Yaoli: First Impressions

June 29, 2009

Tanzania… in little more than seven days those four little syllables has come to represent so much for me – the dry dusty soil that turns into an orange mist behind the roar of rubber tires, lush green canopies of banana trees, women in colorful khangas and hordes of smiling children always eager to greet and exchange hellos. Our journey has taken us 8700 miles from America, but the mere 16 hours of flying cannot convey the differences in geography and culture.

As a foreigner grappling to adjust, I feel the surroundings for points of commonality, anything at all that can relate my life to theirs. I notice similarities in food – tea with cream and sugar, rice and beans, boiled eggs, curried vegetables, toast with jam for breakfast… They also prepare cole slaw, potato salad, and spaghetti especially for us. I learn that American pop music is global. Radios emit the most contemporary US hits; walking past shops, you can hear the echoes of Jay-Z rapping about “dirt off your shoulder”. The death of Michael Jackson reached Tanzanians faster than me. It was the doctor at the dispensary who first informed me that the singer had passed away the night before. All over the media, from local papers to broadcasted news, radio programming to late night sketch comedy, people celebrated the life of Michael Jackson and his musical legacy. I am thankful that there are people who can speak English here – our hosts Mama-nanci and her husband Gilbert, the two doctors from the dispensary, nurses Flora and Rachel, the English teacher at a nearby elementary school, and staff of the Parish. We struggle to overcome our language barriers, utilizing gestures and facial expressions to transmit what our words cannot.

But the disparities far outweigh the similarities. The clinic looks nothing like the hospitals of home. They operate without the technologies which are indispensable to American doctors – imaging devices (X-ray, ultrasound, MRI/CT scans), diagnostics tools (culturing samples, performing and interpreting biopsies), and drugs. Doctors examine cases clinically, relying process of elimination to determine causation. Most of the symptoms are vague – general malaise, coughing, fever, diarrhea and abdominal pain. The prescription can be equally broad – painkillers, a course of antibiotics, and an IV drip to make up for lost electrolytes and mitigate low blood pressure. Patients who do not respond to treatment are referred; it is their responsibility to make the trek over to the other hospital.

Many people live in poverty. Quality of life for even the relatively rich are subpar to that of a middle-class American. Things which Americans take for granted – hot water to shower everyday, a working toilet, steady supply of electricity – are all luxuries here. There is no Medicare for the elderly, Medicaid for the disabled. The sick here rely on family and their community to support them. Basic drugs such as painkillers and antibiotics can suck from a family all of its savings. The clinic does what it can, charging only enough to maintain itself. But even that is too much for some. An elderly woman we saw today could only pay 4000 of the 9500 Tsh prescription fee, medication that costs only about 7 US dollars. She owes the clinic the rest. Her repayment lies only on a verbal promise. And what about those without the care of relatives? The response is simple – “death”.

Yaoli: Why Maternal Health?

We moved recently to a new house late February. When my mother first toured with the real estate agent, she did not notice his animated speech about the newness of the wood floors. Nor did she pay attention to his zealous discussion over the finished basement and the recently updated water softener system. She peered out into the yard and instead of grass and weeds, she was struck by a vision. She pictured flowers bordering the fence, the barbecue pit scrubbed so it gleamed in the sun, and a bountiful garden nurturing baby vegetables springing from the earth. My mother was sold.

On March she began to work towards realizing her dreams. She bought seeds from the local plant nursery. She airated the earth, fenced up a square patch of earth where sunlight shone the fullest, and carefully placed each seed its into its earthly bed before blanketing them with a handful of soil. The rows were neatly arranged and labeled and everyday she faithfully watered them. The radishes, which preferred shade and cooler temperatures, germinated first. Everyday, my mom and my sister worked in the backyard, eagerly charting their progress, noting the number of new leaves and how much taller they grew.

By the time I had gotten back from college early May, it was ready for us the reap the fruits of our first harvest. My sister, though she did not find the planting process terribly engaging, was eager to uproot the plants. Her little fingers grasped around a large, robust plant and plucked it from the ground. Then her little nose wrinkled as she examined the radish before her. An inverted iceberg, it was large, green, bushy on top, but for all its magnificient crown, the real treasure was no bigger than a marble. Kimmie pulled out another, and then another. All the same.

My mother decided to go to the library and consult some gardening books. The reason, she learned, was that she had planted the radishes too closely together. Plants, like all other organisms, are complex organisms very in tune with their environmental conditions. Under certain situtations, they may bear large, bountiful fruit, but in other cases, they may divert their energy to growing leaves only.

People, too, thrive under the right conditions and do poorly in others. We settle in large masses by plentiful soil and near bodies of water. Mothers who were well nourished in pregnancy can afford to expend more energy for their babies. Well nourished babies in turn are shown to have less predisposition towards cardiovascular disease, diabetes, and other metabolic disorders. The benefits of a stronger body and better passive immunity factors from mom means a stronger immune system and a greater chance for survival. A baby is most vulnerable in the first year of life and infant diarrheal disorders have claimed the lives of many. The three brief trimesters spent in a mother's womb is precious time. Time for organ development, rapid growth, for laying down the foundations to a potentially long and healthy life. It is not enough to bury the seeds and water them. We must invest energy and care, for these nine months are the most crucial nine months of a person's life.

4 days until departure