Speaking of …

Goodluck and I arrived back in Kilwa recently after a planning period in Dar with our management team to map out our work plan for the following year. Having a detailed Excel sheet with our strategy relaxed my type-A tendencies a bit as I started being able to visualize the road we have ahead of us.

Hitting the water for an otherwise boring morning swim, I started processing our main next steps. “We have to speak with doctors in each health field to prioritize the data we are collecting. We have to speak with the dentist at the district hospital to see if we can get a complete map of the health facilities in Kilwa. We have to speak to contacts at the health facilities we’re working with this month to plan when to consolidate their data from the previous month. We have to speak…” Get the pattern yet?

I keep assuming there has to be other less formal, less time-consuming ways to get information here, especially for professional organizations and critical health/hospital information. But then I think again and realize that’s exactly why I’m here in the first place (to work on health information systems). I need to remember to shake the Internet age off me every morning before tackling our work, but it’s hard to do.

Information in Tanzania exists in people and is disseminated orally. It is 500 years after the advent of the printing press yet, particularly for rural Tanzania, it’s like that never reached its way down here. Information is locally based and it is shaped by each human who passes it on. The details and accuracy are then the product of the person who owns the information and are virtually impossible to objectively validate or verify outside the community of people one knows.

I’ve been reading Stephanie Nolen’s 28: Stories of AIDS in Africa. In story number one, Siphiwe Hlophe remembers when doctors informed her that her sister was infected with AIDS. Stephanie writes, “Siphiwe kept the information from her sister. She was afraid to touch her, wondering if the rumors were true if she could catch the disease by bathing or feeding her. Three days after the test her sister died. ‘If only I’d had information about HIV, maybe she’d be alive.’ Siphiwe said. But it would be years before she learned any more. ‘The page of HIV was closed to me until I discovered my own status.’ But even then, five years later, people didn’t know any better.”

And how could they know any better? Who were they going to ask? Who even wanted to ask?

At least for our project, Goodluck and I know who we need to talk to and trust that they’ll have the information we’re looking for. Even if we don’t completely trust them, for really important data we know we can verify it with specialists or even via the Internet. Our biggest challenge is time, not quality information or the means to get it.

During one of our visits to a rural health center, Goodluck was approached by a man desperately seeking information and advice on an apparent STI (sexually transmitted infection). He couldn’t physically walk to the hospital that was 20 miles away and couldn’t afford treatment even if he made it. That, and the treatment he would get would likely be from, at best, a nurse with limited training (especially for non critical illnesses). I couldn’t understand what the man was talking to Goodluck about but I could tell it was more than just asking for money. He was terrified.

I came to Global Health Corps and the Clinton Foundation from Google; the virtual epicenter for all information. Many (including myself) have seen the internet as the ultimate liberator of information to the world. However, considering again that western society has had many important technological advances and the oral tradition continues to remain so strong here, it’s unlikely that technology alone (Google or otherwise) will ever solve the information problems facing the East Africa.

Solutions aside, when I think about what it would be like to need information and not know how to get it, I feel terrified too. And though it’s hard to foresee being in a real situation where I don’t know how to get accurate data, I more clearly see the value of working on health information systems in a place where non-existent, poor quality, or false data seem common.