8 June 2018 – I have hesitated a lot in writing this blog. Much of the other recent posts were ones I had worked on over a period of time and just recently finalized to publish. This one, however, I never started – for many reasons. I’ve debated about opening up here; being honest about my experience – holding nothing back – and I am finding that it is good to do so. As public as a blog may be, I have been trying to use it not only as a place to share my experience, but also to create a space in which I can process all that has been going on this year for me.
So, content warning before I begin – just to go ahead and put it out there. During my first week in Tanzania, I found myself in an unfortunate place. What unfolded on May 10th involved me being taken by four men in their car, held against my will, and robbed of the possessions I had on me. The bottom line is this: I am okay. I walked away safe. And thats really all that matters.
I feel as if I can’t write this post and update you all on the past five weeks without first having had to be open about that. If you are up for it, then read on with me and see what I’ve been up to. What I have learned – about my project, about this place, but likely of most importance, what I have learned about myself.
Tanzania Week 1: 5 May – 11 May
I arrived on May 5th in the Dar Es Salaam International Airport. It felt like one of the first times in recent flights that I had finally arrived at a normal hour. Applying for a Visa on arrival and receiving my luggage, arrival came and went without a hitch. Meeting a driver I had previously scheduled, Mzezele helped me with my things and drove me across the city to where I would be staying. During my sophomore year at Sewanee, I roomed with a fellow EMT, Dylan. It turns out that Dylan’s dad lives here in Tanzania working with USAID. I guess you could say I now have lived with two generations of Greers (and they’re both great!). Arriving and settling in, the week began well. I got to see George’s Yacht Club where he sails on the weekend and begin to get myself acquainted with the town. Living not to far from the center part of Dar, I spent a day exploring the downtown streets and felt like I was once again starting over – but at the same time feeling confident and excited about the opportunity to do so. I had set up a meeting at the main National Hospital and was just filling some time in the early days until that meeting came. On the 10th of May, I was out on a walk after lunch and ended up communicating with a few guys also walking nearby me. Through a process of deception, building trust, and a bit of my own drive to embrace newness I found myself in the back seat of a car I should not have been in. The following hours are not worth writing out in detail except that I once again walked out of that car, away, and safe. I had to make the hard phone call a parent never wants to receive – and was met with grace on the other side of that line. I don’t know what you did after you hung up that phone, but you did exactly what I needed when I needed it. I am still thankful for that. George too was a saving grace. His experience, accessibility, contacts, etc. are really what have allowed me to feel confident enough to remain here. A trip with him to the police, a report filed, and a slow following day – my first week in Tanzania came to an end not quite in the way I was expecting.
Tanzania Week 2: 12 May – 18 May
Welcoming in the weekend, I joined George at the Yacht Club and joined him on Jammy Dodger, his small Sail Boat that fits about four people. Though a bit rainy, there were others up for a race, and so we went out to the boats for a day on the water. Having just mentioned in the last post that I drove a boat for the first time, this Saturday brought a whole new level of newness as I helped crew a sailboat for the first time. There were definitely moments I thought we were going under…but I had a blast and it served as a good place for me to put my energy. We spent Sunday again at the club, this time on the beach, I would soon find that this is how my Friday – Sunday’s would work, and I looked forward to them. Having postponed my meeting from the first week – I met with the two directors of the Emergency Department at Muhimbili National Hospital. JP, who I had previously been with in the UAE had worked with these two men and I was excited to meet them. We discussed some of the different levels of emergency care within Dar es Salaam and greater Tanzania and further about opportunities I may have to engage with the system. Much of my other time I spent back where I was living. I began a bit of re-orientation for myself, covering my bases, and preparing to begin again. I used the time to do what I like the most – to run. It’s hot here, and the rainy season was in its final week, so the humidity was quite high, but I was glad to be getting back into the routine of it. Through a contact at the U.S Embassy, I learned about a first responder training scenario the embassy was sponsoring for local police and first responders. I got to serve as an actor in the scenario, and got to see some training in action, which was a great and unexpected addition to the week.
Tanzania Week 3: 19 May – 25 May
With a sunnier day – George and I went back out for another race on Jammy Dodger. The opening weekend of Race Season was fast approaching and everyone wanted to get in some practice. Although there were still moments I felt I was about to fall in, it was cool to see how much I picked up the second time around. We went that night to a dinner party in where we acted out a Murder Mystery. With about 30 guests, everyone played their parts (in full costume), but none of us found the killer. I had never done an event like this before. It was quite elaborate, well planned out, and fun! I was a great variable because most people at the party knew others, but as I was new here, most did not recognize me. On Sunday, I wandered the low tides looking at all the sea urchins tucked against bedrock and was glad I didn’t step on one! During the week, the hopes I had had for work or observation at the hospital seemed to be falling short and so I was forced to begin a bit of a re-approach to my project here. I tried to fill my time meaningfully, focused on my training, and began reading much more. What I began to find (and still as I write now), is that leaving the confines of my living space, especially without having much direction or plan for where I need to be or why, has grown to be pretty hard for me to do. Trust can be a hard thing to build.
Tanzania Week 4: 26 May – 1 June
This weekend marked the opening weekend for racing, which meant that the Yacht Club was full of people, and full of boats out on the water. It also happened to be George’s birthday! Having a good race in some big waves, we popped some champagne as a toast and enjoyed the sun out on the water. We ended up in 2nd place! That evening, George and I went to watch the the Liverpool vs. Real Madrid Championship final. During the week I was able to met with a private security group who also employs ambulances in the area. Hoping to gain a little more access than I did, I was still able to have a good conversation with those in charge and be able to speak to a few medics who work there. Later in the week I met a former Peace Corps Volunteer who now works as a trauma nurse at one of the local private hospitals. I joined him at the end of the week to join in a meeting with other doctors and nurses as they discussed prospective ideas for their hospital. Later, again with Luke, I met others involved in Basic and Advanced Life Support Training classes who aim to raise the level of medical education for those who live in Tanzania. They are called the Emergency Medical Services Academy.
Tanzania Week 5: 2 June – 8 June
In my fourth full weekend in Dar, George was out on a smaller sailing race, so I joined the rest of the Jammy Dodger crew for the larger Yacht Race. This time we came in 1st! All four times I went, I had moments I thought I was going in, but each time I walked away having gotten the hang of it a little bit more. In the following day, I became so wrapped up in the book I was reading, I practically didn’t move from that one spot on the beach all day long. Two days later I turned the last page and raved about it in text messages to family. So I will do it here too. If you haven’t read Beartown, by Fredrik Backman, you should. If you have, I’d love to hear your thoughts! I’ve spent much of the rest of this week doing a bit of online research, finishing up these blogs and preparing for a move on Saturday! I am headed to Arusha! (For Kilimanjaro, and I am so excited!)
This is my Sunday reading spot, and it makes me very content! Sea Urchins! Very cool, but not comfortable to step on… Low tide and sunset
Happy Birthday, George! A great day and a great race on Jammy Dodger My last race on Jammy Dodger. The red sail is called a spinnaker, used to keep the boat moving with a downward wind. Counting down to the finish line – so that we can stop our watches at the right time! (…for first place!) The Yacht Club is one of the few places on the Tanzania Coast that looks back out west, and the sunsets are quite rewarding.
Well, over the course of 5 weeks, I managed to secure a few meetings, but as I have faced elsewhere, access to the medical field as a foreigner has proven to be a challenge. Coupled with some increased latency on my part to fill my down time exploring, going out to meet new contacts, etc. I found myself often feeling as if I was waiting for the next thing – the next meeting – the next email response, etc. etc. During my time in Dar, I met with doctors at Muhimbili National Hospital, had good conversation with people working on establishing an “Uber for Ambulances” through the local telephone company, met with more doctors at an international private hospital who were discussing new ideas for creating a Trauma Registry here for the city of Dar, further engaged with a group called the Emergency Medical Service Academy, and lastly met with a private security company, who also offers ambulance response as a part of their subscription package. I valued every meeting and was glad to have had the time to speak and join in on the conversation here. Where I struggled was seeing these meetings through to the next step – which would have been a more direct line of access to observation as has been done elsewhere. Below you will find a mix of all the things I took away from these meetings and the ideas I connected along the way.
To start, there essentially is no organized Emergency Medical Services in greater Tanzania, at least not recognized by the government here, but that does not mean you wont find an ambulance on the street or at a bay in a local hospital. They exist, but are not organized or regulated by the government. Often you will find inter-facility transport vehicles within hospitals and privately employed ambulances on the street. Positions such as Paramedic are not a recognized field of practice. The existence of private ambulance services here is similar to other places I have been; however, what differs is that these private services are the only ones that exist. While we have 911 in the U.S, Denmark has 112, Chile 131, 132, and 133, and Thailand has 1669 for health emergencies. Tanzania only has two numbers – for police or for fire. It’s a hard realization to come to, but people essentially live here without rapid emergency response care. We discussed this first and foremost at Muhimbili. The two doctors I met with are hard at work training others while also working towards developing a sustainable and efficient system. The World Bank has recently donated money for infrastructure development. In agreement with local authorities, the money comes with a caveat: if road development improves, people will drive faster, and thus more accidents are likely to occur. With this funding, the World Bank also required the implementation of better system of emergency response. To start, this will only cover the main roads in development, and will thus only be a “highway unit,” but I think its important to start somewhere.
Later meeting with Knight Support, a private security company, I spoke with a lead coordinator and paramedic. Knight Support Ambulance technicians are trained under the British Model of EMS and receive training from international instructors every six months. This company works both here in Dar and in Arusha, a larger populated city in the north. Their services come at a price. Either by subscription or immediate call, it it will cost you. Pricing for transport and care are often hard to afford for much of the local population, and circumstances are made more difficult as the security company are unable to accept payment via the national health care system. Since the local government does not recognize these ambulances as a true profession, citizens are unable to use their national insurance. Knight Support is not the only service that looks like this. Other names I found, but was unable to successfully make contact were the Dar Flying Doctors, and the Tindwa Medical and Health Services. What this goes to show is that these services do exist, care is being reached to those who call upon it, but it isn’t accessible to everyone.
It was in my final meeting here at the International Hospital, Aga Khan, and the subsequent meeting with the Emergency Medical Services Academy (EMSA) that these thoughts began to really be pieced together. At Aga Khan I got to sit in on a conversation about different ways to develop a trauma registry for the hospital. I thought this was a cool idea – it was similar to the cardiac registry idea found on the Global Resuscitation Alliance’s 10-step plan and seemed like an excellent place to start. The idea was met with a good bit of pushback – which was, “Well, we don’t really see trauma here. People don’t come to this hospital for trauma, they cant afford it and unless the trauma happens around the corner, here isn’t the easiest place to access.” I found this to be a really interesting point. Doctors and nurses echoed the fact that national insurance wasn’t accepted at Aga Khan, meaning many people won’t bother to come because they cant pay. It is incredibly hard for me to see such a big facility, with good technology and highly trained personnel, and know that only a small fraction of the population here can access it. I also know how often this occurs back home in the U.S., and that too is just as hard of a realization.
Moving to my conversation with the EMSA later that day, I met trainers who were finishing up an “International Trauma Life Support (ITLS)” Class, which is a training class for doctors, nurses, EMTS, and even bystanders that is recognized by the American Heart Association. It was here in my conversation with Faya, a doctor in his later years, who has practiced medicine here in Tanzania and elsewhere in East Africa, that I was inspired about the future of EMS here. He and others behind the EMSA movement, have the intention of first bringing up the knowledge of the local population around the ideas of pre-hospital care. So many times this year, I found myself in conversation about the types of ambulances involved, the tiers of training, etc., but what Faya and others at EMSA were focused on was pure education. He said to me, “ If I could change one thing before I die here in Tanzania, it would be for that person on the street who sees a motorcycle crash to stop and call an ambulance instead of tossing them in the back of a random car with no help. People treat the dead with more respect than the severely injured sometimes!” Faya further went on to explain that much of this “treatment” isn’t out of disrespect, but rather, a lack of knowledge of what to do in such an intense moment. EMSA seeks to change that. The idea is that in time the technology will come: the equipment, the structure, the ambulances – all of them will come, but if they come without a population who is knowledgeable about their service, it just will not work. A second piece of information that stuck with me from Faya was when he said, “For most of the people I train here, I show them things, machinery, that they have never seen before and likely will never see in real practice here in Tanzania, BUT…if I can give them the knowledge that it exists, then I will have done something good. Because one day, they may see it, and when they do, they will know how to use it.” It was a strong message for me to hear and take away for my time in Dar. Knowledge is a powerful thing, and it goes with you a long way in life. My mind was often brought back to the conversation I had about the different myths surrounding EMS in the developing world. I was able to see some of the barriers mentioned more clearly after having learned them. The chain of survival looks quite similar from one place to the next; however, it is the “frame” that often differs and poses new and different challenges for places around the world. I am looking forward to some time in Arusha were I can explore these questions in a new light. Arusha is also another big city in Tanzania, but likely is supported by a much larger tourist industry given its proximity to Kilimanjaro and the Serengeti. It will be interesting to see what part, if any, that plays.
What else am I learning, you ask?
Well, a lot, and much in ways I didn’t expect to have to confront this year. I have thought a lot about what happened to me during my first week here. Often thinking about it much more than I wish to have done so, but some things are easier said than done. I tried to tell myself I was good, that it happened, that it was over, and that it was time to move on. In a lot of ways, I did that. I got back into a routine, I kept my mind busy and focused on running, reading, and researching online. What I didn’t do however, was get out much besides my runs or times out with George in the evening. To be quite honest, I hold a fair amount of shame regarding that – my lack of desire to engage, my readiness to be done, and my latency towards seeking out new discoveries. Much of what has fueled me this year has been exactly that – the possibility of something new, something unseen, and I sort of felt like I lost some of that fire while in Dar, at least temporarily, but I know it isn’t gone either. Sitting in the airport for Arusha today, taking off down the runway, I was reminded of that same exciting feeling I have had before and will feel again. Perhaps I should have moved earlier, realizing that my stagnancy was only further perpetuating a sense of solitude, however, my new Bank Cards only arrived this week (thank goodness they did at all!). As I continue to discover this year, the way it happens, is well, exactly as it should. Of course, I think all of us can agree we could have done without what had happened, but through it I have had to confront new questions about myself, about my future, and about how I see the world.
My aunt said it well to me in saying that, “it seems that [my] journey this year has shown [me] the best in people around the world in innumerable ways. And for that we are all so grateful. Unfortunately yesterday showed you some of the worst. Hopefully the memories of the day will fade and just be a blip on the radar.” Shout out to you, Aunt Kelli, and thank you for encouraging words. I am so grateful for all I have seen, it has truly been the best. I’ve seen new things here in Dar now too, and am reminded of the enormity of the world, and also my smallness within it. There are an incredibly large, diverse amount of stories that make up the lives of people here in Dar, in Tanzania, in Africa, back home in Charlotte, in North Carolina, in the U.S. And there are also an incredibly large amount of those stories that are shared across cultures, boundaries, and borders. In medicine, you confront many of those stories. I would like to say that a hospital doesn’t discriminate, but I know that wouldn’t be entirely accurate; however, we all face the world’s health issues, together and as individuals. As patients, parents, family, or friends, we experience it for better or for worse. Atul Gawande, who wrote Being Mortal, a book I loved so much, recently gave a commencement address to a new class of doctors. In it he discusses the difficulty one faces in treating patients of different stories – yet leaves clear emphasis that anyone who walks through those doors should be given the same right to treatment as the next. A patient should be a patient no matter the race, gender, creed, or origin. Read it here, if you would like. What I am taking from that is this: I met some people early on in Dar I wish I hadn’t, and I really don’t see at the moment quite where my story and theirs is shared, but it does not negate that their story does exist – just as much as mine. Some day they may get sick, go to the hospital, and be treated. Some day I may get sick, go to the hospital, and be treated. Half the world away, but health care all the same. All of this makes me excited for the day I will get to be on the side of giving treatment, working together with others, living shared stories with some and others not. It’s not to say there are not still times I am angry, scared, or wishing I had done one thing different that day, but I’m also trying to keep the right mindset about it moving forward.
Trust is a hard thing to build. It is a beautiful thing when it comes innately, as I often think it should. We all deserve the benefit of the doubt, but it is hard thing to re-build. That’s an internal strife I think we all face at times through our different relationships and experiences. This experience will likely for some time mark a significant moment of struggle for me. I will have to continue to re-open myself to new situations and new experiences that I may now be more hesitant towards, and through it, I suspect I will learn – just as I did before. The world is definitely a beautiful place in that way. It isn’t perfect, anywhere, and you will find that too as you see more and more of it, but we do get to share it. I’m grateful every day for having the chance to have seen so much of it.
Whats up ahead? Can you believe that there are just three (well now two as I proofread and post…) more weeks?!
Well I am off to Arusha today. I am meeting up with a guy named, Samson, who previously lead my sister up Mt. Kilimanjaro. He has been an incredible friend to me even before we have met. On Monday we set out together to tackle the mountain. He told me that he was going to make dreams come true, and get me on top of that mountain, together. Safe to say I am pretty excited about that. When I finish I will just be under two weeks remaining – Samson is going to help me with a short safari trip and I will be spending my final week in Tanzania wrapping it all up. In bonus news, there are four Sewanee faces I may get to see along the way. A few old friends are leading Moondance trips this summer in Tanzania. Our dates seem to align and I am excited to see some familiar faces once again in a place I would not have expected! Fingers crossed.
As always, thanks for sticking through to the end. Here’s to summer hitting full swing and good times ahead.
P.S. I made it to the summit! 19,341 ft above sea level – It was amazing. More to come about my trek, a future safari trip, and my upcoming final week in Tanzania.