Stark Cultural Differences: Native Resentment, Family Ties, Patient Response, and Medicine

(from Leslie Modlin)

One of the greatest obstacles I’ve been having is understanding the local Tanzanians in our interactions in town. In the villages, everyone I meet is smiling and could not be friendlier. Yet in town, we’re constantly pointed at, yelled at, touched, and even followed and surrounded (we were surrounded and followed by 8 men the other day – it was frightening…). It’s a very unique (and not a positive) feeling to have an entire road of people stare at you as you are minding your own business running errands. The children are friendly, but the majority of the adults glare at us, which is uncomfortable and upsetting, especially since we haven’t ever met them before but they have some sort of preconceived notions of us. At the same time, there are a handful of people in the town that are so welcoming, so it’s difficult to understand these stark contrasts. I’m still trying to figure it out – we all dress very conservatively, know conversational Swahili and are attempting to learn more, know the do’s and don’ts in terms of cultural mores…it’s a challenge.

Fortunately, everyone at the hospital is both friendly and (more importantly) respectful. I’ve had lunch with one of the social workers and he invited me to dinner with his wife and son for this coming week. We spoke about our project, compared the US HIV/AIDS situation to the epidemic in Tanzania, discussed poverty and politics, and he was very intrigued by specific aspects of our culture, like gay marriage. (Clearly I am way more liberal than what Tanzania is used to on this issue, so it was an interesting conversation, to say the least!)

Another obstacle is having time to really learn Swahili – for the first few weeks when we were doing 5+ hour long interviews each day (and I had two, one for the patient and one for the family member…), it was very difficult to have time to do anything, even going on a run or just doing yoga. Thus it was essentially impossible to dedicate enough time to learning the language, but now that things have calmed down considerably, I’m able to pick up and understand much more. Swahili is similar to Spanish in the pronunciation, which is a help.

The portion of the project that I have been most involved in – patient interviews – is complete, three weeks ahead of the schedule. I loved the experiences of listening to each patient’s story, comparing it to their family member’s perceptions. The family is an extremely powerful concept here – patients are always accompanied by a family member to the hospital for most every disease, even if they are healthy enough to travel by themselves. Last week, there was a terrible accident – the large trucks we use in the States to transport livestock are used here to carry farmworkers into the mountains. The truck overturned somehow and many people died including children. Many, if not all, victims were transported to KCMC and the entire hospital transformed itself into an emergency room of organized chaos – psychiatric nurses were administering IVs and dressing wounds, for example; it didn’t matter what department you were trained in, you just helped. There was blood everywhere. Perhaps the most striking incident was seeing roughly 100 family members gathered outside of the gate, waiting calmly but with strained looks on their faces. I asked our translator friends why the families were outside, and they explained that there are visiting hours three times per day and they were waiting their turn. I told them how, in the US, few would have enough patience and composure to not demand to see their family member immediately after such a terrifying and horrific accident. Here the families were, in sweltering heat, locked out of the gate that leads to the hospital. It was heartbreaking to know what was going on inside and how many people died while their family had to wait to see them.

This past week, we had the privilege of traveling to Marangu to visit Father Muazo’s family. (Father Muazo is a Chaplain working with us on the project. I’ve made hospital rounds with him at night to visit patients in other wards, which has been an incredible experience.) We drove up in a rickety white diocese pickup truck – the bumps along the way propelled us out of our seats and were reminiscent of a theme park ride. Especially since we were driving on a narrow road up the side of a steep mountain! It was best not to look out the window for too long, I concluded early on. I met Father Muazo’s entire family – his mother, father, siblings, and many cousins and neighbors. They were all so excited to show us their home. They actually had two separate buildings for their house – one where they ate and slept, the other where they prepared the food AND held two cows, 4 goats, and a few lambs. Needless to say, it was quite surprising to open the door in the kitchen and be greeted by a massive, snotty cow’s face. We spent a lot of time talking to the family. I had visited Father’s father in the hospital at KCMC when he was a patient. He’s unlike many of the patients I’ve worked with at Duke in a good way – I feel that some patients want to appear happy and positive for fear of being labeled a ‘bad’ patient, so they don’t actually express how they are feeling. That was certainly not the case here! He was very open about how badly he felt and complained often, which I think is good because I was able to listen to him vent. He has a voice like Yoda (from Star Wars) and speaks emphatically, like ‘Whyyyy arrrree YOUUU makinggg meee exerciseee?’ when his son, Tina, or I would help him with his stretches.

This week, I’m analyzing our patient and family data to explore the themes for the paper(s). I know this will be a daunting task – 42 transcripts to go over, each of which is an average of 9 single-spaced pages. However, I have a good idea of what the themes we’ve heard. Today, we’ll be working on a draft of our manuscript to figure out what messages we want to send. We want to give Dr. Ringo, the nurses, and the Chaplains a draft of our paper before we leave when we present our results in a few weeks. This week as well, we are all working on a grant for the Bill and Melinda Gates Foundation for establishing a national mental health clinic. This is very exciting, and I’m sure Tina will update you more on this specific aspect! I am also working with the dermatology department to establish a program to help the albino population in Tanzania. I’m not sure if you read the article in the NYTimes about the situation, but people with albinism are being hunted in Tanzania – witch doctors are still prominent, and they’ve created a demand for albino body parts. It’s extremely disturbing to me that these individuals are being slaughtered because of their skin color. Nineteen have been murdered this year alone. If they’re not murdered, they die from skin cancer because sunscreen is so expensive and we’re quite close to the equator. As a result, I’ve been meeting with members from the dermatology to determine what types of help this population needs and how best to accomplish these goals. I’m confident that I’ll be able to secure donations from US companies that produce sunscreen, and that we’ll be able to come up with other solutions once I have a clearer understanding of the problems.