Pemba!

The aroma of Zanzibar spices and fresh vegetables is filling our dining area as May prepares our curry meal for dinner. She’s one of my classmates from Australia who has, through her offer to cook dinner, become even more popular this evening – each of us has peeked into the kitchen one-by-one to half-sincerely offer to help, but more so to check in to ensure our spot at her dinner table. Tonight is the first night we have had a long rain, providing a calm evening for our hostel to dine together and catch up.

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Malaria was the major theme of the second week. Our main professor practiced as an Infectious Disease physician and studied Malaria for over four decades. He retired just three weeks prior to joining us for his week of lectures. Most fascinating, he was part of studying the malaria vaccine. It was particularly eye opening to hear him, the academic, the expert, point first to the importance of access to basic healthcare, existing medicines, and public health infrastructure, before more advanced studies on new treatments or vaccines that are either too expensive to be rolled out any time soon or not even very effective.

The middle of the week, instead of exploring three cases in-depth, we rounded rapid fire on about 8 cases within 2 hours.  Case 1: Tuberculosis. Poorly treated the first time, and concern for a multi-drug resistant case, perhaps with an overlying cancer. Case 2: Lymphoma, but we could not investigate further due to lack of pathologist. And even then, there is no access to even basic chemotherapy here at this regional referral hospital. Or an Oncologist. Case 3: Acute onset lower extremity neuropathic symptoms. No MRI machine. No X-rays completed yet due to cost.

You get the idea. It can be gut-wrenching and it’s simply not fair.

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Today was a full day of presentations, hearing about each small group’s one-week (week 3) rural placement. One group studied palliative care and end-of-life beliefs amongst Maasai villagers, another studied malaria rapid diagnostic test use amongst physicians and traditional healers, and another focused on battling malnutrition.

My group traveled to Pemba, the northern of the two major islands that make up Zanzibar. We spent the opening weekend at the apparently infamous “Biederman’s Farm.” The farm excursion was a 2.5-hour bumpy dirt ride from Tanga, and came with fresh cold milk and cheese that we think was properly pasteurized. Mr. Biederman has lived there for 50 years, following an initial placement on the Tanzanian coast by his engineering firm. His property is dotted with barrels of mosquito larva-eating fish that Dr. Albert Schweitzer reportedly introduced to him (?) and swore by as protection from malaria. We spent hours swimming in the incredible warm water of the Indian Ocean, where the stressors of real life back home finally washed away. Some take a few days to really relax on vacation; I took about 12 days to be fully on board here.

The following day we flew to Pemba on a 14-seat plane. A couple cold beers at the airport treated the pre-flight anxiety. The safety demonstration was two sentences. The 20-minute flight ended safely and we were eventually delivered to our destination – the Public Health Laboratory (PHL) guesthouse. Zanzibar is largely Islamic as evidenced by the more conservatively dressed women and the 0445 calls to prayer.

The PHL was originally started by an Italian NGO but is now well integrated into the Zanzibar Ministry of Health (MOH) and its public health campaigns. Zanzibar is actually its own “country,” depending on who you speak to, and is part of the United Republic of Tanzania, but its Ministry of Health functions autonomously.

Health spending in Zanzibar reaches $13 per person per year, versus $3600 and $8600 in the UK and US respectively. Stop and think about that. I didn’t accidentally add or omit zeros.

Our hosts provided lectures on schistosomiasis, water quality, the Zanzibar health system structure, and sanitation, and then we set out on field trips to see some water quality measurements and latrine construction in action. In the evening, we ate our home-cooked meal, played Mafia, and watched the British TV favorites of The Inbetweeners and Fawlty Towers. I had forgotten about Mafia, played when I was younger, but when 11 physicians from different countries are put in a dry guesthouse with little else nearby to do, Mafia proves quite entertaining.

Thursday evening ended with a lavish thank you dinner for our hosts at a nice hotel. We mixed with another group of consultants and funders in town from the UK and US here to assess the Millennium Village on Pemba. Our hosts were actually key leaders in the implementation of the village, selected as one of the poorest in the world. Some of our hosts sat at the consultant table for political purposes while others chose to sit with us to avoid the formal chat. 2015 will be the final year of the Millennium Villages Project and it is when the Millennium Development Goals will essentially “expire.” The Pemba village appears to be on track and the funders seemed pleased with the results in this penultimate year.

And then came Friday night. Friday we flew another short flight across to Unguja (the main island of Zanzibar) to join forces with two of the other small groups. After completing our write up of our project on shistosomiasis, and traveling hours longer than expected, we arrived after dark at the guesthouses on the beach of northeast Unguja. We threw down our bags and walked 10 minutes down the beach to join the others at happy hour – and you would have thought we were heroes returned from battle! Clapping, hugs, kisses, high-fives! I think we surprised ourselves by how happy we all were to be reunited.

It has always struck me how quickly people can become close and build relationships. During times of stress, people seem to need each other. And when the group starts off with baseline commonalities, they start from an advanced position due to an existing high level of trust. Fraternity pledgeship. Residency training. Summer camp. Whatever the experience, it’s a powerful pull that is difficult to put into words and it’s exhilarating to be in the middle of it.

We spent the final night on the beach taking in the clear view of the stars and rising moon celebrating our classmate’s birthday. After blowing out her candles on the dry chocolate birthday cake, she wondered aloud: “I wondered today if this might be the best birthday I’ve ever had. And I think it is.”

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Dinner is ready. Thankfully, I’ve contributed some wine and a chocolate bar for dessert.