Pole Jambo from Arusha!
Since last writing I have been
rounding on the medicine ward, which has been quite a different experience
compared with pediatrics. While malnutrition and respiratory infections malign
the infants and children, HIV devastates the adult population. Surprisingly,
non-communicable diseases are just as common, if not more so, than HIV and its
complications. Diabetes, hypertension, and chronic obstructive lung disease
(emphysema) are much more common that I expected, and, unfortunately, with the
transition of local populations to urban lifestyles, they will likely become
the major burden of disease in developing countries like Tanzania. Just as it
is in the US, chronic disease is difficult for patients to understand and
providers to feel like they can make a difference, but I have been impressed by
the knowledge and compassion of the local doctors to not just treat but to
educate their patients on how to manage chronic diseases. For example, in
outpatient clinic this week, I sat with Christopher, the internal medicine
registrar, as he took about 30 minutes of a busy clinic day to explain diabetes
type 2 to a patient. The concept of disease occurring without symptoms and not
having a one time solution is a difficult one to grasp, but Christopher patiently
reached for common ground in understanding. Despite the myth that doctors in
developing countries are "paternalistic," I have found that in this
case and many others, doctors like Christopher strive to educate and empower
patients and families to understand their condition and proactively participate
in their own care.
For today's Swahili lesson, I wanted
to introduce the word "pole." Just like "karibu," pole is a
common and versatile word that enters into interaction several times per day.
It is usually used here for "sorry," like when you bump into someone
or walk on a clean floor with dirty shoes (I seem to leave a trail wherever I
go). "Pole" also has some unique uses that we have observed. It is
considerate to express "pole" when you see someone carrying a heavy
load (we get a alot of "pole"s when we carry groceries home up the
hill). Many people will say "pole la kazi" when they see people at
work, whether working at the hospital, harvesting roadside crops, constructing/digging,
etc... It means, literally, sorry about the work. It feels similar to the
feeling of sympathy medical residents give each other during a busy night shift
or after a difficult series of events. To me, it seems to be expressing,
"I have been there and I feel your struggle, hope you get to finish work
and rest soon".
The most interesting use of
"pole" for me has been with patients. When most local medical staff
approach a patient on rounds or clinic, they usually begin with "pole
bibi/babu/mama" (sorry grandma/grandpa/mother), which acknowledges the
fact the patient is having a struggle. The usual response is "asante"
(thank you), which feels like an expression of gratitude for recognizing the
burden on the patient and family. As medical workers in the US, I think we do recognize
the value of this sort of sympathy. Some useful expressions that I have learned
from my teachers are "this seems like a difficult time for you" or
"i'm sorry you have to go through this," but usually this comes up
after a display of emotion from the patient or family that beckons validation.
In clinical practice here, I find it most interesting that this validation and
sympathy is the greeting, rather a phrase reserved for certain situations. It
seems rooted in the community values here, that one person's burden is shared
amongst others, not just friends and family, but all people that interact with
them. Here in Tanzania, there are so many burdens that people carry, even in
daily struggles for basic needs. It is frustrating for me, as someone that
takes for granted that my daily needs are easily met, to see the barriers that
people have to providing for themselves and their children. On top of that, the
burden that HIV, chronic disease, and other medical conditions place on an
already struggling people seem absolutely insurmountable. This, for me, stirs
up feelings of injustice and unfairness, questions of why? and how?, and often
results in frustration and fatalism. But for the people here, they bear with
each other in these circumstances, supporting one another and carrying one
another's burdens. Linguistically, I do not know if these words have a common
root, but "pole pole" is another common expression that means
"slowly" or "gradually". It is the unofficial mantra of
climbing Mt. Kilimanjaro: gradually, one foot in front of the other. And such
is seems with bearing one another's burdens. Sorry for your troubles, but
slowly, together, we will carry it together.
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| Walking to Selian Hospital with Mount Meru in the background |
