Working in Tanzania provides one with a variety of contrasts to what we are used to. Living in the US, we take so much for granted. As I have thought about these differences, I wanted to share some of the things that I take for granted.
Water: We turn on a faucet and get fresh clean water; the only complaint we have at home may be if it is too chlorinated or not cold enough. Fresh and clean water readily accessible is the norm. Here in Tanzania, water is a precious commodity. All of the water we drink has to be boiled or bottled. Water in the tap is dependent on the rain (not much this year), city water (episodic) and electricity (also episodic). Water is stored in cisterns and then pumped into the roof-high tanks to provide us some minimal pressure. We had our first rains over the weekend. Considering this is supposed to be the rainy season, we haven’t seen very much. Usually the vegetation is very green when we are here; instead, the grass is brown and the tree saplings are dying. Gardens are dying because there isn’t enough water to spare to keep them growing. My biggest challenge is trying to remember not to use the tap water for brushing our teeth.
Electricity: At home if the power outages are a rare event. Here in Tanzania it is a regular occurrence. Daily the power goes out for at least 12 hours or more. Power in Tanzania is dependent on hydroelectric resources. Since Tanzania is experiencing a 10+ year drought, the situation is very precarious. Without the spring rains, the dams don’t have enough water to keep generating power thus the rolling outages. Fortunately we have generators to power up our OR, but the offices where we see patients are lighted only by the sunlight coming through the windows. Another challenge we are faced with is the limited power available when the power is on. Using the hairdryer can cause the power to flip off.I finally have the full orientation on resetting the switches when we overload the circuit. We have all come to appreciate electricity especially at night when it is so dark. Today we have had almost 24 hours of interrupted power!
Food: Back in the States, we rarely have the same food two days in a row. Here our food is prepared by Lucy, our wonderful cook. We go over to her home to eat lunch and dinner. She provides wonderful food but it is usually a variation of the same. Our meals consist of meat, rice or potatoes, mchicha (a cooked spinach-like dish), fresh salad, cooked cabbage or cooked egg plant, and fresh fruit. The meat is usually picked up from the market the same day it is butchered. The chickens especially seem a bit lean. We have all enjoyed the food but again the variety is lacking. Yesterday, Lucy surprised us with a traditional African dish, ugali—boiled corn flour. Ugali becomes a thick ball and is served warm and either dipped in other foods or covered with one of the vegetables to give it some flavor—not much flavor alone. Last evening after working at the orphanage, we went to a beautiful Chinese restaurant on the banks of Lake Victoria. The food was grand (and gave us some food variety) but the service a bit slow—I suspect 27 people all at once would overwhelm anyone. Breakfast on the other hand is also a special treat. Paula made breakfast every morning for us: pancakes, oatmeal, cinnamon rolls, fresh fruit and eggs and potatoes.
Roads: When was the last time you complained about a pothole in the road? Here finding a paved road is not common except for the main roads of the city. Highways can simply be dirt paths through a secluded area. Even the paved roads will have significant detours due to road collapse and disrepair. Traffic lights are found in the big cities but fewer are out in this area of the country. Travelling without a knowledgeable driver can be risky. In addition to the potholes, there are many speed bumps every few miles to keep the traffic a bit slower. Some require a near stop to get over compared to some that you can take at 5-10 miles per hour. The road into the nearby town of Nyakato is probably one of the more amazing roads we have seen. Rain has washed deep ravines into the road exposing many rocks make travel relatively hazardous. Somehow bikes, motorcycles and a few vehicles make it through on these roads.
Privacy: Something we hold so dear in the US is rarely found here. Examining a patient may be interrupted by patients bringing back their lab results to be reviewed. Our pre-op and post-op both have two beds but no curtain to provide any privacy. Our exam rooms have large windows with curtains that may not completely shut. The people are very gracious despite no privacy and rarely complain. Even at our bungalow, privacy has taken on a new dimension. We have nine people from our team staying here so we have gotten quite comfortable lounging in our pajamas at night.
Medical care: Another item we often take for granted is our wonderful medical facilities back home. We are bringing expertise to Nyakato and providing training opportunities for the providers and nurses as well as teaching them some of the newer medical management trends. The facility in Nyakato is amazing; they provide care to the local folks in this community—care that would not either be available or affordable otherwise. The clinic has a wonderful fund (SNF—Special Needs Fund) for folks that can’t afford care or surgery or meds. No one is turned away. The time here provides us with the opportunity to practice without x-ray, CT, lab (only a few available) and a very limited formulary. Despite all pieces that are missing the people are so gracious and appreciative of what we are able to do and offer them. In addition, we are learning tropical medicine here better than sitting in a classroom.
Computer access: Wow this is really something we take for granted. We complain when the high speed internet is slow for any reason. Imagine speeds back to the dial-up days—and this is if you can get a connection. Currently, our connection is via a cell phone tower using a modem wired connection. Not checking the latest emails or news is a switch for all of us—although not missed greatly by some. Last year a high speed cable was dropped into the Indian Ocean which will provide a connection for East Africa. The problem we face here is that Nyakato is so far inland.
Weather: We are used to seeing the seasons change and even a daily variation within the season. Here we are just 3 degrees below the equator. The wind blows rarely and the sun shines most of the time. Where we are located, the temperature stays around 80-85 every day; so far we have had sunny days every day with little variation. Rain would actually be a wonderful change here. Most of us aren’t complaining about the weather knowing what the alternative back home is! Today was very beautiful and a bit cooler than it has been.
Noise: We are often able to filter out a lot of the noise we hear every day. Car and truck engines going by laced with horns and braking tires. Radio and TV are blaring in the background. Here where we are located, we rarely hear a horn or a vehicle. The noises we hear are very different as Denyce has noted on a previous blog. Today as I write, I am listening to staff laughing and visiting together as the day closes. This is overlaid with the beautiful music and dancing coming from the church across the street. Even though you can’t understand the words, the music is beautiful to listen to and the dancing amazing. Even the bird sounds are very different despite the familiar sounds of the doves. The nights are especially unique; there often is no noise except the noise you make—the intense quiet can be amazing.
As you can see the contrasts are dramatic. We take so much for granted and are daily reminded of this. Yet despite all the differences we are struck by how much we are the same. We have many new friends and are dreading having to say good bye.
Jeff H, MD