An elderly man waves me over, insistent. He is wearing gray trousers, a collared shirt, and a prayer cap. He shouts across the dirt road, in Somali, “Come, white lady, come and sit down with us.” Others laugh and tell him I can’t understand and then they laugh at me when I shout back that I do understand.

I cross the narrow road, careful to avoid puddles of a mysterious green liquid, and sit down on top of an overturned empty can of powdered milk. These double all over Djibouti City as chairs at roadside restaurants and tea stalls. Sitting down is easy to do. I have more trouble obeying his next command.

“Drink,” he says, and hands me a tiny glass of steaming Nescafé. “I am paying for it, drink.” He slaps a fifty-franc coin onto the wooden table where a woman has balanced more glasses and thermoses and a tray of fried biscuits.

The amber-colored glass is the size of a shot glass. Surely that small amount of strong coffee can’t contain too many germs. Right? Surely the water was boiled enough to kill them off. Right?

I was here yesterday, too, and watched how the woman running the tea stall washed the glasses. She had a bucket of lukewarm, mildly soapy water beneath the wooden table and she dunked the glasses into it, swished the water around with one hand for maybe two seconds, and set the glasses out on a cloth to dry. The water used for the coffee was tap water.

I’m actually not concerned about the lack of proper washing or the tap water. I’m concerned about tuberculosis, history’s deadliest disease, having killed one out of every seven people to ever live on the planet.

The tea stall is outside the TB clinic. I had met the generous elderly man inside the day before. He was holding a plastic cup filled with sputum, waiting to be tested. I was there with a teenage boy from the refugee camp who also held a plastic cup filled with sputum, also waiting to be tested.

All around us, while we waited for the clinic to open, people holding these cups coughed and spit, big juicy wads of phlegm splattering to the ground near our sandaled feet. I tried not to notice the plastic cups, tried not to think about what was inside them. But it was hard not to gag.

Fears of tuberculosis and the growing understanding of germs and the spread of disease contributed to the elimination of the American habit of spitting in the 1900s. It was also the reason women’s dresses grew shorter, so their hems wouldn’t drag through dirt and spit and unwittingly sweep disease into homes and why men were encouraged to neatly trim their beards. But spitting is still done, in public places, and with little compunction, in Djibouti.

People exited the clinic and came to the tea stall to drink coffee or tea, to nibble cookies, and to wait for their results. And now I sit here, drinking from the same glasses, thinking about how TB liquefies lungs so that its victims drown in their own tissue, about how TB is contagious and airborne, how the drug-resistant strain has been nicknamed “Ebola with wings.”

I hold the glass with just my thumb and forefinger, around the brim. Its hot and there is no handle. People ask me how I learned Somali, how long I have been in Djibouti, what I am doing with this young refugee, and I explain my job as a development worker. “Drink,” the man says, and coughs into the crux of his elbow. “Do you want another? A biscuit?”

Fried camel hump, unpasteurized goat’s milk, rancid butter, sour flat bread, beef jerky buried underground for months and then soaked in rancid butter, syrupy drinks so thick they are hard to swallow and so sweet they make my skin crawl–I have ingested many things I would have rather not, for the sake of a relationship. To honor a host, to be a polite guest, to have an adventure, often of the intestinal variety.

Is there another way to live as a foreigner? My way has always been to say yes, to the camel hump, the teacup, the invitation. But am I still foreign? I’ve been here thirteen years now. Do those years somehow erase the pressure to comply?

My host looks at me expectantly. TB germs don’t survive long in sunlight, outside the body. As infectious as it is, in cramped quarters and inside bodies weakened from other diseases like HIV or malnutrition, TB isn’t actually that contagious.

I have a friend who is a respiratory therapist. He has worked in the Horn of Africa for years and never caught TB. “It is harder than you think,” he said, “to catch it.” I am a little thirsty. I look at my coffee. I listen to people chatting and spitting. I smile at the man.

How thirsty am I?

Rachel Pieh Jones, a frequent contributor to EthnoTraveler, lives and writes in Djibouti City.