It is hard to describe how different life is here. I thought culture shock was a continuum of adjustment and I expected to resume right where I left off last time. I am learning that it is not a smooth process. There are ups and downs and lessons to be learned over and new ones to be encountered. I thought Don's clinic visits as a patient himself would be a good illustration.
But before I get to that story, I wanted to talk about the attached picture of Wema's three brothers with their computers. I decided they are welcome to use our electricity and WiFi on our patio. They seem fine with this and we are able to go about our day without feeling like we need to entertain them. From left to right are Orjantan, Ombeni and Herison. One issue solved!
There is something unusual about Tanzanian culture that will help to understand the clinic story. Our niece, who lived in TZ for an extended period, warned us about this and I am so grateful she did. It would take a long time to figure this out if someone does not explain it. In Tanzania it is extremely important to save face. In fact, it is more important to save face (avoid shame) than to tell the truth! It is apparently uncomfortable for someone to admit they do not know the answer to a question. This makes them feel shame and it helps explain why so much inaccurate information is given out. For example, if you ask someone for directions and they do not know the answer, they will tell you something whether it is true or not. In fact, we have been told it is better to say, "Do you know someone who might be able to give us directions to X?"
That is one reason we receive so much inaccurate information. Another issue is a general lack of communication mechanisms to disseminate changes in regulations or processes. We have experienced so much misinformation that it is easy to become skeptical. I often wonder if what we are being told is correct.
So, now to the clinic story. After Don had been off work and on antibiotics for over a week, the medical director at Selian where Don works suggested he should be seen by an ENT specialist at the medical center downtown (ALMC: Arusha Lutheran Medical Center). Having no idea how to find such a specialist, we first tried the web site, but that was not functional. We tried calling but there was no one who could provide that information. So we decided to go in person and look for someone who could give him an appointment.
The first person I asked pointed us down the hallway, "It is the third window on the left." There was no third window. So we went to the lobby to ask at the main reception area. He said the first step is to get an appointment with a primary care doctor who would then make a referral to an ENT specialist. I explained that Don WAS a doctor and he needed to be seen quickly so he could get back to treating patients. He said, "But that is our SYSTEM! This is how it works!" He sent us down a different hallway to a window to get an appointment.
This window was totally jammed with people. It was hard to know where to stand because there was no line, just people packed in about 8 across and 4 people deep. We stood there feeling hopeless. Then I recognized an American surgeon on the other side of the glass. I got his attention and asked him to come out in the hallway. I told him we needed help to get an appointment with ENT and he gave us a sad look. He said, "Well first you have to get a file and then you have to be seen and then you get a referral." I asked, "How do we get through this line?" He said, "You push and shove your way to the front the best way you can!" He left us standing there and said he would see if he could help. We gave up after awhile because there was no movement.
We walked back to the lobby and found Dave, the surgeon, talking to the main reception person. Dave managed to find out that the ENT specialist would be in on Friday and he created a file number for us and even got an appointment for us for 9:00! Our file number and the appointment time was written on a little piece of cardboard that we took with us. I asked the receptionist if 9:00 meant we would be seen then, or if we should come earlier than that to put our name on a list. I wasn't sure what a 9:00 appointment actually meant. He did not seem to fully understand the question, and said 9:00 was THE APPOINTMENT, but it wouldn't hurt to come early. (I remember when I brought Herison for his eye appointment last summer that by arriving at 8:30, we were last on the list and he was not seen until 2:00!) I was skeptical.
So in spite of being assured that we had an actual appointment to be seen at 9:00 on Friday, we chose to arrive at 8:00. The waiting room was already full of people sitting in the chairs. Only one person was in line at the window. We got in line behind her. That is when we realized there was no one on the other side of the window. No worries! We would just wait.
When the staff person came to the window, there was an instant stampede to the window! The entire waiting room crushed the window! People shouldered past us on both sides! All of a sudden we found ourselves in the middle of the pack! I must have had quite the shocked expression on my face because the staff person looked right at me and he could stop laughing. Finally he stood up and said, "Daktari, please come!" He recognized Don and let us into the clinic...and he continued to laugh. He said to me, "Welcome to Tanzania!" He asked what we needed and we told him we had a 9:00 appointment to see the ENT specialist. He shook his head and said, "So sorry! He does not come until the afternoon." We were prepared to just wait, but he encouraged us to go home and he gave us his phone number and told us to call him at noon. It took a couple of phone calls but finally he said, "Come now!"
Once we arrived, it wasn't long before Don was seen. Don had effusions in both middle ears and was prescribed two new medications. The infection was gone, but the hearing loss was due to fluid that needs to clear. From there we went to the hospital pharmacy to fill the prescriptions. We were told, "out of stock." So we had to find another pharmacy. We are used to hearing "out of stock"or "don't have"or "not today" often and it doesn't matter if we are shopping for groceries, hardware or medicine.
So, that's how things are in a third world country. Plus, things break more often. Already our car has been fixed 4 times in the month we have been here! In fact it is in the shop today. In addition, I have been stopped by the police 4 times. They just randomly pull people over to check for proper registration and insurance. I wish they would spend their time enforcing traffic laws (it is unbelievable how many cars go the wrong direction on one side of a median!) or directing traffic at problem intersections to keep us safer!
Last time we were here, I had a hard time in the beginning coping with all the dysfunction and chaos, but after several months I got used to it. I assume that will be the case this time as well. It is funny how many of the differences are interesting and enlightening. It is the inefficient, unreliable, broken stuff that is so wearing. Everything seems harder than it should be. Even people who have lived here a long time agree that this is not an easy place to live. So, in the meantime, until I adjust better, I vow to appreciate all the beautiful things here that we do not have at home.... like the BEST avocados off a tree in our yard!
By the way, Don now has an appointment to receive a hearing test in Moshi at KCMC (Kilimanjaro Christian Medical Center), a regional medical center, on Thursday. The ENT specialist wants to rule out sensory nerve damage because of all this fluid and his poor hearing. He IS better, so I am trying not to worry about that!
Last weekend was a welcome respite at a tent camp near Lake Manyara with Erik, Bernice and Nashesha. I never tire of seeing the Maasai with their cattle along the route. They live so simply and are so beautiful. I have much to learn about their culture and I am trying to be grateful every day for the opportunity to be here.
❤️Debi
