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”.