Danielle Brueck (PL3) tells us about the people she met in Tanzania

I suppose it is a common experience to struggle a bit with
how to explain and portray an experience such as this. Ok, ok, maybe I struggle
with the right words frequently in life.  For my last post, I described a
typical day here in Tanzania.  As I near the end of my time here, I have
been reflecting on what I will remember the most, and much of it comes down to
this -- the people.  That has been a recurring theme in life and most
frequently what I walk away remembering. I have been humbled and learned much
from the people I have encountered here.  In describing them, I hope you
will see the Tanzania I have grown to love.



From left to right Joseph, Emily Hall (PL3), Dr. Mantz, Danielle Brueck (PL3) and Maneno


Joseph:  Serving as the pediatric registrar, Joseph is at Selian Hospital
6 days per week with rare exception. He trained in China and is fluent in 4
languages (wow, I'm behind in life). When on call, he also covers medicine,
surgery, and OB/GYN.  He is smart and dedicated, challenging the interns
to think through a differential diagnosis themselves and not simply repeat what
others have said.  He enjoys teaching and has been ever so gracious to
accommodate and answer my frequent questions (which, no doubt, make rounds last
much longer).  If he is told the hospital does not have a medication, he
walks over to the pharmacy himself to check on the availability.  When he
finishes his own work, he can often be found in the outpatient department
helping others with the clinic patients that need to be seen.  During our
rounds, he will pick up a child and set him or her on his lap. He truly enjoys
caring for kids and reminds me of the simple joys found in pediatrics.
 Joseph excels and pushes learning forward in a system where it would be
easier to settle quietly into the background.  I admire the responsibility
he has taken.

Joseph teaching some local students about malnutrition


Maneno:  The intern on the pediatrics team, much of the "scut"
work falls to this guy. You would never know it, however, as he is persistently
eager to learn.  He wants more patients to come, saying that is how he
will learn about what to do.  Being from further away in Tanzania, he
stays in a room on the hospital grounds. But this doesn't bother Maneno; it
means he is available to see more patients. He asks the other interns to call
him if an interesting case arises. He is selfless, willing to pick up an extra
shift if others must go out of town or have another obligation.  Maneno
has reminded me how fun learning can be.



Cifa:  I met Cifa at church.  He is a generous Tanzanian who is full
of life.  He has fostered/adopted many Tanzanian children over the years
and truly has a desire to watch them succeed.  He cares for them and
teaches them to care for one another, the older ones assisting the smaller
children.  What struck me about Cifa is how passionate he is about caring
for the less fortunate of Tanzania and what little regard he seemed to have for
his own interests in this.  During my time in Tanzania, I read a book
called Toxic Charity (thank you, Dr. Kate Venable, for this excellent
suggestion).  It addresses the sustainability of charitable efforts and
discusses how to avoid creating dependency.  The book challenged my own
motives and forced me to ask myself some hard questions.  In the context
of reading this, I had such a moment of clarity when meeting Cifa.  He
genuinely embodied a sustained, grass-roots effort to impact those in need.



J:  J was just one of many patients I will remember from my time here.
 He taught me a lesson in communication.  J is 4 years old and has
been in and out of the hospital over the past several months and was admitted
for approximately 3 weeks during my time at Selian.  He has developmental
delays and is non-verbal.  Not knowing much Swahili, I have felt the
language barrier more than I would have anticipated.  For me, so much of
the joy of medicine lies in talking with people.  I have been able to have
fantastic and academically stimulating conversations with my colleagues here
but have truly missed just sitting to talk with patients.  With J, the
non-verbal parts of communication became even more evident to me.  I loved
walking in each morning to see his smile.  He would peer up from the bed
through the window at me as we gathered our things for morning rounds.  I
would duck down, then pop my head back up to find him laughing.  This game
never got old.  J was scared of us at first, but it turns out that coin
magic tricks and juggling are universally loved despite the language.



E:  We saw E in clinic one Tuesday afternoon, and he quickly captured our
attention.  At 4 years of age, he is extremely small (7 kg or about 15
lbs) with a disproportionately large head.  His mother brought him to
clinic for a completely unrelated complaint, and we wrestled a bit with how to
broach the subject of his odd appearance.  E taught me about the ethics of
practicing medicine.  I found his case particularly interesting from an
academic standpoint and had to ask myself if meddling in his previously happy
and fairly uncomplicated life was for his best interest or merely an indulgence
on my part.  He came back to our clinic 3 other times during my 2 months
here as we arranged to have some testing completed.  He was always a
joyful and cooperative child, bright and slowly taking in the unfamiliar world
of the hospital.  His family seemed genuinely appreciative though I
continued to wonder if any actual good or benefit would come from having a
diagnosis.  Sometimes, both abroad and at home, I feel better having an
answer for myself.  E makes me more aware of how my actions can affect
others.

Team rounds in the ICU discussing causes of heart failure



David:  David is a taxi driver and was the first person Emily and I met in
Tanzania and will be the last we say goodbye to as he drops us off at the
airport this evening.  He was immediately friendly and welcoming.  He
gave us just 2 pieces of advice to consider during our time in Tanzania -- pika
pikas (motorcycle taxis) are dangerous, particularly at night.  And be
careful of the local alcohol; it is strong and causes many a problem.  We
decided to heed his advice on both these matters.  David is an extremely
hard worker with a day job in an office and then driving as a taxi many
evenings.  He never complains but is eager to meet opportunities.  He
chooses good company and sets high goals.  His father once told him
"If you do not clean the dirty dishes at night, you will have no plates
for food in the morning."  His parents provided a constructive
environment where he learned responsibility and discipline, and he looks
forward to doing the same for his children someday.



The stories of others have long intrigued me, and these are just a few that I
will carry forward.  These stories inform and shape my own.  There
are many others (Tanzanians and ex-pats alike) who have made my time here a
wonderful experience.  I am grateful to have been so included and welcomed
here and will certainly miss the beauty of this place.