Posted on behalf of Ryan Fabrizius, Medicine Pediatrics Resident in Tanzania
Jambo from Arusha.
Since last writing, I have been rounding
on the medicine ward, which has been quite a different experience compared with
pediatrics. While malnutrition and respiratory infections malign the infants
and children, HIV devastates the adult population. Surprisingly,
non-communicable diseases are just as common, if not more so, than HIV and its
complications. Diabetes, hypertension, and chronic obstructive lung disease
(emphysema) are much more common than I expected, and unfortunately, with the
transition of local populations to urban lifestyles, will likely become the
major burden of disease in developing countries like Tanzania. Just as it is in
the US, chronic disease is difficult for patients to understand and providers
to feel like they can make a difference, but I have been impressed by the
knowledge and compassion of the local doctors to not just treat but to educate
their patients on how to manage chronic diseases. For example, in outpatient
clinic this week, I sat with Christopher, the internal medicine registrar, as
he took about 30 minutes of a busy clinic day to explain diabetes type 2 to a
patient. The concept of disease occurring without symptoms and not having a onetime
solution is a difficult one to grasp, but Christopher patiently reached for
common ground in understanding. Despite the myth that doctors in developing
countries are "paternalistic", I have found that in this case and
many others, doctors like Christopher strive to educate and empower patients
and families to understand their condition and proactively participate in their
own care.
For today's Swahili lesson, I wanted to introduce the word
"pole". Just like "karibu", pole is a common and versatile
word that enters into interaction several times per day. It is usually used
here for "sorry", like when you bump into someone or walk on a clean
floor with dirty shoes (I seem to leave a trail wherever I go).
"Pole" also has some unique uses that we have observed. It is
considerate to express "pole" when you see someone carrying a heavy
load (we get a a lot of "pole"s when we carry groceries home up the
hill). Many people will say "pole la kazi" when they see people at
work, whether working at the hospital, harvesting roadside crops, constructing/digging,
etc... It means, literally, sorry about the work. It feels similar to the
feeling of sympathy medical residents give each other during a busy night shift
or after a difficult series of events. To me, it seems to be expressing,
"I have been there and I feel your struggle, hope you get to finish work
and rest soon".
The most interesting use of "pole" for me has been
with patients. When most local medical staff approach a patient on rounds or
clinic, they usually begin with "pole bibi/babu/mama" (sorry
grandma/grandpa/mother), which acknowledges the fact the patient is having a
struggle. The usual response is "asante" (thank you), which feels
like an expression of gratitude for recognizing the burden on the patient and
family. As medical workers in the US, I think we do recognize the value of this
sort of sympathy. Some useful expressions that I have learned from my teachers
are "this seems like a difficult time for you" or "i'm sorry you
have to go through this", but usually this comes up after a display of
emotion from the patient or family that beckons validation. In clinical
practice here, I find it most interesting that this validation and sympathy is
the greeting, rather a phrase reserved for certain situations. It seems rooted
in the community values here, that one person's burden is shared amongst
others, not just friends and family, but all people that interact with them.
Here in Tanzania, there are so many burdens that people carry, even in daily
struggles for basic needs. It is frustrating for me, as someone that takes for
granted that my daily needs are easily met, to see the barriers that people
have to providing for themselves and their children. On top of that, the burden
that HIV, chronic disease, and other medical conditions place on an already
struggling people seem absolutely insurmountable. This, for me, stirs up
feelings of injustice and unfairness, questions of why? and how?, and often
results in frustration and fatalism. But for the people here, they bear with
each other in these circumstances, supporting one another and carrying one
another's burdens. Linguistically, I do not know if these words have a common
root, but "pole pole" is another common expression that means
"slowly" or "gradually". It is the unofficial mantra of
climbing Mt. Kilimanjaro: gradually, one foot in front of the other. And such
is seems with bearing one another's burdens. Sorry for your troubles, but
slowly, together, we will carry it together.