The Reality...

Village clinic… 6 hours… 15 patients… 1 birth… 10 cases of severe untreated hypertension… a few upper respiratory infections diagnosed as “malaria”(a common misdiagnosis) treated with strong quinine drugs… 1 case of undiagnosed congestive heart failure that was diagnosed as the flu… a lot of women with back pain after working 14-16 hour days at home making 3 meals a day over a woodfire stove, cleaning the house, and taking care of the children (maybe up to 8 of them)… also tending to the village farm, carrying buckets of water, baskets of maize, and bushels of bananas on their heads… and not complaining for a minute about their physical pain or emotional exhaustion… I think they all need a vacation in Zanzibar… that’s my vote… a vacation for all the African Mamas!

And sweet little 2 year old sister Karyn… what a doll… with a gaping wound on her leg that is finally healing, probably after an infection and subsequent treatment with the wrong antibiotic… which leads me to the point of this blog…

Medication given out like candy… improperly managed… and frightfully dosed with as many as 5-10 medications at a time… just in case it’s the common cold… just in case its malaria… just in case it’s a bacterial infection… and to top it off… let’s throw in a mix of pain-killers… take your pick… why is this okay?… a country so desperate for healthcare… they will “take” anything they can get… and where is the medication coming from?... where is it manufactured?... hmm?

The frustration is mounting… but I knew this before I came to Tanzania… but the reality, when faced with it on a daily basis is frightening… I have asked myself the same question every day for 5 months… what is the point?... does Tanzania or Africa actually benefit from foreign aid?… Is there a way to actually help through empowerment so the country can stand on its on two feet one day?... Tanzania only received its independence 40 years ago… it is very much a “developing” country… but developing toward what? 

So as a native Oregonian, from possibly the most granola, tree hugging city in North America--Portland, I admit that I am a bit of an idealist… where is the recycling?… even more so, where is the waste disposal system?… how about compostable toilets?… where is the solar power?... where is the bio-gas?... where is the “green” building?… organic farming?... good live music?... I will get off that soap box for now…

As a doctor here, it is impossible to not pay attention to everything that affects health which in turn means you learn about politics, religion, history, infrastructure, technology, business, natural resources, socioeconomics, agriculture, water, human nature, and the value of life… wherever you live on earth…

So for now, I will stop the rant and move forward with eyes and ears open to the truth… I am here to learn and see about the long-term potential to integrate natural medicine, rooted in prevention and education, in Tanzania—where there is profound need and abundant natural medicine resources...

Paving the way for the return to natural medicine in Africa and integration into an otherwise failing medical system here in Tanzania is like trying to move Mt. Kilimanjaro with a shovel… That being said, I am working on doing what I can… I can only hope my colleagues have the opportunity to experience this in the future after more groundwork is done in the village here in Moshi… I am honored to be among one of the many volunteer doctors here… and congratulate all of those in the pursuit to improve global health standards…

moja kwa moja (one by one)…

"Let food be thy medicine, and let thy medicine be food." Hippocrates

Chakula ni Dawa or Food as Medicine

On a 2 mile walk to work at a clinic in the nearby village called Kidia, I noticed an “alien” looking tree amongst the forest canopy.  Turns out it was a papaya tree, and they happen to grow here natively throughout the village amongst banana, mango, and avocado trees to name a few.  It’s truly the Garden of Eden here. 

I have started teaching classes once per week to the mamas here about how to use foods that grow locally as medicine to treat and prevent infectious disease and several other chronic ailments.  Papaya is well known for treating parasites, worms, and other gastrointestinal infections—one of the main health problems in Sub-Saharan East Africa.  Papain is the main active constituent in Papaya, an enzyme that digests proteins in the gut when eaten without causing harm to the intestinal lining.  The papain breaks down the protein in worms, physically denaturing and killing them while helping to flush them out of the body.  The unripe fruit and the seeds contain the most papain. 

“Green” or unripe papaya can be made into a salad commonly made in Thailand with tomato, carrot, peanuts, lime, chili, and usually fish sauce.  In the version of the salad I made with the village mamas, I left out the fish sauce and added crushed fresh garlic, ginger, and a little honey for added health benefit.  The garlic is antibacterial and ginger stimulates appetite and is known as nature’s best nausea treatment.  The mamas and the watoto (kids) loved the new recipe.

The plan is to start creating local affordable medicinal food recipes like this to incorporate in the diet of school age children who most commonly have gastrointestinal infections, especially worms.  Intestinal infections can cause a lot of damage to the health and development of children due to problems with malabsorption of nutrients and subsequent malnutrition leading to poor immunity. 

Using food as medicine in Tanzania makes more sense than throwing drugs at a problem where they are often not affordable or available and may cause of number of adverse reactions.  Furthermore, there are not enough doctors or qualified healthcare workers to manage medication so health education to prevent disease naturally makes more sense. 

Mebendazole, a relatively harmless drug, is the common treatment for intestinal worms.  It is given to most children every few months and is quite affordable here but not always available and does not prevent further infestations.  The drug works by poisoning the worms.  I have noticed here that the medication has been incorrectly dosed several times.  Incorporating healthy antimicrobial foods into the diet can further prevent worms from making their home in the gut and can help clear them from the body between doses of Mebendazole.  Papain is also available in many digestive aid supplement formulas but are not available in Tanzania—yet!

Future Food as Medicine classes in the village:

Processed Foods:  The Effects of a “Civilized Western Diet” in Tanzania

Table Salt vs. Sea Salt:  Thyroid Problems in Tanzania

Food Sanitation and Hygiene:  From Seed to Mouth

Diet for Diabetes and Hypertension:  The Reality in Tanzania

Future Public Health Education Classes:

HIV/AIDS prevention:  “Prevention is Better than Cure”

Malaria, Immunity, and Artemesia

Women’s Health in Tanzania:  The Foundation of the Family

What’s in the Water?

More to come!

Live and Let Live

Exploring East Africa and the healthcare situation here has been an eye-opening experience on every level.  I just celebrated the first year behind me as a naturopathic physician- an unconventional year filled with travel, fieldwork, and new horizons not for the faint of heart.  After 4 months living in Tanzania traveling, working, and searching, I found a new home for the next several months. 

I awoke this morning to children singing in the primary school next to my new home in Mowo Village, not long after the roosters and bush babies (monkeys) woke me up before sunrise.  One of the mamas’ here made chai, chapatti, and mango for breakfast while I waited to visit with the village secretary to discuss plans to begin work and finish the construction of the clinic that has been sitting as an empty concrete shell since 2006.

By mid-afternoon, the cool cloudy mountain air was burned off by the hot sun and I had already been visited by a handful of the mamas in the village hoping for treatment.  By 5pm this evening, a heavy tiredness hit after a 6 hour bus ride to the village yesterday and I enjoyed an afternoon siesta, a luxury that probably will not last long.  Again, I pleasantly awoke to more singing.  This time it was choir practice from the nearby church.  I will go for dinner now, probably ugali and marage (cornmeal porridge and beans) before evening yoga in my favorite spot that looks over the valley covered in pine, banana, and acacia trees high above Moshi Town.

Mowo, population 3000, is set amongst the foothills of the “Roof of Africa”, Mt Kilimanjaro, at an elevation between 5000 feet and 6000 feet.  It is the last village before entering the forest to climb the mountain that summits at over 19,000 feet.  On a clear day amongst the cloud-forest of Mowo, one can catch a glimpse of Mt. Kilimanjaro’s snow-capped peak and also view the valley floor of sunny Northern Tanzania overlooking Moshi Town, where I will frequent once a week to have a real latte made with locally grown coffee and check emails.

I hope to spend the next couple of months gathering health information and working in a relatively nearby clinic, as part of my post-doc fieldwork in natural medicine.  I say “hope” and not “plan” as Africa will laugh in your face if you attempt to make a plan.  So with that in mind, I will head in the general direction of my dreams.

Whatever this adventure brings, this has been a true test of patience and being human and really understanding what one can live with and live without.  I hold many stories close to my heart, some of which pictures and words can do no justice.  Going weeks at a time with minimal modern conveniences and spotty communication with frequent power outages (hence the infrequent updates) has brought me much closer to nature.  I humbly respect the power of solitude, culture shock, and homesickness that is only overcome by the joy of connection with humanity and all of its many struggles. 

"East Africans Cannot Afford the Luxury of Falling Ill"...

...as the headline reads on the front page of the East African newspaper...

Tanzanians have been flocking in droves to the village of Samunge near Loliondo, Arusha.  Locals, foreigners, politiicians, rich and poor are making their way by car, bus, helicopter and foot in hopes of a “miracle cure” from the 76 year old Reverend Ambililkile Mwaisapile.  The Reverend claims that last August he began having vivid dreams with instruction from God to deliver a specific herbal remedy to help alleviate suffering from many diseases such as HIV/AIDS, malaria, TB, and a host of other chronic conditions.  

Reverend Mwaisapile charges 500 TSH per cup, equivalent to 33 cents US.  The earnings pay for expenses to cover the cost of production with the rest going to the church.  According to the Reverend, a prayer must be delivered with the cup to be effective and each person is limited to one treatment.  There are many “healers” that are emerging with the same treatment as the Reverend throughout Tanzania and are charging a myriad of rates for the same remedy. 

The decoction is made from the roots of the Mugariga tree and has recently been proven to be safe for human consumption.  It is taken as a warm drink after one hour of boiling.  This tree is understood throughout Africa and by many researchers to have medicinal value and is currently being researched in terms of efficacy.  The root is credited to have anti-diarrheal, anti-emetic, and anti-helminthic properties.  

Many people have abandoned their HIV/AIDS anti-retroviral drugs (ARV’s) in search of the “Loliondo cup.”  Thousands claim to have been cured and some have died as a result of going off their recommended medication.  Nonetheless, people from far and wide have come for a cure or prevention.  The road leading toward Loliondo has been crowded for months and Mwaisapile is seeing an estimate of 2000 people per day.  As Tanzanian health and government authorities are struggling with what to do about the situation, many now recognize the importance of traditional herbal medicine in Tanzania.

The case of Loliondo is a testimony to the lack of adequate healthcare in Tanzania.  Tanzania ranks as the 12th most impoverished country in the world and is among the lowest doctor per person ratio in Africa with estimates between as little as 1 doctor for every 20,000 to 50,000 people.  The global average is about 1 per 1000 people.  In addition, there are very few specialist doctors in Tanzania and most hospitals and clinics are poorly equipped to handle the patient load.  With many foreign doctors coming to Tanzania and many Tanzanian doctors leaving, the situation does not lend to sustainable healthcare.