Uchaguzi!

Jambo from Arusha! Happy fall to you northern hemisphere dwellers! Hope this message finds you well, surrounded by the changing seasons, falling leaves, and aromas of the best season known to mankind. In the weeks since the last update, I have been continuing my work at Selian Lutheran Hospital. We were happy to welcome back two volunteers who had been in Arusha previously. One is Dr. Elena, a pediatrician from Australia, who had previously spent 3 years working in pediatrics at ALMC and Selian. It has been nice to have her back in Arusha and to gain from her wealth of experience. Another volunteer is a Canadian NICU nurse named Lisa who has come to collaborate with the NICU nurses at ALMC to continue improving the level of care for our littlest patients. It is refreshing to have new faces, with new perspectives and skills, to contribute to improving health care in Arusha. It has also been a nice time for getting to know the new interns, most of whom started in early October. As mentioned previously, the medical interns come fresh from graduating 6 years of medical school, which is usually (but not always) undertaken directly after secondary school. They then begin a one year internships, which rotates them through the four major specialties: OB/GYN, pediatrics, internal medicine, and general surgery. At least at Selian, when they stay overnight to take “call”, they must cover the whole hospital. That means performing C-sections, presiding over the whole medicine and pediatrics ward, and sometimes performing other surgeries. This was the way medical internship had been in the US in the past, however, I could not imagine having so many responsibilities! They seem to handle it well, and they have the back-up of more senior doctors on which to rely. The ones who have started this year are a good bunch so far; they seem to enjoy their work and are eager to learn new things. We have enjoyed doing weekly introductory teaching about bedside ultrasound and have reintroduced regular radiology sessions for X-rays (now that the X-ray machine is working consistently—thankfully).

Today, for the Swahili lesson, I wanted to introduce a word related to current events: uchaguzi. This word has the same root as chagua (to choose) and means election, as in the democratic process of choosing the nation’s leaders. It has been such an interesting time to be in Tanzania: witnessing the campaigning, the hope for change, and the general excitement of people. To explain Tanzanian politics briefly, since independence in 1961, a single party has ruled the country: CCM (Party of the Revolution). At first, this was because the country was designed to be a single party system. However, for the last 20 years, there have been other parties, though none have gained enough momentum to challenge the ruling party; that is, until this year. With an interesting background as a former prime minister under CCM, Edward Lowassa left his party to join the opposition, Chadema (Party of Democracy and Progress). With his influence and experience, along with increasing desire for change, Lowassa and Chadema presented a real challenge to the political status quo. With this backdrop, it seemed there were not many Tanzanians who were not swept up in the fervor of uchaguzi. Young and old, educated and laborer, Christian and Muslim, all seemed engaged in this monumental democratic exercise. The children, even, would hold up the sign of CCM (thumbs up) or Chadema (peace sign) or shout “Peoples… power”, the call of Chadema. Flags and placards were visible from almost every corner. It was difficult to understand exactly how the parties differed, though it seemed they were calling for many of the same things: less corruption, better education, health care, and infrastructure. It was hard to tell if one really would be better for Tanzania than the other, and if I had to vote, I do not know who I would vote for. But what was most interesting to me, besides the general passion for politics that Tanzanians show (a stark contrast to the ambivalence many of us feel during US elections—as demonstrated by poor voter turn out), was the deep hope for change. I heard many impassioned speakers explain, with such hope in their candidate, that they would bring about the change in this country that would give their children a better life than they have experienced. Many of them have known desperate times: struggling to make ends meet, suffering from preventable and treatable diseases, commuting on sketchy dirt roads, sleeping in poorly built and un-electrified homes, drinking untreated water running from dirty streams. They hoped for better infrastructure, consistent power, educational and employment opportunities, and a better way of life. Though I explained in my last update how change can seem to happen quite slowly here, people appeared ready for it to happen in a dramatic way with this election. With the results declaring CCM to have won, many people seem to have lost some of this hope. But, as an outside observer, it seems that this fervor for change goes much deeper than which candidate or party has won. I hope that this momentum will carry this generation into building a just, peaceful, and equitable future to pass on to posterity. The people are ready to build a better Tanzania, and I have faith that they will.

Ryan, Global Health Chief 2015-16

Jambo from Arusha! Hope this email finds you all well! It has been quite a busy last month, with a great mix of work and fun. I had the great opportunity to travel for a few days with one of my best pals, Beau, who came to Tanzania for a visit. Highlights included gazing over Africa from the summit of Mt Kiliminjaro (19,000 ft!) and seeing some major wildlife in the epic Serengeti and Ngorongoro national parks. I also had a new experience traveling to visit one of the rural hospitals connected to the Lutheran church in Orkesumet, a 5-hour bus ride south from Arusha through Masaai grazing land. There, I was introduced a bit to life outside the big city, the experience that more than half of Tanzania lives day to day. Health care at Orkesumet was refreshing, with less patient volume and a smaller, but very committed, staff. While there, I had the opportunity to do a few house calls with the palliative care team into the Masaai bomas. From these visits, one can begin to catch a glimpse of what daily life might be like for the Masaai. As some of you know, the Masaai are a semi-nomadic tribe, whose major livelihood is tending to cows and goats. In more recent years they have become less mobile, which seems largely due to restrictions placed on the territories they can use for grazing. Being a polygamous society, they can have very large families, though this practice is also decreasing. Some of the Masaai that I have met who work in the hospital have 40-60 brothers and sisters! They traditionally live in bomas, which are a group of mud huts with thatch roofs for one extended family, surrounded by a fence made from sticks and thorny bushes for containing the livestock.  Entering the boma, one is privileged to enter a world apart. Curious children dressed with brightly colored cloth draped over their shoulder run to investigate. Masaai mamas dressed in bright blue and red, with dangling beaded earrings hung from large holes in the ears come toting the littlest ones on their backs or in their arms. The men, always with pastoral baton in hand (usually with mobile phone in the other), emerge with interesting mixes of traditional clothing and ski jackets or Manchester United hats. Respected elders lean upon walking sticks, sitting or standing. The homes are dark, relatively warm, and smell of the wood cooking fires.  The smiles are broad and the laughter seems constant. They seemed as perplexed by me as I by them, trying to fit each other’s appearance and lifestyle into any framework that could fit.

For this weeks Swahili lesson, I chose a rather cliché phrase heard constantly here: Pole Pole. It means slowly, carefully, or gently. For those who have been to East Africa before, this phrase is almost as overused as Hakuna Matata. It is often spoken both to Swahili speakers and to tourists who seem like they are in a rush or flustered in some way. It is meant to say: slow down, enjoy the moment, don’t worry. The phrase is also the official motto of climbing Mt. Kiliminjaro mostly based on the acclimatization strategy of hiking so slowly that you feel like you might be going backwards at times. Let’s just say that I got much more sick of hearing Pole pole than sick from the altitude, which I guess is the purpose. Pole pole, like most of the phrases that I find interesting, is more than a saying, but representative of Tanzanian culture. The only aspect of daily life that is clearly not pole pole, are the pikipikis (motorbikes) and daladalas (minibuses), which are all crazy. But apart from these, daily life is clearly a different pace than Western culture. People stop for long conversations on the road and enjoy frequent breaks for chai. Fastfood is mostly non-existent and even the suggestion of taking chai, coffee, or a meal “to go” is a bit confusing to some. People seem much more patient, especially as they endure long waits at places like the doctor’s office, the bank, and, coming soon, at the ballot booth. Change is also quite pole pole, which is multi-factorial, but can be observed in the way people dress, the cars they drive, the medical practices, and many of the cultural practices (some good and some not so good). It can be frustrating for a Westerner to get used to “Swahili time” – not just the different numbers they use for time, but the fact that most things are a bit late. It is true that this also frustrates many Tanzanians, especially in the hospital when it delays medical care. There is much to be said about the ways pole pole might not be the best strategy in certain circumstances, however, there are many lessons that we could take from this mantra. Clearly, the fast pace that we live our lives in the urban Western world has detrimental effects on individuals and communities. But what would it look like if we lived a little more pole pole? I think that we would spend less time doing things and more time together. I think our education and careers would be focused less on the length and strength of our resume and more on the relationships we build. I think we could pause long enough to enjoy the moments that pass.