Granola bars, patience, and perseverance in Tanzania

Ashley Waring, MD shared her experience in Tanzania with Her Excellency Ambassador of the Embassy of the United Republic of Tanzania Liberata Mulamula and Tanzanian Economic Affairs Plenipotentiary, Paul Mwafongo during a dinner reception hosted by MUSC's Heart and Vascular Board of Directors.

By Ashley Waring, MD

My name is Ashley Waring, and I’m currently an Internal Medicine intern at MUSC. I want to start with a few words I heard many times in Tanzania, “Karibu,” which means “welcome”. And I wanted to say to Ambassador Mulamula, “asante sana” or thank you for coming to Charleston. We are very honored to be here with you tonight.

I was the first MUSC medical student to rotate through the heart hospital at Muhimbili in Tanzania. My experience was made possible with grants and funds, and I know that these will continue to support future students. Before I left for Tanzania, I spent a great deal of time organizing what I would bring with me. There was what I would physically bring with me: clothes, toiletries, my stethoscope, and of course, 100 granola bars from Costco. But there was also what I was hoping to bring as a student volunteer. The goals of my trip were to work on a database for the new cath lab and also round daily with the hospital team on the cardiac patients. For me, it was an incredibly sad and poignant experience to see all of the young men and women, many of who were younger than me, with crippling heart disease, mostly from rheumatic heart disease, which essentially no longer exists in the US anymore. Honestly, I must say that what I had to offer Muhumbili as a volunteer was meager compared to the values and lessons I brought back home with me.

First of all, I learned the value of resources. As we all know, there are currently financial strains on the US health care system. There is a campaign at MUSC called “Choosing Wisely,” which encourages physicians to only order tests that are absolutely necessary to help guide the treatment plan of a patient. In Tanzania, when the patient can afford one diagnostic test and there are just a handful of medications available, the physician’s only choice is to choose wisely.

Second, I discovered the significance of being exposed to a different culture and health care system. When students are exposed to the same patient population, the same diseases, the same drugs, the same hospital, the same ocean of diagnostic tests, thinking becomes stagnate. Observing differences, making comparisons, asking questions, and thinking creatively can all be expected from international experiences, whereas staying within the boundaries of what is familiar and comfortable only provides more of the same.

Third, I rediscovered the fundamentals of being a physician. As a foreigner that didn’t speak Swahili (except for a few greetings like “jambo” and “habari”), often I found it frustrating not being able to talk with patients. More importantly, many of these patients had severe valve disease with such a poor prognosis that I don’t know what I would have said to them even if I could speak perfect Swahili. For the sickest patients across the world, words are sometimes meaningless. At Muhumbili I was reminded that eye contact and a sympathetic touch are a different brand of healing, often forgotten in the bustle of US hospitals.

Finally, when I was packing my suitcase to return home after one month, I had 5 granola bars remaining, my stethoscope, and a new 10 lbs. wooden elephant carving. To me, this elephant is more than just a decorative reminder of my experience in Tanzania. But when I take a step back and see how far this project has come, it is a reminder of the two characteristics my mentors Dr. Powers and Dr. Zwerner possess and those are patience and perseverance. Elephants walk the expansive Serengeti slowly, but strongly and steadily with purpose. Progress in medicine and volunteer work is not made with gazelle leaps, but over time with an elephant stride.

I will end with the inspiring words of anthropologist Margret Mead, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.”

Asante Sana