Africa: A Practical Guide for Global Health Workers

8: Tanzania

193 tanzania x lisa v. adams helga naburi richard waddell Tanzania: Cradle of Humankind In 1959, in the Olduvai Gorge in western Tanganyika, as the country was known during its period of British occupation, the famed archaeologists Louis and Mary Leakey discovered an intact human fossil skull and other bones dating back 1.85 million years which they described as Homo habilis or Handy Man. This finding generated the belief that this region of Eastern Africa was the cradle of humankind.1 Today, Tanzania is an independent, democratic country in East Africa. Immediately south of the equator, it is bordered by the Indian Ocean on the east; Kenya and Uganda on the north; Rwanda, Burundi, and the Democratic Republic of the Congo on the west; and Zambia, Malawi, and Mozambique on the south. Tanzania is well known for its natural splendor. Travelers come for the adventure of going on safari in its famous national parks and game preserves such as the Serengeti—where lions, wildebeest, elephants, gazelles, zebras, and hippos live in natural balance—or to climb Mt. Kilimanjaro, the highest peak in Africa. The magnificent white sand beaches on the islands of Zanzibar and Pemba also lure visitors. With so much natural beauty and a burgeoning tourist industry, Tanzania is becoming a common tourist destination, no longer reserved for youthful backpackers or intrepid explorers. Tanzania is much more than its offerings of wildlife safaris, mountain trekking, and exotic beaches, however. Its strengths include a peaceful , democratic system of governance and a relatively united populace, 194 africa : a practical guide notable in a region often troubled by tribal conflicts and political instability . While more than 120 tribes live within its borders, each with its own language, most Tanzanians feel a strong national identity. To promote unity across tribal groups, Kiswahili was made an official national language in 1984; it is the language used in social discourse, business, politics and primary education. Tanzania’s political stability has allowed the country to experience several periods of economic growth since independence. Nonetheless, with a gross domestic product (gdp; see the glossary) of $1,300 per person, Tanzania ranks in the poorest 10 percent of the world’s countries. It faces many health problems common to low-income countries in a tropical setting: unacceptably high morbidity and mortality from infectious diseases, and life-threatening conditions affecting maternal and child health—all made worse by a struggling healthcare infrastructure. Like many of its African neighbors, Tanzania has been losing its skilled and educated workforce to better paying positions in the United States, Europe, and South Africa—the so-called brain drain. While travel guides will describe Tanzania’s popular tourist destinations (which we encourage you to experience when you are in the country ), our aim in this chapter is to introduce you to the country’s health system, the critical health issues that Tanzanians face, and the many national and international agencies and programs at work in the country . Finally, we share some of our experiences, in the hope that what we have learned might help prepare you for global health and humanitarian work in Tanzania or elsewhere in Africa. Historical Perspectives Tanzania is a combination of Tanganyika, the name of the large mainland territory, and Zanzibar, the name of the archipelago northeast of Dar es Salaam, the country’s largest and principal commercial city and its cultural and diplomatic capital. Tanzania was formed in 1964, following Tanganyika’s independence from Britain in 1961 and Zanzibar’s independence first from Britain in 1963 and then from the Sultan of Zanzibar in 1964 during the Zanzibar Revolution. In 1996, all government offices were transferred from Dar es Salaam to Dodoma, making it the country’s political capital.2 The Leakey archaeological finds in western Tanzania suggest that tanzania 195 this region has been inhabited since prehistoric times. Trading contacts existed between the East African coast and Arabia by the first century, followed by the Portuguese in the late fifteenth century and the French in the sixteenth, predominantly for slave trade and exploitation of natural resources such as ivory. Nineteenth-century German missionaries reached the Kilimanjaro region. The first British explorers in the area, Richard Burton and John Hanning Speke, traveled west to Lake Tanganyika and Lake Victoria in 1857–58, followed by the geographic explorers David Livingstone and Henry Morton Stanley. Early visitors to Zanzibar included the Persians, Hindus, Jews, Arabs, Phoenicians, and possibly...