Christian Ramers - Tanzania

I have not gone into detailed descriptions of the hospital itself since I've yet to really dive in on the wards, but I did want to share my initial impressions as they are the most vivid. As Dr. Mark Swai put it, just by walking the halls, I've experienced KCMC with all five senses. Today I even took Lauren and Diego on a detour through the hospital on our way to meet some friends just so they could have a sense of where I'll be during the day. A little cruel, I know, but I think it's important for spouses to know what their spouses are doing during the day, don't you?

The first thing that hits you is the smell. Given that we're within 50 degrees latitude from the equator, you can imagine the perspiration is quite profuse. Couple the heat and humidity with extreme poverty, overcrowded waiting areas, heavy loads of babies swathed in brightly colored cloth or food or supplies carried on backs for miles just to be seen by a doctor, all under British colonial etiquette demanding no exposed shoulders or knees, and you can imagine the odors that the people themselves can produce. When mixed with the absolutely acrid whiff of formaldehyde floor cleaning solution, the general dank odor of moist cement floors and walls, and more existentially the waft of poverty, death and despair, it nearly takes your breath away with each inhalation.

On to the visuals, which are a bit easier on the psyche; or at least a step away from the emotional circuitry of the limbic system. I think most Americans have seen enough television images of overcrowded poor Africans needing food or clean water or medical care to be a bit numbed by them. LIVE-AID, the Christian Children's Fund, Bono, Angelina Jolie, the famines in Ethiopia, the spotty yet occasionally profound coverage of the crisis in the Darfur, Sudan.at least we're comfortable with those moving pictures. It's quite a different thing to actually be moving through one of those scenes with hundreds of pairs of eyes following your every step. It hits a different nerve when you've got to dodge through and step over those desperate people to get where you're going. And even more chilling to know that there is on some level an understanding deep in those tired African eyes that you are indeed a doctor who indeed may be able to help them; to listen to the story they've walked so far to tell, to give them that medicine that may return them to health, to perform some of that Western magic that a spouse of a cousin of a friend had experienced.

Depending on the time of day, there are many wards which are quite cavernous and dark. I think KCMC is having a bit of electrical issues at the moment, because some wards are frankly in the dark, with only slivers of natural sunlight spilling through the cast cement windows to outline the shady figures within. I'm reminded of the scary old WWII era abandoned bunkers we used to play in and around on Angel Island in the San Francisco Bay: dark and smelly and filled with imaginary rats and monsters poised to jump out at you. And though you're curious, you're not sure you want to peer deeper into the darkness to find what lurks in the unexplored corners of an African hospital.

Come Monday, I'll be finding out a whole lot more for myself.