OCMC Missionary Maria Roeber holds a baby in Tanzania.
Furaha na amani! Joy and Peace!
I hope and pray that you all had a very Merry Christmas and a blessed and Happy New Year! Here in Bukoba we enjoyed a wonderful hierarchical Divine Liturgy for Christmas. The weather was beautiful—sunny and warm, which is somewhat rare here during the rainy season. I Skyped with my parents which was fun, and Felice and I made a Mexican soup with tortilla chips and nacho cheese for our Christmas dinner (all ingredients a special treat from various guests we’ve hosted over the past several months—and boy, were we grateful!). We’re now looking forward to celebrating Epiphany/Theophany, and then our little plastic Christmas tree will get packed up and put away for the season.
I promised to tell you about hosting teams and just what I’ve been doing during the busy summer and fall months. One of my jobs as an OCMC Missionary is to help host short-term teams that come to volunteer throughout the year. In 2012 we hosted one medical and two teaching teams. The teaching teams provide catechetical instruction to members of the Church. The team I helped to host this summer worked mostly with teenagers, for ten days, and everyone stayed together at the teaching site—the Orthodox seminary which is about an hour and a half drive away from Bukoba. I wasn’t able to spend a lot of time with the team due to my duties with the health centre, but I did shopping for food, water, and other supplies for the team. I also met with them to give them a brief orientation to Tanzanian culture and to give them some history of the Church here. At the end of their time here, I organized an excursion for them so they could see some of the countryside. We also did some shopping together in town, and I enjoyed several meals with them. I appreciated the opportunity to visit with them and to answer their questions.
Hosting a medical team was much more involved for me, and I joined the team for their entire week that they were here in Tanzania. I’d helped to host a medical team last year in 2011, and I’d participated in one as a team member in Uganda in 2008. By this year Felice and I had enough experience both with teams and also with the medical system here in general to have a good idea of how we wanted to try to organize things to make them as efficient and as enjoyable as possible. The typical OCMC medical team experience in East Africa is for teams to travel to a different church community and to set up, run, and tear down a makeshift medical clinic each day. This year, we stayed in a guest house/hotel each night and traveled not more than a 45 minute drive to each community. At the end of the day we returned to our hotel for dinner and to prepare for the next day.
Our goal was to provide loving, compassionate, holistic care and to be witnesses to our faith. In the five communities we visited, the priests had announced that we would be coming to provide medical consultation and medication free of charge. Not only did we care for Orthodox Christians, but we also saw many people who had heard from their neighbors about our planned visit. When our teams go out to these areas we are happy to care for anyone who comes to us, regardless of their religious beliefs.
The first thing we did when we arrived at a community was to greet the local priest and the faithful who would come to shake our hands and make us feel welcome. Then we would enter the Church for a brief prayer service. This year we were blessed to have an American priest on our team, in addition to the medical staff, so he and the parish priests announced that they would bless oil for the healing of the sick and administer it to those who requested it. In addition, they were available to visit and pray with anyone who wished to speak to them. After prayers we announced the “plan” to people, so they would know what to expect. We took time to set up our tables and chairs in the spaces the community had provided for us. Sometimes they were rooms in already constructed houses, and sometimes they were makeshift rooms made out of palm leaves, sticks, dried grasses, and pieces of fabric hung up for privacy. We set up exam rooms, a pharmacy where the medication was stocked, an area to dispense the medication to the patients, and a waiting/triage area. The next thing we did was to hand out index cards and to write people’s name, age, gender, and chief complaint on them. We worked with translators provided by the communities who spoke varying degrees of the local languages (they were different depending on which community we visited), Kiswahili, and English.
What generally happens when you do a medical clinic in rural areas here is that at first there aren’t so many people—maybe 75 or 100. With a team of 10, that always seems very manageable in the beginning, and it would be if the numbers stayed that low. What tends to happen is that word spreads throughout the day, as people are seen and go back to their homes. Usually by the end of the day we have seen 200-300 people, depending on the size of our team and how fast we can work. To our way of thinking, it’s always important to triage and to see the sickest cases first. That becomes extremely difficult here, where the ingrained tradition in the culture is that when it comes to medical care, the rule is “first come, first served.” It is nearly impossible to keep track of who arrives first, although we attempted to do so with a numbering system. This year we tried something new, having our nurses triage and classify people into priority levels. It sort of worked, in that it allowed us to quickly assess and treat people who had complaints we could treat with what we’d consider “over-the-counter” medications. My experience with language and also with the medical system allowed me to quickly triage and prescribe some basic medications for people so they would not have to wait long hours. It allowed the physicians in the group to concentrate on the more complicated patients I don’t feel comfortable working with alone.
Most of the time when we see patients in these settings, we’re not dealing with people who are critically ill. The more minor complaints are aches and pains, cough/cold/flu symptoms, and allergies. There are always a lot of people who complain of vision problems and dental problems we unfortunately can’t treat in this type of setting. After that it starts to get more complex, with people complaining of stomach pain (is it worms, or is it an ulcer, or is it something else?), respiratory complaints (asthma, tuberculosis, pneumonia?), urinary tract infections, sexually transmitted infections, and lots of skin rashes of varying types. We always hear complaints of fevers and general weakness—trying to figure out whether that’s malaria or not is impossible without testing, which we don’t do. We treat presumptively and refer a lot of people to more advanced care if we think it’s necessary. Then we have the people who are really sick who we’re not equipped to care for—women with breast masses, men with severe hernias, babies with birth defects and kids with developmental delays. For these people, the best we can do is education, through a translator, and to hope that they will take seriously the recommendation to seek additional care. It’s terribly difficult to see cases we know we could treat if we were “back home,” but which we don’t have the capacity to deal with when we’re in the bush and we don’t know and understand the local medical referral system. More and more I realize that it’s incredibly disappointing for the people who ask us for help and are told that there’s nothing we can do. I know that we are caring for them by providing thorough explanations, and actually just by taking the time to sit and listen to them—that is so valued by patients everywhere, but especially here. It is hard to say that we’re doing the best we can in a tough situation, to offer to pray with someone, and then have to leave it in God’s hands, but that really is what we do sometimes. At the end of each day, the communities were very grateful, singing and sometimes even dancing for us. Several times the women had been cooking all day to prepare a meal for us as a thank you. We had many requests for us to take pictures with the people, and many new friends were made through the playing of football (soccer) and with balloons.
One of the great things about two other medical teams I helped host was that they were based at the health centre. It’s a very different experience to work as a combined Tanzanian/North American/Greek staff in a facility with dental equipment, an EKG machine, a functioning lab facility, and a wide variety of medications. My role during these teams was to help orient our visitors, organize the patients, facilitate cooperation between team members and health centre staff, and make sure that our volunteers were cared for in terms of food, water, transportation, etc. One team had 17 participants while the other had just 6. The basics of running those teams are the same, but it’s on such a different scale depending on the amount of people one is working with. Both teams had dentists who provided check-ups, filled cavities, and often ended up pulling teeth. Both teams also had family medicine/internal medicine physicians and nurse practitioners who saw the bulk of the patients, but we also had surgeons who did minor procedures, a pediatrician who saw lots of kids, and a surgeon/nurse team who partnered with a larger local hospital to provide more complicated surgical care. Our patient volume always increases dramatically when teams visit—we were seeing between 35-50 people a day, which kept everybody busy but didn’t wear anyone out. That’s important when your providers are jet-lagged and in culture shock, and are often experiencing tropical medicine in the developing world for the first time. I really enjoyed talking to these team members and explaining the history of the health centre to them and listening to their ideas of ways we could expand our services or make things more efficient. Since I am not experienced in running an outpatient health centre in the US, I was really grateful to talk to physicians and nurse practitioners who have that background and have also worked in Tanzania or other African countries before.
This is already incredibly long, so I will wrap it up. If you have any questions I’d be happy to answer them. My latest news is that my Tanzanian nursing license has finally arrived, so by the time you read this I should already be back in scrubs and working directly with patients again. I am really grateful that I will have the opportunity to work with Tanzanian healthcare providers, to learn from them what it’s like to care for patients here, and hopefully to improve my understanding of a wide range of diseases and their treatment. Next time I write, I will share a few medical stories with you so you can get a better picture of what this work is like. Until then, thank you as always for your prayers and support. I am amazed at what I have learned in the past several months and I am glad to be here—I pray that God uses me to the best of my ability to serve others and to glorify Him. I couldn’t be here without you, though, and I do remember that daily. You are all in my prayers, more frequently than you know.
Love in Christ,