IMPRESSIONS OF HEALTH AND EDUCATIONAL PROVISION IN TANZANIA – AUGUST 1981
During August 1981 I travelled with the University of Southampton Department of Adult Education Study Tour round southern, central and northern Tanzania. Our route took us from Dar es Salaam by way of Kilwa, Lindi, Masasi, Tunduru, Songea, Njombe, Iringa, Dodoma, Ngorongoro to Moshi. Covering 2600 miles in three weeks, our stops in each place were often tantalisingly brief but nevertheless I think that our impressions have some validity, particularly because of the wide area that the tour covered.
My own interests are in health and education. My observations of the people we saw in the countryside were that they appeared to be adequately fed and were not suffering from any major disease. I saw no young person with limbs deformed from leprosy. This all suggests that the basic prevention of and cures for the main diseases are now available. What is lacking is what could perhaps be called the secondary level of medical provision, namely spectacles, crutches, access to regular physiotherapy. We saw very few people, except in educational establishments, wearing glasses. In Britain about 50% of the people one meets seem to need glasses for distance or reading. In Tanzania nowhere near that number seem to have spectacles. I saw a number of people disabled, I assume from polio, getting about on all fours; one man in a community centre in Dar es Salaam with his legs doubled up behind him, moving on his knees. This sort of thing demonstrates the lack of appropriate calipers and physiotherapy at the right time to keep the muscles flexible.
There is not, however, a total lack of provision. We stayed at Mgulani Salvation Army Hostel, where there is a residential school for physically handicapped children and where the physiotherapist makes the calipers to help the children be mobile. She has not been there long, however, and is supported from Britain by the Salvation Army. When she arrived her first job was to make new aids immediately for all the pupils, as they were fast outgrowing their old ones.
While I feel that Tanzania can be proud of its progress in the health field, there is not surprisingly still some way to go.
In Masasi we visited the nursing school founded by Dr. Stirling at Lulindi attached to Masasi hospital, now including a training school for Rural Medical Aids (RMA’s). There we saw a class of about 20 of the nursing students in their smart pink uniforms receiving what appeared to be a very thorough training. We disagreed in our group as to whether the training apparently being given to these nurses might be too thorough and hospital-based for the actual conditions in the villages in which the nurses will be working. For myself, I feel that as at present the nurses and the rural medical aids are in the front line in terms of medical services in the community they need a thorough training. This was underlined for me in an ujamaa village near Dodoma, where the RMA told us that he had a visit from a doctor twice a year. This RMA was very pleased that next to his dispensary a new building was nearly complete, where the patients would be able stay overnight and not, like the mother who gave birth to a baby son during our visit, have to return home after an hour or two at the clinic.
The other major hospital-attached project we saw was the nutrition rehabilitation unit at the Kilimanjaro Christian Medical Centre, a mission hospital in Moshi. I was most impressed by the thorough social as well as medical history that the nurses took, the follow-up after discharge (helped by a landrover provided by OXFAM) and the practical approach to increasing the mother’s knowledge of available sources of protein, even to the extent of giving them two rabbits to take home, to be returned when the number had increased to eight!
Nutrition rehabilitation is aimed at the small group of mothers whose children’s growth is below what we might call the poverty line in an area which is normally quite prosperous. Is it a luxury in a country where some villages only see a doctor twice a year? Perhaps, but I think that it shows two things. First, it shows that the Moshi Region has achieved a level of prosperity where undernourishment is not the norm, where the norm is that people do have enough to eat and special Care has to be taken of the few that slip below this level. Secondly, the method used to deal with the problem is in accord with the national policy of education for self-reliance. It is no use treating a persistently malnourished child with sophisticated modern techniques. For anything approaching a permanent improvement it is necessary to involve the mother in taking responsibility herself for change, the same policy which is necessary nationally for the fruits of development to be spread fairly to all citizens. As Ndugu Mwingira, the MP for Songea and Chairman of the Britain-Tanzania Society’s Tanzania Chapter, said to us when we met him in Songea, ‘development is in the people’s own hands’. It was good to see this happening in Moshi and Dodoma.
Turning to education, we were in Tanzania on 12th. August, 1981, the day of the national literacy campaign examinations, and we were impressed by the organisation involved is setting up the tests in the villages all over the country on the same day. We liked to think that the pencils we had presented in Songea the day before might be being used in the tests we saw happening under the trees in the villages as we drove past.
My principal impression of education in Tanzania was the enthusiasm of the people involved in it. I don’t think it is possible to involve particularly adults in an educational programme such as the literacy campaign unless they feel that it is relevant to them. The students we met at Mkwawa Science Teachers Training College, who were the lucky ones who had got through to secondary education and beyond, could not have been more enthusiastic about their studies and their commitment to the service of the state. At this college the classrooms were used after hours for further education classes for people, as the Principal told us, who had missed the opportunity for education during their school days. We saw another example of further education in the village of Mpunguzi near Dodoma in an adult class of women, by no means all young, doing simple arithmetic, both teachers and several of the students with their babies tied round them! No problems with creche, facilities here!
Sometimes the enthusiasm gets ahead of itself, as at one point during our visit to Muhukuru Folk Development College near Songea, where the woodwork teacher, after describing all the different skills he was teaching his pupils, referred to his hopes for future development, including training on electric power tools. First obtain your electricity supply! Generally, however, it was good to see great efforts to make education relevant to the environment in which most people live – the village. The Headmaster of Nkowe Rural Trade School was pleased to inform us that all of the 19 students who qualified last year were still working in their own villages.
As with health care, it was striking that, despite the emphasis on the provision of basic services for the majority, minority needs were not overlooked. We visited a Government trade school for blind students in Masasi and Masalala School in Iringa, which has a residential class for blind children who sang to us most movingly. When the Regional Education Officer in Songea was telling us about educational provision in the Region, he was embarrassed to have to say that primary education reached only 97% of the population, because the Region had as yet no special provision for handicapped children. At least the need was recognised. For a Government to accept responsibility for its disadvantaged members is for me the sign of a caring community as any family should be. Does not ‘ujamaa’ mean familyhood?