Where to Start?

One of the things I have been most excited about for this fellowship year was the chance to come to Africa for the first time and really know the problems that exist here. I’ve been to a number of third world countries before but I’m not naive to the fact that each country, each community has a personal spin on the issues they face. Unless you are there to observe it first hand, I’d contend it’s nearly impossible to form meaningful solutions. That hasn’t stopped me from trying though : )

Before arriving to work on the Tanzanian health information system I had been researching computer based EMRs in both the first and third world. The poor, rural areas I visited in Peru and Bolivia didn’t have computers at home but at least they had internet cafes and a large part of the population I found to be computer literate. So I put together a rough plan of how I thought our system should look like and, in so doing, committed a cardinal sin of design by coming up with a solution to a problem I didn’t understand.

The reality is that 10% of Tanzanians have electricity. 1-3 % use the internet. There are virtually no computers or electronic systems in place at all. The health “Information System” they have consists of stacks upon stacks of paper forms. The hospitals and medical centers are happy to have a box of rubber gloves to work with patients to provide the most basic level of sanitation.

I wasn’t so much shocked at this harsh reality as I was reminded of how to order problem solving; problem first, solution second. What has been different with my experience here thus far, however, has been my emotional reaction to living and experiencing the problems faced by everyday people.

When I’ve volunteered in other countries, I have stayed for a relatively short time usually in hotels with what Americans would consider the very basic necessities. We’d have electricity, running water, beds, showers, clean drinking water, food, security, telephones, etc. And though I have some of that in my home, power shuts off from 6pm to 11pm every third night and water is off every other day for the entire town. My house doesn’t have running water and was burglarized earlier this year. We live on a dirt road that can flood in the rainy season and lack most foodstuffs other than what is at the daily market.

We live in one of the nicest homes in town.

For each necessity that we Americans take for granted that is missing here, life gets a little more stressful, a little harder, and a little less productive. And actually living with this has not only helped me understand the problems Tanzania and Kilwa (the district I live in) are facing. It has made me feel and experience the problems. And, most of all, it makes me angry for the people here and passionate to help.

I could speculate who’s to blame but I won’t because that’s not really the point I want to convey. I’ve felt sympathy and empathy before when volunteering. But, knowing how temporary my experiences were and that a matter or days or weeks separated me from the comforts of America allowed me to disassociate the hardships as “their” hardships, not “my” hardships or “our” hardships. This is now my life for the foreseeable future and as I’ve been seeing things as “our” hardships, I’ve felt anger for the first time. Anger at the injustice that people die every day here because some very basic things don’t exist that should be provided for them by the modern world we live in.

Where to start? Roads? Management? Education? Economy? Governance? It’s overwhelming. But I’ve concluded thus far that GHC has made a great choice in choosing health as their mission. Helping people become and stay healthy can lead to them being able to help themselves in ways they couldn't in the past.

Rich countries have been trying to help countries in poverty all over the world but I believe the most lasting changes will happen from within the country. However, if you’re worried about surviving the day/week/year because of poor health conditions, it must be hard to think about striving to change a system that renders your country without electricity or water.

I have a much better, albeit far from encompassing, understanding of the problems facing the health systems in Tanzania now. Something I couldn’t prepare myself for before arriving here. And though Goodluck and I are working on a small project in an even smaller part of the country, there are sparks of hope with the people we’ve talked to thus far.

Change has to start somewhere and we’re ready to make it happen.