My Experience with the Tanzanian Health Care System

I recently had my first and hopefully only experience with the Tanzanian health care system. It started at the University Health Services Clinic. When I made it in to the office to be seen by the doctor, I was asked to describe my condition. On my description only I was referred to Mikocheni Hospital. I made it there after a bit of a journey Friday afternoon, only to be asked to come back in the morning. Saturday I returned to the hospital and checked in. I waited for awhile. I knew the doctor was in but I didn’t know how I would know it was my turn. I waited for about an hour and a half before the other ladies waiting by the door motioned me in. I sat down at another desk to describe what was going on. The doctor, the Director General of the hospital, took my word for it and sent me to another nurse who would take me to “the theater” to take care of my issue.

I was led into the next building and up a bunch of stairs to a hospital room. After about a half an hour a nurse came in to get my papers. At this point I had a million questions, none of which the nurse would answer. She kept demanding that I sign the papers. When I wouldn’t she would leave the room and come back fifteen minutes later telling me to sign the papers again and not answering my questions. More than once I tried to leave. She kept telling me “Don’t Worry!” Eventually I ended up wrapped in a sheet, sitting in a room alone for about an hour.

As I was about to be put under anesthesia, I realized how many things hadn’t been done. I had not been weighed, asked about current allergies or medications, or even examined. I was about to have a surgical procedure done without ever being examined before I was put on the table. Before I knew it I was out cold and then waking up with my feet hanging off the end of the stretcher being rolled into the recovery room. A bit later I was more conscious, I looked about and had to try to remember where I was. A few minutes later Chris showed up. It was nice to see a friendly face after a day of confusion, pain and tears.

My experience was so differenct from anything I’ve ever experienced or will ever experience in the states. There were so many procedures and protocols what were not followed that I am accustomed to. At one point I contemplated writing my allergies on my chest in Sharpie because it is the one writing instrument I had in my purse. Coming into the Tanzanian healthcare system, I brought with me all of my previous experience and ideas about what type of care I should receive and how I should be treated. None my expectations or preconceptions about how I would be treated as a patient were honored. The whole process does not encourage patients to be informed about their own health and ask questions about their treatment. On the whole as different as the system is it works for the majority of the people here. The viewpoint is just so different. At home, patients are encouraged to be informed about their own health and ask questions to be somewhat in charge of their own health. Patients in Tanzania take the doctor’s word as law. My doctor and nurses didn’t know what to think when I was asking questions. They weren’t willing to provide information only reassurance. It wasn’t a language barrier either. My doctor spoke English very well. He seemed uncomfortable answering the questions I had. He only provided reassurance that I would be OK and the staff could handle my situation.

Since I hope to one day work with the Tanzanian healthcare system, it was a good experience for me to be a patient. I have a new appreciation for what I know and love at home in my University Health Center.

A Really Boring Update

Hey All!

I know it's been awhile since I've put up a post. I've been a bit under the weather and life on campus has been really busy since all of my classes are running now. I'm working out the last of the scheduling conflicts. There will be lots of interesting reading to come including my encounter with the Tanzanian health care system. Yes I'm OK now...it will be a fun story to tell. Miss you all! Thanks for the comments!

Hair

Having more than an inch of hair here is the exception not the norm. Men and women both generally keep their hair short. In Dar es Salaam, I see more women wit longer hair or extensions than I have in other places. It is quite common to see little girls and boys with their hair shorn short. To tell boys from girls in my class I have to look at what they are wearing – girls in skirts and boys in shorts.

Me, having long hair, is a conversation starter. I’ve been asked, “why don’t you cut your hair?” and “how do you get it to grow so long?” among others. I’ve discovered that in crowded places like markets, it is best if I wear it up in a bun or I get the occasional tug from the curious passerby or the school girl who was dared by her friends. I’m not sure if the tugging is to feel it or to see if it is a wig. Either way it is not something I will get used to. While in Mori, Mama Macha’s wifi, sister-in-law, who is a deaf mute even gestured to me that I needed a hair cut. She had only seen it up in a bun. When I took it down, as now it is past my shoulders, she was amazed and gestured even more excitedly that I needed a hair cut. My head should look like hers with hair that was barely noticeable.

Most of the women in Mori wore some sort of head covering, especially headscarves all of the time. IN church this was a definite trend. I think I only saw one or two uncovered heads. The rest were intricately wrapped in printed kangas, sparkly scarves or tattered dress hats. The need to feel pretty is universal and whatever mechanism is available to enhance beauty to a cultural or personal standard will be employed. I use my hair as a decoration per se. It is something that I spend time on to enhance my appearance. Without hair, the ladies use their headscarves for the same reason.

In this culture, for most people there is so much work to be done that there is little time left to devote to doing a child’s hair. As well as hair products and care are a luxury that not everyone can afford.

I’ve been told that all mzungu look the same. I have to admit that I have had a hard time telling Tanzanians apart, especially men, unless I have talked with them and seen them more than once. At home I can walk into class survey the room, and go to my next class and pick out people who were in my previous class by face not by the way they are dressed. I think it has to do with hair or the lack there of. I have discovered that I and most of my cohort recognize people by “reading” their faces top down: hair, then eyes, nose, and mouth. In a culture where there is little or no hair to use as a recognition clue it is challenging to pick out faces. I have to reprogram the way I remember faces. It is a subtle difference though when it comes to making friends and remembering them it is important. Another thing I’ve noticed is that I can pick out varying subtle shades of Caucasian people. When it comes to darker skin, I am not as good at noticing the differences. I guessing that it comes from interacting with and having to recognize those differences. Skin tone is another factor in recognizing people. The more time I spend here, the easier the differences are to see. It is something that you have to train you eyes to see whether you do it from birth or make a choice to see the difference.

Fast Food in Tanzania

The title would be an oxymoron if phrases could be an oxymoron. There is no such thing as “fast food” in traditional Tanzania. Well, there is a single dish I have found, chipsi mayai, fries cooked into scrambled eggs, that could be considered “fast food” though it is cooked to order and can take awhile. There are restaurants with “fast food” in the name yet it is a sit down restaurant where you get a menu and a server.

The best example of this is The Silver Spoon by my dorm. I popped in one day for a quick meal on my way to a movie. Let’s just say I missed the previews and a good portion of the introduction. I went to the counter to order and was directed to a table. A lady in a very clean and pressed green and yellow uniform came to my table and brought me a menu and took my drink order. Realizing that this was going to take a bit of time, I caved to the daily special of beef lasagna (I was craving cheese!). I presumed it was already made and sitting in a warmer in the kitchen…nope. I waited for my very own personal sized lasagna to be made. Upon delivery to my table, after a considerable wait, I unwrapped my napkin enclosed silverware and proceeded to chow down on my pseudo-Italian dish. It was fantastic until the last bite…it tasted like soap. My best guess is that some other individual ordered the lasagna before right before me and in their haste to wash someone forgot to rinse.

Reflecting on this after my movie, I concluded that even “convenience food” in Tanzania is a chance to meet someone...in my story it was my server who chatted with me about why I was in Dar and where I come form. I have to confess that at home I am guilty of eating my share of fast food – the kind you order through a speaker out of your car window. From the time I pick up my “meal” at the next window from the hand that flung it at me to the time I reach the next stop light could have eaten half of the bag’s contents. Eating food was simply a task to be done. Honestly, for me who considers eating to be a social event, I was quite lonely eating my to-go meals. Reflecting on the months before I came here, eating like that several times a week was unhealthier for my soul than my body.

Eating in Tanzania is never lonely. Where I am searching for a seat in the cafeteria or venturing out to most restaurants there are always lots of people. Sometimes I try to go ear alone. It’s something I enjoyed occasionally at home. It gave me a chance to breathe. People generally didn’t bother the lady who went to a busy restaurant at dinner and ordered a table for one. There are times here that I try to eat alone. The only way so far that I have found to somewhat succeed is to by bread and soup mix or cheese at Shoprite and eat in my room. That usually doesn’t last long because someone comes and knocks on my door wondering why I didn’t come to dinner.

Mori: Mzungu Parade

This is the first of several entries about my trip to Mori, a little homestead on the slopes of Kilimanjaro. Keep watching for more tales of Mori to come soon!

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Going to Mori, I knew that it was going to be a big thing for the small community to have so many guests. I didn't think about how much of a spectacle we would be. It started in Kiboroloni...not exactly a tourist destination. When eleven mzungu got off the bus in this small place there were many raised eyebrows. Since it is on the way to a Kilimanjaro base camp, they probably thought that we were just lost. Our ride to Mori was waiting for us though when we got off of the bus. I knew we were going in a Land Rover. I didn't know that the back was open and we were standing in the back along with the luggage holding on to the roll bars on the way up the hill. As we went along, more and more people piled in with us. By the time we got half way up the path there were about twenty people in the back. It was loads of fun, yet there were some huge bruises involved. Every time we hit a bump...and there were lots of them...I smashed my ribs or hips into the bars. Ouch! All along the way, small children came running out of driveways and down the street telling, "Mzungu, Mzungu! Good morning! Hello!" Then they would yell to their friends and siblings in the house something the equivalent of "Come see this strange thing!" It's not everyday that white people come in mass through the village standing in the back of a truck. It didn't help that our driver kept honking his horn - sometimes to get livestock out of the road and other times for attention.

Once we got to the house, there were a host of people waiting to see us. For the remainder of the evening, anytime I looked at the fence, I could see little sets of eyes peering in at us. I felt a little like Marco, my fish might if he had complex feelings. Our compound felt a bit like a fish bowl and we were being watched to see if we would do any tricks. It wasn’t a bad feeling, I just haven’t ever felt like I was so watched in a curious way before. Our host jokingly told us, “They (the community) think that we stand on our heads when we are home.” This of course was not a literal statement. It was meant as we are different and there is so few mzungu that come through that we are a bit of a curiosity. I am generally not a person who draws attention to herself. Having this much curiosity directed my way was a new experience. Being in the community and trying to talk with children who wanted to practice their English also was an adventure. We would make it through the Hellos and Good Mornings before they started giggling uncontrollably.

During the week, we ate the same food they did, washed our clothes and fetched water from the spring. Our host would report to us at night the things she heard during the day about us. Most things were casual statements of amazement. Our cooks apologize for making us their kinds of foods. They assumed that we wouldn’t eat it or like it. Most of what they cooked was good. There was one thing, mtindi, which is a little bit different. It is their version of yogurt. It tasted more like runny sour cream with chunks in it. I liked it but not with rice and ugali. It would have been better with tortilla chips. I think by the end of the week, the community around us realized that we were content to be there and participate in daily life. The kids were always amused by the sight of us moving around town on foot or in the back of the Land Rover.

The Supernatural in the Natural

This entry is from the 6th...this is the first chance I've had to get online. See you all soon!!!!!!

Today was supposed to be the first day of class. I reported to room ARD for SO: 264 – Introduction to Medical Sociology and Anthropology promptly at 12:55pm. Class started at one o’clock. Being on time was a benefit because my professor is a punctual man and made a scene of everyone who was late. This class is an overview of healthcare in relationship to cultural and social systems and norms. I’m really interested in taking it.

My professor this afternoon made an interesting statement in his introduction to medical pluralism. In the context of talking about alternative healthcare systems, he used a personal example. He stated, “In my life I have never taken a malaria tablet. When the doctors tell me I have malaria, I say that I am going to pray. It is an attack on my body.” I wasn’t the least bit bothered by it. The rest of my international cohort made it the topic of the day…almost in a mocking way. I finally mentioned that I was amused by the fact they seemed so bothered by his comment. It is his belief given in the context of saying that it was his method. I think I am less bothered by this because I come from a community that believes in healing. (Personally, I would take the malaria tablet and pray. The side effects are nasty.)

This leads me to an observation. Most of the students I am lumped in a group with are really skeptical about matters dealing with the supernatural in reference to God or witchcraft. This is not the only time I’ve seen this though the comments following class today led me to much thought. This culture is one that embraces the supernatural in the form of God or witchcraft. It is in the media, pop culture, lifestyles and conversation. Coming to Tanzania, it is necessary to have some concept of the effect of supernatural beliefs in the day to day lives of the people. Using the supernatural to explain things from malaria in infertility or a bad business day is common. Coming from the background I do, it has given me the ability to have conversations with people about these views. When something good happens, it is usually attributed to God. When it is a negative event or series of events, it is the result of witchcraft, probably a close family member or friend who is jealous of success or possessions.

Even the legal system is facing the issues of the supernatural. Recently there have been several articles in the news about people being killed because their neighbors considered them witches casting spells against them. One such story from The Guardian recently…A man was murdered by his neighbors because they thought he was a witch when they found him in their back yard. They proceeded to kill him by stuffing twenty, yes twenty, green bananas in his rectum. The courts ruled that this was a justifiable killing because the man had a reputation in the community of using witchcraft and the individuals who assaulted him were protecting their families and property. On the other hand supernatural healing is embraced as a reality because it is the only hope some people have. Not having access to the same kinds and caliber of medicine available in the West, people frequently turn to prayer because something that is considered a treatable illness elsewhere is life threatening here.

In this culture, in the context of health and healing a full discussion needs to include all of the avenues that people use to achieve and maintain health. Yes, it is different and some of the practices here would never fly legally in other countries, yet in this context it is culturally appropriate. To conduct humanitarian work here especially in the health sector workers need knowledge of these traditional beliefs and practices to be able to adequately give care and education to their patients. I see this as an opportunity to learn how to communicate cross culturally and learn how to do it effectively.

Hmmmmm………

I had lunch with a friend of mine recently and the topic of the Maasai came up. I was telling her about the boma I visited and how self sufficient the people were. I left the boma with a different view than I went with. Looking at it with a Western mentality, it is easy to say that they are resistant to change and that they will be either be forced to change or be left out and that some “civilization” is needed along with “modern conveniences.” It is true that a clean drinking water source is needed and more of the community could benefit from advanced medical care as well as the rates of literacy improved. On the other hand, I met some really happy families that are poor in a monetary sense, yet they don’t need as much currency for exchange as you might think. As their lives bleed into more of the contemporary scene, funds are needed for school fees and veterinary services but for the most part there is still plenty of bartering and trading that I could see.

The point that I’m coming to is that the Tanzanian lady I was having lunch called them “savage” and “backwards.” She said, “There is something not right with the way they live. They need to change.” I was bothered by hearing one Tanzanian call another those terms. I know that that this individuals’ family, or at least some of them, live in a similar fashion and she didn’t see anything wrong with that. The whole thing was very strange.

Education will allow future generations to choose if they want to continue in the traditional way of life. It is a matter of choice. Literacy gives the population a chance to know about other subsistence strategies and cultures. From that knowledge, the individual can make an informed choice to change their lifestyle or to continue as they have.

I know that at home individuals have differing opinions of others that are not like themselves. I don’t like that when I’m at home. It was even more challenging to listen to when not that long ago many groups in Tanzania lived as the Maasai still do. It is easy to see little you need to be removed from someone to be able to criticize the differences.

The Supernatural in the Natural

Today was supposed to be the first day of class. I reported to room ARD for SO: 264 – Introduction to Medical Sociology and Anthropology promptly at 12:55pm. Class started at one o’clock. Being on time was a benefit because my professor is a punctual man and made a scene of everyone who was late. This class is an overview of healthcare in relationship to cultural and social systems and norms. I’m really interested in taking it.

My professor this afternoon made an interesting statement in his introduction to medical pluralism. In the context of talking about alternative healthcare systems, he used a personal example. He stated, “In my life I have never taken a malaria tablet. When the doctors tell me I have malaria, I say that I am going to pray. It is an attack on my body.” I wasn’t the least bit bothered by it. The rest of my international cohort made it the topic of the day…almost in a mocking way. I finally mentioned that I was amused by the fact they seemed so bothered by his comment. It is his belief given in the context of saying that it was his method. I think I am less bothered by this because I come from a community that believes in healing. (Personally, I would take the malaria tablet and pray. The side effects are nasty.)

This leads me to an observation. Most of the students I am lumped in a group with are really skeptical about matters dealing with the supernatural in reference to God or witchcraft. This is not the only time I’ve seen this though the comments following class today led me to much thought. This culture is one that embraces the supernatural in the form of God or witchcraft. It is in the media, pop culture, lifestyles and conversation. Coming to Tanzania, it is necessary to have some concept of the effect of supernatural beliefs in the day to day lives of the people. Using the supernatural to explain things from malaria in infertility or a bad business day is common. Coming from the background I do, it has given me the ability to have conversations with people about these views. When something good happens, it is usually attributed to God. When it is a negative event or series of events, it is the result of witchcraft, probably a close family member or friend who is jealous of success or possessions.

More to come later…running out of rented computer time.

Crossing Over: The Challenge of the Other Side

Coming to Tanzania, I had no idea that they drive on the opposite of the road than we do in the US. The first time in the car was an interesting experience. Driving or even riding in a car in Tanzania can be scary enough. It was even more so until my brain realized that we were not driving into oncoming traffic. This whole arrangement has caused a few other changes in my behavior as well. On campus and basically everywhere else, people walk down the sidewalk or road on the side that they would be driving on. The same is true going up and down the stairs and aisles in the supermarket. For example at home I would walk down the right side of the sidewalk. I try to do that here and I have to step around people until I remember that I should be on the other side. Most days I forget until I’ve nearly run into someone. When walking in groups, I frequently feel one of my team member’s hands on my shoulders moving me into the appropriate “lane.”

Going home is will involve learning how to do these little things over. I never realized how much of an impact which side of the road I drive on has on other social situations and how ingrained it is to be on the appropriate sided of the foot traffic flow. Maybe it’s not the driving that affects the other things, but it is the most obvious option see. Seeing as how almost everything is researched these days, I’m sure I could Google it and come up with an acceptable answer.

Live from Zanzibar!

I'm in Zanzibar and have been for the last few days. It's been amazing! I'll have to come back sometime soon. Stonetown grows on you. More stories to come soon...snorkeling, Idd festival, shopping and spring rolls with cinnamon. Stay tuned! Miss you all lots!

Tanzanian Toys: Recycled Treasures

I spotted a little boy today playing with the most interesting toy. It was a small, narrow board with four water bottle cap wheels. On either end of the board was a half of small water bottle that had been anchored to the board. He would push this make shift car with a stick by putting it inside the front bottle half. He was having more fun pushing this small thing around than I’ve seen in a long time. It wasn’t the sturdiest toy, nor did it roll straight. Nonetheless, he was having fun pushing the thing around. The reason this stuck with me is that I had previously had a conversation about what is was going to be like going home at Christmas. I’m dreading it a bit. I like Christmas, but I find the holidays and the shopping and busyness that go with it to be a bit overwhelming. I know that at some point I am going to brave the crowds to buy clothes seeing that I have very few left in Washington since they were stolen and I don’t have any clothes to wear in Texas while I am home. Back to the point, I will see numerous families clamoring to buy the latest gadget for their youngsters that will probably be forgotten by April and the credit card bill will still need to be paid. The kid I saw was having more fun with something that could be considered trash than most kids will ever play with the toys they have in their toy box. I’m not anti-stuff, but I think this puts it in perspective and is a reminder that sometimes simpler is better. I remember my sister having more fun with a milk jug and clothes pins than her toys. I am more resolved than ever to make my life and the things that come from it simpler.