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International Child Health Section: Articles
Mbeya, Tanzania
Submitted by Julie Johnstone
That day we had worked hard. We worked along side Tanzanian physicians and we saw real pathology. Not like the type of pathology we see in Canada, where the vast majority of children are diagnosed so quickly and treated so efficiently that we only see the tip of the iceberg. By real pathology I mean abdominal tumours protruding like pot-bellies on kids who don’t consume enough calories or fungal infections that wrap the skin like fabric on a the backs of children and youth who have scarcely enough clothing. We saw the history of Canadian medicine in real time: rheumatic heart failure, spotted rash of measles, and frozen limbs from past polio. It was real pathology, and there was only so much we could do. We were there though, and that was something.
That day we had worked hard, and as the sun got ready to set behind the majestic Tanzanian mountains, we walked. To our Tanzanian friends our love of walking was astonishing. Why walk for pleasure? Why walk for pleasure when your sister walks fourteen kilometers a day to collect water; when the only way to travel to the market in the next village is with two feet and a heart beat; or when walking could mean being exposured to snakes or schistosomiasis? But Naima*, the single and pregnant Tanzanian physician working with us, came along. As we walked the sky changed colour to showcase an almost supernatural mishmash of orange, pink, purple and red. Naima divulged that the estimated rate of HIV in the area where we strolled was about 17%. Many regional health care providers thought it was probably considerably more, but no one knew for sure. No one was testing there. No one is treating there.
HIV is orphaning children, widowing lovers and shrinking the workforce. And, in rural southern Tanzania, most locals have had no opportunity to learn about the disease. The majority of people have never heard of Ukimwi, the Swahili word for AIDS.
Ukimwi is an unvoiced word, a silent assassin.
As we walked, we fell silent, each of us remembering our patients of the day. Recalling the big distended bellies of the kids who eagerly took our mabendazole, the bloody urine of the teenagers who swallowed our prazequantel, and the ulcerated bodies of children with staphylococcus-scalded skin who took away with them one of the few antibiotics we had, cloxacillin. These tiny, yet commanding, faces walked with us that night. Their images shaped the tableau that filled our minds as the sun made its daily departure and, as we arrived back in our village, our moist eyes were masked by the shadows.
I was in Tanzania for two months. During my time I worked with an organization called “The Olive Branch for Children.” We worked along side local physicians and traveled to rural villages to bring health care. Mostly we treated acute illness and infectious disease. We educated where we could. We built friendships and a community. In pastoral villages, we continued our work during evenings to bring health care to those who herded or farmed during the day. For those who were too sick for us to treat, we facilitated travel to and payment at hospitals. We will never know which of them made it.
In Canada, we have a health care system that helps so many people. We have become victims of our own success. It has been so long since we have seen such overwhelming and devastating disease, that we find fault in the imperfections of our system. We drive a BMW and are obsessed with its broken sun-roof. It certainly is important that we fix the sunroof in order to keep out the rain, but it is a gift to remember that regardless, we are sheltered from the storm.
Upendo na Amani
Julie Johnstone, BHSc, M.D.
Resident
The Hospital for Sick Children
* Name has been changed
Posted: May 2009
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