Al Macfarlane - Medicine & Healthcare in Tanzania
Before arriving in Tanzania, I was given two pieces of advice to make my trip more worthwhile: 1 - the more you put in; the more you get out, and 2 - learn as much Swahili as possible. In all honesty, I couldn’t quite decipher what the first instruction really meant, but I picked it up pretty quickly. The second one was more straightforward to follow, so as soon as I landed in Dar es Salaam at 4am in late July, I got started.
From the outset, I began to pick up basic Swahili, including the numbers and greetings. After getting the hang of the basics, I started working in the hospital, where the language barrier was one of the biggest obstacles to helping patients. Soon enough, I began to learn commands to help individuals know what I was doing or what the problem was, for example when measuring blood pressure. I also worked in the labour ward for a few weeks, which was by far the most rewarding experience, but also presented some of the most challenges.
During the last stage of labour and into delivery, keeping patients calm is very important in reducing the risk of complications, and being able to communicate with them in their own language is invaluable in achieving that. Two of the most important commands I learnt in Swahili were ‘push’ and ‘breathe’! Towards the end of my placement, I became more familiar with the tenses in Swahili, as well as expanding my general vocabulary, and spent longer periods of time talking to my host family (who were fluent in English) in Swahili.
Medicine in Tanzania
It is very difficult to sum up the myriad emotions I experienced during the four weeks of hospital work in Dar es Salaam. Early on, it became apparent that this was not going to be like any normal medical experience in the West: both from others’ stories and from the structure of medicine in Tanzania.
Superficially, Tanzanian healthcare looks reasonably well structured. It boasts both governmental and private healthcare systems, and provides compulsory training to all medical practitioners. However, the healthcare system is chronically under-resourced, practitioners work long hours for low pay, and there are very few trained specialists.
The problems were compounded by the astounding lack of equipment in the hospitals: there were no MRI scanners, no ECGs (or indeed any equipment for cardiac surgery), air-conditioning was non-existent outside of theatre and small essentials such as sterile gloves and anti-bacterial handwash ran out almost every day. Furthermore, the training and experience that all of the staff had were not always put to full use, and there were very few protocols in place to standardise routine procedures. This contrasted with the situation in the UK, and most other high income countries, where almost every procedure has a recommended, evidence based set of steps associated with it and is expected to be performed consistently.
In four weeks of working at Mwananyamala Local Hospital, I experienced a wide variety of different scenarios. I spent time in major theatre, the outpatient department, neonatal ward, surgical ward, paediatric ward, the laboratory and the mortuary. This gave me the opportunity to follow up patients and see the longer term impact of their medical care. I began to help in any way that I could, which included measuring vital signs and using the medical workshops that Projects Abroad provided. After being taught how to suture and practicing on sponges, it did not take long before a patient was wheeled in to the outpatient department, semi-conscious, with two large lacerations in his head and one on his arm after being involved in a motor traffic accident. Whilst a doctor sutured his head wounds, he told me that if I wanted to help I could stitch the laceration on his elbow, which I managed to complete successfully.
My original aim for this placement was to see if I still wanted to pursue a career in medicine after experiencing it firsthand. The four weeks I spent in Mwananyamala Hospital confirmed my decision, and also gave me some real insights into what can happen when practising medicine in an under-resourced setting. I experienced this most dramatically in the several night shifts I volunteered to do, which by far offered the most intense and interesting clinical situations. Furthermore, I became more accustomed to dealing with those events, which can be fraught with panic and uncertainty, in a more professional manner.
With such an intense and unpredictable environment as the hospital to work in, many days ended with the volunteers meeting for a much needed beer. Many ‘mzungu’ (‘white person’) pubs were available, but we quickly found that local bars were much more exciting, cheaper, and better for practising Swahili. In fact, most of the Swahili I learnt in Tanzania came from chatting to locals in bars. Wednesday night karaoke at a place called ‘coco beach’ became a tradition, and it didn’t take long for me to discover that I have no real shot as a celebrity singer.
Other events that took place in Dar were outings such as group volleyball, African cooking lessons and dance lessons. These all helped us to immerse ourselves in the local culture even more. At the weekends, there were opportunities to travel round Tanzania. With other volunteers, I travelled to the picturesque island of Zanzibar, and went on safari to Mikumi National Park, visiting a local Masai tribe on the return journey. Although these were quite touristy, they provided a necessary few days to relax before starting another hectic week at the hospital.
When my placement was finished, I travelled to northern Tanzania with three other volunteers to climb Mount Kilimanjaro. I experienced severe altitude sickness, having summitted in 5 days, with frequent hallucinations, splitting headaches and vomiting, but I was determined to finish. It was a very worthwhile experience and I would recommend anyone travelling to Tanzania to give it a go!