Notes from Africa (Tanzania January 24, 2008)

View from the Muhumbili University of Health Allied Sciences/Dar es Saalam City Council/Harvard University (MDH) partnership rooftop.

Satellite dish on the roof of the MDH partnership site.

The Harvard delegation visiting Muhumbili University laboratories.
Muhumbili University building.

January 24, 2008
I was hoping I'd semi-starve to jump start weight loss. No such luck! Even in resource poor Uganda the eating was good for the fat Americans. One night in Uganda I ordered a whole Tilapia -- it reminded of Power Friday night (Friday night dinners at my grandfather's house). The head was on, the skin was rubbed with peppery spices, the eyes were milky white and there were so many bones I had to roll up my sleeves. By the end only a sucked dry carcass remained on my plate. I wasn't playing! There's lots of Mediterraen food choices (hummus, baga ganoush, falafel, grilled lamb/chicken, feta etc.). Today, for the first time, I forced myself to moderate my eating and exercise (did my Forrest yoga tape since there's a DVD player in my room and I went for a swim on the rooftop pool:-/

Dar es Salaam, Tanzania is full of contradictions. When we arrived I was reminded of New Orleans. It's bordered by the Indian Ocean -- and very hot (102 yesterday!). The air smells like water (it's very developed. There are no burning smells though I see did people burning cook fires on the beach). The streets are wide and traffic-filled. The city is old with lots of wrought iron facades and balconies. There are mid-day traffic jams that easily rival any US metropolis.

We visited a premiere clinic yesterday funded by our tax dollars, literally (and our President's promises: PEPFAR). It was absolutely incredible -- better than any clinic I've seen anywhere (Bellevue can learn a thing or two). In the center of the building there was an open-air garden surrounded by wait room seating canopied by an overhanging roof (so that clients don't have to get wet when there's a spontaneous rain shower). The treatment, counseling, reception, data entry etc rooms are on the perimeter - all air conditioned (highly inefficient one of the workers commented to me during lunch). The rooms are walled with frosted glass so there's a lot of light everywhere. The only sadness are the faces of the clients who are managing their illness. But here's the contradiction: only HIV/AIDS diagnoses get these resources.

If should find yourself with cancer (or any other chronic disease) -- kiss your ass goodbye. Seriously, find a gun and end it. There's one radiotherapy machine per 2,000,000 people (compared with one per 150,000 people in the US). Cancer care in Tanzania is palliative -- and this descriptor is generous. Opiates are banned in Tanzania (as in most of Africa) for complicated reasons. Families not resourceful enough to smuggle morphine in must settle for two Tylenols when their loved are writhing in pain as their bodies rot from the inside out (which we witnessed when we toured the Oceanside Cancer Institute today - THE premiere cancer treatment center).

30% of their cases are women with cervical cancer who present (that is, come to the hospital) at the point of no return. To give you an idea of what this means: NO ONE in the Western world dies of cervical cancer! We get annual pap smears to detect changes. Our daughters get HPV vaccinations before they bloom (the human pappiloma virus which is sexually transmitted is the number one cause of cervical cancer).

I refused to go into the men's ward during our tour today because I could see from beyond the glass doors that there were men lying on pads on the floor in immense pain in an overcrowded un-air conditioned, unlighted room with their loved ones sleeping beside them (or tending their needs). There were no nurses. I was sort of rope a doped into entering the children's ward. I cried. Deformed children with massive tumors growing on the sides of their heads, eyes missing, bandages in unlikely places, again tired mother's lying beside them. No nurses. No painkillers. No cure. The director of the Center said they must ration care. 50% of the people get nothing other than Tylenol to treat their cancer.

None of the great HIV/AIDS machinery can be used to treat these other horrible diseases. Just miles away there are state of the art laboratories (and clinics) for HIV/AIDS because of our government gives (but only to HIV/AIDS). Antiretroviral drugs are completely free but no one can get antimalaria medication for free (which is much more pervasive). Or simple antibiotics for that matter. It's strange and sad.