The following notes are from the University of Copenhagen MSc Global Health field trip to Tanzania. We are currently a group of 19 students visiting the Kilimanjaro Christian Medical University College (KCMC) and surrounding health facilities over a 5 week period. Throughout this duration I will continue to upload my field notes from this exciting trip.
All comments here do not reflect the University of Copenhagen, KCMC or any of the mentioned individuals. All comments are my own personal views relating to my academic and cultural experience in Tanzania.
Tuesday 6th May, 2014 - Departure.
So after spending the best part of 9 months in Copenhagen learning about this relatively new concept of Global Health, where a significant proportion of the material is focused on Low and Middle Income Countries (LMIC), I get my first opportunity to theory into practice. It’s been nearly 3 years since I have travelled outside of Europe, and I wasn’t too sure how I felt leading up to the trip. I knew in my heart that if my first Africa experience was anywhere as good as my first Asia experience in China, then it would be an enjoyable experience. However on the other hand I didn’t have the wealth of knowledge regarding SSA countries, compared to my pre departure to China. It’s also important to take into consideration that due to the Field Trip, Internship and Leisure time, I know I won’t be in my newly formed home in Copenhagen for more than 2 weeks over the next 6 months. This is a strange psychological feeling for a Briton who is not used to travelling for that period of time.
However the penny finally dropped on the evening before departure. I was reading the different travel advice from different countries regarding their advise with visiting Tanzania. Therefore hearing about the variety of culture differences is what made me feel excited. I suppose this is where my passion comes from - understanding the variety of influences on human health.
So after spending the best part of 9 months in Copenhagen learning about this relatively new concept of Global Health, where a significant proportion of the material is focused on Low and Middle Income Countries (LMIC), I get my first opportunity to theory into practice. It’s been nearly 3 years since I have travelled outside of Europe, and I wasn’t too sure how I felt leading up to the trip. I knew in my heart that if my first Africa experience was anywhere as good as my first Asia experience in China, then it would be an enjoyable experience. However on the other hand I didn’t have the wealth of knowledge regarding SSA countries, compared to my pre departure to China. It’s also important to take into consideration that due to the Field Trip, Internship and Leisure time, I know I won’t be in my newly formed home in Copenhagen for more than 2 weeks over the next 6 months. This is a strange psychological feeling for a Briton who is not used to travelling for that period of time.
However the penny finally dropped on the evening before departure. I was reading the different travel advice from different countries regarding their advise with visiting Tanzania. Therefore hearing about the variety of culture differences is what made me feel excited. I suppose this is where my passion comes from - understanding the variety of influences on human health.
I believe it is also fair to say that I felt a certain amount of trepidation in visiting a country which has a plight of infectious diseases. I’m not so much talking about the actual insects themselves but more the concept of infection and the negative health implications. However I am sure that this will make me appreciate not only infectious disease as a whole, but also the potential double burden of disease within LMIC.
Finally I think it will be really invaluable in not only hearing the experiences from health professionals on the ground level, but also to see the working conditions within the health structure. We are truly privileged to be able to give the opportunity to have a tangible grasp within a LMIC such as Tanzania.
Wednesday 7th May, 2014 - Initial Day
So after arriving at 4am to our apartment, I was met by a rapid attack by some ‘killer ants’, resulting in my clothes being removed rapidly. Faced with sleeping under a mosquito net for the first time, feeling tired from the travels, I really felt I had arrived in Africa.
A number of hours filled with restless sleep equated to me waking up before midday. Maria and Ib soon met us at the house with greetings and bread. Soon the rest of the class joined us at our house and we began the walk towards the campus. We spent a number of hours registering at the international office but I found it interesting to see the variety of looks. Some Tanzanians were passing by, while others were looking with great intrigue. I suppose I was also doing the same, but for alternative reasons. My first impression when driving through local business last night was confirmed today. Branding is everywhere. Particular reference goes to Coca-Cola and everyone seems to be a consumer. It is also important to remember this was also based in a medical university setting. However I look forward to documenting more on this in the coming days.
The remainder of the day was spent with a mini campus tour which included a brief look at the hospital. It was quite a calm environment but it was my first look at the basic equipment within a clinical environment. I also felt quite weary walking through as we are white westerners looking at an SSA clinical setting, and the subsequent perception this gives off to locals. I was also desperate to take more photographs, but maybe more over the coming weeks within an ethical context. We then quickly moved onto the main campus building where we could see a vague outline of Kilimanjaro. We also had a peek into the computer room which was filled to the brim with the latest Macintosh desktop computers. My fellow peer commented that they clearly have been sponsored by Apple, but by god as one of the ‘apple drones’, it was impressive to see around £100,000 of computer equipment in one room.
A number of hours filled with restless sleep equated to me waking up before midday. Maria and Ib soon met us at the house with greetings and bread. Soon the rest of the class joined us at our house and we began the walk towards the campus. We spent a number of hours registering at the international office but I found it interesting to see the variety of looks. Some Tanzanians were passing by, while others were looking with great intrigue. I suppose I was also doing the same, but for alternative reasons. My first impression when driving through local business last night was confirmed today. Branding is everywhere. Particular reference goes to Coca-Cola and everyone seems to be a consumer. It is also important to remember this was also based in a medical university setting. However I look forward to documenting more on this in the coming days.
The remainder of the day was spent with a mini campus tour which included a brief look at the hospital. It was quite a calm environment but it was my first look at the basic equipment within a clinical environment. I also felt quite weary walking through as we are white westerners looking at an SSA clinical setting, and the subsequent perception this gives off to locals. I was also desperate to take more photographs, but maybe more over the coming weeks within an ethical context. We then quickly moved onto the main campus building where we could see a vague outline of Kilimanjaro. We also had a peek into the computer room which was filled to the brim with the latest Macintosh desktop computers. My fellow peer commented that they clearly have been sponsored by Apple, but by god as one of the ‘apple drones’, it was impressive to see around £100,000 of computer equipment in one room.
Thursday 8th May, 2014. Dalla Dalla
Today began with a warm welcome from the Provost of KCMU followed by another mini campus tour. It is fair to say that we were all impressed at the quality of the laboratory settings. Immaculately clean, flatscreen screens, high-tech centrifuges, camera operated microscopes. By far the best lab I have seen during my academic career, and Ib along with others also concurred. We then met Dr Mahande who recommended to take the local bus, ‘’Dalla Dalla’’, into the local town Moshi. The best way to describe Dalla Dalla is a bus which is built for 8 people but has 20 crammed into it. A combination of the over crowding, strange stares and the driver avoiding the number of potholes made it quite the exhilarating ride. We soon arrived at the town centre and we were met with a bustling vibrant crowd of Tanzanians. We then spent the next two hours trying to find a USB dongle, and then another hour picking a restaurant avoiding a number of ‘local advisors’ swaying us from side to side. On a alternative note I was again amazed at the number of coca cola advertisements everywhere. Kiosks, Saloons and Schools. Yes Schools. More specifically a primary school. Therefore when children are growing up in an educated setting, they are instantly surrounded by soft drink branding. This ultimately has a detrimental behavioural effect on children, which may continue throughout the life course, if no further education is sought. I wonder if we will look back in 40 years, and see the current soft drink branding, as immoral as the smoking advertisements in the 1960s.
We finally managed to grab some food and it was well worth the wait. My african food experience was furthered with a beautiful marinated lightly fresh fish with gambui. Eating all of the food with our hands was an enriching experience and was a through able enjoyable dinner. We then swiftly went to Ib and Maria’s compound where we were invited for a little get-together. A few beers and samosas later the evening was well under way with good chat and even a little bit of networking with external academics. Overall a long but enjoyable day.
Friday 9th May, 2014 - Hospital Visit
The day opened with an academic forum from a KCMC MSc and PhD student. Both talks were interesting but you could see some cultural differences in terms of delivery from our ‘western presentation style’. We were then introduced to the forum on behalf of Laura who did a pretty sterling job mixing the Welsh charm, with some Swahili and Danish thrown in for good measure.
After a brief lecture from Dr. Rachel Manongi on an overview of the Tanzanian health system, it was off to see the real thing in action with a visit to KCMC hospital. Our groups were divided into our topic areas, and we were lucky to have Ib come along with us. We visited a variety of wards ranging from intensive care units, fractures, skin infections, casualty, drop in clinics and general wards for those suffering from chronic and infectious diseases. It was very interesting to see that the staff were incredibly upbeat, considering how understaffed they were. In one ward we were told that there were 5 day shift nurses which had to cater to the needs of 60 beds. However they did not seem stressed or anxious at this idea, which may not be the same in a western context.
After a brief lecture from Dr. Rachel Manongi on an overview of the Tanzanian health system, it was off to see the real thing in action with a visit to KCMC hospital. Our groups were divided into our topic areas, and we were lucky to have Ib come along with us. We visited a variety of wards ranging from intensive care units, fractures, skin infections, casualty, drop in clinics and general wards for those suffering from chronic and infectious diseases. It was very interesting to see that the staff were incredibly upbeat, considering how understaffed they were. In one ward we were told that there were 5 day shift nurses which had to cater to the needs of 60 beds. However they did not seem stressed or anxious at this idea, which may not be the same in a western context.
We also saw that there was a shortage of space in the clinics with up to 14 patients in one room, and many others in the corridors. However this not something which is exclusive to SSA, as we see the same overcrowding or shortage of beds in the NHS, but maybe not to such an extent. I should also note that I was impressed at the cleanliness of the hospital floors and the use of sterile equipment. It was also impressive to see the level of english of the senior doctors, however it is primarily linked to their oversees training in an english speaking context.
I did however have one problem. When we were walking around the different clinics, the nurses were very open with the specifics of different patients within each ward. This was to an extent where they would go up to each bed and say what this person is suffering from, the physical manifestations of this, and how it happened. I have no problem with those who have a medical background seeing this as they have a vested interest. However I felt very conscious at the fact we were a group of 5 white western students walking around this setting and we couldn’t directly improve their situation. I understand that it is important to see these settings to understand the clinical environment which many individuals within a population have to use, and which health systems operate under. However I couldn't shrug the feeling that I was being too invasive and as a result I often held back at the entrance of the room, and tried to take a more holistic approach in looking at the facilities and general patient picture, rather than a one by one perspective.
I was also interested to see the differences in the public and private services offered by the hospital. The difference from what I could see was there was 2 beds to a room, no people in the corridors, and slightly more nicer surroundings. However they would be a heartbeat from the public services and I am sure they are staffed by the same individuals. It was interesting to see this contrasting price have little aesthetic difference, but maybe the quality of treatment may be different.
On a more positive note the tour ended at the patient records room. It was very interesting to see a paper based record system, which is such a stark contrast to the super secure centralised system seen with the Danish CPR. It was very impressive to see the vast amount of records organised in a manageable manner. Furthermore they also recorded data which was used for the Tanzania census which was very impressive to see. Multiple staff members sitting with their IDM 10 and NHS booklets, classifying diseases into a quantifiable manner. I couldn’t help but think that I wish they do not have a fire in the hospital which would damage this invaluable department.
Saturdays 10th May, 2014 - The Famous Market
After a relaxed morning spent in our newly found swimming pool, we took a short taxi ride to see one of the well known markets for some shopping. As I am not a keen bargain hunter, I instead spent this time taking some photographs. The market was filled with a variety of interesting people selling mainly clothes. I spent a considerable amount of time just watching one female shop owner who was standing in the middle of a mountain clothes and just throwing them sporadically towards potential customers. This was also the same woman who then made a funny remark to me in Swahili when i took a picture. I knew it was funny due to the rapture of laughter of all the locals around me. This was further enhanced when I semi slipped in the mud, but just about managed to gain my composure and crawl to safety. I spoke to a number of people throughout the time spent at the market but there is one conversation which will stay with me for a long time.
I was walking aimlessly around the market by myself as the girls were shopping and taking in the sights. I was in a very quiet part of the market and as many Tanzanians do, I was greeted by the local hello - Jambo. I’m not sure why I decided to stop this time, as previously I had just replied and walked on. However I stopped and said to the man explaining that I do not speak that much Swahili. He then replied ‘’Why ?’’ while smirking profusely.
The young looking man standing with a cup of tea introduced himself as Mr James and proceeded to ask me if I believed in Jesus. Now I’m not genuinely somebody who talks about religion as I feel it is something which is a personal viewpoint. However I felt obliged to answer the question but in a sensitive manner. I described that I was christened as a child but I find it hard to associate myself with any religion when religion as a concept is partly involved the development of wars and deaths of people. Mr James replied that you don’t have to be religious to believe in Jesus. ‘Jesus loves everybody’ he said and he pointed to his heart describing how it gave him hope in life. I respect this part of religion among people. Hope is an important part of life and mental health, however I don’t distinguish between jesus, god or any other religious character but did not mention this. Mr James then asked me a few questions about the religious culture in the UK and he described the culture in Tanzania.
He then began to ask me why I was here. You were instantly asked if you were a doctor if you associate yourself with KCMC. I then explained that I was interested in T2DM and that I thought like many LMIC who are undergoing urbanisation, this has a detrimental effect on health systems and on health as a whole. I obviously explained this in very plain terms as it is a complex topic. Mr James seemed very interested at this point. I then went on to describe our research project and how we are focusing on hypertension and how high blood pressure is a chronic risk factor which is extremely important within the field of Cardiovascular disease and other NCDs.
He then said to me that he suffered from high blood pressure. He said that he could feel his heart beating fast sometimes (heart palpitations) and that he would drink water to try and ‘make it go away’. He was also taken aback at the idea that high blood pressure is something which can be a life long condition and is bad for the whole body. However he explained that it is very hard for people in Tanzania to seek information about their health status as it is expensive to go and see the doctor. I then sensitively asked him whether he had seen a change in society since he was a child in relation to soft drink consumption. He believed it had and I then asked whether his children drink a lot of soft drinks. He said they do but he described the satisfaction as a parent to return home with coca cola in his hand, and to see the children with big smiles on their face. However he said that with the new information he had received from myself, he wanted to reduce the number of drinks his children consume. I then started to chat to him about fruit and vegetables, and the concept of ‘5 a-day’. He then went on to describe how when he returns from work each day, his wife gives him a bowl of chopped banana, orange and mango. He also said how his wife always includes vegetables like avocado within the evening meal. I was pleased and I then suggested a few ways to increase consumption, focusing on breakfast which was just a cup of tea.
Unfortunately I had to go and find my other friends but I felt very enriched after speaking to Mr James. The 30 minute talk felt like I had maybe helped somebody by providing basic health information, which ultimately could help prevent or delay the onset of a chronic disease. After all this ultimately the aim of this global health game.
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Monday 12th May, 2014 - Milestones & Malaria
We had a relatively quiet start to the week today with a couple of morning lectures. Dr Manongi began the proceedings with a lecture on the major health challenges in Tanzania. It was interesting to see that the only group of health challenges which didn’t have any ‘major achievements’ was NCDs. The same health challenges which are rapidly rising putting extreme pressure on their health system. Ib then talked about one of his many academic interests - Malaria. It was an interesting lecture followed by some group work, which is timely considering our field visit tomorrow.
Tuesday 13th May, 2014 - Experimental Ethical Dilemmas
The main activity of the day was a visit to the experimental malaria huts. We had a timely introduction to the methods used, experiments undertaken and the health issue of malaria, from final year PhD student Johnson Matowo. We were then shown the wooden huts which the experiments subjects would sleep in. Basically the concept of the huts is to allow mosquitos to enter the huts, and determine if they die from the insecticide sprayed walls or bed sheets, or alternatively be safely contained if they confer resistance. However we were told that the subjects were pre pubescent males, as they were the most reliable subjects to stay in the house. Other maturer males were suspected of possibly asking female companions to come and stay with them throughout the night, or smoke cigarettes within the hut, thus compromising the results of the experiment. It is also important to mention that the male children would have to sleep within the huts for a 8-10 week period, and often be bitten by mosquitos. One could argue whether it is ethical to subject children to such emotional and physical distress. Furthermore we were told that the children would receive a ‘token’, which I presume was cash based, for their participation within the experiment. This information we were told was not included within the publication’s methodology and therefore raises some interesting ethical and scientific research questions.
We were then showed the methods of catching and collecting mosquitos, which included a deep pit in the ground, and larvae locations within a crop field. Overall the visit to the experimental huts was not only interesting to see the tangible experimental conditions associated with malaria, but also the ethical and methodological validity of some experiments. As scientists luckily we are taught to always critically analyse papers. I think this experience has further imprinted this into my mind.
The evening consisted of a pleasant surpass goodbye party for Maria. Considering the months of hard work which Maria has undertaken to make this trip happen, it was a shame she could not enjoy the fruits of her labour more. However an Indian feast and some beers with everyone from the course was a pleasant way to send her back to Copenhagen. I also had the pleasure of having a chat with Ib regarding some broader global health topics, along with my own research topic within Sri Lanka. More of this to come over the next days as I will hand in a revised research proposal at the end of this week, and discuss it with Ib in person before his departure next week. Busy but exciting times ahead.
Wednesday 14th May, 2014 - Ib’s Birthday
Today was a day which many had been looking forward to for a long time. When we initially found that Ib’s birthday was during the field trip back in March, we were instantly excited and knew celebrations were a necessity. The reason why ? Well considering the vast wealth of research during his career, achievements within International and Global Health, worldwide respect from other academics, and his recent knighthood from the danish monarchy, he is one of the most down to earth academics I have come across. Always approachable, humorous, and incredibly humble, as the maturing children of his ‘baby project’, the global health course, we felt indebted to ensuring his birthday abroad was enjoyable.
The proceedings began with a surprise celebratory breakfast at 7:15 where the 19 students arrived at his house singing happy birthday accompanied with a generous european african breakfast. After the fuelling session, the bus arrived at the accommodation to take us to the Maternal and child health clinic in Majengo and Pasau. I will only write on the visit to Majengo as I believe that this was the more engaging visit and to avoid repetition.
The first thing which struck me when entering the ‘waiting area’ of the clinic was the child nutrition related posters. We were then showed where every child was weighed using a scale which I associate with butchers weighing pieces of meat. This weight was then recorded and used to determent where the child was in the child growth charts, within an hour long consultancy with a nurse. Overall we saw a variety of rooms associated with administering vaccinations, dispensing pharmaceuticals, maternal advisory sessions, respiratory consultations and the clinic’s laboratory. It was a very interesting visit but I managed to confirm something which I have been dwelling over the last days. When the nurse told me that the most common respiratory disorder was not tuberculosis, but acute upper respiratory infection, I thought this may be associated with indoor air pollution. During our travels on the bus, I have seen a number of mud houses with smoke billowing out, which can have detrimental health effects on the respiratory system. However I was weary as children in general have a weak immune system and acute respiratory infections are not uncommon, let alone in malnourished children. My suspicions were in-fact correct, but my joy was short lived. The senior nurse in the room said that this aspect of indoor air pollution was correlated to income, and the inability to cook in an alternative room, and the clinic does not seem to actively address this issue. I couldn’t help but think, since we have both mother and child accessing these clinics, could we not provide basic information associated with this environmental factor and possibly prevent chronic diseases such as Asthma ?
During our visit to the lab we also managed to get a look at the rapid diagnostic kits used for malaria patients. It was interesting to see these tools first hand, and I even managed to get a quick picture of one in action. The visit was rounded off with a visit to the labour ward. The first thing which struck us was that the whole ward was well equipped and every bed had a immaculate mosquito bed net. It was a very impressive facility and it was interesting to see the reality of where many mothers are recommended to deliver their children.
It was soon back to KCMC for some lunch and for a quick group discussion on malaria. However during lunch Ib was further surprised with a birthday cake and gift from the class. After singing happy birthday, and the candles being blown, cake was distributed among the whole canteen due to the sheer quantity at Ib’s disposal. The small gift comprised of a personalised stamp with Ib’s titles and a KCMC inspired logo, which Ib jokingly commented made it as official as some seen within the WHO and UN agencies. After class and a quick Facetime session with Lisa, it was back home to quickly change and back to Ib’s house.
Ib had invited the class round for pizza and beers for an evening get-together. It was a highly enjoyable night, accompanied with the presence of Dr Mahande, which was rounded off with some singing and Ib playing his harmonica. I remember the first time Ib played his harmonica which was at christmas after the oral examinations. It was very impressive to see such a unique skill which is not seen as much within the current generation. Thankfully it is always a pleasure when Ib brings out the harmonica and some suspect singing from myself when picking a ‘national song’ equated for a humorous but highly enjoyable end to the evening. Ib seemed to throughly enjoy his birthday abroad, and the bar was set quite high for the incoming student’s to replicate such events for his 70th celebrations in 2015.
Thursday 15th May, 2014 - Group Work
After a 7am 5km run with a couple of my housemates, it was off to listen to LSHTM’s Hugh Rayburn talk about Malaria diagnosis. He provided a throughly interesting lecture on malaria over diagnosis and the under diagnosis of other respiratory diseases. Basically severe malaria can lead to acidosis within the vascular system, which subsequently can manifest itself in the patient breathing fast. However these symptoms are also similar to what is seen within respiratory tract infections (RTIs). Based on this information, Dr Rayburn stated that up to 40% of all malaria diagnosis are incorrect. Approximately 60 to 85% of rapid diagnostic tests (RDTs) of negative malaria are due to RTIs, which half qualify for IMCI pneumonia. Thus the use of RDTs has resulted in an increase in antibiotics.
As a result another issue has arisen - increased resistance due to incorrect dosage. There are also questions on the grand topic of pneumonia. If we consider that we all have these viruses and bacteria existing within our respiratory tract, then why do some develop pneumonia and not others. I asked whether malnutrition and indoor air pollution could have a contribution. Dr Reyburn agreed.
The rest of the morning and afternoon was spent working on our group projects. I was looking forward to presenting our groups work to date. We have worked hard and the fruits of our labour have resulted in the following title: The effectiveness of a secondary school based education intervention in urban Tanzania raising awareness of risk factors leading to hypertension and Cardiovascular Disease. Our education based intervention study was well received from Ib and our fellow students. We even survived a few tricky questions, but survived to tell the tale. I strongly believe that over the next week our project will continue to become stronger, as long as the group work continues in good vain.
Thursday ended with some football - Africa style. Konstatine, who is a talented German goalkeeper, joined me in a location what can best described as the middle of a crop field. The ground was uneven, dry and tilted to an estimated 20 degrees to the right. However this does not deter the 20 strong Tanzanian group who meet up every day, unless it is raining. My team were playing in skins (without wearing a top) and the game kicked off. It was overall an enjoyable game, albeit lacking technical skill, but very fast paced. I also noticed that the football was much harder than European footballs. Such was the extent that after 2 headers within the space of 60 seconds, it felt like I had just walked into a brick wall, and thus felt quite dizzy. With the light soon fading and half of the insect world coming to join the game, we left the pitch feeling exhausted but impressed at the willingness to still participate in physical activity in testing conditions.
Friday 16th May, 2014 - Monday 19th May, 2014 - The Show Must Go On
Not much to report these days due to my body providing quite the host to the viral infection sweeping our class. However I was still able to work on some group work and more urgently my own field research proposal relating to Sri Lanka. During my literature review I was surprised to see that the BMI and Waist to Hip ratio was significantly lowered in South East Asia, compared to those used in the West. In Sri Lanka they consider overweight to be between 23-25 BMI, and anything over 25 BMI as obese. This is an significant finding considering the critiquing of the use of BMI amongst these populations but at there has been measures to address these concerns. After all dexa scans would be ideal, but not finically practical to implement within health systems which already have limited healthcare resources. However the racial and ethnic differences amongst south east asians relating to the internal and ectopic fat is an important factor to take into consideration. Back to class tomorrow with a bit of luck.
Tuesday 20th May - Transition Takes Time !
Today was a relatively quite day, in contrast to the rest of week, with a panel discussion on health priorities within TZ. Ib, present with Dr Mahande, Dr Mahonde and Dr Sia created an interesting discussion around the health priories on maternal and child health, with the appropriate communicable disease measures. Although we knew there was a lack of prioritising and policy focusing on NCDs, we were baffled to hear that not only is mental health thrown into the same ‘health category’, but also injuries. Injuries are not diseases per se, and like mental health, warrant their own category to allow the appropriate health and non health resources allocated to it. Not simply chucked into the NCD spectrum, which is already at full capacity, close the lid, have a look inside from time to time, then close again. Dr Mahonde did mention that she believed in a couple of years NCDs would become a bigger health priority in relation to policy and implementation. She also confirmed that the health system is currently experiencing the NCD strain on healthcare resources. I can only hope those who wish for this to become true, overcome the political and mainstream barriers, and prevail in highlighting this essential health topic.
Furthermore it was very interesting to hear that 40% of TZ’s health system funding comes from donors. As a result these donors have a significant influence on which health challenges and internal geographic locations are prioritised. Is this right ? I thought back to the Richard Horton article I read over the weekend which he argued against the concept of ‘Global Health’. He was grateful that he was defeated in the debate, however he made a number of interesting points. One was that global health is a front for the global north to fund development within the global south. This self fulfilling prophecy for the global north gives too much influence within the global south. However the global south are reluctant to bite the hand which feeds them. Either way it is an interesting dilemma, which I believe will only further be fuelled over the coming decades. When NCDs and climate change enter the main stage of Global Health topics, funding organisations like the Global Fund, who’s partners include Chevron, Coca-Cola and Vale, may have objections with this transitional health focus.
Wednesday 21st May, 2014 - TB Clinic Visit
After an early start, and a potential crisis surrounding the lunch situation, it was a 90 minute bus trip to visit the national leading TB clinic in Kibongoto. It was very impressive to see a whole facility covering TB primarily, TB & HIV patients, along with TB & NCD patients. The facility was very vast with well over 10 individual buildings, surrounding lush green spaces with ‘British esque’ landscape maintenance. There was the usual understaffing issues but it was very interesting to see the gender segregation ratio, which stood at 80:20 towards the men. The reason behind this was that Tanzanian men have an increased occupational risk, such as working within mines, and therefore the incidence is significantly more in males. However it will be interesting to see if the double burden of diabetes, will increase the incidence of TB as seen in South Asia.
However considering this clinic is already considering the double burden of disease is a huge positive. Regardless of the superiority of funding within this facility, it is always a positive to see up to date approaches on the ground level, considering the lack of national policies focusing on NCDs within TZ. Furthermore the health facility has started to ‘open it’s doors’ by attempting to spread the workload of TB patients to other regional facilities, and only focusing on the most severe cases. On Ib’s last day, he made an interesting comment saying that in his experience, this approach of open doors ultimately impacts on the facilities health statistics. Subsequently this portrays negativity from policy makers and MoH and questions of effectiveness and efficiency may be asked. However their approach is forward thinking and maybe the double burden may come sooner than expected and ultimately may void this concern.
Thursday 22nd May, 2014 - An Alternative Birthday
The foreign celebrations kicked off in great fashion with Nina baking a delicious banana loaf for breakfast. Soon after we were accompanied with some of the Danes singing their traditional birthday song, and it was off into the pouring rain to reach the bus. Today’s plenary was mainly centred around a regional hospital visit in Moshi town which specific focus on the HIV clinic.
In comparison to the previous day’s visit, this health facility was equal in size but visibly lacked funding. The health facilities were of an acceptable standard but they were not to the superior status as seen yesterday. A couple of points really stood out for myself, which may not have initially been expected. Firstly during the Q&A session at the beginning of the tour, one of the senior doctors admitted that over the last 3 years they have found an increased health resource burden relating to hypertension and type 2 diabetes. Furthermore the diabetes patients were increasingly of a younger age cohort, where even some children as young as 7 years of age have been seen within the clinic.
Secondly we had a brief glimpse at an Tanzanian psychiatric ward. I wasn’t expecting too much in relation to standards, and this was exactly the case. The ward seemed more like a jail institution to be quite frank, and reminded me of some images seen within western psychiatric facilities 50 years ago. However at least this regional facility had some sort of capacity to treat mental health patients, which is not the case in many SSA health systems.
After a short day, came a short rest before heading out to dinner with the global health team. It was very humbling to have around 20 old and new friends at the dinner. Our Indian dinner in “El Rancho’ was very smooth sailing and even managed to have a few Jack Daniels to toast the evening. Overall a very enjoyable and alternative birthday in an interesting setting.
Monday 26th May, 2014 - Emergence of NCDs ? False.
Today signalled the beginning of a week focussing mainly on NCDs. I have got to admit I have been looking forward to delving deeper into certain NCD topics this week. It has been an eye opening experience so far to see how NCDs are being largely neglected within Tanzania. It amazes me to a certain extent that It is not prioritised more, but I console myself with the fact that it’s related to budget constrictions. The question is when will change occur ? I have estimated based on my observations within the field trips, that health services currently divide 10% of their services to NCDs. There is no doubt that this will have to be scaled up to meet the needs of the population. However again when ? 5 years ? 10 years ? 15 years ? How many DALYs could be averted ? How many deaths could be averted ? How much TZ health care money could be saved ? All questions which are very expansive but ultimately have received no answers yet in Tanzania.
The lecture in the morning however highlighted again the interesting concept of the double burden of disease. Dirk provided an interesting overview of the relationship between under-nutrition and over-nutrition, CDs and NCDs, along with the double double burden of disease. Some interesting points were raised ultimately the gender differences in relation to weight in SSA. Often men are categorised as lazy and inactive in SSA, however they were significantly less overweight and than women, who were significantly more overweight. One of the major contributing factors relating to this is the physical inactivity in women is the associated occupational physical activity among men. Furthermore we talked about the racial differences amongst African Americans and West Africans, and the theory of Darwinian natural selection and survival of the fittest. The talk concluded with Dirk and Ib’s interesting research into the relationship between Malaria, low birth weight and the risk of DM and other NCDs in offspring. It was very enriching to return to the world of scientific concepts relating to histone modification, the barker hypothesis and skeletal muscle changes in DM. Overall a very enjoyable session and hopefully more to come throughout the week.
Wednesday 28th May, 2014 - How To Stop The Inevitable ?
The middle of the week marked the turn for Dr Venance P Maro, a KCMC consultant physician, to discuss the growing burden of CVD in Tanzania. To be honest the content of lecture was not what turned out to be the most interesting aspect of the talk. We of course mentioned the epidemiological changes associated with the alterations in ‘life conditions’ due to urbanisation and globalisation within SSA. However it was an image of the evolution of man and the question of ‘whether man can return to a more un-urbanised’ form of mankind. Unfortunately this is not the case. The reality is that economy’s in low and middle income countries depend on big industries to mobilise areas of the economy. These have been naturally exploited by the profit driven nature of the tobacco, alcohol, soft drink and food industry, and they are embedded into the economical and environmental nature of Tanzania. There apparently is this admiration of all things western in Tanzania, which comes with status symbols and social hierarchy. However as we in the West have found out the hard way, when you dance with the devil, it often has inevitable negative and irreversible consequences.
I came to the consensus that the best thing for Tanzania to do is not avoid the inevitable, but to adapt and embrace urbanisation. Make the required policy changes, ensure the correct health facilities are there to treat those with chronic diseases, appropriately tax big industries for their luxury goods and design the new urban infrastructure around a healthy living concept. Unfortunately this a very optimistic view point and not really feasible considering the financial constraints on a governmental level. Ultimately the NCD working group with the Tanzanian government is inactive on a public and professional level according to Dr Maro. As a result I think the first two points previously made are a realistic aim over the next 10 years. By that time the cost associated with CVD will be 500 million USD each year, 5 times the cost seen 20 years previous. In an ideal world we could invest now to save in the future and better manage the inevitable.
Thursday 29th May, 2014 - These Roads Are Made For Walking
Today I experienced the harsh realities of being disabled in Tanzania. I was walking back home through the hospital grounds when I saw a young man in a wheelchair struggling to move. The wheelchair was small, with the patient overhanging the two rear wheels. Furthermore the single front wheel was acting like a navigating oar, but with little success. The young man was not moving very fast on the rocky road, and after a minute of assessing the situation and surroundings, I offered to help him. It turned out he was going to one of the Dalla Dalla’s (local buses) and I offered to push him manually there. I initially tried to push with all 3 wheels on the ground, but I was quickly told this wouldn’t work by the young man. He then told me to tilt the chair onto it’s back two legs and move him that way. However much to my surprise, this was a great strain on my own arms due to the weight.
After a couple of minutes of chatting about soccer we soon arrived at the Dalla Dalla where another man he knew said he would help the man from here. I could not help feel that if I struggled to move him with 2 and 3 wheels on the ground, then the physical and psychological burden for this young man to do this himself everyday must be huge. There are hardly any pavements in Moshi, which leaves those who are wheelchair bound to ride on the rocky road dodging the mammoth potholes in every direction. It is far from ideal to say the least.
On a more brighter note this morning signalled a positive end to our week of NCD lectures. We had the pleasure of having a young gynaecologist named Dr Bariki L Mchome, talk to us about the health challenge of cervical cancer in Tanzania. 85% of cervical cancer occurs in developing countries, where there is 79,000 new cases per year, of whom 78% die due to late diagnosis and cancer malignancies. Compare this to the 48% whom die in Europe and we have a very start contrast between the two continents. However Tanzania was one of countries in Africa who have one of the highest incidence rates of cervical cancer. Even though there is not a national strategy in relation to cervical cancer, KCMC have began screening since 2005 targeting women aged over 25 through satellite clinics and local radio & TV advertisements.
I was initially very concerned to hear that women were being targeted so late, however my fears were soon alleviated. Dr Mchome went on to describe that within the last year there has been a pilot study targeting school children of 14 years of age with the HPV vaccine. If successful, this WHO and Tanzanian government funded project is hoped to spread to other regions and eventually become nationwide. Overall I was very pleased to hear that this project was put into place, and I wish the pilot study all the best with the research.
Friday 30th May - Alternative Medicine
Friday’s first lecture came on behalf of a University of Copenhagen student studying a BSc in Human Physiology. He had arrived the evening before to participate and collect data for a project which Dirk had been working on within the Masai community. The study plans to measure the effect of the month long cultural event ‘Orpul’ on the blood lipid profile of the Masai. Orpul involves eating between 1 to 1.5 kilos of meat each day for one month. The male Masais see this as a cleansing activity and a well deserved rest from their home lives. Furthermore the Copenhagen student will also be following the same diet, while taking daily food recalls, along with blood samples. It seems a very interesting and daring project for the young MSc student, who seemed very enthusiastic and confident in his abilities.
The following lecture was equally as interesting and diverse with a focus on alternative medicine (AM). AM is a topic which I previously came across with one of my sociology modules during my undergraduate studies. I enjoyed it immensely then and as a result I had high hopes for this current lectures from Christina Mutuya. It did not fail to disappoint but did provide quite a sobering insight into the Tanzanian AM perspective. I spent the lecture trying to work out whether the lecturer was just describing what AM meant in TZ, or whether she actually believed in some of the medically abstract AM. To elaborate the two AMs which stuck out to me were to ingest raw beef with alcohol to cure alcoholism and burn elephant dung to produce smoke which will treat epilepsy, seizure and fever children. However after a very interesting lecture, I was surprised to hear that the sociologist actually believed in these AMs. She gave an example of how her father in law had a fracture, went to hospital, was fed up with waiting for a month recovering, decided to use the AM method of applying a special porridge in a very specific longitudinal or rotational depending on location of the fracture, and he was fine a month later. Of course from a medical point of view this is a very unconventional method, but it’s a fact that 60% of Tanzanians use AM. Unfortunately this may have a negative influence on their ability to seek medical support relating to chronic NCDs. Christina stated that many Tanzanians were not comfortable with taking traditional medications for a long period of time. They would much rather seek a cheap, quick and convenient AM from a local supplier, rather than seek advise from the traditional route. This does not bode well for the lifelong chronic NCDs which is currently, and will continue to, severely challenge this region of the world.
The week concluded with a look at KCMC’s own nursing school. The facilities were of an impressive level, with specific focus on the simulation room, where I saw a mammoth amount of high quality anatomical models. It was also interesting to hear the intensive duration that full time nurses have to complete before employment is granted. Furthermore it takes a total of 8 years, which 2 are work experience related, to gain a degree in nursing. This is double the time seen in some developing countries.
Monday 2nd June - Money Talks
The start of the week was highlighted with the visit to the KCRI clinical research facilities. Majorly funded by the Gates Foundation, this was by far the best laboratory facilities I have ever seen. A newly built modern building, with copious amounts of space, with pristine equipment left, right and centre. Whether it be the latest microbiological equipment, genetic assay machines or the fingerprint scanners on every single door, this was a was extremely impressive, well funded facility. Even though it is great for the researchers and institutions to have such impressive equipment at their disposal, I could not help but think of the drastic contrast to other near by settings.
Even the well regarded TB clinic’s laboratory facilities weren’t even in the same league as what was seen today. One could only imagine the stark contrast between the research facilities and rural health facilities. I hope we get the chance to compare and build on this experience on Thursday’s trip.
Tuesday 3rd June - The End Is Near.
Today marked the end of formal lectures for the field trip and ultimately year 1 of the MSc course. It is a rather looming feeling to know that we are nearly half way through this course, and I just hope it continues in such great vain. Our final local lecturer was a gentleman named Dr Mtamakaya who spoke on the topic of health financing within TZ. The talk covered the major funding sources of the TZ health system along with the challenges and the search for solutions. However it seems they are in quite a predicament, and one which I did not foresee. Only 15% of the Tanzanian population are in formal employment. Of these two thirds are employed by the government and are directly taxed via their salaires. However there is 85% who don’t pay any taxes on a local level. Therefore where does the money come from for publicly funded services ?
Well it’s not the majority of people in TZ, but in-fact donors, who currently cover 60% of the healthcare costs. The rest is left to patients to pay out of pocket payments. Furthermore there is not much of a deterrent of those, such as market sellers or seasonal workers, to pay tax as their is limitations to the jurisdictional influence on punishing tax invaders. Once again I could not help this does not bode well for a country which is ultimately going to face a severe health financing strain with the predicted raise of chronic debilitating NCDs.
Dirk rounded off proceedings with a preparation lecture on the Maasai of Kenya and their ability to be protected against metabolic diseases. For someone like myself who has limited knowledge on the Maasais, it was very interesting to hear about the interesting aspects of their diet, physical activity and perceived inability to develop diabetes. Dirk concluded with some evidence from his own studies showing there was low prevalence of glucose intolerance among rural and urban populations in Kenya. He had also some interesting studies focussing on cardiorespiratory fitness and physical activity in Luo, Kamba and Maasai of Rural Kenya using the expensive Actopods. A very interesting lecture and a great finish to an enriching year of lectures.
Today was by far one of the highlights of the trip and here is the reason why. After a very 5am rise, we visited another small district hospital. However there was a sincere feeling of underwhelming. I think we had all expected to see a large contrast between the rural hospital and regional hospitals. This was not the case. To be quite frank, I failed to spot many large differences between the two. This was a good thing though, but many were a little deflated. My personal highlight was spotting a number of workers launching medical supplies off of a lorry and then into a storage room. You could be mistaken to think they were throwing a sports ball, rather than expensive life saving treatments.
Time did not stand still and we were soon off to the much anticipated Maasai retreat. We had to depart from the bus and walk around 30 minutes to reach the rural retreat. I wasn’t too sure what to expect before, but I was very surprised when we arrived. It was a very basic environment within a variety of trees and shrubbery. There was an area for sleeping, an area for eating, and a designated place to go to the bathroom. The 6 Maasai people seemed to be very friendly and were very happy to see us. They were dressed in a mixture of traditional and modern clothing. One man had a armani hat on, while many seemed to have mobile phones. The modern Maasai has even been touched by the new urbanised and globalised environment !
Two of the Maasai then began to slaughter two goats. With everyone eagerly watching, they opted to suffocate the goats by kneeling on the chest of the goat, and holding it’s mouth closed. They did not slit the goats throat as they did not want to waste any of the blood. They use the blood as part of a soup which many individuals later consumed. However as one of the students pointed out, why could not slit the throat of the animal over one of the many basins ? It would have been a slightly more humane way to kill the animal, rather than a 5-10 minute struggle.
However it was very interesting to see the dissection of the animal. Well at least from a geeky anatomical perspective, I was able to put my biology knowledge into use. Also when the Maasai said that they do not waste any part of the animal, they were not exaggerating. I witnessed them eating the kidneys raw, picking the eyes out with a knife for a ritual swinging round the head, along with the legs and liver for us. They called this ‘meat for the hyena’ which is given to people passing by. The meat was in-fact very nice. It tasted a bit like lamb in my opinion. Ok a little chewy lamb. Maybe a little over done, but I failed to spot the Michelin stars when I entered the retreat.
We also got to watch some traditional medicine being created. A number of leaves were ground up and boiled amongst a couple of pieces of special wood which was brought in from a nearby mountain. Furthermore we learnt that the Maasai people would frequently eat throughout the night during Orpul. This possibly provides one of the many challenges which the Danish MSc student faces during the data collection period. However he seemed very upbeat on his first day within the retreat, which I hope continues for as long as humanly possible.
Overall it was a very interesting visit and I felt very privileged to be able to have an insight into this unique population. I found the Maasai men very warm and friendly people. They seemed to be smiling a lot and loved the attention from the westerners. I wasn’t too sure if I could read the masculine aspect of the men we visited. Maybe I was looking too much into specifics. The trip was rounded with an organised traditional singing and dancing from another group of Maasai people, which lasted for nearly half an hour and included a lot of jumping. I suppose it is just one of those things you have to see. Not sure if I would pay for the pleasure …
Wednesday 11th June - Departures
As with many events throughout life, all good things must come to an end. Monday’s presentations weren't only an assessment, but a celebration of the hard work which we have all put in over the last 5 weeks. Even though it has been hard and laborious at times, I think the majority agree that it was an worth while task.
Our presentation was scheduled to be the fifth and final presentation of the day. However after an unusual nervous weight through the 4 initial talks, our time came and our performance was worth the wait. It was much to our relief that even though we had the ‘most ambitious’ study design of the class, there was a general positive feeling from both Dirk and Dr Mahande. Even though there was a mistake on my behalf of using the adult classification for BMI among an adolescent group, which severely irked my perfectionist characteristics, we survived relatively unscathed.
I have got to admit, I began to feel a bit sentimental by the end of the session. This was ultimately going to the last time within the course that we will have a class together. With everyone pursuing a personalised track in year 2, there leaves little time for us to all be in one room together. However I feel pleased, looking back at how far I have personally come with my knowledge within Global Health. It has been a really great 10 months. Furthermore the best of this year may still to come.
The day was rounded off with a rather disappointing meal at another curiously named Indian restaurant called ‘Milan’. Dubbed the best restaurant in Moshi, it served food in prison trays 90 minutes after ordering. The food may have been poor overall, but the rooftop cocktail bar provided a well needed sparkle to complete the trip.
To conclude the field trip was eagerly anticipated by the whole class from day one. Some may even say this is one of the motives to enrolling in the trip. I am happy to say that it was by far an anticlimax. The staff at KU did a fantastic job in ensuring that my first trip to Tanzania and SSA was one which I will never forget. Furthermore I feel I am able to put the mammoth knowledge I have gained within this first year into an appropriate global health context.
Thursday 15th May, 2014 - Group Work
Today was a relatively quite day, in contrast to the rest of week, with a panel discussion on health priorities within TZ. Ib, present with Dr Mahande, Dr Mahonde and Dr Sia created an interesting discussion around the health priories on maternal and child health, with the appropriate communicable disease measures. Although we knew there was a lack of prioritising and policy focusing on NCDs, we were baffled to hear that not only is mental health thrown into the same ‘health category’, but also injuries. Injuries are not diseases per se, and like mental health, warrant their own category to allow the appropriate health and non health resources allocated to it. Not simply chucked into the NCD spectrum, which is already at full capacity, close the lid, have a look inside from time to time, then close again. Dr Mahonde did mention that she believed in a couple of years NCDs would become a bigger health priority in relation to policy and implementation. She also confirmed that the health system is currently experiencing the NCD strain on healthcare resources. I can only hope those who wish for this to become true, overcome the political and mainstream barriers, and prevail in highlighting this essential health topic.
However considering this clinic is already considering the double burden of disease is a huge positive. Regardless of the superiority of funding within this facility, it is always a positive to see up to date approaches on the ground level, considering the lack of national policies focusing on NCDs within TZ. Furthermore the health facility has started to ‘open it’s doors’ by attempting to spread the workload of TB patients to other regional facilities, and only focusing on the most severe cases. On Ib’s last day, he made an interesting comment saying that in his experience, this approach of open doors ultimately impacts on the facilities health statistics. Subsequently this portrays negativity from policy makers and MoH and questions of effectiveness and efficiency may be asked. However their approach is forward thinking and maybe the double burden may come sooner than expected and ultimately may void this concern.
Secondly we had a brief glimpse at an Tanzanian psychiatric ward. I wasn’t expecting too much in relation to standards, and this was exactly the case. The ward seemed more like a jail institution to be quite frank, and reminded me of some images seen within western psychiatric facilities 50 years ago. However at least this regional facility had some sort of capacity to treat mental health patients, which is not the case in many SSA health systems.
Monday 26th May, 2014 - Emergence of NCDs ? False.
The lecture in the morning however highlighted again the interesting concept of the double burden of disease. Dirk provided an interesting overview of the relationship between under-nutrition and over-nutrition, CDs and NCDs, along with the double double burden of disease. Some interesting points were raised ultimately the gender differences in relation to weight in SSA. Often men are categorised as lazy and inactive in SSA, however they were significantly less overweight and than women, who were significantly more overweight. One of the major contributing factors relating to this is the physical inactivity in women is the associated occupational physical activity among men. Furthermore we talked about the racial differences amongst African Americans and West Africans, and the theory of Darwinian natural selection and survival of the fittest. The talk concluded with Dirk and Ib’s interesting research into the relationship between Malaria, low birth weight and the risk of DM and other NCDs in offspring. It was very enriching to return to the world of scientific concepts relating to histone modification, the barker hypothesis and skeletal muscle changes in DM. Overall a very enjoyable session and hopefully more to come throughout the week.
Wednesday 28th May, 2014 - How To Stop The Inevitable ?
The reminder of the morning was spent at KCMC's maternal and child health clinic. It was another interesting look into the workings of a LMIC MCH clinic, focusing on a variety of different areas such as child vaccination, pregnancy complications and family planning. However while waiting for our tour to begin, I found it very enriching to be placed in the same location as the mothers waiting to see a health professional. This outdoor seating area is filled with parasols, plastic chairs and plentiful amounts of soft drinks. This was no doubt one of the better waiting areas we have seen in the region, however it's quite a contrast to what is seen in the west. There was also only a few men accompanying their partners to the clinic. Interesting observations all round.
I was initially very concerned to hear that women were being targeted so late, however my fears were soon alleviated. Dr Mchome went on to describe that within the last year there has been a pilot study targeting school children of 14 years of age with the HPV vaccine. If successful, this WHO and Tanzanian government funded project is hoped to spread to other regions and eventually become nationwide. Overall I was very pleased to hear that this project was put into place, and I wish the pilot study all the best with the research.
Friday 30th May - Alternative Medicine
The following lecture was equally as interesting and diverse with a focus on alternative medicine (AM). AM is a topic which I previously came across with one of my sociology modules during my undergraduate studies. I enjoyed it immensely then and as a result I had high hopes for this current lectures from Christina Mutuya. It did not fail to disappoint but did provide quite a sobering insight into the Tanzanian AM perspective. I spent the lecture trying to work out whether the lecturer was just describing what AM meant in TZ, or whether she actually believed in some of the medically abstract AM. To elaborate the two AMs which stuck out to me were to ingest raw beef with alcohol to cure alcoholism and burn elephant dung to produce smoke which will treat epilepsy, seizure and fever children. However after a very interesting lecture, I was surprised to hear that the sociologist actually believed in these AMs. She gave an example of how her father in law had a fracture, went to hospital, was fed up with waiting for a month recovering, decided to use the AM method of applying a special porridge in a very specific longitudinal or rotational depending on location of the fracture, and he was fine a month later. Of course from a medical point of view this is a very unconventional method, but it’s a fact that 60% of Tanzanians use AM. Unfortunately this may have a negative influence on their ability to seek medical support relating to chronic NCDs. Christina stated that many Tanzanians were not comfortable with taking traditional medications for a long period of time. They would much rather seek a cheap, quick and convenient AM from a local supplier, rather than seek advise from the traditional route. This does not bode well for the lifelong chronic NCDs which is currently, and will continue to, severely challenge this region of the world.
The start of the week was highlighted with the visit to the KCRI clinical research facilities. Majorly funded by the Gates Foundation, this was by far the best laboratory facilities I have ever seen. A newly built modern building, with copious amounts of space, with pristine equipment left, right and centre. Whether it be the latest microbiological equipment, genetic assay machines or the fingerprint scanners on every single door, this was a was extremely impressive, well funded facility. Even though it is great for the researchers and institutions to have such impressive equipment at their disposal, I could not help but think of the drastic contrast to other near by settings. Tuesday 3rd June - The End Is Near.
Today marked the end of formal lectures for the field trip and ultimately year 1 of the MSc course. It is a rather looming feeling to know that we are nearly half way through this course, and I just hope it continues in such great vain. Our final local lecturer was a gentleman named Dr Mtamakaya who spoke on the topic of health financing within TZ. The talk covered the major funding sources of the TZ health system along with the challenges and the search for solutions. However it seems they are in quite a predicament, and one which I did not foresee. Only 15% of the Tanzanian population are in formal employment. Of these two thirds are employed by the government and are directly taxed via their salaires. However there is 85% who don’t pay any taxes on a local level. Therefore where does the money come from for publicly funded services ?
Dirk rounded off proceedings with a preparation lecture on the Maasai of Kenya and their ability to be protected against metabolic diseases. For someone like myself who has limited knowledge on the Maasais, it was very interesting to hear about the interesting aspects of their diet, physical activity and perceived inability to develop diabetes. Dirk concluded with some evidence from his own studies showing there was low prevalence of glucose intolerance among rural and urban populations in Kenya. He had also some interesting studies focussing on cardiorespiratory fitness and physical activity in Luo, Kamba and Maasai of Rural Kenya using the expensive Actopods. A very interesting lecture and a great finish to an enriching year of lectures.
Thursday 6th June - The Day of the Maasai
Time did not stand still and we were soon off to the much anticipated Maasai retreat. We had to depart from the bus and walk around 30 minutes to reach the rural retreat. I wasn’t too sure what to expect before, but I was very surprised when we arrived. It was a very basic environment within a variety of trees and shrubbery. There was an area for sleeping, an area for eating, and a designated place to go to the bathroom. The 6 Maasai people seemed to be very friendly and were very happy to see us. They were dressed in a mixture of traditional and modern clothing. One man had a armani hat on, while many seemed to have mobile phones. The modern Maasai has even been touched by the new urbanised and globalised environment !
Two of the Maasai then began to slaughter two goats. With everyone eagerly watching, they opted to suffocate the goats by kneeling on the chest of the goat, and holding it’s mouth closed. They did not slit the goats throat as they did not want to waste any of the blood. They use the blood as part of a soup which many individuals later consumed. However as one of the students pointed out, why could not slit the throat of the animal over one of the many basins ? It would have been a slightly more humane way to kill the animal, rather than a 5-10 minute struggle.
However it was very interesting to see the dissection of the animal. Well at least from a geeky anatomical perspective, I was able to put my biology knowledge into use. Also when the Maasai said that they do not waste any part of the animal, they were not exaggerating. I witnessed them eating the kidneys raw, picking the eyes out with a knife for a ritual swinging round the head, along with the legs and liver for us. They called this ‘meat for the hyena’ which is given to people passing by. The meat was in-fact very nice. It tasted a bit like lamb in my opinion. Ok a little chewy lamb. Maybe a little over done, but I failed to spot the Michelin stars when I entered the retreat.
We also got to watch some traditional medicine being created. A number of leaves were ground up and boiled amongst a couple of pieces of special wood which was brought in from a nearby mountain. Furthermore we learnt that the Maasai people would frequently eat throughout the night during Orpul. This possibly provides one of the many challenges which the Danish MSc student faces during the data collection period. However he seemed very upbeat on his first day within the retreat, which I hope continues for as long as humanly possible.
Overall it was a very interesting visit and I felt very privileged to be able to have an insight into this unique population. I found the Maasai men very warm and friendly people. They seemed to be smiling a lot and loved the attention from the westerners. I wasn’t too sure if I could read the masculine aspect of the men we visited. Maybe I was looking too much into specifics. The trip was rounded with an organised traditional singing and dancing from another group of Maasai people, which lasted for nearly half an hour and included a lot of jumping. I suppose it is just one of those things you have to see. Not sure if I would pay for the pleasure …
I have got to admit, I began to feel a bit sentimental by the end of the session. This was ultimately going to the last time within the course that we will have a class together. With everyone pursuing a personalised track in year 2, there leaves little time for us to all be in one room together. However I feel pleased, looking back at how far I have personally come with my knowledge within Global Health. It has been a really great 10 months. Furthermore the best of this year may still to come.
To conclude the field trip was eagerly anticipated by the whole class from day one. Some may even say this is one of the motives to enrolling in the trip. I am happy to say that it was by far an anticlimax. The staff at KU did a fantastic job in ensuring that my first trip to Tanzania and SSA was one which I will never forget. Furthermore I feel I am able to put the mammoth knowledge I have gained within this first year into an appropriate global health context.
Hi Jack, very good reading. Interesting to find that the campus you initially talked about was how good their computer system was and up to date kit, but the hospitals were understaffed and no computer system. Shame something couldn't be done to split the finances to help with medical care.
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