Tanzania and Global Rehabilitation
Published October 23, 2019
Describing the “why” behind my dedication to Tanzania has required a lot of insight, thought, and research. I know why my heart keeps getting pulled back to Tanzania: the people, culture, mountainous & lush landscape, faith, love, and passion. Additionally, I’ve found a way to use my unique skillset to help with the increasing need for rehabilitation services. As my understanding of the need increases, so does the forward momentum of access to services for children and adults with special needs. I feel the pull from Tanzania and, as I’ve described before, I am willingly obligated to continue serving and understanding the people of this country.
In order to continue service in Tanzania, I have dedicated myself to learn more about the country from a broad, global perspective. I have been relentlessly curious about helping without hurting, poverty alleviation efforts, and general statistics regarding the world’s progress in education, rehabilitation, and more. As a huge portion of my dedication to Tanzania is facilitating others during international service learning opportunities, I feel it’s imperative I have a bigger understanding of the culture, people, and needs.
With my insatiable desire to learn, I’ve decided to share my research here! This way, I have a place to reference the information and share it with others, while also opening the door for input and gathering information from people like YOU! I can’t wait to learn together.
Read more for a zoomed-out view of Tanzania’s culture, plus the current state of rehabilitation in the world and Africa.
The world is shrinking as accessibility to people and places increases with technological development. Connecting to others takes a mere text message, which can reach someone in a different time zone via WhatsApp instantaneously. We can fly across the world in 18.5 hours from Singapore to Newark (yes, this is the longest flight in the world as of 2018! It sounds long, but look at that distance on the map! HOLY COW!). The cost of travel is not as big of a burden as it once was and people all over are crossing states, oceans, and hemispheres to reach different parts of the world.
Living in the United States, I am in a unique position. Growing up in a middle-class family, I have had the blessing to travel far and wide – both with my family and independently. In 2016, I traveled to East Africa to provide service to a country in profound need of my skillset. When I was first offered to travel to Tanzania, I didn’t even hesitate to say yes! After putting down a deposit, however, I realized just how unknown this journey was to me. I didn’t know anyone who had been to Tanzania (or Africa!!). I also thought Africa was something on my Bucket List that would/could NEVER be crossed off as a single woman under the age of 30. I thought it’d maybe be a honeymoon destination, or just something I fantasized about forever. The idea of a safari sounded expensive and unachievable. Yet… there I was, at age 26, planning my first trip to Tanzania!
Though the cost of traveling to Tanzania is not low, I raised funds with the support of my family and friends and made my first trip a success. I’ve since used countless days of Paid Time Off, airline miles, savings, and energy to continue journeying to this far away place. Tanzania has almost become my second home, so I can’t imagine NOT dedicating so much time, money, and energy to making this trip happen again and again.
Oh gosh. Ya know, I keep talking about Tanzania… but maybe you don’t know much about the country, so let’s take a step back! Allow me to paint a picture of Tanzania and the people who live there…
Driving along the dusty road, we manually roll up the windows as other cars pass by to prevent another layer of dust from gathering inside the safari vehicle. The road is filled with potholes and bumps like I’ve never seen before, and I wonder how the suspension on the car can handle this? Yet, beyond the road itself, are Africa tulip trees draping over the road, and fields of sunflowers in the foreground of mountains and lush landscapes. Mount Meru casts its shadow upon us as we drive towards Arusha. We pass by local markets and shops, where locals walk by carrying buckets of water on their heads, or lugging heavy carts of fruits, vegetables, or hardware materials to their day of work. They have probably walked miles in their sandals, yet they smile and wave at passersby’s. They look busy, but they’re not in a rush. “Haraka haraka haina baraka,” they say. “Hurry, hurry has no blessings.” When we arrive at our destination, we are greeted wholeheartedly with a “Karibuni” – “Welcome” in the national language Kiswahili. When we arrive, we are home and we are welcomed.
TANZANIA (officially named The United Republic of Tanzania) is the largest country in East Africa with a population of 58,536,993 people (as of 2019). The land in Tanzania is lush, green, and mountainous. A lot of people I’ve traveled with to Tanzania often report this to be the most surprising aspect of the country! I also had pictured expansive deserts, but actually only 25% of Africa is desert, with the Sahara being in the north and Kalahari Desert in the southwest.
Tanzania has a very low median age with more than 44.8% of the population under 15, 52% between 15 and 64, and just 3.1% over the age of 64. The low median age of Tanzania is attributed to a generalized HIV epidemic in the country. It’s estimated that there are over 1.6 million Tanzanians currently living with HIV/AIDS, and the epidemic has resulted in an estimated 1.3 million orphans.
There is a ton of wildlife in Tanzania, but there aren’t any TIGERS (gasp!)… those only live in Asia. Jane Goodall studied chimpanzees in Gombe Stream National Park (fun fact part two is I did a whole project on Jane Goodall in fourth grade!). Tanzania is the southern home to the Great Wildebeest Migration of 1.5 million wildebeest traveling between Tanzania’s Serengeti and Kenya’s Masai Mara. Other places to spot wildlife and the “big five” (can you name them?!) include Ngorongoro Crater and Tarangire National Park. Don’t worry, more on the parks later (or you can check out the integrated links from my previous visits!).
Tanzania is home to over 120 tribes, including the Maasai tribe, which has held onto many of its traditions. The Maasai women are responsible for building the homes and Maasai men are polygamous. Some of the customs of Maasai are changing, such as the objective to kill a lion in order to become a male warrior, but a lot of the traditions including the colorful, beautiful dress and jewelry have remained the same. The Maasai can be found in Southern Kenya and Northern Tanzania along the Great Rift Valley.
When I travel to Tanzania, I spend most of my time in Arusha – a city in Northeast Tanzania with a population of 416,442 people (2012 census). Arusha sits at an elevation of 1,400 meters (4,600 feet) and is in the shadow of Mount Meru, a dormant stratovolcano at a height of 4,562 meters (14,977 feet).
Tanzania is the home to beautiful people and places, with a culture that thrives on connection and community. Everyone is greeted with sincerity, offered help without asking, and connected to faith. Christians and Muslims are the religious pillars in Tanzania, with a little more than half being Christian (61%). The presence of faith is palpable and audible, echoing through the streets near churches and mosques.
With a variety of religious, cultural, and tribal beliefs and cultures, Tanzania has a diverse population. The local population is welcoming beyond words to visitors and unite under a strong national pride. There is a strong respect for elders and people are generally happy and friendly to others. Okay, that’s a severe understatement. People are joyful, smiling 99% of the time, and hospitable in the most genuine, heartfelt way. I have never felt so welcomed by people of a different culture, and this feeling emanates from all areas I’ve traveled to in Tanzania.
Hopefully that suffices (for now, at least) to paint a picture of Tanzania. Of course, there are so many more facts and fun things to learn about the country and my mind is buzzing with memories of soulful interactions and beautiful places.
Tanzania is a wonderful place to visit, but I don’t ONLY go for the people and the culture. I happen to have a skillset as a Doctor of Physical Therapy that is in high demand in Tanzania and Africa at large. During my first visit to Tanzania in providing Physical Therapy service, I didn’t really capture the “big picture,” yet responded effectively to local reported need. As I continue to travel back to Tanzania, I am getting a clearer view of what rehabilitation and access to services for individuals with disabilities looks like. Of course, this is just the beginning of my understanding so bare with me as I continue to learn.
The profound need for rehabilitation services in low- and middle-income countries has been identified by the World Health Organization (WHO). Since there is a low proportion of providers to individuals in need of rehabilitation services (sometimes as low as 10 providers per 1 million population!), the WHO has created a ‘Call to Action’ for “concerted and coordinated global action by all stakeholders to scale up rehabilitation” worldwide. There are countries all over the world in need of rehabilitation services including: Physical Therapy, Occupational Therapy, Speech Language Pathology, Prosthetics & Orthotics, and Rehabilitation Medicine. The most effective ways to provide these services and address the unique needs of each country and region requires further research and understanding.
The mission of the World Health Organization requires cooperation with the local governments to put systems in place for increases in rehabilitation services. Yet, there’s something to be done on a local and smaller scale. When looking at the big picture of rehabilitation worldwide, it can often feel daunting as there is a significant lack of access to services. However, even the smallest steps could make the greatest noise.
The communities I’ve worked with in Tanzania are making A LOT of noise. I’ve engaged in challenging conversation about mental health, learned from teachers, participate in advocacy, and collaborated with providers across the country. The need for rehabilitation services is being identified by locals in the Arusha region and beyond.
Despite the large number of people with health conditions requiring physical therapy intervention, the number of qualified personnel in the African, South-East Asia and Eastern Mediterranean regions is well below 30 per 1 million population (Figure 4, above). Again, low-income countries tend to have the lowest densities; there are fewer than 10 physiotherapists per million inhabitants in many countries of Sub-Saharan Africa and the South-East Asia Region, where millions of people with health conditions face challenges in attaining and maintaining maximum independence, health and well-being.
With regards to pediatrics, the burden of pediatric disability may be hard to estimate. This is largely due to many children that are unidentified due to being hidden, mis-, or undiagnosed. Often times, individuals with disabilities are shunned and kept in hiding. When a child is born with a disability, the family and/or mother may be perceived as cursed. This often leads to the father abandoning the family, so there are many single mothers dealing with the burden of raising a child with special needs. I have seen this in most of the children I’ve worked with in Tanzania, though some family units stay united to share the responsibility. Organizations such as Shanga and Step-by-Step Learning Centre are working to raise awareness of disability in Tanzania and provide education, vocational training, and work for adults and children with disabilities. According to CCBRT,
“There are 4.2 million Tanzanians living with a disability. People with disabilities are often among the poorest and most marginalised in society.”
According to the Association of Physiotherapists in Tanzania, there is estimated to be 217 physiotherapists in Tanzania as of 2019 and 57 of them are part of the Association of Physiotherapists. In contrast, there are 217,619 physical therapists in the United States as of 2019, with over 250 programs to study Physical Therapy at the professional doctorate level. In Tanzania, Kilimanjaro Christian Medical University College in Moshi offers a three- to four-year BSc in Physiotherapy. Note: This is the only physiotherapy program I have been able to find in Tanzania (though the WCPT website indicates there may be three programs).
There are many barriers to increasing accessibility to rehabilitation services in Tanzania, but efforts remain extremely important. Finances, decreased cultural acceptance of disability, and accessibility appear to be some of the greatest barriers to access. Additionally, there is a low percentage of professionals who can provide these services.
The need for rehabilitation services is rising with awareness of disability. Every time I travel to Tanzania, I learn about more services that are available to children and adults with disabilities. Though the current access is low, it’s important to realize it is on the rise. It’s even more important to consider your role in this process. Can you contribute in some way to the quality of life of Tanzanians? I sure hope I can, and I pray that others are up for the challenge.
As I mentioned, this is just the beginning of my understanding. I hope I have helped to shed light on some of the reasons behind my frequent travels to Tanzania and why I don’t intend to stop any time soon. Please feel free to share any of your opinions, thoughts, and feelings about any of the information. Thank you for reading and learning with me!
With love and gratitude,