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Tillman Hurst
Tillman is a Chemistry major
interested in pursuing a career
in healthcare. This paper, “Bush
Doctors or Biomedicine?” was
written for his Exploration-term
project with Dr. Jason Heaton.
He spent the 2015 Exploration-
term volunteering at a small
hospital in Arusha, Tanzania.
This experience exposed him
to much of the rich culture of
East Africa and also made him
aware of the striking discrepan-
cies that exist between healthcare
in western nations and those of
Sub-Saharan Africa.
Now a junior beginning the
medical school application pro-
cess, Tillman’s time in Tanzania
has proven to be valuable in
revealing his passion of ensur-
ing that a country’s healthcare
system and all healthcare profes-
sionals are maximizing their
positive impact on vulnerable
patients.
Bush Doctors or Biomedicine?
Tillman Hurst
“Sometimes we are just bush doctors around here,” lamented Dr.
Quaker, a physician with whom I worked for three weeks in Arusha,
Tanzania in January 2015. An elderly widow no more than five feet tall,
Dr. Quaker received her medical training in Romania and came to Tan-
zania to practice medicine after marrying a native man. Her statement
of exasperation came after a frustrating consultation with a pediatric pa-
tient and mother that ended in her prescribing broad spectrum antibiot-
ics for possible pneumonia, simply because she knew the mother would
“shop around” until she received antibiotics of some sort. She wanted to
ensure that the safest course of treatment was employed, even if it were
less than ideal.
Over the course of my three weeks of volunteering at St. Elizabeth’s, a
district hospital in Arusha, Tanzania, I learned that the state of health-
care in Tanzania (and for that matter much of Africa) is in desperate
need of systemic improvement. Not only are the healthcare facilities
under-equipped and the staff under-trained, the mindset of Tanzanian
citizens is that biomedicine is a last resort tactic that need only be ac-
cessed when all other forms of treatment (largely home remedies and
traditional healing methods/witch doctors) are exhausted. Although
the majority of the factors contributing to the inadequate and frankly
deplorable state of healthcare can be tied to the terrible poverty that ex-
ists in Tanzania, I would like to focus briefly on four major causes of the
undesirable healthcare practices: lack of adequate infrastructure, short-
age of funds to provide doctors with reimbursement/shortage of respect
for the medical profession, insufficient resources for hospitals, and the
poor training that doctors and other healthcare professionals receive in
comparison to the vast number of illnesses and problems with which
they are forced to deal.
The poverty and lack of resources that exist in many African countries
severely limit any government’s ability to improve the infrastructure of a
country, which negatively impacts many rural citizens and their chances
of utilizing such infrastructure. One manifestation of this phenomenon
is the difficulty many poor citizens have in simply accessing sophis-
ticated healthcare. Many Tanzanians live in areas not even connected
by modern roads, instead relying on narrow, bumpy, dirt roads with
limited accessibility. In addition, these citizens have no viable form of
transportation that could be used to reach healthcare facilities. Rural
communities are reliant on either volunteer agencies, such as the one
with which I was involved, making an effort to come and bring health-
care to them or traditional forms of healing, which are both ineffective
and dangerous. Even in instances when a patient has some limited abil-
ity to gain access to biomedical facilities via some monumental incon-
venience, he/she often does so as a last resort. I saw, on many occasions,
the noticeable marks of traditional healers attempting to remove some
spirit or demon from a child who, only after an unsuccessful trip to
the village healer, was taken all the way to a hospital. Though shock-
ing to me, the doctors and nurses saw these markings as unsurprising
and came to expect them. It did not take long for me to realize that the
huge inconvenience that many families and communities feel at gaining
access to modern healthcare contributes largely to the inadequate and
ineffective use of healthcare in Tanzania. Improving the infrastructure
of a poverty stricken nation is a daunting task, yet it is a necessary one
to revamping many aspects of the citizens’ quality of life. Unfortunately,
the access to healthcare is not the only major problem with medicine in
Tanzania; the medical practices themselves need major reform.
While being a physician is a stressful and difficult position in almost