HOW THIS STARTED

I vividly remember that evening of Nov ’15 when my close friend and coursemate, Kezia, came over to my house to catch up.

During our 5 hour long catch up session she reminded me about this e-mail the Medical School had sent out to us about the KiCS Project – a non-profit organisation based in Leeds that recruits medical students to work on healthcare placements in Tanzania over summer. Funny enough, I was already fixated on the idea of visiting an Eastern African country over the upcoming summer.

My only problem was that I did not want to do merely community based or healthcare based volunteer work, and the fact that KiCS seemed to combine both was what really made me go ahead and join.

In the beginning it seemed another one of those far-fetched goals you never get around fulfilling. As I often say, things do not happen, they get done, and I was in desperate need to spend my summer being ACTUALLY useful and not just turn into a couch potato for over 3 months. After all, I was quite unsure about whether I would ever have again an entire summer free to spend travelling AND visiting home.

I called mom and dad straight away – I am honoured to have parents who support every step I make and are only there to advise me rather than dictate the decisions I make.

The next step was to figure out a plan on how to find the money needed. Thanks to fundraising and YOU who contributed, this trip became reality! A million thanks.

And here I am just under a year later writing this blog about an absolutely must experience for everyone to have – one that has moulded me and allowed me to gain a different perspective on life.

Read on!

 

A LITTLE BIT OF BACKGROUND INFO

Tanzania, officially known as the United Republic of Tanzania, is a South-Eastern African country.

GEOGRAPHY

Its eastern border is the Indian Ocean, with several countries surrounding the rest of the country, including Kenya, Uganda, Rwanda, Burundi, the Democratic Republic of the Congo,Zambia, Malawi, Mozambique. The idyllic island of Zanzibar is part of the Republic.

Around 40% of the land is protected for conservation; the country has over 15 national parks and reserves and is reputed to have the world’s best safari’s.

HISTORY & POLITICS

It is believed that the first people to migrate into what is today known as Tanzania were Southern Cushitic speakers about 4,000 years ago. This was followed by waves of migration from Southern Nilotic people, like the Datoog, and Eastern Nilotic people, like the Maasai.

The Portuguese first visited the area in 1498  and ended up being in charge of most of the Southeast area by 1506. In 1699 the Portuguese were driven out of Zanzibar by the Omani Arabs, establishing the island in effect as the centre of the Arab slave trade.As much as 90% of the islanders there were enslaved. German colonisation of Tanzania began in the late 19th century, until post WWI, when the country was handed over to the British as a result of the League of Nations.

In December 1962, British rule came to an end and Tanganyika became a democratic republic. Following the revolution in Zanzibar which overthrew the Arab dynasty Zanzibar became an independent state (1963). In 1964, Zanzibar joined Tanganyika to form the United Republic of Tanzania (“Tan” from Tanganyika and “Zan” from Zanzibar).

The country since then has embraced a more socialist approach to politics (embracing Pan-Africanism as well) and way of living.

In the 1990s there was a constitutional reform to establish a multi-party democratic system.

In 1996 Dodoma became the capital city, even though Dar es Salaam (former capital city) is by far the largest and most populated city.

ECONOMY

Tanzania is of the poorest countries, with ~70% of its population living below the poverty line.

Tanzania’s economy is heavily driven by agriculture, industry and tourism.

POPULATION

The current population in Tanzania must be ~ 45 million, with ~50% of the population being children and young teenagers (each woman has an average of ~ 5 children).

The majority of the population lives in the Northern-Eastern area of the country. In addition to that, the majority of people live in rural rather urban areas.

TRIBES

99% of the population is of African descent, and the remaining of Asian (particularly Indian), Arab and European descent.

There are ~125 tribes in Tanzania and the 4 major ones are Chagga, Sukuma, Nyamwezi and Haya.

The majority of Tanzanians, including the Sukuma an Nyamwezi people, are Bantu (people who speak the Bantu languages and who and inhabit mainly the South-Eastern areas of the continent).

Tanzania also has some tribes, like the Maasai and the Luo, who speak Nilotic and are mostly found around the Northern border of Tanzania (neighbouring Kenya).

RELIGION

The majority of Tanzanians are Christians (~60%; Roman Catholics and Protestants), with Muslims to follow (~35%; including all Sunni, Shia, Ahmaddiya and non-denominational), ~ 2% African Traditionalists and the rest are either aethist/agnostics or of other religions (e.g. Hinduism).

To my surprise, religious differences do not constitute a reason of conflict in Tanzania.

LANGUAGE

The official languages of Tanzania are Kiswahili and English. Primary education is conducted in Kiswahili and secondary and higher education is conducted in English.

There are also over 100 languages spoken including Bantu and Nilotic.

HEALTH

The life expectancy of Tanzanians is ~60 years old.

Malaria, Sepsis, Diarrhoea and AIDS are still leading causes of death.

Healthcare provision in rural areas is almost non-existent.

In urban areas healthcare is provided mostly via state hospitals and very few private hospitals.

 

 

FIRST TASTE OF AFRICA

I remember when I first got off the plane at the Kilimanjaro International Airport I felt really alert with all my senses probably overworking so as to prepare my body for something foreign; something new.

It was early morning hours, therefore I couldn’t see much. However, there was something very distinct about the atmosphere that was quite familiar.

It felt humid, yet with a light touch, and had a special smell – I think it is the smell of dry soil.

This very first contact with Tanzania was reassuring for me – the atmosphere smelled and felt just like it does back home, Cyprus.

 

*Photo taken from Tanganyika Flying Co.

THE AFRISHARE HOUSE

The Afrishare House is the accommodation Afrishare Solutions offer.

It is a nicely built and decorated house; and it is a house, not a hotel and not a motel.

It consists of about 8 bedrooms with wooden furniture, a living room with 1950s Western décor and a photo of Zanzibar hanging on the wall. The dining table is also found in the living room and the kitchen is right next to it.

The house is located a 5 minute drive out of Moshi in the area of Soweto. Soweto, before getting built up, used to be a foresty area where dead bodies would often be disposed by the murderers and that’s why it was given the name of the original Soweto: the South African scene of violent anti-apartheid rioting in 1976, where a student protest led to clashes with police – in 2000, the district was officially incorporated into Johannesburg. Nowadays Soweto looks nothing like a creepy area and is rather a family housing area.

Let’s just say I am glad I didn’t accidentally unearth any human remains during my stay.

The house is run by Ibrah, the owner of Afrishare Solutions. Ibrah is a very well established business man with a university degree and a family man. I think the first thing that stroke me at the airport when I first met him was how warm he is. In the month to follow I also established that he is the most knowledge thirsty and curious person I know – he never stops asking questions! He is also very charismatic, has a great sense of humour, is great at teaching Swahili and is literally worry free – as he often says “I am free like a molecule”. I have to thank him about the fact that whenever I am stressed I am reminded of “be free like a molecule”…

(To read more about Ibrah or to contact him please visit the CONTACTS post).

Hussein is the cook of the house. He is very dedicated to his family; he works at the house Monday to Saturday and only visits his wife children on Sundays, in order to make sure that he provides enough money for them. Hussein is a house-proud person who is extremely welcoming and was very fatherly to us. He would always make sure that we had whatever we needed and loads of delicious food to indulge in. The most surprising thing was that although he could not afford spices, his food tasted amazing and I really do not know how he did it! I can assure you that I will hardly ever meet another person who is more passionate than Hussein when it comes to food and cooking. My favourite recipe of his which I looooooove is fried cabbage and onion. Hussein’s instructions are:

1. Add oil and butter to the pan
2. Add some garlic
3. Add grated cabbage and grated white onion
4. Add very small pieces of green pepper
5. And indulge – try it!

 

I surely miss the Afrishare house and I deeply wish that one day I shall return.

 

 

MEET THE TEAM

Let me introduce you to the rest of the Team (from left to right):

 

Me

Kezia – the optimist of the group

Melanie – perhaps the friendliest of all; the sort of person who hasn’t lost the ability to make friends with literally anyone

Natalie – our strong independent ‘Queen Bey’ woman

Anjali – the sensible and mature friend

Jessica – the mom and essentially the bridge between all the teammates

 

AND Cindy, the hyperactive friend (who was away trekking when this photo was taken).

MAWENZI HOSPITAL

The Mawenzi Hospital is a state hospital situated in the town of Moshi. It has taken its name from one of the volcanic cones of Mount Kilimanjaro.

This is the hospital our team worked at for the entire month we were there, Monday-Friday 08:00 – 14:00. We were supposed to pay the hospital a fee in order to have an internship there, but instead we agreed to spend the same amount of money investing it in equipment the hospital needed. That way we ensured that no money from your donations would get lost in the corrupt system.

Since a nearby teaching hospital (KCMC) was built, the majority of government funding is directed towards KCMC, leaving the Mawenzi and St. Joseph’s hospitals starving of the most basic of resources, despite the fact that these two hospitals are of extreme significance to the community of Moshi and nearby villages. For instance, the personnel there sometimes have to sterilize tools using boiling water; they also lack soap.

Do we ever go to the hospital in the countries we live in wondering whether there is basic hygiene practice? No, we take it for granted.

The hospital is not one huge building but instead a collection of wards – each being a building of its own – with beautiful gardens in between them. I often sought relaxation and calmness walking through the gardens trying to alleviate the strong emotions triggered by the frenzy situations back in the wards.

The hospital is built-up with concrete and the healthcare professionals there have tremendous knowledge, albeit my initial assumptions that the hospital would be rundown with incompetent personnel.

The main problems, however, are (a) the lack of equipment which reflects in the fact that doctors use outdated methods of examination, diagnosis and treatment and (b) the non-existent medical knowledge of the public.

I give more insight about the hospital in the posts for each of the wards I was based in at the hospital: Paediatrics, Gynaecology and Obstetrics, Psychiatry and HIV/AIDS.

MAWENZI HOSPITAL-GYNAECOLOGY AND OBSTETRICS CLINIC

My first placement was in the Obs and Gyn clinic.

The clinic is divided in an antenatal, a labour and a postnatal ward and it is usually understaffed of doctors.

 

ANTE-NATAL

The ante-natal ward is was often used for gynaecological issues not involving a pregnancy, such as gynaecological cancer, due to the lack of space.

A particular case we saw was a lady who came in with incomplete abortion which she tried to perform herself. She could not look at us in the eyes because of the shame Tanzanian women feel about terminating a pregnancy.

Abortion is illegal in Tanzania and a woman, according to the doctors, can face a sentence of 15-30 years if she tries to perform one herself, which is devastating especially because a lot of the pregnancies terminated are the results of rape. In an effort to help such women, healthcare professionals will file false reasons for a patient’s admission, since confidentiality in Tanzania does not seem to hold the place it should.

You shall later read about Walter and how his uncle is responsible for him losing his eye. His uncle was not sentenced to jail and instead paid a penalty fee; but a woman is imprisoned for a good time if she tries abort and have a choice over her body and her life. Gender equality I guess.

 

LABOUR

Labour was intense.

Women give birth without the support of a family member or their husband. If too many women give birth simultaneously, then some of them are left all alone until when the baby’s head pops out, which is when a midwife will rush in to stitch and wipe before she disappears again.

On a particular occasion, I stayed with a woman for 4 hours waiting for her cervix to dilate and give birth. I was terrified about the fact that I was left there to take care of a woman while I never received any training in labour. All I could do was provide fluids through a cannula and take quite a few slaps and squeezing from her in an effort to deal with the pain.

Not only women do not receive any medication to alleviate the pain during delivery but they are often stitched up afterwards without any anaesthetic agents.

On top of that, as soon as they give birth, they get off the bed alone, dress up and walk to the postnatal ward where they often share a bed with another woman.

In the time I was in the labour ward, I counted 12 babies which were either born dead or died within the next couple of hours. The reaction triggered in the room by the event of having a stillborn baby was not what I expected at all: the mother was usually silent and mentally stable, and the healthcare professionals would simply tap her on the shoulder and carry on with whatever they had to get done. I was expecting a reaction much different to that, one that would involve crying, shock and empathy – however, none of that happened. And even though my feelings at the given moment were never in context with the atmosphere of the room, I was obliged to press my lips together and don’t show any emotion; I had to go by the cultural norm. After all, what right did I have to show weakness and sorrow when the actual mother portrayed such strength and acceptance? By the end of my placement in the labour ward, I established that having a stillborn is not a rare event in this country; women know it happens, they are aware that there is a big chance of such an unfortunate event happening to them and they are more familiarized  than we are with what having a stillborn entails.

 

 

POST-NATAL

Women in the post-natal ward would often ask that we touch their babies in order to bring them good luck; again just like I discuss in the ‘Moshi: The Dala Dala’ post, I had, and still have, a hard time understanding why I have the privilege to be viewed as superior to them merely on the grounds of my skin colour.

Through a discussion I had with a trainee nurse in the post-natal ward, I found out that a lot of women struggle to breastfeed their new-born due to either being malnourished or under psychological stress of what may be awaiting for them back home.

No need to mention that the majority of fathers would not show up, and women only expected to see their husbands only after their return home; and that is if they were around. The few men who did show up, I congratulated.

I think one of the most disturbing aspects was that women would often return just a couple of days later suffering from vaginal infections because their men would often not understand the concept of the 40 days no sex healing period for the mother. And I deeply believe that this is not something you need to be taught to know about; I believe that the fact that there should be a refractory period until everything heals up for sexual intercourse to be pleasurable again and not another painful experience for a woman should be something people know out of instinct and innate behaviour.

………….

This is a short insight for you of the gynaeco-materno-socio model a woman  – a ‘lucky’ woman having access to healthcare, leave aside the ones in the villages who just go through the process alone in the most primitive of ways – experiences in Tanzania.

And I could go on and on, but I’d like stop here. I think you did get the gist of it.

It has surely made me feel lucky and I have promised myself I am never complaining again for things like having to have a pap test. Instead, I am appreciative and lucky to have the CHOICE to take care of my body as a woman and have access to the best of healthcare.

All women should have the right to choose for themselves and the opportunity to take care of themselves and this is a matter I shall always advocate for with even more passion after witnessing the reality of the Tanzanian women – true heroes.

Labour Ward

A poster in the Post-Natal Ward.

MAWENZI HOSPITAL-PAEDIATRIC WARD

I spent a week in the Paeds Ward.

I do believe it was, along with the Obs and Gyn ward, the hardest one to be in.

I genuinely think that on a  general level across the globe, no matter what a child’s place is in society, there is a common sense of prioritizing the young. Illness or death of the young is always more devastating and more shocking. I do believe this is a behaviour dictated by our genes as prioritizing the young is an innate behaviour that does in a sense ensure the survival of a species.

Maybe this is why finding myself face to face with sick children was particularly difficult, harsh, unfair and shocking. Shocking not because I haven’t seen before sick children, but because children should not be subjected to such life threatening conditions.

Children would usually share their hospital bed with their mother; very rarely you would see the father caring for the child. I remember on a particular occasion a mother holding her child had a black eye. When Dr. Ray (the consultant I was shadowing) asked what happened she said that her husband beat her with a gun. Dr Ray advised that she leaves him but she said that that would be inappropriate as it is out love that he abused her. I often wondered why abused women are often convinced that abuse is a sign of love because in my eyes, any stimulus that causes pain and sorrow to an organism is instinctively avoided, but not in this case. Reading up on it I found out that the attacker-victim relationship is much more complex than I thought. The attacker will often hold the victim instead of himself (or herself) responsible for the violent behaviour. This is how the guilt game is instigated and then amplified further by claims on behalf of the attacker that this kind of behaviour is a reflection of immense and passionate love. I guess it reaches a peak when the actual attacker comes across as the one victimised which does spark forgiveness and overlooking of the abusive behaviour.

 

Now back to the Paeds Ward.

Dr. Ray was awesome in allowing us to try reach a diagnosis conclusion and then giving us feedback on it. The majority of children had malaria and urinary tract infections (UTIs). UTIs are not commonly suffered by children in developed countries, but in contrast the hygiene standards in Tanzania are not the best in preventing such infections. A couple of children also suffered of sepsis, which is unfortunately very hard to stop from being fatal even in the more developed world, let alone in Tanzania.

The one condition, however, that has really shaken me up is AIDS is children. I do not know why I feel differently facing a child with AIDS than a child with sepsis. Perhaps because it is unfair that a child with HIV in developed countries would have a normal life expectancy whereas a child in Tanzania will die before it thrives; perhaps because it is not a consequence of a child’s own actions, and perhaps because it is such a slow painful death.

To read the story of Raymond, the child in the Paeds Ward with AIDS, please read the post dedicated to him.

RAYMOND

This post is dedicated to Raymond. I was honoured to meet Raymond. If I had to make a list of all the people in Tanzania who helped me realize how lucky I am, Raymond would be the first one on the list.

On my first day in Paeds ward, I was made aware of this one child lying down in a bed right at the end of the room, ‘isolated’ from the rest.

He had the look of a person currently on the highway to death: tired face with wrinkles, eyes bulging out, cheeks sucked in and an anorexic body, devoid of any life.

 

Raymond is only 10.

Raymond has AIDS.

Raymond is an orphan.

 

Raymond contracted HIV through his mother during either pregnancy, or delivery or breastfeeding. Both his parents died of AIDS and his aunt is his current carer. Raymond’s HIV infection progressed to AIDS due to a poor diagnosis and lack of treatment. When he was eventually diagnosed with AIDS he was put on treatment which he did not want to take due to suffering of really serious side effects – this is also the reason why he keeps visiting the hospital every 2-3 weeks with a new infection.

In the time I was there he was suffering of both tuberculosis and bacterial meningitis.

I watched him have a cannula fitted on his head, and I am not exaggerating when I say I have never heard a child scream like this before. Over the next couple of days I observed him sitting on his bed. He seemed restless and fed up. I was scared to go play with him because he can be violent and irritable, so I instead tried to wink and smile at him as an effort to make him feel included and make me feel less guilty. He never smiled back.

I decided to go buy him a present, perhaps which, would lighten up his day. I got him this beautiful tribal small elephant made of wood and painted with turquoise and white dye. I went in the next day looking for him, but his bed was empty and he was not in the ward – Raymond was gone. I panicked that he died, but according to the ward nurse he was transferred to a bigger hospital to receive better care.

With no second thoughts, I got the Dala Dala and went to KCMC, the hospital I was told he was in. I wanted to cry when I realised I wouldn’t be able to track him down in 3 huge Paeds wards crowded with hundreds of children. After searching for a long time I decided to leave, and as I was walking down the corridor I saw a room labelled as ‘Isolation’.

I walked in. And there he was.

Raymond was sitting on his bed staring out the window. He then turned and looked at me and gave me the brightest and biggest smile ever. He asked how I found him and I had someone explaine to him the story in Kiswahili. I handed over the elephant, which he did not believe was for him and asked him to keep it for good luck.

And then it hit me how ridiculous I was being speaking about luck to a 10 year old suffering of terminal AIDS.

I left knowing I wasn’t seeing him again. I knew he would probably die and to be honest wishing that he stayed alive would be me wishing for the lesser of two evils; his life has been, is and will be a life in hospitals, pain and sickness, with no parents and no understanding of WHY that is.

This is the unfortunate reality; if I were to contract HIV in the developed world, I would have access to treatment, chances are I would never develop AIDS, would have a normal life expectancy and be able to have a family. This is not the case, however, for people in the developing world. Despite the fact that the total number of people living with HIV in Tanzania has declined from 7% to 5.1% from 2003/4 to 2011/12, only 37.5% of sufferers have access to treatment. According to the doctors, the government claims to pay for the medication but in actuality it does not (and just to give you an idea, good quality HIV medication in the UK costs around £600 per pack per month), let alone the fact that a lot of people do not know they are HIV positive and even if they are, I would imagine a lot of them do not have access to healthcare in order to receive treatment and be educated about what living with HIV/AIDS entails.

MAWENZI HOSPITAL-HIV/AIDS CLINIC

My visit to the HIV and AIDS clinic was short.

The clinic did not have a ward, but rather a couple of consultation rooms and a common waiting area.

The three most important messages I left with were:

1. The majority of people suffering of an HIV infection look perfectly healthy. And that is scary considering how many people all over the world do no take precaution thinking that they will be able to tell whether someone is infected or not.
2. HIV and AIDS constitute a social stigma more for women rather than men in Tanzania; again a reflection of gender inequality.
3. While a person suffering of HIV/AIDS in a Western country can have the same life expectancy as a healthy individual, can proceed to have a family and generally have a close to normal lifestyle, people in Tanzania live a much shorter of of lower quality life, and do not have the same lifestyle opportunities due to the fact that they cannot afford the medication and do not have the same access to healthcare as people in wealthier and more privileged countries.

Even though HIV infections are on the fall in Tanzania, it still angers me how people’s lives are often dictated by pure luck of where they are born and live.