Health in Tanzania

In my first blog entry, I wrote a little about the course I am taking while in Tanzania. During the second week of class, we were given a presentation about the healthcare system of Tanzania by Dr. Njau, one of the doctors and professors at Kilimanjaro Christian Medical College. In his presentation, he stated that the healthcare system was failing at the link between regional and referral hospitals. In order for the system to function effectively, individuals should first be seen by the district hospitals and if they can not handle the case, they are directed to the referral hospitals. KCMC is one of the few referral hospitals in the north-eastern region of Tanzania. However, many are skipping the district hospitals and going straight to the referral hospitals.

To respond to my question as to why exactly the system was failing, Dr. Njau responded with a number of reasons. For one, the surrounding population knows that referral hospitals like KCMC have better facilities and often better personnel. Secondly, the regional hospitals are often understaffed, as the best doctors like to stay at hospitals with superior facilities. Thirdly, the doctors at the regional hospitals receive the same wage no matter the number of patients they see, so they often refer as many patients as they can to referral hospitals in order to work less. Such added numbers are increasing the burden on the doctors and facilities at the referral hospitals. I was able to see KCMC in action during the early part of this past week.

Last Saturday, all of the Cornell University students and a Cornell professor in Moshi for the week decided to take a tour of traditional Chagga culture. (The Chagga are the most prevalent tribe in the north-eastern region of Tanzania. All of Cornell students are staying with Chagga families). During the tour, we saw a traditional Chagga dwelling, crept into a cave that the women and children would hide in during battles with the Maasai, and were briefly told how to make the traditional Chagga brew, mbege, which is made from bananas. Most of the things the Chagga traditionally ate, made, constructed, etc. came from the banana tree.

After the next morning, I noticed that I had some sort of rash on the inner regions of my arms, between my forearm and biceps. I thought it was some reaction to a bug or an allergy that had been triggered during the tour. Suspecting that it would go away shortly, I put some Cortisone cream on it and tried to ignore it.

Tuesday came and it had gotten worse. It had spread to the abdominal region of my torso and oddly enough, no where else. After explaining my condition to one of my professors, she said that we would go to the dermatology department during a class break. 11 o’clock came and we headed the short distance to the clinic. My professor said she knew the head doctor in dermatology and began to search for this illusive doctor. Returning a few minutes later, I was told that the dermatology clinic is not open on Tuesdays or Thursdays. I guess people don’t get skin issues those days.

Stating that she knew a general practitioner (GP), she made a phone call and we headed up to the central hospital. Walking up various flights of stairs, we passed a wide array of people. There were a few Maasai, with their shaved heads and enlarged earlobe holes, walking into the eye clinic, to young children being wheeled around on gurneys, to elderly men waiting by the pharmacy. I had taken a tour of the hospital, visiting a number of wards, but being a patient had a different feel.

At the fourth flight, we walked into an office filled with ex-pats. I was escorted to a corner of the room and given a very informal examination. After a few questions and a few pokes, the doctor stated that it was most likely a fungal issue and I should use the Lotramin that I had brought with me. Walking back to the classroom, by stomach began to itch again.

The next day, Wednesday, I told the professor that I wanted to go to the dermatology clinic, as the itching hadn’t stopped. The professor couldn’t go with me again so she asked a Tanzanian student to accompany me. Peter, a 25-ish Tanzanian with an ever-present gapped-tooth grin, said that he would help me. Walking to the clinic, Peter said we would take a small detour to grab his medical coat. With the coat, he claimed, he looked more official, and we would later need his doctor persona.

The first stop was to the file office where I had to open a file. So now, if I get sick again, I’ll have a medical file in Tanzania. And I guess there is now some legal document / proof that I actually went to Africa. The file clerk wanted to charge me more then the 4000 Tanzanian shillings (Tsh. Roughly $3) to open the file, but I told Peter that another Cornell student had opened a file for that amount so the 4000 was paid and the file was created. We then headed to the dermatology clinic where instead of waiting among the other Tanzanians with some sort of skin issue, Peter escorted me through a hallway among examination rooms. He said that I should wait here while he found a doctor. As he searched, I tried to avoid the obvious fact that I was out of place and shouldn’t have been standing awkwardly in the hallway, within direct eyesight of the Tanzanians I had skipped in line. I was feeling guilty, but still itchy.

After some pleading and being dragged into another examining room to learn a little more dermatology, Peter escorted me into a room where a Rwandan doctor was just finishing up with an elderly Tanzanian woman in a brightly patterned body wrap. Taking a seat, I began to describe my issue to the doctor. He said that it was probably allergic eczema and after writing a script, I should come back in a week as a checkup.

Leaving the clinic and picking up a cream, we headed to a specific pharmacy that could administer the pills I had to take. Waiting for the pills, I finally felt that I wasn’t cheating the system. I had to wait my turn, among the locals for my medication. I wasn’t receiving any special treatment that the woman with her tiny infant to my left, or the grey-haired man to my right couldn’t get. I was back among the general public. (The cream was about 1000 Tsh and the pills 1500. The whole trip cost about $5)

Before I had taken this adventure as a patient at KCMC, my professor had used the term “white privilege”, meaning that no one really questioned your actions if you were white at KCMC. As other local youths were being stopped by KCMC security, the Cornellians quietly walked past. At the hospital, this “white privilege” had truly taken shape. I was brought to the front of lines and skipped people that probably had more severe problems than me. I feel bad about this fact and slightly ashamed that I had let it happen, especially as a hopefull doctor, I should be aiding those that need care, and not skipping them to get care myself. I wonder if I had been a Tanzanian myself and a friend of Peter’s, would he have taken the same strides to ensuring such speedy treatment as he did for me, the white American? Possibly. And if so, then a phrase I hear back in America rings true. It’s not necessarily what you know, but the people you know.