Global Health Portal

Usa River

When I stepped off the plane at Kilimanjaro Airport, the familiarity of the air hit me immediately. I breathed in freshness, smoke, humidity, earth. The air is distinctive and raw, and I felt happy.  I am back in this place of simplicity and yet overwhelming complexity, a world that never ceases to fascinate me. I found myself feeling at once totally connected to Africa through my memories of studying abroad in Uganda, and yet completely jolted by the very different world from my own that is Tanzania.

Waking up each morning to milk waiting on our doorstep still hot from the cow, I am reminded of how convenience dominates my American life. Even here, temporarily residing in the house of European missionaries, I am fortunate to have many of the comforts of home: running (even hot) water, a modern toilet, a washing machine. I wonder how I am perceived by the Tanzanians, a mzungu (white person/outsider), living comfortably, when most people nearby live below the poverty line.

Great pride is taken in landscaping here. Beautiful flowering trees and plants are bountiful.

Every day, I get to be a part of the unfamiliar, and it unfolds in really beautiful and unexpected ways. At five in the morning, when through my window I hear the melodic singing of the Imam’s call to prayer, I feel totally at peace. This is unusual for me here, as I unfailingly grapple with culture shock whenever I travel abroad. At the marketplace, a colorful and bustling scene, I feel uncomfortable as I struggle to communicate with the young boys that won’t leave my side, either begging or persistently trying to sell small items. But then I look around and feel incredibly grateful and excited by the discomfort. When I come home from traveling abroad, I also unfailingly miss the constant newness, the satisfaction that comes from pushing one’s boundaries, and all the novel knowledge I get to soak in.

Living in the Usa River Rehabilitation and Training Center, daily life is quiet and calm. All sorts of people live and work here. The other day, a disabled man who crawled on hand and knee, using flip flops to protect his hands, came by and fixed our toilet. My initial reaction was shock and (yet again) discomfort, but upon reflection, I realized how remarkable this was. This man has built a life for himself despite the considerable restriction on his mobility—skills he learned from dedicated staff at the facility.

The local hospital’s maternity ward

I think this man provides an introductory glimpse at the types of people I am encountering on a day-to-day basis. It is never optimal to generalize about a population, because Africa as a continent is wonderfully diverse. But I will say, that in Uganda, and now in Tanzania, I am struck by how hard working and committed the people I’ve met are. They pool all their resources to educate their families, to improve agriculture, to build infrastructure at health facilities, and to implement systemic changes when possible, utilizing a kind of mind-boggling creativity unnecessary in our resource-rich environments in America.

Touring a local hospital, I was shown the maternity ward, the pediatric ward, the TB ward, the pharmacy, the surgical theater, the multipurpose laundry/teaching building, the laboratory, the dentistry facility, the HIV clinic, the male and female wards, and numerous other areas. Like Mulago Hospital in Uganda, there were many outdoor waiting spaces here, but unlike Mulago, there were no ill patients laying on the floor due to lack of beds. The institution functions without much of the necessary equipment to provide the most advanced medical care, but with strong leadership, it has nonetheless been able to build significant infrastructure and cope with limitations through ingenuity and strategic planning.

Women laboring outside the maternity ward

During the tour, I wondered what patients here think about the hospital experience. Are they scared? Hopeful? Secure? Looking at the cracked concrete walls, subjected to the lack of patient privacy, and aware that the medical technology is not what it could be, I know what I as an American would feel: afraid. None of these things go unnoticed or are uncommon knowledge for Tanzanian patients and relatives at the hospital. But then I observe the community in that hospital, and despite the lack of privacy, I imagine this sense of community offers comfort in solidarity. The doctors, nurses, and staff work closely to contend with large numbers of patients—patients with chronic and acute illnesses that may or may not be treatable. What they lack in infrastructure and equipment, they make up for in dedicated commitment to the betterment of the entire community they serve.

One of the two rooms of the dentistry clinic

Speaking with Professor Noelle Sullivan (global health faculty and critical medical anthropologist) about her experiences at this hospital and Tanzania in general, I am prodded to think critically about what these difficulties mean for development. Is it better to invest in people, in diseases, or in infrastructure? How can global organizations give Tanzanians a voice? Do they at all? Is it possible to design interventions that are impermeable to greed? If so, what would these interventions look like? How can I, a young mzungu, understand a culture in which I will always be an outsider? Perhaps over the next five weeks, I will be able to pull apart these questions further, and figure out what role I can have as a foreigner in this developing country.