It’s hard to believe more than five weeks has passed and the time has come to tally up my cases and go home. Paradoxically the total time has gone by very quickly while the down time, and there has been more than a little, has seemed excruciatingly slow. I have experienced disturbing mood swings here ranging from exhilarated and commanding to feeling helpless and depressed. The dark side, I’m sure, stems from watching tragedy unfold under my gaze and being powerless. Idle time intensifies the frustration which lasts until the next triumph. Fortunately the triumphs have outnumbered the tragedies but by far less than I am used to in clinical practice at home. The highs have been many. The standouts are seeing the three year old girl eating normally for the first time in her life, the woman who nearly died from intestinal obstruction laughing with her family as I removed her stitches and the pretty young woman going about for the first time in years without a shawl to hide her horrible ear keloids. Then there are the open ended cases. What will happen to the nun who lost her lower leg to melanoma? How will the young woman with the malignancy on her toes be able to walk on a foot that looks like the middle of it was bitten off? Will the man with the huge lymphoma on his neck really get to Dar es Salaam for proper treatment? The biggest question of all is have the powers that be really listened to my pleas and suggestions to bring some order to this chaos? Or, has my presence here been like sticking my finger in a bowl of water. I can stir things up and make lots of waves but when the finger is gone it’s as though nothing happened. I believe something will stick. I feel emotionally tied to this place though if you saw it you would certainly wonder why. The people have gotten under my skin and I think I have finally started to really understand who they are and how they think. Believe me when I say that there is not much in our American experience to help me relate. Being here, now for a total of ten weeks and finally being able to settle into the indigenous pace and mindset has left me connected in a way that is not always pleasurable but certainly challenging and, I believe, irrevocable. East Africa is now part of my being.
The night before I left Sumbawanga I was invited to the home of Daniel Njoolay,the Regional Administrator (Governor) for dinner. You remember that I entertained him and his wife a couple of weeks ago. This time it was him, me and Jasper sitting around his dining room table seriously discussing hospital problems and what to do about them. Jasper, unaccustomed to such meetings was sure he would lose his job over this. In Africa frankness is not common in such conversations. Circumlocution leading nowhere is the norm and that’s why so little gets done. Because of his education in Canada Daniel understands my style which is polite and certainly not blunt but gets to the heart of matters fairly quickly. I made my points carefully, surrounding each with background facts that locked it into an inescapable discussion pattern. Daniel was very frank with me explaining where the bureaucratic resistance to change is and what are the extents and limits of his own power. By the time we were half way through the second bottle of wine Jasper was giving a pretty good account of himself. He is the senior and best trained physician in town and has the respect of everyone including the politicians. We went on for over four hours and in the end had formulated a restructuring plan. We determined that the reason for a lot of the shortcomings at the hospital is that no one is running it. The regional medical director who is responsible for all of Rukwa has his office in the hospital and he is the de facto administrator but does not function in that capacity. Daniel has decided to move him out of the hospital into the regional government office building where he belongs and replace him at the hospital with a real administrator. I suggested he get a newly minted health care MBA out of Dar or Nairobi to come in there and kick some butt and make a name for himself. I must, of course follow up this meeting with a report and I’m happy to do it because I finally feel that I have done more here than just care for one patient at a time.
Back at the hotel I packed my stuff and prepared for my morning departure. You’re already familiar with the details of my trip so we’ll skip to today.
The National Museum in Dar es Salaam is no Smithsonian. Located near the waterfront about four blocks from my hotel it is a smallish building with displays in two parts. The first is an interesting somewhat sanitized version of the country’s history before and since independence in 1967. It is mostly pictures of revered but outside Tanzania, obscure individuals who played some part of the “bloodless revolution” Looking at it closely though one gets a sense of the intensity and fervor that was involved and still lingers in the minds of Tanzanians. Forty years is a short time for nationhood and the pride is still there. The second section is the anthropological history of the country. Because of the great geological rift that runs through it Tanzania is a great repository for fossil evidence. Someone very knowledgeable has taken very great care to reconstruct and illustrate the fossil record of humankind creating a remarkable journey through our evolution that is truly worth seeing. All in all the museum, though lame in parts, gets pretty fair marks for giving the visitor some idea of what this country is about.
Then I went off to the Kariakoo market. This is one of those places where the guidebooks and travel mavens tell you to stay away from. There are pickpockets, thieves, murderers and perhaps even worse just lurking there waiting for the unwitting visitor. As my 10th grade English teacher used to say, Balderdash!! The market is a huge place built like a square stadium, Inside are hundreds of stalls each, apparently, its own individual business. It’s sort of an impoverished version of the Reading Terminal in Philadelphia or Pike Place Market in Seattle. What interested me is what they sell. In a city of nearly three million people who have access to cell phones, satellite TV and all of the associated hype what would you expect to find in a central market, electronic toys, gadgets and such? There are some but not much. Most of this building is dedicated to simple farm implements, seeds, fertilizers and garden tools. There are multiple stalls selling sewing machines, some of which are Chinese knock-offs of the ancient foot treadle Singer that my grandmother used. They sell for about 100 bucks as do the best of the Chinese bicycles. Almost all of the merchandise here is dedicated to people making their living. The place was packed and I met some of the nicest people there. I was the only white person not only in the market but in the whole neighborhood so my presence did not go unnoticed. Parking myself on the corner of a balcony I was able to get some great candid pictures and walking among the crowd people were only too glad to pose. My only detractor was a local Imam who accused me of stealing peoples’ souls with my camera. I assured him that out of respect I do not take pictures of Muslims without permission and if I have stolen any Christian or heathen souls I promised to take very good care of them. He actually laughed and was satisfied with that.
The lesson of the market is that these people are hard working and, so far, basically uncorrupted by the “I wants”. Families come to the market to buy the things they need to sustain their lives and one can see on their faces the joy of the shared experience. Maybe it’s a good thing that the guide books steer people away from the place. They really don’t need us there.
Then it was time to reclaim my suitcase and head back for the hotel. Happy hour was fun. I met some nice people here for an international financial conference. Dinner was, to use an old fashioned term, splendid. I’ll not go into details. Back in my room I finish this piece, make final preparations for my flight to join Marcia and Ara in Paris. It is our wedding anniversary and his birthday on Wednesday and we plan to celebrate.
So the Africa 2008 adventure is over. I know it has changed me in ways that will emerge slowly over the coming months. Of course I’m already planning when and how I will return and which of the many people I’ve met that I will continue to contact. When one’s world expands there is no stuffing it back into the old container. You just have to try to keep a handle on it and go where it takes you.
If you’ve been a fan of this blog thanks for reading. Go out and have your own adventure. I’ll be glad to read about it. Watch for a pictorial review on this site after I have had a chance to review and edit my photos.
Tutaonana (until next time – Swahili)
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