I completed the 4 clinical weeks of my elective at St Joseph Hospital, in Moshi, Tanzania. Tanzania is a country on the east coast of Africa, where 43.5% of the population live below the international poverty line of $2.15 a day. Moshi is a small city at the base of Mount Kilimanjaro with a population of 221,733. The primary language is Swahili, although each tribe in Tanzania has its own language. Medicine is taught and medical records are completed in English.

St Joseph’s Hospital is a small, council designated hospital that is split into 4 sections: medical, surgical, paediatrics and obstetrics. It also has outpatient clinics on specific days including general, antenatal, surgical and orthopaedics. The hospital sees around 290 outpatients and 300 inpatients a day.

My elective was hosted by Tanzania Volunteers a small local company who specialise in volunteer placements in healthcare, teaching and childcare. I stayed at their hostel in Shanty Town, Moshi. It happened to be quite quiet at the hostel during my 4 weeks, with few other volunteers. This made it difficult but forced me out of my comfort zone to do things on my own, and to go out of my way to find other volunteers.

The Hospital

The hospital was laid out very differently to any I have seen before. While the wards and courtyard had a roof, the corridors did not and were full of plants. Inside wards, there were around 20-30 beds, with no privacy curtains and with less than a metre between each. There was no emergency equipment, and all medication, venepuncture and cannulation equipment etc was kept in the pharmacy. Patients had to purchase what they might need before they could have any medical investigations or treatment. In the emergency ward, there were four beds with oxygen and privacy curtains. It was a small room, and mostly saw outpatients who had been sent for a blood test or a one-off IV medication, rather than emergent cases.

During my 4 weeks I rotated through different departments in the hospital. I began in the paediatrics ward, and then rotated to obstetrics, emergency, outpatient clinics, surgery, and internal medicine. I was able to take histories from patients who could speak English, complete procedures including ECGs, cannulation, venepuncture and catheterisation, scrub into surgeries, observe vaginal deliveries, discuss management with doctors and offer support to patients in pain or distress.

Key Differences

There were some key differences that I noticed between healthcare in Tanzania and in the UK, that I wanted to talk about in this report. Firstly, antibiotics are much more widely used. There does not seem to be any concern about antibiotic resistance, and IV antibiotics are given prophylactically after c-sections and for any respiratory infection (without a severity score or confirmation of bacterial infection).

In contrast, pain medication is used much less. Women are not given pain relief in labour, and I sometimes got the impression that there was shame around being in pain and it was viewed as an inconvenience to the doctors, so it was hidden more often. I observed a debridement of a diabetic foot ulcer which was done on the ward with local anaesthetic, however the patient was still in significant pain, but no further pain relief was given. I also observed the cleaning of a deep surgical caesarean wound (where sutures had been removed due to a surgical site infection) with no pain relief.

Patients presenting with mental ill health was very uncommon, and I did not see one consultation during my time in the outpatient clinic regarding this. Speaking with the doctor, he confirmed that this was mostly for cultural reasons, and that mental health was not something that was discussed in Tanzania, as well as the lack of mental healthcare available. There is also a lack of patient education surrounding mental wellbeing.

During surgery, there were no surgical checklists or confirmation of the correct procedure. Sterile conditions were maintained but using reusable drapes and gowns, that were sterilised by nurses in the sterilisation room. I observed and was able to assist in some caesarean sections; the procedure was very similar to back home, but the baby was not shown to the mother and was then whisked away to the labour ward, and the father was not present in theatre.

There were many more examples of paternalistic care which lacked patient input. Healthcare seems to be much more authoritarian, which may be due to cultural reasons, lack of patient education or the way medical teaching is done. Doctors wear white coats instead of scrubs which adds to this. Despite this, patients showed immense gratitude for healthcare, and I did not observe any occasions where complaints were made.

Reflections

This clinical placement has highlighted how important patient centred care is to me. There were times when I felt uncomfortable due to a lack of doctor-patient-family discussion, and this is something that I will bring into future practice. However, I also acknowledge that differences exist due to cultural reasons and that is really important to respect. When I inevitably have patients from diverse cultural backgrounds, I will make every effort to adapt my care to their needs.

My 4 weeks here has shown me that healthcare staff will always endeavour to provide the best care, despite limited resources which has been inspiring. There were several investigations that St Joseph Hospital could not offer, but alternative plans were always made, or the patient was referred.

Many patients would turn to herbal medicines or alternative therapies before presenting to hospital due to a fear of medical care, or a lack of financial means to pay for healthcare. There were many cases where the disease or wound was much more extensive than it should have been if medical care had been received in a timely and appropriate manner. It demonstrated the importance of patient education, but mostly highlighted the stark healthcare disparities between developed and developing countries. One of the reasons I chose to apply to study medicine was due to a long-term goal of working for Medicin Sans Frontiers or similar, and this experience has strengthened my desire to provide healthcare to those in developing countries or after natural disasters, and to reduce the inequality gap.

My time in Tanzania

During my free time on elective, I spent time exploring Moshi. Some highlights were a day trip to Lake Chala, visiting Msamaria Centre for Street Children and a cooking class where I learnt how to make some traditional Swahili food. I learnt some Swahili and practiced using Duolingo and talking to the staff at the hostel, which I found really useful in building rapport with patients and also just for general daily life in Moshi. I was lucky enough to participate in a hike up Kilimanjaro which was an incredible experience, and my family joined me in Tanzania once my elective was complete for a safari and a few days relaxing in Zanzibar before the start of final year.

I feel very grateful and lucky to have spent my summer in Tanzania and I would once again like to thank the Kings Ely Alumni Charitable Trust for their considerable bursary. It has been an experience I will not forget, and it has had significant positive impacts on my professional and personal development.