Difference

You are studying abroad; you must prepare yourself to be confronted by vast difference from what you are familiar with. You will feel overwhelmed. You may experience culture shock. That is what the pre-departure materials tell me. This is what I signed up for.

Despite these warnings of difference, all I can think about are the similarities. Going through pre-orientation with Professor Sullivan, I expected to be excited by the prospect of new experiences. However, looking at a slideshow of pictures capturing dusty streets and open markets, a wave of nostalgia swept over me. It looked exactly like Antsiranana, the city in which I was born and Tananbao V, where many of my family members currently live.

My grandparents’ new house in Bemoko

Many study abroad students are excited to experience difference, but I am excited to re-experience old childhood memories. I cannot wait to navigate the markets, to eat street food, to ride in over-crowded buses. While these things may seem foreign to other people, I am comforted by their familiarity. It reminds me of my time in Madagascar. While in Tanzania, I want to focus on these similarities instead of the differences.

Even though Swahili is a completely new language to me, Malagasy words keep coming to mind, words I have not spoken in a long time. Unfortunately for me, Swahili and Malagasy have very little in common. However, a lot of Malagasy and Tanzanian manners are similar: respect your elders, don’t use your left hand, always offer your visitor food, be a courteous host, pretend you don’t have news when you do, and every time you greet someone go through an elaborate set of phrases with predetermined responses. I am curious to see what other similarities I can find in between these two different cultures, and reflect on my identity not only as an African, but an American as well.

Back at home

Stepping into the windowless, spotless, and crowded Turkey airport lit just as brightly as a Tanzanian midday, I marveled at the change. Shops with untouched merchandise twinkled under the steady brilliance of manmade lights. Although I expected the lights to putter out, they never did during the two-hour layover.

Coming back to said “developed” countries I noticed many habitual aspects of life: waking up and groggily and turning on the electricity without considering that the lights might not work; turning on the hot water for a bath everyday; walking across a pedestrian walkway; knowing I can have food delivered to my door if I don’t cook a meal; knowing that pushing the refresh button will ensure that the webpage will reload; putting clothes into the washer and dryer. I realized that at home, I had a lot more reliability and convenience in terms of electricity, appliances, and clean sources of water and bathroom.

Yet these aspects of life that I thought would restore comfort surprisingly did not. Rather, I missed going out to the supermarket to bargain for a pile of tomatoes. I also missed the simple “shikamoo” and “mambo” greetings that were considered a courtesy in Tanzania. Back at home, man made noises and objects seemed to have replaced a lot of nature’s sounds and pictures that I loved in Tanzania. At night, as I listened to the whirring of the car engines rushing by on the highway, I thought of the crickets and bullfrog symphonies that kept me up at night. Looking across the brightly lit city, I reminisced of the twinkling starry nights that nature gifted us in Usa River. As I thought back to the parts of Tanzania I missed, I realized that I learned to love a country that had a culture, language, and people that differed from my own.

 

The man who passes the sentence should swing the sword

Post by Jacob Sherman

jacobchickenIn the first episode of HBO’s Game of Thrones, Ned Stark imparts upon his sons a piece of fatherly wisdom that stuck both with the characters, and with me: “The man who passes the sentence should swing the sword.” He proceeds to chop off the head of a man found guilty for deserting his position as a member of the Night’s Watch. Ned Stark and his parable on death and responsibility was the reason I felt compelled to slaughter a chicken while I was here in Tanzania – something absolutely routine and benign in every Tanzanian household, but a gross and shocking idea for me. My task, in absurdly hyperbolic fashion, was to either take responsibility for the deaths I passively take part in everyday with my protein consumption or fail to swing the sword and never again eat meat.

So now, I will present a technical guide on how you can slaughter a chicken with none of the grace or power of Ned Stark. First, you should have your Tanzanian research partner (Filbert) accompany you to the market to buy a chicken. In order to avoid the wazungu (white people) price, your Tanzanian friend should do the bartering; even my presence with Filbert at the market was enough to drive up the price. It’s also useful to have a Tanzanian accompany you to the market because holding a chicken can be scary at first. They can help ease you into contact with the chicken and even help you comfortably take a selfie with it on your walk home.

chickenpan

 

From here on out, it’s absolutely necessary to have a Tanzanian friend assist you. Slaughtering a chicken is one among many useful life-skills held by every Tanzanian but stolen away from us device-dependent, soft-stomached Americans by the Capitalist Machine (maybe I’m being too harsh since a lot of hip people are raising chickens these days). After perhaps debating with your Tanzanian partner that that knife looks too small and it would be more humane to use a bigger knife to get the job done faster, you should probably just listen to him because like he’s said, he’s done this a thousand times. Try not to get lightheaded. Pin the chicken down on its stomach. With one foot on its legs, draw its wings together and place them firmly under your other foot (the chicken wasn’t necessarily comfortable but I wasn’t breaking its bones and I’m not sure it was even in pain, yet). Pull its head out to extend its neck. Pick a few feathers off its throat to create a point where you can easily access skin. Try to make that first cut – take a deep breath and try again. When your knife connects and you hear that terrible sound of tearing flesh, don’t take your feet off of its flailing body and don’t stop sawing (the word sounds so cruel to my American ears but that’s what it was, and that’s how I was told to do it) until you’re holding its head in one hand and a bloody knife that looks too small in the other. Drop the head because it’s still moving. Keep your feet on its body because that’s moving too. After a minute it will stop shaking.

The rest isn’t pretty but your color should come back and you can probably stop holding your breath. Put the chicken (head too, because a Tanzanian or a brave American might want to eat that) in a bath of scalding water. Have some friends help you pluck the feathers off. Lay it out on a tray and have a Tanzanian assist you in cutting a large slit down its chest. Widen it until you have access to all of its guts and stuff. Carefully remove said guts and stuff, taking caution not to burst the little sac by its liver holding its sour, gastric juices. Save the liver and the legs because someone will eat those too. From this point, most everyone can figure out what to do. It tasted good but noticeably different from any chicken I’ve had before, just like the Tanzanians said it would (if I’ve learned anything from the experience, it’s that in these kind of contexts, our Tanzanian friends are always right).

 

chickengroup

 

Now back to the larger, existential themes that lurk at the edges of my how-to-guide. I passed the task I gave myself. I was able to look the meat that I regularly consume in the eyes and take responsibility for ending its life. I felt I had earned the right to eat my dinner that night, and by some faulty logic, I even earned the right to keep eating meat in the future that I hadn’t slaughtered? I think I’ll try to not think too much about that one. But maybe it’s a problem that it’s usually so easy for me to not think about where my meat comes from. It’s comforting to hide behind the facelessness of the supermarket chicken breast, but being the one to step-by-step turn a live chicken into a meal adds a sense of immediacy to the question: where does your meat come from and is that ok? A girl on our program stopped eating chicken (for a week) after this episode. While I thought that was a tad dramatic, maybe her reaction is also telling; if we all saw where the meat we eat comes from on a daily basis, we might think twice about eating that meat and endorsing the way those animals were treated. In case this blogpost took too preachy of a turn, let me be clear that I can only be so self-righteous in my support for the ethical treatment of animals while I continue to eat them. So for now I’ll accept my faulty logic, thinking a little bit more (but not too much) about where my meat comes from and knowing that at least for a day, I would have made Ned Stark proud.

Back to Basics

Post by Rachel Onders

I’ve been reading a lot here. I usually read a lot over the summers, but here, in Tanzania, it somehow feels different. Perhaps it has to do with the unreliability of electricity – it’s hard to watch a movie or television when the electricity could be out or the wifi might not be working. Instead, I’ve been reading.

I’ve always been a bit of a book nerd. I grew up with Harry Potter and other adventure novels, playing pretend in the backyard with my brother. I had re-read the series countless times by the release of the seventh and last book. I hadn’t read them in a while until this summer, when I decided to read the whole series again, from the very beginning, since I had so much time for reading here.

Returning back to the books I had loved so much when I was younger is a different experience than I expected. Reading them here, with limited electricity and Internet, emphasizes the feeling of being a child again when I read them. It’s a back-to-basics type of experience, where fun and leisure comes from books and the people around you instead of the Internet or a television. My roommate even joined me in re-reading the Harry Potter series, so we can talk about each part with each other as we read through them. It amazes me how much joy I can still find in reading this series, supposedly meant for “children.” There is something simple and pure about the things that can amuse a child, and being here is reminding me of that.

Watching the kids run around the compound where we’re staying, or chase each other on their way to school, inspires me. They take the greatest fun out of the simplest things: running with each other, playing with an old bike tire and a stick, or seeing us “wazungu” – white people – and saying “Hi!” with a wide grin on their faces. This type of unadulterated excitement can feel nonexistent at times, under the pressure of school, responsibilities, or looming “adulthood.” After this summer in Tanzania, remembering my childhood through books, and playing with the happiest of children, I know that I’ll be able to recall the unabashed joy we felt and saw here for the rest of my life, and help others rediscover that feeling as well. `

The Words Behind All The Numbers

Post by Udita Persaud

Emmanuel motions for the mother to bring her young child to get weighed. The mother, modestly draped in a royal blue kanga with vibrant hibiscuses, approaches the hanging scale. She tenderly secures the matching kanga around her little boy. After tying two sturdy knots in the cloth, she hangs the kanga on the scale. As he dangles from the scale, the little boy with his big, dark brown eyes stares curiously at the contraption above him. Dr. Emmanuel meticulously pencils in the weight of the boy in the patient card and nods at the mother.

The number written in the patient card will travel from document to document. The information flows through a specific system: from the patient card, to the report book, to the national database, to the donor reports, and into the hands of a representative of a nongovernmental organization. As the number funnels through the different stages, it loses its personal value. The representative does not know the circumstances to obtain that single statistic. Little is known about the doctor, who attends to all the patients at the health center, and how severely overworked he is with little supplies and staff to aid his work. Information is lost on how mothers and children are sometimes not able to make it to the center due to transportation issues. On the flip side, the health workers don’t realize the potential that these numbers have in respect to their health center. The value of statistics at a large scale in respect to donors sometimes does not get translated for the workers.

Most people recognize that data is really important. However, data is not necessarily a “glamorous” thing to be worried about. At face value for health workers abroad, it is a bunch of numbers that have to get recorded and reported for the government and various organizations. However, a deep understanding of data reveals that these numbers have the potential to change how aid and support are allocated. Data is a type of currency. One gets the right to speak when there is data to back him or her up.

Alternatively, big governments and organizations sometimes lack to connect the people behind the numbers. When goals or targets are not met in summary reports, there are explanations for the downfall that do come to the surface. People and situations surrounding these people seem to become invisible when connected to data. Donors are not aware of the extenuating circumstances that hinder and sway data. As a result, sometimes even the final reports are not accurate.

I feel that no one really understands what data means on either side of the partnership. Donors are not aware of the true meaning of the numbers in practice, and health care workers are not aware of the value of data reports. After six weeks of research on data and its burden, I feel that I also do not have a complete understanding of data. Maybe the next step for data collection is not to get more or better data, but to actually understand the data we already have.

The hanging scale that is used to weigh babies in the Reproductive and Child Health  (RCH) department

The hanging scale that is used to weigh babies in the Reproductive and Child Health (RCH) department.

 

Exotic Animals

Post by Elizabeth Kelly

I love animals, and ever since I was little they have fascinated me. Any shape, size, color, or species sparks my interest. At home, we get so accustomed to the sight of certain animals that we only really notice them when they do something extraordinary. I find a squirrel interesting, but I will really only take time out of my day to notice it if it does something like carrying a whole pizza slice in it’s mouth, because if not it appears just average. When there are 10 deer in my backyard, I may watch for a bit, but they are not as interesting considering they are there almost every day.

Here, the “average” animals are far from average for me. It doesn’t matter what I have to do or where I need to go, if there is a monkey sitting in the tree near me, I’m going to stop and watch it until it decides to move out of my sight. Some of the locals recognize that as foreigners, these average animals are exotic. We saw our first monkey during the first week of Swahili lessons, where a big one dropped from the roof and sat right by the window. Mwalimu (“teacher”) let us take a break to run outside and watch as he swung through the trees to join his friends. The second weekend on the coffee tour, our guide went out of his way to catch a chameleon he had spotted so that we could hold it. It was tiny, but we fussed over it for about thirty minutes. The next time we saw one we were prepared, and picked it up and passed it around as if we did that all the time, but it was still so exciting to have a lizard the size of a stick of gum sit on your shoulder.

As he began to relax, he started getting some of his green color back.

As he began to relax, he started getting some of his green color back.

When we ventured to a lodge near Lake Diluti one weekend, we found ourselves surrounded by trees packed with Vervet monkeys. Vervet monkeys are the most common in Tanzania, and I’ve now seen them on a stump near the road, stealing food from the tables of numerous picnic areas and hanging out in trees by the highway, but I still want to see more. This time at the lodge was special, and as we sat in the grass under the trees where they were, we watched mothers jump around with babies clinging to their chests, teenagers play around, a few clean each other, and even one who ventured to the ground to investigate us.

The next time we saw these monkeys were on our safari, which obviously involved views of plains and fields of exotic animals. I’ve seen most of them in a zoo, but it is different to see them wild and in their natural habitat. The giraffes and zebras, lions and elephants and hippos were fascinating to everyone there, and it was very special to appreciate them there.

We definitely watched The Lion King after the safari weekend.

We definitely watched The Lion King after the safari weekend.

Our opportunities to hold different animals did not stop at the chameleon. Looking through pictures on Facebook, many of our photos are of us holding lizards, chicks, snakes and tortoises. I think best of all was the monkey named Chobi that we met in Zanzibar. It only cost us a small donation to “Chobi’s family,” but it was definitely worth it to have the monkey jump from person to person, sometimes stopping to sit and eat the fruit we had given him, or stopping on the boys to try to groom their arm hair. Monkeys are my favorite animals (if you couldn’t tell) and that definitely made my weekend.

Chobi preferred sitting on the tallest in the group.

Chobi preferred sitting on the tallest in the group.

Although the point of this trip has absolutely nothing to do with animals, it has really become a large aspect of it. Being the biology major that I am, the places I travel to are largely defined to me by the nature in my surroundings. But playing with the monkey, or even marveling over the geckos on our porch roof, has made me realize that there are many things here that are so simple but exotic, beyond average, and are really shaping the experience I have had here. Doing my laundry by hand is quite foreign but amazingly simple. Going to the market and bargaining for the price I want is so easy and not very novel at this point, but I still get the thrill of being in a foreign place and the sense of adventure.

When I go home, I’ll definitely miss these little things. I can do things such as make fresh fruit juice and go find a lizard in my yard, but they won’t have the same impact or impression as doing those things here has. I’ll appreciate the monkeys and chameleons even more, but I also look forward to the squirrels and deer that make the places I go special.

Excerpts from Tanzania

Post by Aislinn McMillan

“If you talk to a person in the language they understand, it enters the head. If you talk to a person in the language they were born with, it enters the heart”

My research team was visiting a local dispensary to inquire about the prices of their drugs and how they acquire them. We really only needed to speak to the pharmacist for a few minutes, but the doctor there was so welcoming and took us into his office to talk, that we ended up staying the afternoon at the facility for teatime. The other American and I began, as we always do, exchanging pleasantries with him using our limited Swahili. We asked if he would prefer to speak in Swahili or English, and at this point he delivered the above quote.

This quote sticks out to me as I find it characteristic of the way in which many perceive language in our interactions here. Greetings are an integral part of the culture here (you can see a classmate’s previous blog post on them), and you commonly greet strangers as you pass them by. I have frequently experienced how an elder’s face lights up when you greet them “Shikamoo” (how you greet someone older than you with respect). To me, such instances demonstrate how even small efforts at another’s language can be signs of respect.

“The diseases of Tanzania are love and peace”

OurGroupOnTheCoffeeTour

Our group on the coffee tour.

Our first weekend in the country our group went on a tour of a coffee plantation, and here is where our guide recited the above quote. I found this notable because it rejects many peoples’ sweeping perceptions concerning the state of Africa, and conveys the friendliness that I have encountered. Some expressed concerns for malaria or Ebola when they heard of my travels, even though malaria is not prevalent where we reside and Ebola is closer to London than it is to Arusha. This quote also illustrates the contagious nature of people’s kindness and generosity that I have experienced—including people inviting us to teatime or helping us with our Swahili as we try and barter at the markets.

 

“Laughter is life—it helps you live longer and better and happier”

One day during our first week of Swahili class, our teacher went off topic and reflected on her husband’s passing a few years ago and how it has affected her and her children. She spoke of how they live with constant laughter, and through it he can live on through them. She feels his spirit when she experiences happiness, and it makes her know that her husband is remembered well.

I was amazed by her candidness, energy, and positivity as she opened up to us. She holds a unique love and appreciation of life that I deeply admire—she demonstrates the happiness and comfort that can be found even in the face of misfortune and a recognition that life continues on.

Our Group and Mwalimu (“Teacher”)

Our Group and Mwalimu (“Teacher”)

Market Day!

Post by James Fan

It’s Sunday and we need food for the dinner we’re cooking tonight, so five of us grab some of the leftover supermarket plastic bags from the house, board a cramped dala dala, and ride it to Usa Market. We quickly split up into two teams and buy what we need. Avocados? Check. Bananas? Check. Rice and beans? Check. 10 minutes and we’re in and out. We again get pushed onto an already full dala dala and make our way back to our home. It’s the 7th week and this has already become a normal routine; something that we’ve learned to master even though our Swahili isn’t great. It hasn’t always been this easy though…

Usa market day

Usa Market Day

I can still remember our first market day on one of our first days in Tanzania. The first time we even had Professor Sullivan to help guide us along. It was the same Usa Market, but as I remember it was much more packed than today. The moment the seven of us jumped off the dala dala, still jetlagged and processing that we’d arrived in Tanzania, little boys swarmed us, shoving their black plastic bags in our face. “Hapana, asante” I responded to one (no, thanks). This was one of the few phrases I knew at the time. The seven of us followed in a line behind Professor Sullivan as she navigated her way through the cramped market. We probably looked like little ducklings following their mother: dazed, confused, and desperately trying to not lose track of the person in front. The market was an amazing scene and reminded me a bit of the Chinese markets I saw when I was young. There were people everywhere: rows and rows of women with fruits and vegetables laying in neat piles in front of them, men and women meandering through the shops, and people shouting prices, shouting what they were selling, and, of course, shouting “Wazungu!” (white people) when they saw us. It was all a bit overwhelming.

Front of Usa Market

Front of Usa Market

We stopped in front of an old woman selling carrots. Dr. Sullivan taught us: “Bei gani fungu moja?” meant “how much is one pile?” and “Naomba nipe fungu moja” meant “could I buy one pile?” “Okay, easy enough, two phrases…I think I can do this,” I thought to myself as I repeated the phrases out loud. Just as I was going to buy tomatoes though, I froze. Shoot, I forgot the phrases already. I turned around to ask Udita, and with her help, we were able to pay 500 shillings for a pile of tomatoes. A small success. We left that day overwhelmed and imagining how Usa could be considered the “smaller” market, not really wanting to come back. But of course eventually, the thought of hunger set in. We went to the market again that week, and again the next…and before we knew it, we could buy ourselves dinner.

Public health stories

photo 1 (1)

Analyzing data with my research group

The chiming of the alarm clock lulls me out of my sleep at 7 AM. As the sunlight streams between my roommate’s bed and mine, I blink my eyes open and stretch, hoping to wake up from the haze of sleep shrouding my thoughts. The mosquito net rustles as my roommate also stirs from her sleep. It is another day of qualitative research in Tanzania.

As the three of us – a Tanzanian, a Caucasian, and an Asian – call out “hodi!” at the village doors, people stop and gape at our spectacular trio. (In Tanzania, before entering any building, we call out “hodi” to announce our presence and ask permission to enter.) Children often yell out “Mzungu!” – meaning white or more generally foreign people – and giggle when we wave or respond in Kiswahili. Every moment in the field is new and unfamiliar, and therefore I am constantly learning.

These past four weeks, my Northwestern counterpart, the Dar es Salaam student, and I have been trekking through villages to hear people’s perceptions regarding the new “private” pharmacy outside the gates of Meru district hospital – or Patandi hospital as locals call it. Several interviewees had negative perceptions toward the new pharmacy. These individuals revealed their reliance on a public hospital system that provided delayed services and a dearth of medications. They questioned the stark disparity between the new, well-stocked private pharmacy and the frequently out-of-stock public pharmacy. Thus, their story about the new pharmacy functioned as a vehicle to express a deeper, personal belief about the difficulties of a system: in this context, the public hospital system within the Meru district.

Yet even those with negative perceptions discussed the potential benefits that the pharmacy brought: non-expired medication, closer access to drugs, and trained pharmacists. Their opinions on the pharmacy were not a single emotional color. Rather, their conceptualization of the pharmacy comprised both positive and negative feelings, and both complaints and praises. Thus, different ways of listening have been crucial in understanding the myriad of opinions, thoughts, and emotions regarding this entity and the public health system.

The Tanzanian Healthcare Pyramid Tier

From dispensaries to consultant hospitals, the Tanzanian healthcare system is a decentralized, multi-tiered referral system. During our first two weeks in Tanzania we visited the different levels to observe how the various facilities provided health services.

The dispensary

Simulation baby at the dispensary

Simulation baby at the dispensary

A total of 11 people piled into a rented dala dala – a Tanzanian public transport system – and headed towards the dispensary. Simply put, the journey resembled a 4D rollercoaster movie where the seats unexpectedly jerked the consumer around in all directions. The path to the dispensary was unbelievably dusty, hilly, and unpaved. How a sick person could be transported to and from the dispensary was a complete mystery to me.

This particular dispensary served the Meru tribe in the area. With one doctor, nurse, and a nurse assistant, the dispensary provided rapid malaria, HIV, and syphilis testing, painkillers, antibiotics, dysentery medication, condoms for males, family planning, and pre- and post-natal services. Although pregnant women could deliver at the dispensary, complicated cases in need of C-sections were referred to the next level: the health center.

The health center

The Mareu health center offered out patient care, reproductive and child health, CTC (Counseling, testing, and care) for HIV, family planning, adolescent sexual health, vaccination for children under five, PMTCT (prevention of mother to child transmission), tetanus shots, and TB screening. This particular health center had recently upgraded from a dispensary in name. However, they lacked supplies, staff, or infrastructure to function as a health center. With two nurses, one clinical staff member, and two registered nurses, the center functioned five clinical officers short for a facility that ran 24 hours.

Although this facility had intermittent electricity, the staff did not depend on biotechnology to administer their services. For example, I observed a cone-like stethoscope with a metal plate soldered onto the narrower edge. The health staff used this equipment to monitor fetal heart rate – a sound that I was surprised they could distinguish past the mother’s stomach, uterus, and fluid. Without biotechnology the patients had no access to ultrasounds, echocardiograms, and other precision assays. Yet, without technology the patients had access to doctors with skills that those trained in a “tech-savvy” world may not have.

The district hospital

Compared to the dispensary and health center infrastructure, Meru district hospital was beyond large. The hospital had an enormous compound with grassy plots scattered between numerous buildings. Several plots had wet kangas – a traditional Tanzanian cloth – and blankets strewn out in the sun to dry. Ambulatory patients and families alike communed on these open areas. The open landscape enabled natural ventilation that contrasted with engineered vents aerating multi-story hospital buildings that I had grown up with.

This facility had a laboratory, operating theater, x-ray and radiology department, health care services for family planning and pregnant mothers, in patient wards, pediatrics, TB clinic, diabetes clinic, HIV treatment, pharmacy, maternity ward, dental treatment, physical therapy, and laundry facilities. Initially I gawked at the numerous specialized services Meru district hospital provided. From briefly observing the outward lists and infrastructure, I believed that this hospital had plentiful resources to provide care. Yet, not long into the tour, the matron discussed that even in this seemingly well-supplied facility, staff shortages diminished quality of care. Thus many staff members learned experientially while providing services where most hands were needed.

The regional hospital

Mt Meru hospital

Mt Meru hospital

The regional hospital had the first two-story building that I had seen thus far. They even had a parking lot filled with cars, and nurses’ day ribbons wrapped neatly around poles throughout the hospital. Yet, similar to the district hospital, Mt. Meru regional hospital grappled with challenges that hindered equal provision of affordable care to all patients in the hospital. Here, budget shortages underpinned human resource deficiencies, equipment and drug scarcities, and infrastructural failings. Due to inadequate finances, Mt. Meru attempted to deter self-referrals in order to treat referred patients who required services provided only by the higher tier regional hospital. At Mt. Meru, opening a file costs 3000-5000 shillings. Yet for self-referral patients, the cost is 10 000 shillings (this is about 5 US dollars). Despite their efforts, the regional hospital continued to function at a deficit.

The referral hospital

KCMC

Kilimanjaro Christian Medical Center (KCMC)

The ultimate facility at Tanzania: the referral hospitals. We visited KCMC (Kilimanjaro Christian Medical Center). As the first teaching hospital that I toured in Tanzania, KCMC had a modern and well-maintained infrastructure. At KCMC the staff had distinct roles that shaped their responsibilities, skills, and physical location unlike the “jack-of-all-trades” mindset in previous health facilities. Staff had an official hospital badge identifying their name, credentials, department, and position. Furthermore, each department at KCMC had its own physical location including their own surgical theater.

However, KCMC had infrastructural challenges that underpinned patient overflow in specific departments. Built between 1965-1971, the main KCMC buildings remained unchanged while the patient influx steadily increased. Thus, rooms built using 1965 capacity approximations could not accommodate current patient populations. In the surgical ward alone, many occupied patient beds were lined along the hallway due to lack of space.


Climbing the healthcare pyramid tier, I observed increasing biotechnology and field specialties. Yet, even at the most “prestigious” hospital – KCMC – doctors faced challenges that stunted their ability to provide quality care to all incoming patients. Thus no matter how excellent a facility appeared to be, each dispensary, health center, regional and district hospitals, and referral hospitals had difficulties specific to its context.

I had initially come into this week wanting to learn about the one success method that eradicated all difficulties at a health care facility. However, I am reminded once again that no permanent solution exists. Even when solutions are implemented, the solutions create a new environment – social, infrastructural, and economical – where unexpected challenges arise.

At first glance the recurrent problem-and-solution resembled the Korean story of the broken clay urn: a man laboriously pouring water in a broken clay urn in hopes to bring home a full pot of water. The urn with the hole represented the never-ending cycle of problems; the water embodied the continuous stream of solutions; and the hope for a full urn reflected the hope for a permanent answer. This depiction presented a bleak world with continuous tribulations.

However, I wonder if my black and white conception of problems and solutions as sadness and happiness represents reality. Perhaps problems and solutions are natural facets of a chaotic life, and not necessarily distinct negative and positive entities. Thus if problems exist as a reality, approaching challenges in the Tanzanian healthcare system with the mindset to eradicate could lead to more unexpected consequences. Rather, one sustainable approach to healthcare issues in Tanzania could simply be the understanding that problems and solutions will always be present.