TANGA, Tanzania—Dr. Abbas was late for our appointment because he was called to attend his friend’s sister’s funeral. When he finally arrives he makes his apologies, and as he pulls off his long white over-robe he directs us four Harvard students to sit on the examining table in his office. We are to be questioning the doctor on the management and procedures of his health clinic, in order to write a quality-improvement report, but the discussion is broken up every few minutes as he sees various patients. While most doctors block off time to talk to us, Dr. Abbas makes us part of the circus of his clinic.
He sees his patients at his desk. They sit on a stool next to him, and the appointment is part examination, part interview. Six-year-old Jamal comes in with his father because he has been having sore throats. Jamal wears a long-sleeved striped shirt with a yellow skull and the words “Tiny Terror” on it, but today Jamal looks like the terrorized one. His father sits on the stool, and Jamal stands between his legs, emerging only to have his heartbeat listened to. As Dr. Abbas explains to the father that Jamal has to have his uvula—a small fleshy extension located in the back of the throat—cut, the little boy’s eyes get wider and wider. Then the doctor takes Jamal’s chin, moves close so his white beard almost touches the boy’s face and looks over his glasses directly at Jamal, “you’re not going to cry are you?” Jamal stares, shocked, and then abruptly shakes his head. “Good, good,” Dr. Abbas pats Jamal’s bald head and gives him a toffee from a box on his desk.
In the end, our report excoriates Dr. Abbas’s clinic. Besides having a toffee box, the doctor’s desk also contains a messy array of loose antibiotics, piles of money, and insurance receipts. He keeps medical records only for his long-term patients, and even those are largely written on loose papers stuck in a notebook. After I accidentally drop the notebook, I spend frantic minutes collecting all the sheets that fell out, terrified that if I miss one I will lose all trace of a year of a sick patient’s illness. His attending nurse wore flip-flops during a minor operation and talked on her cell phone while conducting a pregnancy test.
But I still feel there is something valuable in the care that Dr. Abbas provides. Just as he compelled a small boy to be brave for a scary operation, Dr. Abbas looks to give all his patients more than simply a medical cure; he aims to provide them with the strength to face their small hurts on their own. He treats them as compassionately and interestedly as one would treat family, and though by reasonable medical standards this is terrible practice, in an area where just the idea of being sick seems ominous, this makes his patient care most appreciated.