Blue Cloud "Power Co": Unazungumza kiSwahili?

Jambo, habari sana!

I've just returned back from a two-week venture into Tanzania. I went there with a small, local group of medical professionals from the Helena area. Coming home took some serious transitioning. I caught myself, on the large airliner, somewhere over northern Africa, admiring the spaciousness and cleanliness of the lavatory, until I realized it was exactly the same as before--it's just that my brief experiences of third-world poverty reshaped my view of the flushing toilet. It was very humbling to work in the circumstances we did and to see and treat the people of Tanzania, who were grateful for anything we could do.

While in Tanzania, our small team of two PAs, one ophthalmologist, five nurses (one in training) was able to see and treat over 1,000 Tanzanians. Most of our time was spent in clinic, but there was some time set aside to see the sights of the very cool Ngorongoro Crater, which is part of the Serengeti. More on that later...

Mt. Kilimanjaro, viewed from our base in Sakila.

We were based out of Sakila, about a 45-minute nail-biting drive--eastward--from Arusha, and well within easy viewing distance of the awe-striking Mt. Kilimanjaro, whenever the clouds parted to permit us to see it.

Loaded up in the truck, ready for another day in clinic.

I found this video put together by the medical team who preceded us in Arusha. The main difference is that my group did not operate out of the Sakila clinic. We were on the road every day, loading up our supplies, and ourselves, into the back of an open truck, and then bouncing down the road to a new village every couple of days. We did not have the luxory of shelving or, for that matter, organization beyond cardboard boxes on the ground. Each clinic we set up was in a village church house, sometimes on a dirt floor. We hung sheets between the two examination rooms, grabbed our indispensable interpreters, and then we opened up the doors and worked like hell until our last patient was seen.

The vast extent of the medical care that is needed in these small villages is overwhelming. Only some of the people who show up in the mornings are able to get through the doors before we have to shut down. Some people wait for hours and are never seen. It is very true, as in the video, that many people you just cannot help. I was able to do some small procedures, pull some teeth, and hand out the supplies (ie: pain meds, antibiotics, vitamins, antifungals) we had. More importantly--but most challenging for me--we had the ability to give a limited amount of life-changing referrals. Our funds allowed us to send some people for more intensive, life-changing procedures (ie: large mass removals from the head, extremities and torso, or simple surgical procedures like hernia repairs or hysterectomies). The decision came down to those we could help, and those whom we had to send away. Some were way too progressed in their illness and likely to die, despite treatment. Some required treatment which was not even available in the hospitals of Tanzania. To determine when to help, what you could do to help, and when holding the heroics was the help, was the difficult part.

Amani clinic. ("Amani" is Swahilian for "peace".)

The women, who are the manual workhorses, inevitably had neck problems, back pains and headaches, which came at no great surprise; a typical woman you see walking down the roadway or trail has something on top of her head, whether it's a bundle of bananas, or a five gallon bucket full of water. I get a headache just thinking about it.

The children struck me most of all. Many of them were hungry. Many of them had not eaten or had anything to drink in more than a day (we arrived to Tanzania in the midst of a drought). Many were infected with scabies or intestinal worms, and nearly all had some form or another of ringworm. We sent many for ventral hernia repairs, some for mass removals, and others for orthopedic procedures.

Kids at clinics in Roadtoll and Amani.

However, when we rattled down the roads, they would rush from out of the bush, barefoot, sometimes howling "Mzungu!!!" (white person), each child waving one or both of their arms frantically, eyes dancing. I was always surprised that each time a child climbed up onto my exam table in the clinic, each one--no exceptions--first politely removed her or his shoes, despite that their feet were as filthy as whatever they had on their feet.

Running after us in Sakila.

Here are some more of the patients I saw. Beautiful Tanzanians...

Majichai Clinic

Without an exception, every day in clinic, the town leader, which was always the local pastor, stopped our work to serve us coffee and snacks. Roasted fresh peanuts were served, most of the time, with boiled eggs. Then again, we would stop for lunch. Always lunch consisted of rice (which is actually an expensive nicety in this part of Tanzania, where corn is the staple), some form of meat stew (beef or goat), boiled spinach, and sometimes skinny pieces of fried chicken. Watermelon, too, which is an Arusha export. Nearly each meal we were also served bottled soda. This special treatment came at great cost to the villagers, most of whom eat ugali (boiled cornmeal, which basically tastes like a form of polenta) every day, period. No frills. Even more maddening, one day after clinic, we were tossing out our used wash water, and the preacher stopped us, requesting us to put the water into a big plastic bin for them to reuse the water. I treasured every warm bottle of Coke after that, even though, going down, it burned my throat and my eyes, having to drink it in front of all those hungry kids watching me.

Roadtoll Clinic (pronounced: Rho-add-tall)

A typical day started when the 3 AM gong woke us up, though we didn't have to be up and moving until 6AM. Breakfast at 7, on the road by 8, travel and set up clinic, then close down shop at 5PM to make the return trip. Dinner at 7PM. By then, I was dirt tired, dirt-caked, and ready to crash. We got a shower every third day, which consisted of a cold rinse off for a few seconds, enough to jolt you awake and wash off some grime.

The last day of clinic was heartbreaking. When people realized they would not be seen, there rose almost a panic outside the church. Mothers held their children up against the barred, but open-aired, windows of the church. Old women pointed to their bodily infirmities or the rotten teeth in their mouths. People cried and yelled and begged. It was all I could do to keep focus on those who were already inside the church, those who were lucky enough to be seen this time.

Ngordito Clinic

At the tail end of our visit, we took a day safari into the Serengeti. During the 4.5 hour drive to get there, we traveled out of the desert, and through coffee plantations, into banana fields and eventually rice paddies, and then up and over the great African rift, into Maasai country. Entering the Ngorongoro crater was mystical, with the fog heavy and the visibility short. Eventually we burst through the fog and could see the giant crater below. Apparently the drought this year has wreaked havoc on the large herds, but there was still plenty to see. Dancing zebras. Terrified hyenas tearing through the grass. One lone, methodical elephant with enormous tusks. Lazy wildebeasts. Snorting rhinos. Birds of every color and size, including ostrich and the African crowned crane. And a lion snoozing right by the side of the dirt track. It was absolutely magical.

Looking down into Ngorongoro Crater

Wildlife of the Serengeti, viewed from the pop top of our forerunner.

Herd of Wildebeasts

Interestingly, there is somewhat of a battle between the Tanzanian government and the Maasai people, nomadic herders, who have inhabited the Ngorongoro crater for the last few centuries. (One of the towns we held clinic in was home to many uprooted Maasai; they had been stripped of their cattle and their land. And they were, basically, pathetic, poverty-stricken, and lost.) The government plans to uproot the Maasai from the crater, as well, as their cattle are contributing to erosion problems in the crater. I see no easy answer to this problem.

On the way out of the crater, we were able to visit a tourist-friendly Maasai village. Most folks in the tribe abhor their picture being taken, as it is believed that photos rob them of their souls; however, this particular village was happy to take our American dollars in exchange for a mug shot and entry into one of their dung huts. Our tour guide, the chief's son, took questions while we sat in the dark hut (with two windows the size of softballs on either side). For whatever reason, out of my mouth popped a question about the community toilet. Chieftain Jr.'s limited English comprehension did him a disservice that day, as he proceeded to tell me how his father, with 16 wives, sent the kids away to another wive's house during copulation. It was extremely awkward, and hot, in that small hut, and I was happy to escape.

Maasai village: The kid is peaking out from behind a dung hut. The women are sitting in the cattle corral making jewelry. The men are dancing. The Maasai dress in beautiful reds and purples, and the men always carry their spears or herding sticks.

Part of our time working was spent giving medical care to kids in an orphanage near Arusha. Nearly all of the kids here have lost their parents to AIDS. Looking these kids over and spending time with each one was certainly a highlight of my trip. Overall, they were well taken care of.

Orphanage near Arusha.

Probably most of the adventure I had, besides sampling and sustaining myself on the local village fare, was riding down the road, whether in the way back of the truck, or inside the land rover, speeding down the narrow, heavily-peopled highways. Seatbelts? Nope. Helmeted motorcyclists? Definitely nope. Pedestrian rights-of-way? Hell no. Here's some of what I saw from the road...