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This past summer, I spent six weeks volunteering at the Bagamoyo District Hospital in rural Tanzania through an organization called Cross-Cultural Solutions. With a population of only 30,000 people, Bagamoyo is a relatively small village. It is a village where the unemployment rate is 98 percent and where the HIV infection rate tops 10 percent. It is a place where most families survive on less than $1 a day and lack access to the most basic amenities, such as electricity and clean drinking water.
The Bagamoyo District Hospital is located on the outskirts of Bagamoyo. The hospital was built to serve 100,000 people, but currently serves over 270,000 people from Bagamoyo and 83 surrounding villages. The district hospital has 150 beds and operates on an annual budget of $70,000, which is sufficient to sustain an American hospital for about two hours. The hospital is not equipped with computers, so all patient records are kept by hand. The hospital’s most technologically advanced piece of medical equipment is a CD-4 cell count machine, which is essential for monitoring the vitality of an HIV/AIDs sufferer’s immune system.
I spent three-weeks volunteering in the family planning unit and three-weeks working in the pediatric ward. In the unit, I worked under the guidance of head nurse MaChana. The unit consists of a single room, which doubles as a consultation office and a physical examination room. The walls of the unit are plastered with handwritten signs that state patient rights, such as their right to dignity, confidentiality, and safety.
Nurse MaChana counseled women on their birth-control options, which included: an injectable contraceptive called Depo-Provera, Norplant Implant, Implanon Implant, and condoms. Nearly all of the women chose Depo-Provera and refused the free condoms because their husbands would not wear them. Many of the women I saw in the unit came without their husbands’ permission and were fearful that they would discover their whereabouts. In the male-dominated society of Bagamoyo, women are viewed as their husband’s property, and many men are opposed to their wives receiving contraceptives.
In the pediatric ward, my primary responsibilities included weighing the children, measuring their heights, and taking their temperatures. Many of the children were abnormally small, likely the result of chronic malnourishment. A majority of the sick children who came to the ward were diagnosed with Malaria. Malaria is the most common disease in Bagamoyo, as well as the leading cause of death.
I spent a few days volunteering at the hospital’s HIV/AIDS clinic, where I weighed patients and graphed their weights on their growth charts. HIV/AIDS sufferers come to the clinic to receive antiretrovirals. A few days a week, the nurses at the clinic delivered antiretrovirals to the homes of those patients who were too weak to make the journey to the hospital. I accompanied the nurses on two of their home visits, which gave me the opportunity to see the conditions in which the patients live. The homes I visited were constructed from mud, sticks, and rocks and were comprised of two unfurnished rooms.
Volunteering at the Bagamoyo District Hospital highlighted the many dichotomies between health care delivery in the industrialized world, where annual per capita health care spending exceeds $7,000, and in the developing world, where annual per capita health care spending amounts to as little as $4 in Tanzania. While volunteering at the HIV/AIDs clinic, I witnessed painfully thin patients denied antiretrovirals because they were not “sick enough.” Meanwhile in America, articles abound about how doctors are overprescribing antibiotics to their patients.
Despite the dismal statistics and the seemingly insurmountable challenges facing the people of Bagamoyo, all of the people I met during my trip seemed genuinely happy, which may seem like an impossibility, considering the preceding descriptions. The children especially enjoyed getting their picture taken and subsequently viewing themselves on the digital camera’s viewfinder. The other volunteers and I taught the children and some of the nurses at the hospital how to play UNO and Frisbee. The nurses especially enjoyed listening to our I-PODs. Although it was difficult to communicate with the natives of Bagamoyo because of the language barrier, they always smiled at me and greeted me in the streets with “jambo,” which means “hello” in Swahili. The people of Bagamoyo seemed grateful for the little that they did have, which in most cases were not things, but rather people, such as family and friends.
While my mornings were spent volunteering at the hospital, I spent many afternoons helping out at an after-school program for orphaned and vulnerable children. I spent one weekend volunteering with an NGO that constructs homes for families whose members are suffering from HIV/AIDS. I also visited women’s empowerment organizations in Bagamoyo, as well as a microfinance firm and the Bagamoyo Job Training Center.
Visiting and volunteering at all of these organizations made me realize that people from a variety of backgrounds and disciplines, not just health care professionals, are essential to sustaining and improving the health of a community. For example, the business professionals operating the microfinance firm and job training program help people acquire the skills and financial means to provide their families with an environment that is conducive to health. I now realize that it will take the concerted effort of people from all educational backgrounds, interests, and skill sets to help improve the living conditions and remedy the social injustices that are occurring in the most neglected corners of the world.