I do my best thinking when completely deprived of personal space

Last night, in a rather masochistic decision given Dar's rush hour traffic patterns, I accepted an inviation to "Mexican food" at Sarah's home out in Mwenge. (I have to say, she did a pretty decent job. If you overlooked the fact that the chips were made of cassava rather than tortilla, you'd judge the meal almost perfectly TexMex.) The ride out took more time than I'd care to say. But at least as I stood crammed against the door of the outward-bound daladala, dripping sweat and watching us creep forward about a half mile every 20 minutes, I had lots of time to think.

First, I grumped to myself about Dar's terrible, awful roads. Putting aside the question of enormous potholes and paving and such, there's simply not enough road space for the traffic in this city. I'm sure the streets were laid out perfectly well when the town was thousands of cars (and millions of people) smaller. But the city quickly built itself right up to (and over) the curbs, and denizens nowadays are faced with a crazy situation where the main highway - the only route out of town, really - is a two-lane road. Traffic between 4 PM and 8 PM is both completely jammed and completely unavoidable; there's no other way to get home. There's a certain novelty to the ride for me - I'm still dazzled by the candle-lit road stalls selling bits of fruit and ugali and octopus - but if I had to make the commute every day I'd go nuts.

And it's hard to imagine how they'll fix it, really. I'm not an engineer, but I can't see how you'd turn the Morogoro Highway into the modern thoroughfare Dar needs without enormous upheaval. There are sprawling markets for miles right along the side of the street, with permanent stores and homes (when daladalas go off-roading, as is their wont, they often have to honk their way through throngs of shoppers buying that evening's dinner). I have a tough time imagining the Tanzanian government mustering the willpower to shut down and raze thousands of small businesses. And can you really ever close down your only highway, even for badly needed renovations? How will people get into/out of the city?

And then I thought about Tanzania's transportation problems in relation to its health sector problems. In the former case, there's clearly massively insufficient infrastructure. Not only do adequate roads not exist, but it's hard to see a clear plan for ever creating them. With the health sector, however, I realized I'm a lot more optimistic.

Perhaps naively, no doubt. I've actually been reading rather gutwrenching health statistics all day in preparation for WD's upcoming Maternal Mortality and Morbidity conference. Tanzania's one of the top ten countries in the world in maternal deaths - 1 in 24 Tanzanian women will die from complications of pregnancy or childbirth. (Compare this with the US's 1 in 4,800 or Ireland's 1 in 48,000.) More than half of women never make it to any sort of health facility when giving birth. And the birth-giving starts early and goes long: more than 50% of 19 year olds are either pregnant or mothers already, and the average number of children in some regions of the country is 7.4 per woman. (Fifth page.) And this doesn't even consider all the women who are injured or permanently disabled during childbearing. Oof.

BUT. While the health system is clearly not serving its women (or anyone, really) all that well, it doesn't seem to be at the same sort of complete cluster...fudge....as the transportation system. For one, the physical health facility infrastructure is actually pretty decent. The government is doing a fairly good job of peppering the country with basic health facilities, and in fact more than 80% of Tanzanians live within 5 km of such a site. The problem is not the facilities - the problem is the lack of resources, particularly human. The sorts of things I saw out in Kongwa and Chamwino - a lack of staff, or consistent electricity, or antibiotics - those struck me obviously dire but not insurmountable. I/Tanzanians/the global health community can think of lots of different ways to try to fix those resource gaps, even if we all know its easier said than done. Furthermore, unlike the roads, you can keep the health system going while you attempt to fix it, training staff on new procedures or buying new supplies or increasing starting salaries for nurses. Seems like a key feature.

So I guess my final conclusion, as I rolled off the daladala into a sea of bodies and food stalls and sidewalks bedecked with cheap plastic goods, was that the Tanzanian healthcare system seemed....not a lost cause. I realize that's not the strongest of praise. But the current system is a bit like those little divot-covered platforms they have at the Lego stores - not much to look at now, but with clear building potential. (My analogies are AWESOME.)

Might, just might, have discovered a Dar-based Tuesday frisbee league. Checking it out this evening. Fingers crossed.