While the Tanzanian nurses at Tumbi Hospital have accepted me graciously, they don’t entirely understand why I’m here. They know I am an American nurse-midwife and that I will be staying with them at Tumbi’s Reproductive and Child Health clinic for six months.  As an explanatory aid, I have whipped out my “Scope of Work” at various points, but in response to the English words “capacity building” I get only blank stares. 

Every morning the nurses scrub the floors in their proper pressed blue dress uniforms and plastic gloves, wipe down the countertops and cabinets, and empty plastic mesh garbage pails into a putrid, fly-swarmed receptacle outside.  Aside from working as custodians and well-trained nurses, all of them are also receptionists, lab technicians, medical assistants, and occasionally clinicians. 

The hospital’s pressing need for more staff is obvious to even the most unenlightened observer.  I stepped onto this scene as a fully qualified nurse.  I’m sure that they hope I’ll do more than the other foreign experts who’ve passed through their exam room doors, experts who’ve planned trainings and produced technical reports instead of dirtying their hands with the work of clinical nursing in a developing country.  But who am I to judge?  I didn’t want to be a nitty-gritty nurse in Tanzania, either. 

I offer what I can, which, given my poor Kiswahili-speaking abilities, is limited.  I run the rapid Bioline HIV tests, a task both similar to and as simple as performing urine pregnancy tests.  My stubby fingers swim in Tumbi’s one-size-does-not-fit-all rubber gloves as I release single drops of blood from capillary pipettes onto benign-looking test sticks.  This time the double pink lines which, at my old job at a Connecticut women’s health clinic would have indicated growing embryos, now confirm replicating viruses. 

Unless they “opt-out”, all pregnant women who attend antenatal clinics are tested for HIV.  Although this work is routine for my new nurse colleagues, the management of HIV as familiar to them as the treatment of gynecological infections was to me, positive results pain them.  I watch M, a quick and competent nurse in her early thirties, give positive HIV results to healthy-looking young women with out-poking belly buttons.  As she gently delivers the news, M’s jaw tightens and the tiny muscles underneath her cheekbones quiver, setting the dozens of braids on each side of her face into vibrating motion. 

When I first started, I expected patient meltdowns.  I expected wailing and shock.  This rarely happens.  More often than not, women already know their status, or strongly suspect that they are HIV positive.  In most cases, past sexual partners are sick or have died.  New partners are generally unaware of the existence of these ailing exes.  M advises, with compassion, that these women bring their current partners back to the clinic for testing.  I have yet to see a single one of the dozen or so of these positive patients return with a husband or boyfriend in tow.   I think I understand why. 

Wanting to know if my suspicions were accurate I asked M, “Why don’t the partners come in?”  She paused for a moment to reconfigure difficult thoughts into English.  “Most of them will not inform their partners.  They do not want to explain that they were married before.  Sometimes, husbands are cruel.  Women are beaten.  Women are left with no money.” 

Following her response, I pulled a well-worn notebook out of my dusty canvas bag and jotted down the words “lack of partner participation”.  This will feature prominently in my initial findings under the heading “Challenges in services provision”.

Although this is a dismal eye-opener for me, it’s old, tired news to these women.

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