The Early Years in Tanzania
by Charles R. Swift
University Press of America, Inc.
Reviewed by Joe Kovacs (Sri Lanka 199798)
THE MISSION OF PEACE CORPS VOLUNTEERS is certainly unique in the opportunities it provides for grassroots Americans to live and work among the peoples of developing nations. Some of the first Volunteers in the 1960s had the opportunity to witness firsthand the efforts of post-colonial nations to build their own civic and social infrastructures following the withdrawal of European administrators. This is certainly the case of Dr. Charles R. Swift. Although not a Volunteer, he could have been. In 1966, Dr. Swift left his position as medical director of a Child Guidance Center in New Jersey to work as a psychiatric consultant in the Muhimbili Hospital in Dar es Salaam, the capital of the newly nation of Tanzania. No trained psychiatrist lived in Tanzania at the time, and the Ministry of Health responded to Swifts query by inviting him to study the current national health system and develop new programs and opportunities for providing care. What began as a two-year assignment turned into an eight-year commitment including a stint as a United Nations Volunteer to work with host-country colleagues and medical students to integrate psychiatric capacities into Tanzanias medical infrastructure. The result of his diligent note-taking during this period is Dar Days: The Early Years in Tanzania.
An environment of mixed feelings
Swifts work begins two years following the union of mainland Tanganyika and the island Zanzibar, an unhappy consolidation from the perspective of Zanzibar. In this environment of mixed feelings, Swift records his encounters with expatriate holdovers from the British administration, whose attitudes he frankly records as tired and narrow, or professionally competent. He is also frustrated by the attitudes of some host-country colleagues who do not pay sufficient attention to the problems facing the mental health field in their country. Traveling to the regional districts, he is shocked to find some patients relegated to prisons due to a lack of hospital space and their inferior medical status. Despite some difficulties however, Dr. Swift finds support at the Muhimbili hospital, at the local university where he receives an appointment, and among other health officials.
Dar Days recounts Swifts personal experience in postcolonial Tanzania more than it provides a clinical study of mental health diseases. He does note a common hysterical laughing disease that many Africans are prone to, and seeks to modernize the local attribution of disease to witches. His observations of stress-related illnesses broaden his understanding of the family unit and the local village culture, though it is a little disappointing that he doesnt always share his findings or conclusions with the reader.
But Swift dedicates himself primarily to developing self-sustainable capacities within Tanzania, especially given the appalling physician-to-population statistics at the time. In 1966, one physician served an estimated 35,000 citizens. Eight years later, Swift says his anxiety about leaving is assuaged by the growing number of successful mental health physicians, practitioners and nurses in the country.
The issue of expatriates in post-colonial Africa was a tenuous one. In Uganda, in 1972, Idi Amin had ominously directed all Asians to leave the country. Swift highlights the Tanzanian position when he recounts a public appearance by President Julius Nyerere at the University of Dar es Salaam. Nyerere, who had utilized a village model to develop a national brand of African Socialism, was asked about the presence of Westerners as potential breeders of capitalism. Suspicion of U.S. ventures had led to a phasing out of the Peace Corps in 1969, but Nyerere downplayed the threat by praising the humanitarian principles Westerners often brought to Tanzania, a tension-breaking response that emotionally affects Swift.
Swift ends his tour by co-authoring a textbook on African mental health system with the Nigerian president of the Pan-African Psychiatric Association.
Dar Days provides an engaging account of a Western physicians dedication to and collaboration with African colleagues on the development of a functional mental health field in Tanzania. Often encountering resistance as the result of disparate traditional and modern perspectives on the field of mental health, Dr. Charles Swift was nevertheless fortunate to work during the presidency of Julius Nyerere. His recorded observations offer readers a unique insight into some characteristic growing pains of a new African nation.
Joe Kovacs is a contributor to WorldView magazine and a marketing manager for the American Association for the Advancement of Science.