Tanzania: A Visit to Moshi, Tanzania - Karibu!
Updated: Sep 2, 2019
Nimmi Ramanujam, PhD, Director
This is what I heard all around me during my visit to Moshi – a small city near Mt. Kilimanjaro with warm people and an incredibly lush landscape full of exotic plants and animals. The goal of my short trip was to visit the Kilimanjaro Christian Medical Center (KCMC) to start a cervical cancer-screening program with the director of the reproductive health center, Dr. Olola Oneko. My bigger goal was to gain an appreciation of the health care system in Moshi and be able to meet women in different socioeconomic settings.
During the initial part of my visit I spent time at both the reproductive health center clinic where cervical cancer screening is performed and also in the women’s ward of the main hospital. I was surprised to find out that the reproductive health clinic was one of the few facilities in Moshi that actually did cervical cancer screening, which we take for granted in the U.S. However, when I went to the women’s ward at the main hospital I witnessed a more somber scene. I witnessed middle-aged women with late stage cervical cancer who were getting palliative care. The significance of the reproductive health center and what it is doing for cervical cancer screening cannot be overstated. Our hope is to launch a new technology that we have developed called the transvaginal colposcope which is inspired by the form factor of a tampon and a spy pen to provide low cost cervical cancer screening without a speculum. Our goal is to test this technology on women undergoing cervical cancer screening at KCMC but ultimately, we would like to bring this technology to the community health setting.
While I was in Moshi I wanted to visit the Majengo primary health center, run by the government, to see exactly what they do there and whether patients come to get care at this facility. Dr. Mariki, a very pragmatic and articulate physician, is the director of this center and sees approximately 100 patients a day and he is one of 6 physicians. When I waited for him in his office, I was looking at the list of the top 10 health issues in individuals under 5 and adults, and most of them were related to infections. When I toured the facility and saw the patients that were lined up in the hallways, Dr. Mariki showed me a basic but well run facility that utilized its resources maximally. Clearly children under 5 and pregnant women were a high priority as well as patients with HIV. The clinic was completely full of people with patients waiting in long lines to see the physician. It was great to see that the primary health center was being maximally utilized by the local community members. When I asked Dr. Mariki about cervical cancer screening, he took me to a tiny room with a bed and stirrups but then he said, none of his staff had cervical cancer screening training. One could argue that this is not a priority given the plethora of problems patients have but when thinking about a community where education about diseases like HIV is increasing and treatment is provided, it is only logical that cervical cancer screening and treatment be part of the care provided to women who are at high risk for contracting HPV from their sexual partners.
I also found out that there is even another level of health care delivery in the East African health care system called a dispensary which does the absolutely most basic level of diagnostics and care and also has a pharmacy on site to dispense drugs. I went to one such privately run dispensary, called Pamoja Tunazewa (Together we Can). This was actually founded by a Canadian nephrologist from Queens University that wanted to focus on women’s health in Moshi. Like other dispensaries this one had a small clinic with a medical officer (physician) who sees patients, and a dispensary that makes commonly needed drugs available to their patients. But what was special about this dispensary to me was its focus on women’s health. There were studies ongoing at the time that I was there that used Iphones to image the cervix in women for cervical cancer screening-a grassroots effort to get cervical cancer screening launched at the community level. I am very excited to have been able to initiate a collaboration with this organization to incorporate our transvaginal colposcope into their cervical cancer screening program.
My journey through these different health systems ultimately led me to the women at the community level. If we are thinking of delivering health care at the community level I needed to understand what it is like to be a woman living in a village in Tanzania. I went to a small village of 120 families called the home of the cow or in Ki Swahili Boma Ngomba. I met a 50 year old woman, Domina, who was kind of enough to answer many of my naïve questions and show me the environment that she lives in. Domina lives in a beautiful village that is surrounded by vegetation and crops, mainly maize and sunflowers amongst other less common crops. Her family has and still owns a small plot of land that they use to do self-subsistence farming and to sell for other basic domestic needs. Her family had built a small mud house and had made a hole in the ground to use as a latrine that was right in front of her home. She had a separate wooden structure with a tiny window, which served as a kitchen with literally enough space for one pot. Her family also has a stall with cows, goats, and a duck or chicken pen. It was interesting to see that there was progress in the village towards a better quality of life. The villages appeared to have moved from wooden structures to mud for their homes and progressed from pit latrines to brick structures that provided privacy, albeit without any real plumbing (there was one being constructed right next to the hole in the ground where Domina lives). When I asked Domina what her top three priorities are she said electricity (they have no light and it costs 2000 schillings for 8 hours of a kerosene lantern and the median income for this community is 60,000 schillings per month), access to water at the home (although the government does provide a central water supply) and some kind of opportunity for work when the harvest is over for the year, which can be a period of 4-6 months when they don’t have income from their crops and animals.
As I reflected on these interviews, the topic of health did not cross my mind as much as basic engineering skills and the empowerment of women to have the things they needed. Could we train members of the community and in particular women, who are the ones that have many of the domestic responsibilities to be able to build tools and in particular light sources using renewable energy? By engaging Duke students in helping teaching women in low resource communities how to build and use light sources, there is an opportunity to immediately improve their lives, shift conventional thinking that engineering is really a man's job, and to get Duke students to be involved in an activity where they have the opportunity to design and implement a technology for the greater good with immediate impact.