Today is the last day of the Ilula-Minnesota International Health Care Conference, and I present today. I have never spoken in front of more than twelve people and I heard the conference hall echoes, so it has to be a large space. Walking up to the building I see a journalist snapping candid photos, a registration table with colorfully dressed participants huddled around it and as I walk inside the building I feel a sense of disguised anxiety or excitement bubble inside me. The conference hall has rows of tables covered in brightly patterned fabric with Tanzanian nurses, accountants, laboratory technicians, doctors, nuns, pharmacists and hospital administrators sitting attentively waiting for the the conference to begin. As Dr. John introduces the day’s schedule, my mind wanders out the big bay windows and I forget about my talking points and feel immensely present under the tin roof and hum of shuffling chairs.

My conference “job” for the day is to be the photographer. So, I tried my best to be a chameleon in each room I pop into. I sat in on everyone’s talk for at least 5 minutes, trying not miss any memorable moments such as Sarah’s debut as a pregnant pre-eclampsia patient.  For the most part it was our Minnesota group that was presenting on topics.  While I learned about chronic kidney disease and intimate partner violence I wanted to hear more from our Tanzanian colleagues. Three talks were happening at the same time. I shuffled between buildings, scurrying away from the beating sun and by the time I knew it, it was my turn to present. I was nervous.

I wondered how relevant me harping about the devastating consequences hypertension will be.  Will I convince anyone that blood pressure control is important? I worried that my minimal clinical experience will disengage people before I reach my second slide. I felt unprepared to answer questions about medical management of strokes in Tanzania. While, two weeks in Ilula Hospital provided context to the health care infrastructure, I didn’t know what resources and training the participants had in order to be “helpful”. Nothing is worse than wanting to know the answer and hearing “I don’t know”. I, myself am still trying to get comfortable with the idea that we actually don’t know a lot about how our bodies work. 

I stand up tall, trying to not think too much, and begin my “schpile”. Before I know it, I was done talking and was relieved to hear another voice fill the room. A doctor in the front row asked a very relevant question about whether anti-retro viral therapy increases the occurrence of strokes. This shocked me since this question did not remotely cross my mind, albeit incredibly relevant. Another doctor asked how to tell the difference between ischemic and hemorrhagic strokes. I prepared a slide about relevant symptoms to each, but blanked when he asked me. I knew he was making me aware of the fact that CTs and MRIs are not a common tool here. I felt a little ashamed that I did not prepare my talk for my audience well enough. It was clear that Tanzanian health care workers had challenges with available resources. 

As the conference was coming to an end, birds began scratching at the tin roof and Randy motioned at Sarah flapping his arms and pointing at the barn doors. I chuckled, as Sarah without protest and a gentle smile walked outside to clear the commotion. We wear many hats here in Ilula! The conference finally finished on a very high note with a “special” song, that I doubt anyone on this trip will forget.

After the conference, Minnesotans and Tanzanians from Ilula Hospital boarded the bus, and we drove to Mama Iringa’s for dinner. The Italian eatery was a welcome change from our fried food diet.  Don’t get me wrong, I love all the food Anna cooks for us, but who doesn’t miss a Neapolitan pizza.  I was sitting between Dr. Malala and Dr. Benjamin, shoulder to shoulder. Of course, Dr. Malala ate some pizza but it was clear that pizza was not as appetizing as umgali with a tomato sauce. Dr. Benjamin, commented that in medical school after long days of studying he would order a pizza. At that moment, I felt very connected, either by experience or by eating together. To end an already great dinner, Dr. Saga brought himself and the whole table to tears with a rendition of our “special” conference song. We laughed, squealed and cried to the point of silence. I couldn’t be happier that night.