, there is one in Yallahs and one in Morant Bay, the Parish capital. I also read that the Jamaican government had a plan for every Jamaican to have an e-mail address by the end of 2002 -- didn't happen -- the idea was that Post Offices could receive and download messages, and put them in envelopes for customers.

The secondary school we'll be working with as our main partner is Yallahs Comprehensive Secondary School. This is one of two secondary schools in the town. A technology teacher and his class are eager to collaborate and learn from the Gratz students. The principal has given permission. I'll try to get the teacher's email contact, so we can be in touch with him directly. All are quite excited about this initiative. We had meetings with the appropriate officials at the Ministry of Education and there is great interest. In fact, they told us of many experiences where "the computer stopped working" and no one knew what to do about it -- often, it turns out to be a small problem. I told them that there are organizations in Philadelphia that distribute second-hand computers to low-income people and their experience is that buyers who take a short course to learn about hardward tend not to come back saying they have problems... (Do you know of Stan Pokras' work?)

The students will also be doing the same with training teachers in basic schools that have received computers through Edu-Tourism (and others, as identified by our collaborating Ministry officials). This means about 50 teachers, probably in at least 2 sessions. Some training may also happen in the individual schools, as we definitely want to Gratz students to visit at least some of these schools and have experiences with the students and teachers on the ground.

Edu-Tourism began distributing computers to schools in January 2004. Basic schools are early childhood schools for children 3 to 6, before they enter primary school. The student-teacher ratio is 45-1, and only about 22% of the teachers qualify as "trained teachers" (data from 2003). The teachers have received only very basic training in computers and only a handful of the teachers (and even fewer of the students) have computers at home. Currently we have distributed approximately 35 computers to 12 of these schools (2 or 3 per school) which have an average of 3 teachers per school and together account for approximately 1000 students (so, a total of about 35-40 teachers). Other Edu-Tourism partners have also received some computers. Computers are donated mostly by West Chester University, with some business and private donors. Since December 2003 we have taken 50 complete desktops and 12 laptops and 3 printers to Jamaica. We currently have approximately 60 desktops (complete with monitors, etc.) waiting to be shipped; approximately 30 are Pentium 3s. There are also some printers, as we have had requests for these (initially we held back on printers because the cost of ink is very high). Most of the computers are internet ready, though our emphasis has not been on Internet readiness, given the information above. Our goals for the basic schools are to familiarize teachers and children with computers, improve their school readiness skills, so they can make a more successful transition to primary schools. Computers in basic schools are also often used by the local community -- entrepreneurial teachers have been known to give classes (small fees charged), prepare and print flyers for local happenings (again, fees charged), etc. So the presence of computers in a basic school can also improve the quality of rural life and create small revenues to support teachers and schools. Needs for training, software, possible uses of computers and printers, etc., were identified through a needs assessment conducted by the last group that visited St.Thomas through sponsorship by Edu-Tourism.

Wednesday, January 19, 2005

invitation to organizing meeting for summer 2005 trip

Please come to this meeting if you are interested in being involved in planning this semester, and/or traveling with us to Jamaica in June. Mike

We are beginning planning for a Summer I International Service Learning course that will again take students to a rural (non-tourist) area in Jamaica. You are invited to an organizational meeting next week:

January 25, from 4 to 5 pm, in Ritter Hall 303

Please RSVP to or

The course will be a combined undergraduate (upper level) and graduate course in education. It will involve several meetings prior to leaving for Jamaica, starting at the beginning of Summer I; two weeks in Jamaica, and follow up meetings and writing of final papers/reports etc., before the end of the Summer I session. While in Jamaica, students contribute to one of several community development projects: computers in school; eco/edu-tourism development with a farmers cooperative in the Blue Mountains; an education project for teen mothers; education linked to medical/health/sanitation issues. In addition to participating in these community projects, students explore the historical and cultural aspects of the rural area where we will be staying (the Parish of St.Thomas, in Eastern Jamaica). We also take advantage of vicinity to the capital city, Kingston, where we attend some classes at the University of the West Indies, and visit important sights including the National Gallery, the Bob Marley Museum, etc.

Novella Keith
Urban Education Program

Friday, January 14, 2005

rita denies recent reports

From recent press reports: Rita Marley has denied any intentions to exhume Bob Marley's body from Nine Miles in St. Ann and re-inter the remains of Jamaica's most famous citizen at Shashemane in Ethiopia. Coverage in the Jamaica Gleaner and BBC Entertainment News.

Very confusing, to say the least.

temple university reflects on the marley news

Two discussion lists that I subscribe to here at Temple University are currently engaged in a heated debate over the recent news that Bob Marley's widow Rita plans to exhume and rebury his remains near of Addis Ababa in Ethiopia. I may be posting more on this discussion if I find the time. Meanwhile, check out the AP coverage of this story.