One low building had been divided down the
middle by a long wall with a door on each side of the divider. It was a chapel
for Catholics on the left, and for Anglicans &
 |
| The 'bi-chapel" |
Lutherans on the right. What drew
my attention were the loud exhortations and the “fire and brimstone”
fist-pounding rhetoric of a funeral service being held on the right side. Despite an
open casket on wheels, draped in white linen and covered with red roses, the
minister felt no need to send this soul “gently into the dark night” but
rather, used his demise as a reminder that the time to repent is now! Mohimbili has everything!
While some buildings were packed with
patients scrunched together on the few available benches, leaning against the walls
or sitting on the floor as they wait for care, many other buildings, often 3- 4
stories high had unused offices and meetings rooms. The old wooden desks are
empty, the walls are bare and defaced and a lone receptionist at the front
entry chats with the ubiquitous security guard. As I explore the many
departments, often without David, I am seen as a visiting white woman of the
medical sort and have easy access to anywhere I wish to go. If I am stopped, it is only to inquire how I
can be helped. I talk freely to the
patients, to doctors, to families and all are delighted to be acknowledged and
be photographed.
The wards of the combined neuro/ortho hospital consist of a large open room with
25-40 beds all very close together. Bed count, however is not an accurate
patient count since many patients lay on mattresses on the floor as well.
Families handle most of the patients needs such as bathing,
changing and washing
linens, providing food and feeding. Upon admission, the physician will write
down the required medicine needed, and the family will buy it and bring it in (morphine,
opioids and the rare use of insulin are the exception). Patients take very few
medicines, they can’t afford to buy them. The nurses say they work hard, but to
my assessment, they do very little. This laid-back relaxed African style is
similar to what we had experienced in Kenya and Ethiopia. All hospital staff,
that is, cleaning people, doctors, security guards, nurses etc. seem to “hang out”/schmooze
a lot. They’ll wander in and out of different areas, they’ll meander outside,
chat with friends, laugh and share pleasantries before slowly migrating back to
their work area, only to repeat the process a short time later. “Hakuna matata”
is a common phrase they frequently say with a gentle smile. It means “no problem”,
and despite dry IV’s, soiled dressings and minimal handwashing, all is taken in
stride.
Doctors Rounds
 |
Rounds are made by doctors and nurses (often 15-18 people total).
Note the mosquito netting that hangs over every bed |
Rounds
take a very long time. Neurosurgeons
lead the once weekly grand rounds and David saw close to 100 patients over 3 hours. The residents (“registrars”)
and medical students round on these patients the remaining 6 days, when they
can. This being said, however, it is essential to understand that since the
 |
This young girl has a brain tumor
(craniopharyngioma) and is blind in one eye.
Hopefully she will have surgery soon. |
“standard of care” is on an entirely different level, the competence, relative
to this standard is still adequate. Patients only get what they can afford. Most can manage the cost of an x-ray ($8) but only those with insurance get CT scans ($50), and MRI's ($200). Often there is little alternative except to “wait and see”. The good news is
that many patients slowly improve on their own. There’s no feeling of intensity
to do more. During rounds, doctors rarely converse with the patients, and the patients do not
ask any questions nor seem too concerned, even when they appear quite ill. The nurses follow the doctors on their rounds, creating a large crowd in white
as they all inch their way along from bed to bed. Charts and films are kept in a large brown folder on the patient's beds. Doctors do not carry stethoscopes and rarely
touch the patient or look under dressings, probably due to the fact that there
are few sinks and even fewer working hand dispensers. Residents and medical students often wear lab coats provided by drug companies as evidenced by the large logo and brand name of their most popular drugs embroidered on the breast pocket in large letters (just to serve as a reminder).
 |
In making rounds, doctors and staff must sometimes step on
mattresses. Patients often stay for months to hold their place in line for surgery.
|
We saw many, many
nasty looking open extremity fractures and there is a very serious problem with
infection. However, since cultures are too expensive to process, patients are regularly treated
with broad-spectrum antibiotics, a “hit-or-miss” approach. The doctors we met had been trained
abroad (Japan, Norway, South Africa) and are capable of doing more for their patients but since many supplies, instrumentation and treatment modalities are unobtainable,
they are resigned and acknowledge they can only "work with what we've got". They are keenly aware that their medical system will not change until the priorities of their government changes. They accept this with a good natured cheerfulness. despite the profound and glaring inadequacies that they face every day.
A Gastronomic Desert (no, not "dessert"...)
 |
| Hospital cafeteria kitchen at lunch time |
Tanzanians are great meat-eaters, relying on
sausages, fish heads, tough beef kabobs and roasted (scrawny) chicken parts.
When served with rice and chopped greens of various varieties,
their meal is complete. One of their everyday favorites is ugali, a cross
between corn-meal mush and mashed potatoes. It is served in immense snowball
size portions and when kneaded between the fingers, it serves as a
pick-up/dunking/smooshing tool, eliminating the need for silverware. Another very popular all-day item is "chips majai", essentially, a pile of French fries cooked in an omelet. I guess it could equate to hash browns and scrambled eggs at Denny's, Tanzanian style.
Our only real complaint about the food was:
where do we find it?? A small eatery (“cafeteria” would certainly be a
euphemism) with “hot bar” of assorted items was set up outside the front door of
the hospital, and locals cooked during the late morning and early afternoon.
For those who might eat later, the only offerings were leftovers that had
already been found most attractive to the endless hordes of flies. The Tanzanians
don’t appear to eat their evening meal outside the home, hence, there are very
few restaurants. One local restaurant called “Delicious Food” was already
closed at 6PM when we stopped by. The young woman there said “no food”. Could
she recommend a place nearby? “No, no restaurant”. Unfortunately, she was
correct. Most restaurants are in the large hotels and cater to foreigners but
the MOI Hospital, being a public hospital, is not near any tourist areas. Our Swiss
Garden Hotel offered an evening meal but the choice was limited to one
curry dish served daily. Our wizard friend Tara came to our rescue and sent us off to
a hole-in the-wall called “Texas Grill” that
 |
| Texas Grill. All finger food, but isn't everything here?! |
made the best bbq chicken and
fresh garlic naan we can ever remember having. We stocked our hotel room with freshly roasted cashews, salty
cassava chips and ripe bananas; after all, we hadn't come to Tanzania for the food.
Zanzibar!
Exoticus Ultimus Maximus! What other thought could such a name conjure up?!… and I was not proved wrong. We had an open weekend and
were ready to go! For $40 a ticket we
traveled first class on a large capacity catamaran for the 2 hour sail to Stone
Town. Disembarking was a nightmare, the moment one is off the gangplank, the
jostling and heckling starts by the “touts” who far outnumber their hapless prey.
 |
| Dar, as seen from our catamaran |
They
are not rude, merely insistent on selling you, showing you, telling you that
they have just what you need (Hotel? Taxi? Tour? Snacks? Postcards?) and they are reluctant
to be dismissed. I am not too proud to admit that we were eventually ensnared
and taken, by a longer route than necessary, to The Tembo House (Swahili for
“elephant”). This magnificent waterfront hotel was originally the US Consulate
and had been renovated into 26 rooms with private bath ($125). Our 3rd
floor shuttered windows indulged us with breath-taking views of fishing boats,
swimmers in the Indian Ocean, the hustle-bustle of beach life and golden-orange
sunsets.
 |
| Our spectacular waterfront room |
 |
| Lunch at our hotel by the Indian Ocean |
Our guidebook recommended to ignore
restaurants for dinner and instead, go to the beach front in the center of
town, where a nightly array of perhaps 40 local “chefs” cook up skewers
of succulent meat, lobster, shrimp, crab, on small charcoal grills. It is served
with your choice of a yeasty coconut bread (yes!), chapati (Tanzanian
flatbread) or toasted pita. It has a carnival/food circus atmosphere
that
enlivens all of your senses as you watch and hear and smell the sizzle of your
fresh-from-the-ocean dinner being prepared. It was easy to find seating near
the
water on the large open benches and I was soon surrounded by a patient orchestra
of street kitties, waiting for tumbling tasty morsels (they were rightfully indulged). We finished off
our repast with freshly squeezed tamarind juice and a grilled crepe with sliced
banana, mango and Nutella which was then drizzled with chocolate! It was an
evening to remember!
 |
| Fresh seafood skewers |
We set out the next morning for a look around
Stone Town. Our first stop was a visit to the Old Fort from 1700 where Arabs
defended attacks by the Portuguese. Much of the fort still remains and is now
home to a dozen souvenir shops. Close by was the Palace, built in the 1890’s
for the Sultans, their families and harams (Sultan rule ended in 1964 with a
revolution). Much of the original furniture, porcelain and paintings is still
in place and provides a fascinating glimpse into an earlier era.
We braved the endless stream of foot traffic
to explore the vast maze of tiny, narrow lanes of the street markets. Large
groups of Muslim women shopped for brightly jeweled dresses to wear beneath
their black hijab and “days of the week”
 |
"Days of the week" panties,
ready for Muslim ladies fannies |
panties in hot pink and lace mounded
in 3 foot high piles on the ground, were also a popular item. All essentials can be
found in these stalls: plastic ware, clothing and shoes, children’s toys,
computer parts, henna “tattoos” and hair-braiding.
 |
| Noisy and hectic street market in Zanzibar |
In 1967 a new gem was discovered near the
foothills of Kilimanjaro. Tiffany &Co bought rights to mine it and bestowed
upon it the name “Tanzanite”, as this is the only known place in the world
where it is found. When cut and polished, Tanzanite becomes a kaleidoscope of
royal blue, violet, indigo, lilac and periwinkle. It is 1000 times rarer than
diamonds and earns the Tanzanian government $20 million dollars a year. So…what’s
a girl to do?? I felt it my duty to assist the local economy and had soon adorned
my pinkie with a small violet-blue chip - the perfect souvenir of a
delightfully delicious weekend in Zanzibar!
The Muhimbili Compound
 |
| Hospital census frequently doubles as patients sleep in hallways wait for surgery |
It took almost a week before I could find my
way around this very large health care area. It can best be described as a multi-building
complex for many specialty units that are linked by a long and circuitous
outdoor walkway, much like spokes on a wheel. You can “get on/off” thru the occasional
openings. It is 6’ wide and covered for protection from the rains. It
is much too narrow for the masses of ill and barely ambulatory patients and
vast number of visitors that shuffle along from one clinic to another. One must also step aside for the food carts and
medical supply wagons. It is a perfect macrocosm of downtown Dar! David worked
in the Muhambili Orthopedic Hospital (MOI) with 300 “official” beds. This number almost doubles when you add in those who are lying on mattresses on the
ward floors and in the hallways. I asked Patrick in Social Services for an accurate census. He said he
didn’t know but would be happy to send a “helper” to go to the wards and count
heads. (Nothing is computerized.) There are also rooms for “private patients” who have a medical plan with their employer, or an adequate income. These rooms may be singles,
doubles or triples (depending on the insurance plan) with a shared bathroom
and a small TV and they cost $15 a day. Doctors receive reimbursements for
these private patient services, unlike in the public side of the hospital where 80% of the
patients cannot pay. It is here that doctors earn enough money to support their families.
Everyone has a mobile phone. The various ring
tones erupting from pockets or purses are ubiquitous. It is not considered rude to pick up a call
at any moment or in any place; it is their only way to keep in touch since very
few of the hospital departments have telephones or computers.
In 2008 the government passed a law allowing
motorcycles to transport passengers (essentially, taxi-“donor”-cycles). Since
then the hospital patient census has increased by 67% due to the horrendous
number and nature of crashes. They are building a new modern hospital close by and
hope to move in within a year. Though the equipment will be the most advanced available, the biggest challenge will be the maintenance needed to keep
 |
Bad news: This guy really shouldn't be hanging
around the operating room.
Good news: He probably ate up a lot of the flies
that had taken up residence there. |
it running. Lights,
computers, air conditioners are often non-functional, I’m not sure I saw a
single clock that had anywhere near the correct time. All operating equipment is autoclaved
which causes corrosion to many of these delicate instruments. And no one knows how to fix this
stuff! It is very frustrating to see donated equipment worth many thousands of dollars to be ware-housed in a back room, and now missing dials or
buttons or handles which had been pilfered and repurposed for home use or some other nonsense.
Due to the lack of certain sophisticated
equipment, Tanzania has contracted with the Apollo group of hospitals in India,
which offers state-of-the-art surgery for certain
brain surgeries, and has excellent results. It must be certified by 3
physicians that such treatment is not available in Tanzania before the patient
can be put on a lengthy waiting list. This poses the question: How can Tanzania
 |
The new hospital expected to open
by the end of 2014 |
advance in its health care delivery if it does not have the opportunity to
learn to do these surgeries in it’s own country? The new seven storied hospital being built, adjacent to the present one, has so far cost $11 million and will have 380 beds. It is envisioned to be Tanzania's surgical "tour de force". We have little doubt it will be magnificent; the question is: Will its
high caliber of proficiency be maintained in a year or 2, or will the equipment
break down, and staff revert to its previous inefficiency. It’s a
head-scratcher but the answer will present itself soon enough.
Nursing Care
After being a hospital nurse for 30 years (Ye
gawds!!), you never get it out of your system, even with retirement. I have
always been anxious to learn more and Tanzania proved a fascinating place for
comparison.
I chose to visit the combined neuro (125
beds)/orthopedic (320 beds) wards. These beds are always full and the number of
patients almost doubles when you add the mattresses on the floor between
the beds and in the hallways. The AM nursing shift starts with vital signs
but only for those patients who “appear sick”. When I
 |
| Nurses station on the 66 bed neuro/ortho ward |
approached the open
nursing station in the mid-section of the ward, I was surprised to see all
staff members relaxing in chairs and joking with each other. There are no call
lights and the patients require little care as the families do the bathing,
feeding and ambulating. In fact, many of these patients are quite healthy, and
have only “moved in” as they await surgery. They may well be living here 2-3
months and by occupying a mattress, they are assured not to ”lose their place
in line”. All surgeries are the same price: $140 and patients must pay at least
half of that ahead of time in order to have their operation. Often the patients
just live there as their families organize enough money to make the payment, or
until they move up on the OR schedule. They want to be ready whenever the doctor
is. Nurses with a 4 year degree earn 500,000 to 600,000 Tanz. shillings a month
($350-400) from which is taken 15% taxes, as well as insurance. Living costs in
the surrounding hospital area are high, with typical rent for a moderately
dilapidated 2 bedroom apt. from the 60’s-70’s renting for US$1400, and those of
a barely higher quality going for $2000. While local fresh fruit is a bargain, remaining food stuffs are not; a
pound of coffee: $8, a cup of yogurt or a pint of milk: $1.50, one dozen eggs:
$3. and chicken is over double what we pay in the US.
NGO (Non-Government
Organizations)
This is humanitarian work in every field
imaginable run by organizations which have no ties to any government. NGO’s
must be independent of any political ideology and are often (though not always)
funded by the private sector. They offer multi-faceted support to developing
countries in the fields of need such as
literacy, agriculture, family-planning, sanitation, AIDS etc. It is impossible
to overestimate their value as they effect change throughout Africa. No doubt,
they are more ubiquitous than McDonalds and Starbucks combined, and though they
have been criticized in the past for pushing their own values, they now operate
under the buzzword: “sustainability”. This philosophical shift of mentorship
has created the proliferation of offices and programs managed by local
people, who in turn hire locals for outreach programs. They also focus on using
only local services and goods for their operation.
I spent a morning at the Ariel/Elizabeth
Glaser Foundation. You may recall how Elizabeth Glaser captured headlines in
the 1970’s when, 5 years after receiving a blood transfusion in childbirth, she
was found to be HIV+, as were her 2 children. Her husband, Michael was a
well-known actor from Starsky and Hutch as well as other movie roles. Elizabeth
started the foundation and was an outspoken voice to this still “silent
epidemic”, long before it became "acceptable" to speak out. Tragically, her daughter Ariel died at age 8 and Elizabeth died
several years later. The foundation now has a
 |
| Elizabeth Glazer and Ariel / press photo |
yearly operating budget of almost $122
million and has health centers around the world. It's African affiliates are in Tanzania,
the Ivory Coast and Mozambique. The district office in Dar employs 20 and
another 40 work in its outreach programs in rural areas. Speaking in their
mother tongue of Swahili, local people are trained to run clinics, organize
treatment regimens and foster close ties with remote communities. These African
affiliates are run entirely by their own people and are therefore sustainable.
That means that even if the NGO were to close and abandon its mission, its work
could continue with minimal transition. NGO’s are unquestionably a win-win for
all.
David accompanied me when I spent an
afternoon with USAID (United states Agency for International Development).
Their headquarters are located in the US Embassy and since the bombing in 1998,
the security is very, very tight. After multiple screenings, sign-ins and
bullet-proof doors, we were finally admitted into the office of a director
of the AIDS and literacy program. The goal is to empower local areas but
there is a continuous problem with funds being “diverted” (we all know what that means-). To counteract this,
all funding is now handled on what they call a “G.to G.” basis, that is “government to
government”. We pressed to better understand how this avoids corruption; does
it not just result in greater pays-off to the “higher ups”? The director had no
explanation. USAID’s largest programs include Health, Education, Feed the
Future and Democracy in Government. Tanzania receives $275 million from the US
government and has seen a reduction of AIDS from a previous high of 8-12%, now down to 5% in some provinces.
There is no shortage of work to be done.
Nursing School
 |
| Nursing school. Class of 2016 |
After asking 3 clueless security guards where
I could find the Nursing School, I finally stumbled on an old obscure building
that appeared abandoned from the outside. The 4 year nursing program has just
recently been shortened to 3 years in hopes of higher graduation rates. I sat
in on 2 classes and was asked to speak about “Nursing in USA” as well as do a
Q&A. The students complained that nursing is not considered a respected
profession and they wanted to know more about employment opportunities in America. I
responded that nurses in America are highly valued and that the mandatory nursing boards
are very challenging for those not truly fluent in English. They also were very interested
to know the different between hospital care in Tanzania vs. USA. With great
diplomacy, I carefully crafted words to minimize the wide disparity. In the
classes I attended, the teachers were highly didactic (rarely breaking their
oratory except when their own cell phone would ring) and students would come
and go at whim. There was no text, students wrote lecture notes in small
notebooks, and the material itself was simple and of minimal importance.
Interaction with the students was rare, and teachers did not know their names.
Every Wednesday at 7:30AM was a weekly conference for nurses. It was almost 8AM before close to
40 charge and head nurses had gathered in the conference room. Nurse Violeth started her
presentation by reading the power point slides that she had copied from an
out-dated English nursing text. For the remaining 75% of her lecture, I was
surprised and disappointed that she spoke only in Swahili. I didn’t mind that
the power point material was boring, but its absurd simplicity troubled me (“Remember
to respect the patient and his belongings”, “The health of the patient is our
primary goal”, “Inform the patient of any planned treatments”, “Chart your
actions and observations”). This might have been appropriate for new nursing
students in their first week of class, but certainly not for seasoned nurses.
 |
| Tara and David check on patients in ICU |
The hospital made a concerted effort several
years ago to improve the quality of its ICU by sending 5 of their RN’s to South
Africa for intense training. Paying for airfare, housing and wages, the plan
was for them to return to Tanzania after 2 years and teach their co-workers the
high level of care they are learned. Even though the cost savings would have
been tremendous had they instead, imported one nurse from South Africa to come to Dar; the
feeling was that only such intense “reprogramming” would change the ways of the
Tanzanian nurses. The consensus is that this program is working, albeit slowly. There is some push-back, as expected, on the part of those nurses who stayed home. They really aren't too interested in change-
Nobody knows nuthin'
A great frustration for us was trying to obtain simple
information. The people are intelligent, kind and eager to help but seem to
know only what is happening in their own small microcosm: a secretary on the first
floor of the nursing building did not know that the administrator’s office was
just one floor above; a security guard at one entrance of the hospital could
not direct me to the other entrance, our taxi driver never heard of the
American Embassy, We got lots of nods and smiles, everyone wanted to be
congenial but no one seem to have answers to our simple questions. Another
problem is “African Time” ie, late! The hotel kitchen staff often arrived late
for breakfast set-up. Classes in schools started late, nurses arrived late for
their shift, and restaurants took an inordinate amount of time to fill even a small order. “Hakuna matata” (no
worries) they would say if you showed any frustration, reminding you that the
problem was yours and not theirs. It is just the way of their world, and required adjustment on our part.
The Three “R”s
A law was passed in Tanzania
that schools may no longer collect fees for children to attend. Unfortunately,
many public schools continue to demand a “contribution” before the child will
be enrolled; in effect, denying education to a large majority of
Tanzanian children. Only 1 out of 3 kids start secondary school (grade 8) and
of these, only 4 out of 100 will complete grade 12. Families often discourage
education because they have no money to pay the “contribution” as well as
uniforms, shoes, texts and school supplies, and “rent” toward a desk. For those
parents earning just a few dollars a day, this is an impossibility, especially
if they have more than one child. They also lose that child for work at home,
or in the fields for 9 months of the year. Most schools are in a horrific state
of decay with crumbling walls, minimal lighting and desks designed for 2 kids
now crammed with 4. With rare exception, public schools do not have toilets,
not even for the teachers. Of the few that do, there is no separate facility for girls.
 |
8th graders at an all-girls school who were on break from classes.
They were anxious to learn about the American education system. I
I had brought yarn for "cat's cradle", which we all enjoyed. I also
handed out chapsticks to all the classes, a thoughtful donation
from Costco Pharmacy Services.
|
As in Ethiopia, English is
taught as a core class starting in 5th grade, but not spoken in the
classroom until the start of secondary school, grade 8. Unfortunately, by then
it is difficult to master the necessary nuances of proficiency and a heavy, hard-to-understand
accent remains. Considering how few children actually continue on to high
school, it makes for a country sorely lacking in verbal skills that are
necessary for economic advancement in a modern world. It was often difficult to understand many professionals with whom we had conversations. Often David and I would look quizzically at each other, as if to ask: is this person speaking English or Swahili? We often couldn't tell until much of the conversation had been completed.We have received emails
from several Tanzanian doctors since our return and find very basic spelling
and grammar errors in each one.
Standard 5
“Standard” is the old British word for grade
level, and is commonly used throughout Africa. I had made appointments to visit
a primnary school and a secondary all-girls school. Earlier that
week I had spoken to Teacher Yacinta of the 5th grade primary school
class and she welcomed my visit. She had shown me where I could
find her. I poked my head in the door, expecting it to be her office and much
to my surprise about 50 excited little kids jumped up and down in their
seats and, speaking all together in a loud cadence, announced: “Welcome, Mara
to Dar es Salaam, we are very happy to meet you!” And they certainly were, that was
apparent! As was I…this was one of the warmest heart-felt welcomes I can
recall, and I didn’t hesitate to tell them so. Their English was very basic but
they eagerly participated in a simple geography game about the U.S. that I quickly
invented. When responding to a teacher’s question, they are not allowed to
speak until called upon. Instead, hands go flying high in the air and their
fingers go snap! snap! snap as they all vie to be called upon. When chosen,
they immediately stand at their desk and eagerly speak. They are joyous little
learners and the teachers of this primary school age group seem to easily keep
the class motivated. As I left, they blew me kisses and asked me to return the
next day which was not possible. I was already scheduled to visit an orphanage
and after that…back to the states. I made a 10 sec. video of their greeting to
me, please take a look at it. Their happiness is infectious!
Kiwohede (KIota WOmens
HEalth and DEvelopment org)
 |
| Lovely Edda, and I show off my new bracelet |
Since we were staying in our small hotel for
2 weeks, I got to know the staff and asked them for recommendations of
interesting places to visit, and this was at the top of the list. Kiwohede is
the Swahili word for “nest” and it was founded by Justa Mwaituka. She started
this foundation after a trip to India 15 years ago, when she visited orphanages
that also served as drop-in centers for girls at risk. Her foundation now has
22 such centers (“nests”) throughout Dar, each bustling with educational and
vocational programs, health information, social activities and counseling. I
arrived to the music of 45 boisterous and youthful voices singing African songs as they
strung beads and created brightly colored necklaces and bracelets.
Along the wall were over 20 sewing machines where tailoring was being taught,
and there was a large area for making batik. These items were then sold in a
small shop next to the center to earn
money for more materials.
Justa
introduced me to Edda who is the program director She was dressed in a beautiful batik
dress, sewn by the students. As we toured the building she spoke of her biggest
concern: the girls at risk on the streets. It is not unusual for girls to be married
very young, often just at puberty, and they are expelled from school when they
become pregnant. There is often violence in these relationships and 1 out of 3
adolescents reports being beaten, choked, burned or attacked with a knife. If
they flee, there is little left for them except prostitution, as their families
will not take them back. There are over 2 million AIDS orphans in Tanzania. The production
of sisal (used for rope) is a major export for the country, as is coffee, tea
and sugarcane, and 1/3 of the labor force for harvesting these crops are
children, ages 12-14 who do back-breaking labor for 11 hours daily. Clearly,
there are lots of at-risk kids who can benefit from Justa’s vision.
 |
Making beaded jewelry at Kiwahede. Notice the toothbrushes that
I was able to give out, donated by my kind dentist, Dr. Lui in Bellevue. |
The Kiwohede Centers offer a retreat; a
place to go for street kids to experience a more appropriate environment and
make new friends, get health information, learn a vocation and even attend
secondary school tuition-free. I enjoyed immensely my day there and was very
impressed with all they do. I bought a lovely beaded bracelet as a souvenir and
will send them our remaining Tanzanian shillings as a donation.
Saying good-by (Kwaheri)
 |
Seeing the city in a Bajaji (aka tuk-tuks), air conditioned
3 wheelers that zip thru traffic and drive on sidewalks. |
What a country of extremes is
Tanzania (pronounced “Ten-ZEN-ya” by its inhabitants), as it is poised for major growth and technological advancement, yet still remains primitive and agrarian.Though most visitors
have plans for a safari or to scale Mt. Kilimanjaro, our work kept us in Dar. Dar es Salaam actually means “abode
of peace”, though perhaps not so much in this modern era as when they named it.
The traffic is abominable, perhaps the very worst we had ever seen, and during
rush hour (4-8PM) cars are often at a complete standstill, moving only a short
distance every several minutes. The roads are a disaster with immense pot-
 |
| Typical pothole with broken pipe below ground |
holes
causing many drivers to just drive on the sidewalks or create their own
roadway thru the shrubbery. Considering its metropolitan population of 2½ million people, it
has barely more than a dozen stoplights, which are frequently ignored or just
out of service. The cars have the steering wheel on the right and they drive on
the opposite side of road, but the truth is they drive anywhere and everywhere
and no one seems to stop them. As a pedestrian, one must be very, very vigilant.
It is clear there is good reason to worry since we usually saw morning reports
on 20-25 patients that had come into the emergency room with mangled arms and
legs and brains. Young adults and children are not spared by the fast and wild
drivers who don't limit their hellish driving to the nighttime.
The Tanzanian people are good and kind. They
love their babies, and they care for their elderly. In the morning as we walked
to the hospital, women gathered along the roadside brewing rich dark African
coffee on small piles of charcoal or they grilled fresh chapati to sell to
passers-by. I don’t know where they sleep, no doubt some small hovel not far
away, but they never hesitate to say “good morning” to everyone they see. Poverty does not
undermine their cheerfulness. This is the camaraderie of the street and their
fundamental good nature.
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Downtown Dar as seen from our catamaran. New sky scrapers
are appearing everywhere |
 |
| Downtown open market where all major produce is sold |
There is a total of 6 neurosurgeons in all of
Tanzania serving a population of 45 million inhabitants. It is a country rich
with minerals and resources but much too little is spent on infrastructure,
health care, and education. Dar is the 3rd fastest growing city in Africa and building cranes populate the skyline. The many skyscrapers going up on every available
empty lot are being built by businessmen from India and China; few are from
Tanzania. As frequently seen in African nations, economic development has a
parasitic relationship with many of its developers. But who can fault it; even
with 2 steps back and one step forward, there is still that one small forward
step that otherwise would not be.
As I walk to the hospital from our hotel, I
think of the basics I have come to expect: running water for a shower, a
healthy meal, a safe place to sleep, a chance to realize my dreams, and I am overwhelmed by such a
rich bounty. I see a young fellow on the street, perhaps 12 or 14 years old, hauling a
heavy wooden cart laden down with sweet pineapples, mangoes and papaya. The handles are yoked over his shoulders and he sweats in the humid heat. I wonder
what he thinks. Does he wish he were in school? Does he ask himself if he will he be able he to pull this
cart for the next 40 years? Has he given up on his dreams, or did he never have any? Is it already too late?
 |
"Tinga-Tinga" is a well known folk
art style from the 60's, created by Edward
Tingatinga, a Tanzanian. David thought we didn't
have room for any of his artwork, but
I found a perfect spot!
|
I have come to realize Tanzania will never
catch up, nor will any other country in sub-Saharan Africa. There is no broad
stroke of a paintbrush that will brighten the shadows; there just isn't time. Eventually
new equipment will be in the hospitals, wider roads in the cities and the
first generation of tech-savvy programmers will connect with cyberspace. But by then, the rest of the modern
world will be even further advanced, leaving in its wake this nation
that coulda, woulda, shoulda…but didn’t. I’m so sorry, Tanzania, there is so
much of you and so little of me to make any difference whatsoever, but of course, I knew that before I came. You are like a sweet
little lagging toddler who just needs to keep taking those steps forward, as best you can-
We fly home, 9 hours from Dar to Amsterdam
then almost 10 to Seattle. We sleep, read, and watch movies. My home feels so good
to me. I put my head on my pillow and drift off into sweet Tinga-tinga dreams about Africa.
Ahhh...hakuna matata...
