“After our Dispensary Health Board collaborated with us to buy an ambulance through cost-sharing, all the other communities in the district are demanding an ambulance as well.” – Administer, Tabata Hospitali
The first week of the Health Project has reiterated and exceptionally illustrated the misleading and myopic assumption that development is a process of the “first world” aiding the “third world.” Development theories often negotiate the classic debate on aid through the lens of Jeffrey Sach – a proponent of Millennium Villages – and William Easterly – his book “The White Man’s Burden” discusses the harm that Western aid propagated. However, little discussion hinges on what can be learned by developed countries from developing countries. Yes, the patronizing rhetoric of the poor as happy with little is often used to help guide the moral compass of the privileged. Such statements rest of the assumption that developing countries have little to contribute other than their ability to be happy in resource-deprived conditions. A quote from Poor Economics aptly summarizes this notion – “If the poor appear at all, it is usually as the dramatis personae of some uplifting anecdote or tragic episode, to be admired or pitied, but not a source of knowledge, not as people to be consulted about what they think or want or do” (Banerjee and Duflou, 2011).
Last week, the Health Team visited Tabata Hospitali a dispensary in the Ilana Municipality of Dar es Salaam. We learned of their remarkable community-based measures of ensuring not only access to healthcare, but also the monitoring of diseases like HIV/AIDS and tuberculosis. As a resident of the United States, and having worked in inter-city community clinics in Philadelphia, our meeting with Tabata Hospitali was a humble reminder. The United States is a country that provides a significant amount of aid towards healthcare in Tanzania. However, seeing many of Tabata Hospitali’s community-based initiatives, I would definitely argue that the United States could learn from some Tanzanian healthcare practices.
The Health Team learned the intricate community frameworks that are interconnected with nearly half of the dispensaries in Dar es Salaam. Home-based carers, for example, monitor the treatment of HIV/AIDS by tracking drug compliance. Home-based carers then relay this information to public dispensaries, which attempt to minimize patient loss to follow-up. Not only do these carers serve as an essential linkage for compliance, but they also decrease stigma towards HIV/AIDS. These carers, often themselves being survivors, through the narration of personal experiences, encourage community members to seek treatment.
Additionally, a group called the Dispensary Health Board, consisting of community volunteers, advocates for the community to dispensaries and district-level officers. The Dispensary Health Board of the Tabata Hospitali used cost-sharing to build a new facility at the dispensary as well as buy an ambulance! Community driven outcomes like investment in both an ambulance and increased outreach systems is phenomenal. Our team hopes to understand such existing frameworks and collaborate with community partners to co-create new initiatives.
Circling back to the discussion on the necessity for the exchange of knowledge both from designated “developing” and “developed” nations, the Health Team’s experiences at Tabata Hospitali clearly demonstrate the power of national support in community driven infrastructures. The incorporation of such systems in the healthcare system of the United States and other such developed nations could significantly increase preventative practices and community-based advocacy. The ideas for such exchanges are boundless, but for now as the Health Team attempts to learn and co-create in Tanzania, we will remain humble and ensure a true exchange is kept in the forefront of our mind.
Sonya Davey, Health Project Director