A pre-med student in Tanzania

This is not your regular travel article. In August 2011, a pre-medical student at the University of Washington, traveled to Tanzania with 16 fellow students to provide healthcare to a Massai village tribe. She and her group observed and provided care for roughly 300 patients, taking notes on their health and living conditions, to try and ascertain why certain diseases were more prevalent than others. In October 2014, Christine and I met, thanks to our significant others’ love of football, and she gave me her journal, asking me if I could turn it into a story of her experiences there. Here is that story…

 

Part one: Arriving in Africa

As I stepped out of the airport, the heat of Tanzania hit me like a wave. I squinted in the bright sunlight, grabbing for my bags, trying not to trip on the stray dogs chasing one another on the street, which was crowded with people. More than anything, it was the trees that made this place feel strange: they were oddly shaped, and they looked like the trees I had drawn when I was little: fat and misshapen. The houses too, looked like stick figure drawings of houses: most without electricity, lit only by candles. Our flight had taken us over Greenland - nothing but a vast expanse of snow capped peaks – and then down along the Mediterranean coast of Africa. When I saw the Nile river, my heart skipped, and I thought “this is it!”

After a simple breakfast on our first morning, the other students and I explored our ‘lodgings’, taking photographs of everything we could find. There was an unnerving proliferation of skulls and bones (animal) scattered in piles on the ground, or balanced in the branches of trees. We identified an orangutan skull, and the jaw of a hippo, and what had to have been an elephant bone. The yard was dotted with avocado trees, and some kind of long, stringy tree from which a crop of beans, each as long as my arm, swung in the breeze. We ventured outside, and walked away from the town, passing fields of bright yellow sunflowers and corn, and nonchalant (seemingly untethered) clusters of cows and goats feeding beside the road. Tall women passed us, huge baskets of bananas balanced miraculously on their heads, never faltering as they greeted one another. Small children in long navy blue uniforms ran along the road, and a small boy was helping his father chop wood. 

When we returned, we ate rice and chicken for lunch, and then arranged to drive into the town. We changed our money and got back on our bus, but were suddenly swarmed by street vendors selling snacks, who had obviously seen us coming out of the exchange center. They pushed their wiry arms in through the bus windows, their voices alternating between harsh and pleading. None of us bought anything, and we looked away, unsure if this was how we would be treated every day, or just in the beginning.

 

We had planned to go to see a waterfall in the afternoon, but our bus was turned around by an official on the way, and told to go back to the “weigh station”, where we were once again swarmed by vendors. Out of nowhere, a man came up to the window and bit my friend on the arm! He told us he was hungry. Hoping to avoid another incident of cannibalism, I gave him one of my lunch bars, to which he instantly demanded money. I ignored him and told him to go and eat his food. None of us were sure how we were expected to act.

There was a lot of shouting at the front of the bus, and suddenly we were being driven into a parking lot surrounded by barbed wire fences, and before we could protest, they had locked the gate! We were all desperate for the bathroom, but there was nobody to tell us what was going on, because our translator and our driver had been taken into the building. We eventually snuck out, and found a rickety shed with a pit for a toiled and a door that was more hole than door. The stink was incredible, I had to hold my breath to relieve myself, making me so lightheaded I almost fell into the hole! It turned out our driver didn’t have the right kinds of papers to be driving, so we waited in the heat for another two hours before they let us leave.


We soon learned that this kind of disorganization (resulting in minor run-ins with the law) was par for the course in this part of the world. Nothing runs smoothly here, and nothing is to be taken for granted…



Part two: Playing Doctor


We left town the next day to go to the village where we would be spending the next two weeks. Our time was divided into eight days of triage (visiting patients in their homes) and four days of clinic (diagnosing and prescribing patients with treatment in the small medical facility on site). During triage days, our team would visit around 5 houses and record the names, birthdays, and levels of education of the people who lived there. The majority of the Maasai people we visited had never had a healthcare worker visit them before. After recording their basic information, we would ask if anyone in the household was sick or in pain. If they were, we would make note of their symptoms and give them an intake form to come to our clinic.

            A typical Maasai house consisted of a mud hut with a thatched roof: concrete and other more permanent building materials were rare. Each dwelling typically housed seven or more people, since it is not uncommon for Massai men to take more than one wife. Despite the efforts of the Tanzanian government to prevent the spread of diseases by providing the villagers with a covered well for clean water and mosquito nets to ward off malaria, the living conditions we saw during our stay made certain preventable diseases more prevalent. A lack of toilet facilities and secure fences fro livestock (necessitating animals being kept in the house) meant that human and animal feces were often to be found in the living space. A lack of screens and closing windows gave easy access for mosquitos, despite nets above the sleeping area; and the scarcity of water made personal hygiene a much lower priority than it should have been to maintain health.


            We soon settled into a routine in our new home: triage or clinic in the morning, followed by lunch, then we would play soccer with the local kids for a few hours. In the evening we would sometimes have a slideshow or presentation, then we would review our notes for the day, play cards, eat dinner, and go to sleep. One of the children who played soccer with us every day was named Michael. Michael was amazing at soccer, but he always wore the same dirty shirt and shorts, and his shoes were barely clinging to his feet. One day he showed up barefoot (and still destroyed the other team), because his shoes had finally given up, so two of the other boys on the trip bought him new clothes and shoes.

            We were all really excited about the safari we had planned for the end of our trip, but we got a little (very unsettling) preview of the wildlife, when we realized that we shared our living quarters with a family of unnecessarily huge tarantulas, who would make random appearances out of nowhere, usually just before bed, causing everyone to scream until someone disposed of them. Probably one of my least favorite experiences!


            We sat in on some of the local church services, and even though we couldn’t understand the sermons or the songs, we learned some of the dance moves (thanks to some lessons from our translator) and played with the kids afterwards. The children here are so lively and affectionate – more than once, a little one has just run up and hugged one of us for no reason. There are so many of them, everywhere! In some of the houses we visited, they would forget how many children lived there! We would be taking their patient histories, and all of a sudden one of the mothers would say “Oh! And we have two more in the back!”

            Predictably, I got sick, as did one of the other girls, but luckily it wasn’t malaria or anything serious. We saw a lot of patients with the same three illnesses (malaria, fungal infection and parasites) but there were a few cases that really stood out. There was a man whose knee-cap had moved, and was sitting above his knee joint on his thigh! The doctor aid there was nothing they could do to fix it, because the man couldn’t afford surgery. This happened so many times. Once a young man came in, about 19 years old, because he had been having fainting spells every month or so for the past three years! The doctor diagnosed him with a rare form of epilepsy, and said he needed to get a CT scan the hospital in town, but his mother said that they couldn’t afford it – they had no livestock to sell. I asked the doctor how much the scan would cost, and then I gave him the money, and asked him to make sure the man got the scan. He said the village leader would go with the family to the hospital and make sure it was done, and that he would email me the results when they came through. It was frustrating not to be able to help every patient, but helping one made me feel better.


            Apart from the time a local man offered to buy me for his wife (apparently I was worth several cows), the event that stuck in my mind most was when we treated a local man with albinism. He had to be brought to the hospital under protection, and we found out later that the witch doctors in Tanzania and the neighboring countries believe that albino body parts bring good luck. Although much has been done to protect them, there have been several cases of murder and mutilation in the last decade, and albino children are often given up by their parents and put into special homes for their protection.

For more information on this issue, see:

-       http://time.com/3666772/tanzania-witchdoctor-ban-albino-attacks/

-       http://www.bbc.com/news/world-africa-27409965

-       http://www.theguardian.com/world/2012/nov/02/south-africa-model-albinism-prejudice




Part 3: Getting ready to leave


            After our two weeks of triage and clinic, we had two days of safari before we left to go home. The scenery was absolutely breathtaking, and we saw so many animals we couldn’t believe it! It was a little nerve-wracking to be that close to elephants and lions, but our guide was very calm and we felt safe. On our last night we drove back to the town and packed, and then headed out to find a place to dance. We were having such a great night – it felt just like a regular club back home, until twelve local guys got up on stage, and started doing this Macarena-esque choreographed dance…and everyone else joined in! We learned the moves pretty quickly, and everyone just kept going, repeating the same moves over and over for each new song that came on.

On out last day in Tanzania, we explored the local market, and I met a man who was an art teacher, selling his paintings. When I told him why I was there, and that I was leaving soon, he taught me a few simple brush strokes, and wished me good luck. We made our way to the airport, and were treated to one final view of Mt Kilimanjaro in the distance, and a beautiful sunset. 

About the Author:

Christine Scullywest is currently studying medicine in Chicago, where she lives with her husband, Justin and their adopted dog, Lulu. This article was based on the journal she kept during her time in Tanzania, and her pre-med thesis on the proliferation of certain diseases amongst Massai tribespeople.