About the Author

International Health: Practicing Rural Medicine in Tanzania

By Andrea Mantsios
Article printed in Abroad View magazine fall 2004

As I sat in the waiting room of the Arusha Hospital for Women and Children in Tanzania, I couldn’t help but smile at the scene. All around me sat men stunningly draped in traditional red cloth, their stretched earlobes hanging practically to their shoulders, an assortment of piercings displaying beautiful beadwork and intricate hair pieces fixed upon their heads. All of them had their eyes glued to a 10-inch television screen on which a circa-1986 Oprah Winfrey, dressed in a heavily shoulder-padded, teal-green blazer and sporting massive hairsprayed bangs, somberly warn- ed young women about the dangers of walking alone in shopping mall parking lots. It was a perfect introduction to the complexities and contradictions of life in Tanzania as I would come to know it over the next ten weeks.

I had traveled to Tanzania for a 10-week international health internship with Global Service Corps. I was not exactly sure what it would entail, but I knew it would provide valuable field experience in preparation for entering a master’s degree program in international public health the following fall. During my first four weeks, I co-led HIV/AIDS prevention trainings in and around Arusha for groups ranging from rural farmers to urban youth. Having led peer education trainings on HIV/AIDS in the U.S., I felt relatively well prepared for this aspect of my internship. I was wrong. When a training participant, a 73 year-old firecracker of a woman, raised her hand and asked, “If a man with HIV rapes a goat, and I eat that goat, will I get HIV?” I realized that running AIDS prevention workshops in rural Tanzania would be quite different from running them in suburban New Jersey.

Opening up conversations about the highly taboo topics of sex and AIDS was not easy at first, but once we gained the trust of the group, we were able to dispel dangerous myths and provide crucial information about the virus. We worked with groups of farmers in rural areas, where we set up outdoor classrooms with benches under a banana tree and a flip chart over a fence. We also worked with groups of young men from the city, many of whom knew the words to popular American rap songs but believed that Americans put holes in condoms to spread HIV throughout the continent of Africa in an attempt to kill off black people. Many of the groups we worked with were skeptical of our intentions at first and voiced their belief that HIV was created in a laboratory in the U.S. and challenged us to prove them wrong. By the end of the trainings, it was remarkable to see these cynics turned into energized activists, ready to spread the word.

In addition to HIV/AIDS prevention trainings, I also had the opportunity to work in Tanzania’s local hospitals and clinics. After graduating from college, I had worked at one of New York City’s top hospitals with access to all the technology and amenities that I had come to expect from a healthcare facility. In Tanzania, I suddenly found myself in very basic facilities with limited resources and, for the first time, had direct experience with the kind of healthcare the large majority of the world’s people receive. At one clinic, my work focused on malaria; at another, I dealt mostly with intestinal worms; and at one of my favorite placements, a child and maternal health clinic, I weighed babies, distributed vitamin supplements, and counseled mothers about proper nutrition to enhance their babies’ growth and development.

While I was working at the child and maternal health clinic, a group of visiting Dutch doctors led a workshop on how to use abdominal ultrasound equipment. I will never forget the rush of emotion I felt when we explained to a Maasai woman who had come to the clinic from a remote village that the image she was looking at on the ultrasound screen was, indeed, her uterus. To someone who has never seen a computer, let alone an ultrasound machine, this is quite a concept. She came in complaining of the most common complaint I heard in the clinic, “tombo,” which in Swahili very generally means lower abdominal pain. We began with the obvious question—Are you pregnant? Her answer was, “No.” Once we began the ultrasound, however, we discovered three fetuses in her uterus. The woman was completely unaware of the triplets she was carrying, but to watch her face as we explained what she was looking at on the screen was truly priceless.

When I think back to my time in Tanzania, I believe that living with a local family and learning the local language were critical factors in getting the most out of my internship. Being immersed in the culture and the language made me feel more confident interacting with people in my role as a health worker.

As a young white American woman in a local clinic, I often received quizzical looks from patients as they wondered who I was and what I was doing in the examination room with them and their doctor. As soon as I opened my mouth and offered the customary Swahili greetings and exchanged small talk about an upcoming holiday or the ripest fruit of the season that I had tasted the night before, a warm smile chased the puzzled looks off their faces. My ability to communicate with the patients, while also grasping an understanding of their culture, enhanced my experience and helped me earn the trust and respect of the people with whom I worked.

Being exposed to alternative approaches to healthcare forced me to learn more about promoting and maintaining health for a population whose healthcare providers must utilize whatever resources are available. Until my internship, I might have regarded these clinics as inadequate. I now have a better understanding of the challenges of working in resource-limited environments.
I have developed a great deal of respect for healthcare practitioners who use natural resources for alternative medicine. Through my experience, I have begun to appreciate the fundamental knowledge of the human body that provides the foundation for their work, and I also have come to value the traditional healing practices that they have used successfully for hundreds of years.