African Standard Time (AST): living in the present moment

Haraka haraka haina baraka.

If you hurry hurry, you will not receive blessings.

The pace of life in Tanzania, particularly the rural inland region of Shinyanga (where we are working now), is pole pole. It is a remarkable departure from our compulsive, over-scheduled, and micromanaged culture at home in the US. Here, we are less encumbered by abstract details. We deal mostly with what is in front of us.

On one hand, this means that life can be mellow and take on the façade of hakuna matata, without worries. In non-work life, I take on more of the chilled-out attitude of the people around us. I can focus on the people and events in front of me. My morning meditation is clearer, simpler. I have fewer detailed worries clouding my mind.

On another hand, this means that most things are unplanned and happen at the last minute. It makes work challenging for me. Long-term strategy and vision are relatively foreign concepts. I like to work with both clinical and systems issues, both things that need to happen right now and things that need to happen over the next ten years. My ability to make any big picture changes is muted by the fact that systemic advocacy and activism is not culturally acceptable (from Tanzanians, and certainly from foreigners like me). Systems issues are under the jurisdiction of people in power, who are frequently and unfortunately quite corrupt. It makes me wonder about how things can move forward.

Pole pole can feel terrible when I still see young people dying of AIDS. It is heart-wrenching when I see people spending their week’s salary to travel to an HIV primary care clinic which doesn’t have adequate medications in stock and provides sub-standard care.

It makes me think hard about how effective I am in providing clinical mentoring if I cannot also provide advocacy over systems issues. For me these go hand-in-hand. I do not self-potentiate if I am not working on both. I will need to take this into account and think hard about my role and next job in global health.