August 3: Today we visited the Dareda Kati public health clinic. It is located in one of the busiest parts of the village, not far from the road that stretches all the way to the major city of Arusha and to Mt. Kilimanjaro International Airport. Travel to Arusha and the airport on that road was grueling until the past few months, when World Bank money, Chinese engineers, and Tanzanian laborers completed a tarmacking process that had taken several years. During our time in the village in 2011, every dwelling or shop that stood too close to the old, potholed dirt road bore a huge painted X, crudely incised through the building’s heavy overcoat of dirt borrowed from that road, which warned of its impending destruction. A knowledgeable local resident assures us that, thanks to the lavishness of the World Bank, the owners of the vanished homes and shops were compensated at above-market rates. But even if they had been underpaid, I suspect that sympathy for them would have been in short supply in this community. The pressure in favor of a faster, smoother, cleaner way to get to bigger markets for goods and labor was irresistible.
Although the drive to Arusha will eat up most of a morning or afternoon, the district capital, Babati, now can be reached in half an hour. A teacher who makes her monthly trip to Babati to the bank that the government has authorized as the teachers’ paymaster may still find that the bank’s computers have failed, necessitating an empty-handed return to Dareda Kati. Maybe the teacher’s pockets are also empty after buying the one-way fare to the big town. But in case she cannot find a friend to lend her the fare back, she will be much happier to make her exhausting walk—don’t put it past the capacity of a healthy African who has acquired some experience of village life to travel thirteen miles on foot—beside a paved road.
The World Bank that paid to make the journey from Babati to Dareda Kati so much nicer, whether by tire or shoe, overlooked the public health clinic which serves forty thousand people in Dareda Kati and a number of surrounding villages. With money provided by Karimu (www.karimufoundation.org), the clinic is adding the first shower, the first sinks, and the first three toilets it has ever had. These will not be pit toilets, but modern flush toilets.
However, Martina Hando, the nurse in charge of the clinic, says it needs two more sinks than the architect’s plan stipulates, and we think she is right. Construction is only part of the way along, so altering the plan to include the extra sinks should be easy.
The clinic has other needs, though: for example, it has no doctor. Sadock Wilson Bilalama, who was called “Doctor,” was not one, but he did have more medical training than did Martina or any of the other nurses whom he supervised. Sadock wished to become a real doctor and the Tanzanian central government has agreed that he should. Since we talked with him at the clinic last year, he has moved away to receive additional training and he has not been replaced; Tanzania simply does not have enough doctors. I ask whether he will return after he has become a doctor, but I regret the question. On Martina’s face, the discipline of her good manners grapples with an urge to melt me with her stare.
We were reminded of another of the clinic’s deficiencies by yesterday’s visit with the leader of a group of local HIV patients. Our first look at the clinic’s needs, two years ago, underscored its remoteness from most of the people it is supposed to serve. Karimu still has done nothing to solve this problem. Today is Friday and we will not see Martina over the weekend. But when we meet with her again on Monday, we will raise the possibility of making the clinic mobile by supplying it with a motorcycle.