For my medical elective I went to Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, East Africa for seven weeks. I spent most of the time in the paediatric department but also visited other departments. Whilst I was there, the Tanzanian attitude to life and death was one of the aspects of African life that had a big impact on me.
In the western world a lot of time, effort and money is spent preventing death. People are living longer, and previously fatal diseases are curable. We have the money, the power and the education to cheat the inevitable for a while. But if death is inevitable why try to put it off? In some cultures, old age commands great respect, but in others once you can no longer work you are a burden. At the other end of the spectrum, if a child dies in a paediatric ward in the UK, parents often try to apportion blame to someone or something. There has to have been a reason for the death and 'it happens' is not a valid answer.
Two events happened whilst I was at KCMC that affected me deeply. The first was the death of a promising young surgeon from the hospital. He was involved in a head-on collision between his car and a lorry. His wife and six year old son survived the crash, but his injuries were too severe and he was pronounced dead on arrival at KCMC. He was only 31.
I attended the funeral, partly out of respect for him as a colleague, and partly out of curiosity as to what a Tanzanian funeral would be like. The hospital chapel was packed and everyone was dressed in bright colours. The service was in Swahili but seemed to consist of a funeral mass much like in England. Then came the part I was unprepared for – they opened the coffin! I've seen dead bodies before but this was still a shock. Sadly, his face had borne the brunt of the impact and despite obvious efforts to reconstruct it, the scars and damage were obvious.
Everyone filed past the coffin to pay their last respects - it took over an hour as there were over 2,000 people, with many standing outside who couldn't fit into the chapel. The whole hospital ground to a halt that day. Clinics were cancelled, the operating theatres shut down as a mark of respect, and many doctors were too upset to work, leaving only a skeleton staff. I couldn't imagine the death of one doctor having such an effect on a tertiary hospital or a local community in England, however tragic the circumstances.
The second incident that stuck with me was a mother who arrived at the department carrying a small child, who was obviously very sick. Examination revealed that he was suffering from malaria, septicaemia, malnutrition and possibly meningitis. His mother had walked from her village to KCMC carrying her sick child, taking four days. She had had to leave her other five children and elderly mother in the care of the eldest daughter (who was only twelve). Despite our best efforts the child died three days later. The mother paid her hospital bill (which cost her nearly everything she had and left her without enough to feed her family back in the village) and left silently. No tears, no frustration, no blame - she just left.
A little while later I saw her sitting in the chapel. I went in and found that she was praying, thanking God for everything in her life. Still there were no tears or signs of emotion over the death of her child. Did she not care? I couldn't understand; what was she thanking God for? She had next to nothing, lived in a squalid hut in the mountains with no electricity or running water, her child was dead, she didn't have enough money to feed her surviving children and she still had a four-day walk ahead of her to get home. She got up to leave and saw me, obviously looking perplexed. She explained, 'I'm still alive, I have five other beautiful children and my son has gone to a beautiful place where he is loved. Don't be sad, we'll all be together again one day.' Then she started her journey home. What she lacked in material goods, she gained in love and faith. A faith that God would take care of her, that he loved her, and that everything happened for a reason as part of God's plan for her. I realised I didn't have such a deep conviction – when my father died three years ago I was just angry. My reaction had been 'why did you do this, what did I do wrong to deserve this punishment?' I should have been thankful that I'd had my father for 23 years and asked God for support in my grief. I asked God then and there for the strength to be more like that Tanzanian woman.
So what is death? Is it a disastrous event to be prevented at all costs for as long as possible like in the West, or an unavoidable part of the circle of life that happens to everyone at some point as in the Tanzanian view? Should we mourn the loss of a friend or celebrate the joy their life brought to the world? Can death ever be a happy event? Is death acceptable? Before I went to Tanzania I would have agreed with the first statement. Life is precious, a God given gift that should be prolonged in as healthy a state as possible for as long as possible. Now I'm not so sure that's 100% correct. As a doctor, my main duty is to preserve life but where do you draw the line between prolonging life and just extending an existence in a defeated body?
Many people die in Tanzania, both adults and children, who would be cured if they were in the UK. An inordinate amount of money would have to be spent to bring the healthcare standards in Tanzania up to the same level as the West. Improvements in education and infrastructure as well as changing people's long held opinions and beliefs would be involved. You'd have to change part of what makes Tanzanians the people they are. And I found them to be a terrifically warm and welcoming people, full of love and faith. Western medicine makes it hard to have complete faith that although what God gives, he can take away, he will never do so out of spite or anger. He always has a plan even if we can't see it ourselves. That's not to say that we should not make an effort to save life. God has given us the abilities to cure illnesses, and to prevent early death in many cases. We should use these gifts to the best of our abilities.
You're born, you live, and then you die. The time between these may be long or it may be short, but you are here to do God's will and follow his path. When that journey is complete, you are returned to the one who created you in his own image. Maybe part of the surgeon's role was to unite a community. Maybe part of the little boy's job was to remind me to have faith. Whatever our role is, death is not to be feared.
The average life expectancy in the UK is 86 years; in Tanzania it is only 49. Death happens there often but life has to go on for those left behind. It doesn't mean they don't care. I returned from Africa with a renewed faith, a thankful heart for how lucky I was, and a desire to use my skills as a doctor as well as I could, especially for the benefit of those who most need it instead of just those who can pay for it. Having little money or material goods doesn't mean you are poor and every person on this planet is precious.
God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to distinguish the one from the other. (Reinhold Niebuhr)
