Jambo from Arusha! Hope this finds you all well. November in Arusha begins the “short rains”, which is a lovely, cleansing time. The dust of the dry season is replaced with greenery, the cool breeze, and flowing streams. Crops are planted and seem to grow almost instantly. Again, as in harvest time, the hospital seems to have emptied, since people are busy planting their crops for the year. I still wonder how sick someone lets himself or herself become before they are able to leave the source of their livelihood to seek treatment. But there does seem to be a sense of joy and renewal with the coming rains: children playing, people gathering under shelter together, farmers planting. This month, for me, also was a time for renewal with the visit of my parents. It was a blessing to have them in Arusha, to show them daily life and the places where I work. There is something powerfully centering to see one’s family after a time of very new experiences.
Today for the Swahili lesson, I have chosen a common phrase with a bit of a negative meaning, but a significant one, nonetheless: imeisha. It means, “it is finished”, but is usually used to say, “we’ve run out”. For example, imagine being in a restaurant on a hot day after a long walk. There is nothing better in a moment like this than a cold drink (fill in your brand/drink of choice). You ask the waitress for your drink baridi sana (very cold) and they reply, sorry “imeisha”, it’s run out, try something else. You run through your second and third options, perhaps finding these have run out too, and settle for a warm purple Fanta. This pattern occurs on a daily basis, and requires one to be a bit flexible, but can be a frustration. It can be quite ironic, at times: the bar that has run out of beer, the sushi restaurant that has run out of fish, the ATM that has run out of money. Many of these are frustrating only to Westerners, myself included, who have come to expect establishments to supply what they advertise. The concepts of shortages, disrupted supply lines, rationing, poor business management, and other similar root causes do not often affect us in our home countries.
When it is only the lack of a cold Coke on a hot day, it seems like life will still go on, despite the parched throat and betrayed expectations. But when it occurs in healthcare, it borders on injustice. During medical rounds in the hospital, at least 3-4 times daily, we send a nurse to check on the availability of a medicine or piece of equipment that a particular patient requires. Often she/he returns to tell us “imeisha” and we return to the drawing board on our plan for that patient. We discuss with the patient and family about the probable cost of buying the particular medicine or equipment outside of the hospital, and try to determine if they will actually be able to buy it. Because most patients themselves do not bring money to the hospital, this often involves mobilizing relatives from near and far to collect money. If they can collect the needed money, a relative often has to search many pharmacies to find what was requested, causing a significant delay in the patient receiving it. The medical team is often forced with decisions about how important is this medicine, exactly; is it really worth the burden on the family? Will the cost push a poor family further into poverty? What if the medicine does not actually help? Is there a halfway suitable alternative that might be a bit cheaper or more available?
I understand, from talking with medical providers who have been in the country for a while, that the situation has definitely improved over the years. Generic drug manufacturing has made a wide variety of medications available to the poor, and this is a miracle. People with HIV and TB get free medications in a reliable fashion from the government, and this is lifesaving. But one lesson that I learned from Professor Mark, our mentor and leader, really hits home in moments of “imeisha”. To paraphrase his wisdom: “Nothing is more frustrating than having something, when you have it only part of the time”. It is here, though, that I see the resilience and creativity of the local doctors and staff come on the scene. Often, with some improvisation, and a lot of patience, a suitable plan can be created. It stretches the boundaries of medical knowledge, cultural wisdom, and street smarts, but I have been so impressed with how the way forward can be found. Sometimes it cannot and the patient may suffer. Other times, you may realize you did not actually need the medication or test that you usually rely on. In the end, I have faith that the people I have met are making a future with more equitable medical care for the poor in Tanzania. In a global sense, I think it is vital for people in resource-rich countries to know the reality of what occurs in resource-poor countries, and to receive the challenge of creating a just world.