Jonathan’s Blog

Zahanati

4/15

Previously I said that I would write more about the clinic. This post will probably be drier than the others, but I think it is worth posting considering it is after all the reason I am here and where I spend every morning. A bit of background on the organizational structure: The clinic (zahanati) itself is run by the African Inland Church (AIC), a private, nondenominational organization spread throughout much of Africa and whose focuses include health care, agriculture, refugee camps, and yes, Christian evangelism. The AIC is run by Africans as opposed to the African Inland Mission (AIM) which is run by missionaries and fund much of the AIC’s projects. The two organizations are historically and practically linked. Much of the funding for the AIC’s health clinics come through donations from private organizations and believe it or not from the Canadian government. 

The clinic on Bumbire, Maisome (a neighboring island), and Kahunda (the closest mainland town) are largely managed by so called “community health evangelicals” or CHE workers (actually pronounced “Chay”).  They are local Africans who administer vaccines, do much of the testing, and provide home care in the villages. They also instruct people on sanitary practices and provide basic health education. The qualifications to be a CHE worker however and minimal, and their understanding of disease in many ways is less than the lay person’s in the U.S.

In addition to socioeconomic barriers to health care, there are many cultural barriers that exist here as well. For one, the clinic is seen by many people here as second-line only when traditional healers’ remedies do not work. On several occasions I have noticed scars left from cuts made along the abdomen of patients where I’m told the healer has placed various herbs and elixirs.

Many people also do not understand the concept of a chronic disease. Here disease is seen as something that can be cured with a specific remedy. The idea that something like say, asthma, needs to be constantly controlled with inhalers and other medications is foreign. So an endless cycle of taking meds, feeling better, stopping meds, getting sick, etc. continues. This is where frustrations sets in on our part. There is also no understanding of the difference between “clean” and “sterile”. Generally speaking though, nothing here is truly sterile. I’ve learned to be happy with clean.

The clinic somehow manages to cover the cost of the salaries of the CHE workers through donations and the nominal fees it charges its patients. The idea is to be self-sufficient. The charge for a single visit (which includes any medications given) is 4000 shillingi or 5000 shillingi for procedures. This is about $4-5 dollars. Or for the price of just 10,000 shillingi (or about $9 dollars) a family of 6 can buy insurance for 6 months. This covers all expenses for all visits and meds dispensed within that time frame. No co-pay, no limits, no extra charge for preexisting conditions. As in the rest of TZ, treatment for HIV patients is free (their equivalent to Medicare). The cost of an entire pregnancy including prenatal visits and delivery is also 10,000 shillingi.

So yeah, it’s a pretty good deal. But if you’re thinking “well, you get what you pay for”, then you’re partly right. As far as diagnostic tests go, we’re limited to urine dip, urine pregnancy, syphilis, HIV, HepB, malaria, and whatever we can see under the microscope. And all of the above depend on availability. We have a variety of the most basic antibiotics, Tylenol, ibuprofen, steroids, albuterol inhalers and other essentials. We can suture lacerations, splint and cast, pull teeth (though probably not very well), and deliver babies. But we’re obviously not suited for any obstetric emergences, or any other emergencies for that matter. If you need an appendix taken out you better get on the next boat.

 All that being said though about the shortcomings of the care provided, there are certainly bright spots. Immunization of children on the island is fairly widespread. Also, a recent effort by the government to spray homes with insecticides has resulted in a steep fall in the cases of malaria on Bumbire. But it’s not the expensive diagnostic tests and treatments that would make such a large difference in the types of diseases people face here, but the widespread implementation of seemingly simple but practically difficult measures such as water sanitation, hygiene, and nutrition education. Over and over again I see the same things: schistosomiasis, round worm, giardia, etc. Wearing shoes, using the toilet, washing hands, boiling water before drinking–these are the measures that will really improve lives. Easier said then done. I suspect that with more advanced technology we would probably run into diagnoses that would require only more expensive treatments that we don’t have. On the other hand, an ultrasound machine would be fun to play with.