Day 2

 Day two of our trip to Tanzania. I am writing this reflection in the quiet hours of the morning—not because I am a night owl, but because jet lag has finally caught up with me. Last night, I tried to stay awake for the AFCON match between Senegal and Egypt. By halftime, with the score still 0–0, sleep won. Now, fully awake at 2 a.m., I find myself reflecting on an experience from yesterday that has lingered with me.

For the first time, I am witnessing clinical care being delivered to a patient population I have long held close: patients with cancer. In my country of birth, my exposure to clinical care was limited, primarily within obstetrics and gynecology. I did not have the opportunity to observe patient–clinician interactions across internal medicine—the field in which I now train—making this experience both personal and formative.

I sat in a red chair beside Dr. N, a Tanzanian oncologist, as a patient made a slow walk toward the consultation room. For a brief moment, time seemed to pause. Outside, the heat and bustle of the city blended with the chatter of the waiting area. Inside, the atmosphere shifted—the steady hum of a fan and the rustle of paper creating an intimate space for conversation and decision-making.

The four patient encounters that morning revealed the deep collectivism that shapes care in many African societies. Each patient was accompanied by at least one family member. In three of the four visits, the patient themselves was not physically present in the room. Instead, daughters, brothers, cousins, or spouses spoke on their behalf, advocating fiercely and compassionately.

They described the emotional and financial weight of illness—often absorbing it themselves. Some spoke of selling land or a car to afford treatment. Others had traveled long distances from remote areas in search of a diagnosis. Still others came hoping to negotiate delays in treatment because the cost felt insurmountable. The central role of extended family in these encounters stood in stark contrast to what I am accustomed to seeing among my patients in the United States.

This model of care feels deeply holistic, offering patients support that extends beyond the physical. Yet it also raised difficult questions for me. What is the unseen cost borne by caregivers? The responsibility frequently falls on women—wives and daughters—though this is slowly changing. I also wondered whether the patient’s absence is by choice, necessity, or exclusion? Whether this approach limits patient autonomy? Does autonomy itself carry the same meaning and priority and is it expressed differently for example, by delegation within collectivist societies. finally, what is the burden of the clinician in the room?

This experience reminded me that health care does not exist in isolation. It is shaped by culture, family, and economic realities. As a clinician training in global health, I am learning that providing meaningful care requires more than clinical knowledge—it requires humility, cultural awareness, and a willingness to sit with complexity, even when there are no clear answers.

Yours,

Tawa Alabi