My pursuit of nurse-midwifery was originally driven by the impotence I felt as an HIV-educator with Peace Corps from 2000-2002 in Malawi.  The Life Skills classes that I taught at a remote secondary school seemed laughably insignificant among a population of girls who had little control over their eventual partners, professions, or reproductive futures.  After spending two years with them, I worried about the girls I’d left behind. Their sense of powerlessness was mirrored and compounded by my own.  Socio-cultural changes take place over generations and I was 25 with little patience.     

After graduating from Yale School of Nursing’s nurse-midwifery program four years later, I felt an intuitive disconnect between my personality and my new profession.  This profession seems to be defined by high-tech American hospitals, regimented power hierarchies, clinical algorithms, and fear-of-lawsuits decision-making.  Taking advantage of accrued vacation time, I decided to take a mini-break from my first clinical job to work with midwives in Haiti.  I was extremely impressed by those women, struck by their desire to improve their own, their family’s, and all Haitian women’s quality of life.  After a week teaching in front of a sweltering classroom of elbow-to-elbow women eager to obtain paid employment as skilled midwives, I realized it was time for me to return to what is called “capacity building” in the NGO, or non-governmental organization, world. 

I have now been in Tanzania, a sub-Saharan African country with a population of 34.4 million and an HIV positive rate of 9.6 percent for three weeks.  The first few days were spent in the Dar es Salaam’s office of the American International Health Alliance (AIHA) reviewing the complicated interplay of organizations responsible for my volunteer placement.  AHIA, funded by PEPFAR, matches “implementing partners” with local care-providing facilities.   In my case, Columbia University’s ICAP (International Center for AIDS Care and Treatment Programs) was matched with coastal Tanzania’s Tumbi Hospital in order to boost Tumbi’s efforts at preventing the transmission of HIV from mother-to-child.  AIHA brought me on board to work with Tumbi nurses in the day-to-day functioning of the program. 

At this point, I know only a few statistics about the place that will be home for the next six months.  Tumbi Hospital is a 253 bed hospital that sees about 400 outpatient visits per day.  Approximately 2,500 HIV positive individuals are enrolled at its AIDS Care and Treatment Center, about half of whom are on antiretroviral medications.  Nineteen nurses and twenty counselors shoulder the burden of these patients’ ongoing needs. 

After one more weeks of intensive Swahili language classes I will report to my new job at a hospital made nationally famous by the number of automotive accident victims its emergency room manages.  And yet, I am thrilled to be here.  I welcome the opportunity to work side-by-side with Tanzanian nurses, to count myself among their courageous company.  I expect that my own learning curve at Tumbi will be great.  I expect that the reality of HIV here will overwhelm me at times.  I expect that, by the end of six months, I will feel indescribably indebted to the nurses who will have shared their knowledge, experiences, and company with this American nurse-midwife.

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