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September 3, 1997

Fanya Kazi Pamoja

Author Affiliations

Seattle, Wash

JAMA. 1997;278(9):697. doi:10.1001/jama.1997.03550090015007

"In Africa, one needs to negotiate the evening meal—if there is one," or so the saying goes.

As a medical student commissioned with an international disaster and relief agency, I assisted an African physician in his three-room clinic in Kisongo, a remote outpost on the Masai Plains in Tanzania, which is situated on Africa's east coast, along the Indian Ocean. This country of approximately 28 million, known for the great Mount Kilimanjaro, is home to the seminomadic Masai people, who constantly struggle for survival because they cannot support themselves agriculturally in the dry, desertlike plains.

The Masai have very little food, almost no water, and no consistent medical care. In our outpost, one physician serves more than 8000 people spread across four villages, requiring many to walk over 50 km to a rather primitive medical facility. Each day, young and old wait patiently in long lines in the hot sun