While the past two days have been very productive, something else has also started to really hit home. After learning more about the socioeconomics of people living comfortably in Tanzania such as the staff at the clinic, I have come to realize that the American lifestyle makes people inherently materialistic and lazy. Please let me explain.

            Dr. Frank, before he and his wife quit their jobs and sold all their possessions, lived wealthy lifestyles. As a doctor in private practice, his income was well into six figures, allowing him to indulge in collecting various toys and art. Here, they pledged to live off $1500 per month, which is enough to allow the two of them to live comfortably. Now, this is almost 50 times less than what they formerly spent per month, but they’re just as happy if not more so.

            Here’s the perspective part. Tanzanian doctors who have MDs and go through residency programs earn about $700-900 per month. Nurse practitioners earn about $500 per month, and nurses earn about $300 per month. These salaries are more than 100 times smaller than equivalent jobs in the US. Furthermore, these are the jobs that require quite a bit of education.

            Here in Tanzania, if you’re wealthy enough to own a house or a plot of land, you probably will hire an escari and housemaids. Escaris are usually tribal men who guard the house at night. They work from around 7pm to 7am, patrolling the premises with their spears and knives. Personally, the idea of staying awake and alert for 12 hours doing pretty much nothing seems absurdly mundane, which is why I have enormous respect for the escaris who do this for a living. Most of the escaris have no other skills, and any income they can generate for their nomadic tribes is significant. They work 12 hours shifts 7 days a week for 6 weeks at a time and then take a week off to go back to their families. Here’s the kicker: Currently, an escari’s salary is about $35 per month. Tanzania recently raised the minimum wage to $80 per month, but you can bet that only foreigners will actually pay that wage.

            Now, back when I took the D-Lab class at MIT, we spent a week living off $2 a day. That experience was difficult, but not altogether impossible with sufficient foresight and careful planning. One can only imagine how difficult it must be to not only live off $1 per day, but also kick back a portion of that salary back to one’s family.

            To put things into perspective, a doctor in American can make over $1000 a day, which is almost three years’ salary of an escari. Even an American who is working for minimum wage is making more in one hour than what an escari makes in a week. While the cost of living here is definitely less than what it costs in America, it’s still less than an order of magnitude less. In terms of the disparities in wages, we’re now talking about a couple of orders of magnitude. It’s just absolutely eye opening.

Yet what’s fascinating is that most Tanzanians think the American lifestyle of excess and consumerism is what happiness is all about.

 

The FAME medical dispensary

Waking up this morning, I was extremely excited to go to the now opened FAME dispensary. What Africans call a dispensary is equivalent to what Americans would call an outpatient clinic. The dispensary is not legally allowed to The last time I was here in January, they were still wrapping up construction, nothing was painted yet, and none of the rooms were furnished. Now that the dispensary has been opened for three months, I wasn’t sure what to expect. Normally the 2km distance to the clinic is a great walk in the morning, but because we had a bunch of gear to carry over, we took a 40+ year-old Landrover. For those of you who understand Landrovers, you can imagine how excited I was to be bustling up and down a dirt road in Africa. It really was the quintessential Landrover experience.

Closeup of the dispensary

When we made the final turn and saw the dispensary for the first time, I was suddenly reminded of just how beautiful the surroundings are. The clinic is built on a hill much like “the Sound of Music.” You can see for miles in each direction and when the light is good, the view is just magnificent. It really is one of those places in the world where you feel good just being there.

Once I got inside, I was amazed by how much as changed since my first visit in January. All the walls were finished and painted, the wiring was complete (more or less… but a story on that later), there were doors in all the doorways (I met the woodworker on my first day. Apparently it is extremely difficult to get a woodworker to use dried wood that won’t warp), and there was a good collection of drugs in the storeroom. However, the clinic was still missing a decorator’s touch. All the walls were more or less empty and there was very minimal advertising of the name and services provided. I later learned that this has to do with strict government regulations over where signs can be placed and what information can be posted. After a brief tour, we were whisked away to tend to our patients for the day.

Kids from the Shalom orphanage ready for a checkup.

This wasn’t a normal day in the clinic as the dispensary is normally closed on Sundays. The operating hours are 8:30 a.m. to 4:30 p.m. Monday to Friday and 8:30 a.m. to 12:30 p.m. on Saturdays. However, this Sunday was special because the dispensary scheduled a health screening for 40 orphans from the Shalom orphanage (no Jewish influence whatsoever), which is about 1km away. A group of Americans on Safari decided to include an altruistic project with their vacation and raised $6,000 for the clinic to provide health care to the local orphanage. In return, they asked to take part in a day’s work to get their hands dirty with the kids. We met our guests outside the orphanage and were immediately mobbed by a whole school of kids. They were absolutely hyper and insanely off-the-wall; it was great! We got a brief tour of the orphanage and they sang the group a few songs in English. I’ll post a video when I get a chance.

"Whoa now, you didn't say anything about a picture!"

Then, we took a kid in each arm and walked them up to the dispensary. There, we measured each kid’s weight, his or her height, and did a quick vision test. Then, each child was brought into one of two consultation rooms to be inspected by Dr. Ivan or Dr. Frank. I sat in on one or two of these and learned very quickly that the most common ailments affecting kids in Karatu are worms and infections. We saw a few kids with infections, but overall the group was very healthy. However, this was not the case two months ago when the children came in for their first screening. Half of them were suffering from worms or malaria. Everyone got treated for worms and was given anti-malarial medication along with multivitamins. The effects of the preliminary treatments were evident in this second screening. It’s amazing what a dollar or two of medication can do here.

While the kids were getting treated, I was doing a study of the electrical system, paying attention to how everything is wired and installed. Going through this process, I learned a lot about how different architecture and construction is in Tanzania. Almost everything is done by hand and little attention is paid to international building standards. In the brief duration when the kids didn’t swarm all over me, I learned that the building needs a dual voltage system of 230V for Tanzanian equipment and 110V for donated American instruments, but the contractors completely ignored the latter system. They wired it into an electrical box, but that box was left empty! Furthermore, the initial plans of the building included Ethernet drops in every room so that the clinic can be networked in the future. However, to the best of our knowledge, there is only one Ethernet drop in the clinic, and that drop may not even be connected to any wires! I smelled a project already.

Dr. Frank tends to a young patient

After every child was screened and treated as necessary, everyone in the clinic was thoroughly exhausted. All in all, it was a very productive day. I got to see the finished clinic for the first time and found a few things that I can enhance in my time here. We helped out the local orphanage with a health screening, which was both fun because it involved forty of the most energetic toddlers you have ever seen, but it was also exhausting for the same reason.

 

 

 

 

Twenty hours and seven time zones after entering terminal E at Logan airport, I walked out of the only terminal at Kilimanjaro International Airport, sluggish and tired since I tried to sleep as little as possible during the flights. Had my plane arrived with the sun still up, I would have been welcomed into Tanzania by a stunning view of Mt. Kilimanjaro, but as my flight landed (exactly on time, I might add) at 10:30pm, the only thing I could see was a bright full moon breaking out of evening clouds over what can only be described as an airport in the middle of an Arizona desert. All in all, I didn’t lose any baggage, all my flights arrived early or on time, and I managed to stay awake for most of the trip; No complaints here.

MIT's iLab waits in Amsterdam

Randomly, during my three hour layover in Amsterdam, I decided to walk around the airport for a bit and suddenly heard my name being called out. Now, my name, for those of you who don’t know, is pronounced like the letter “K.” To the untrained ear, people who shout “OK” without emphasizing the “O” sounds just like as if they are shouting my name. I have gotten good at making the distinction over the years, but occasionally I still get turned around because I thought I heard my name. So as I was walking in Amsterdam International and heard a vague “K,” I was sure that it was nothing. Well, it turned out that I was being summoned, by three other MIT students. I turned around to see Bryant, Adnaan, and a third member of MIT’s ILab project. They had just returned from a three week expedition to Tanzania and Uganda and was stuck in Amsterdam with a long layover. Bryant and Adnaan traveled with my D-Lab team this past January and got to know each other pretty well. It was extremely serendipitous for us to run into each other again, and during a layover in Amsterdam of all places.

Pit Stop: Beautiful Lake Manyara

Since the Kilimanjaro Airport is still a good three hour drive away from Dr. Frank’s dispensary and my plane arrived late at night, we decided to crash at a place between the airport and Arusha for the evening and make the drive next day. Today, we made a few errands in Arusha and then drove South to Dr. Frank’s house, which is a mile down the road from the FAME dispensary. I’ll spare you the boring details of errands and travel, but the whole time Dr. Frank and I talked about life in Africa and he told me quite a few stories that were fascinating.

 

The “Heartbreak of Africa.” 

In the midst of driving down to Karatu, on a road that makes driving in Boston or the Jamaica Way seem ridiculously easy (cars go over 70 MPH on an one-lane street riddled with potholes), Dr. Frank was sporadically on his cell phone talking to Dr. Ivan, a Tanzanian colleague who also works at the dispensary. In the course of the three hour drive, two phone calls changed the way I see healthcare in Africa forever. The first was about a neo-natal infant brought to Dr. Frank by a local “Mama” who runs an orphanage down the street from the clinic. A two month old baby was abandoned at the doorsteps of the orphanage and was immediately brought to Dr. Frank’s attention. The baby was severely malnourished and weighed less than five pounds. In two months of life, the baby actually LOST weight. What she desperately needed was an intensive neonatal clinic and a feeding tube pumping vital nutrients. Dr. Frank and Dr. Ivan took in the orphan and did everything they could to try and stabilize the child and help her gain some weight. However, early on in our car ride, a text message informed Dr. Frank and their efforts had failed. The baby was just too frail. 

As we drove further, Dr. Ivan again gave Dr. Frank a call, this time seeking consultation on a 16-year-old girl who presented with a severe murmur. A murmur is a failure of a heart valve that is characterized by the long drawn-out sound produced by the heart at each beat. Properly identifying a murmur without an EKG (Electrocardiogram) is difficult, even for a skilled cardiologist. However, it just so happens that an American doctor who specializes in cardiology and has extensive EKG experience will be in a nearby town starting this Friday. However, Dr. Ivan called to inform us that the girl is now so sick that she was unable to walk. Dr. Frank explained that the chances of the girl making it to the EKG is very low, and she is most likely going to die. However, African customs stipulate that a physician cannot tell a patient that she is going to die, because doing so would put blame on the doctor for cursing the patient. What the girl desperately needs, is a valve replacement surgery for her heart, but that cannot be done without an EKG. It’s a frustrating double-dagger of not being able to give a patient the immediate treatment that she needs and then not being able to tell her that she’s most likely not going to survive to the end of the week. For doctors in this country, determining the correct diagnosis for a patients is not the tiring part. The hard part is when the diagnosis is extremely simple, but requires a medication or procedure that may be readily available in the US, but is just not obtainable in Africa. The emotionally draining part is sending the patient home knowing full well that she is most likely going to die by the end of the week.

In my first day here, I am beginning to understand the heartbreak of Africa.

It’s official, my flight leaves in less than 40 hours. That’s 1.7 days to packing everything I need for a month and a half abroad, 2400 minutes to make final preparations, and a paltry 144,932 seconds to get ready for the adventure of a lifetime.

With that scary (well, for me at least) introduction, I would like to welcome you to my blog. This website is where I will attempt to keep friends, family, and all those who are interested up-to-date on my activities in Tanzania.

I titled this blog “Empowering FAME: Helping FAME, The Foundation for African Medicine and Education, provide medical care in rural Tanzania,” because it appropriately summarized the purpose of my travels. FAME is a small nonprofit organization founded by Dr. Frank Artress and Susan Gustafson, a dynamic husband-and-wife duo who left their comfortable Californian lifestyles eight years ago to address the pressing need for medical care in rural Tanzania. By conducting remote clinics in the back of a retrofitted minibus, Dr. Frank already provides a much needed medical service to impoverished Tanzanians living in rural villages. This past April, FAME expanded their services with the grand opening of a medical dispensary on a luscious plot of land near the Ngorongoro crater. This dispensary is where I will be spending the majority of my time in Africa and where you will most likely hear from me next. 

Of course, the only thing that prevents that from happening, aside from an ocean and two continents, is my luggage.

It’s time to pack.