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Brenda’s Travel Diary

Tuesday, 15 Nov 2011

Location: Kahama, Tanzania

MapIt's time to write something about my experiences in Africa for Brenda's travel blog. For those who do not know me - I'm a medical student from Germany and I had the great pleasure to be a member of the TOPP team of 2011. I came to Kigali one day before Brenda and Karen arrived from Canada and I stayed with them until they left in October. I stayed here in Kahama to continue my field work at the Government Hospital. I experienced many situations which I probably couldn't have in Germany.I do not want to write a lot about the general situation here in Kahama as you can read about that in Brenda's blog.

First of all I want to tell about the Kahama District Hospital, how patients are treated and how people work here. The Hospital is the biggest one in Kahama (there are some private Hospitals, but they are very small) and the city has about 300.000 inhabitants, no one knows the exact number. But there are also many patients who come from the countless villages surrounding Kahama who are refered from the dispensaries that are usually built in the bigger villages.

During my whole time I experienced a very pleasent working climate - all staff members are friendly, everyone wants to help, and usually no one seems too overworked. The general rule: you can work wherever you want, you can do whatever you want to do (and what you dare to do!). So I took the chance to work in almost every department in the Hospital, from the OPD where I had my own patients together with another student; the labour ward, where the midwives were very happy about the help when there was a lot of work; the theater (OR) where after a short introduction you are allowed to perform some operations on your own; the radiology department, the HIV department, up to the different wards (female, male, ante and pre-natal; and pediatrics) where I often joined the ward rounds. I was even invited several times to do the ward rounds on my own, but because of my lack of experience I didnt dare that.

Although it is a great experience to work here, there are a numerous things the people have to struggle with. I recognized 3 major fields that need the biggest improvements: the first thing is the lack of proper material. For example, there are just 3 drugs available at the theatre: ketamin, lidocain and diazepam. That has to be enough; they do every operation with these although ketamin is contradicated in some cases. Theres no other choice. Another thing that is missing during the operation is the monitoring of patients. The hospital has a monitor, but the cables for ECG and Pulsoxy are missing, so staff can only assess bloodpressure. One time we had a boy with Haemopneumothorax but the operating tools couldnt be found (so we just had to improvise...)
The second point is the lack of knowledge among staff. Most of the "doctors" are not MDs, but clinical officers, who have absorbed a training for three years compared to six for the MDs. Many of the procedures that would be done from a long-trained physician in Germany are conducted by the COs here; also most of the ward rounds are made by them (that doesnt mean they do bad work; there,s just a lack of background knowledge which in some causes could be fatal) Also there's a lack af good textbooks for the staff. Staff were all keen on the books I brought with me. Unfortunately I didnt have enough for all.

The last point is the poor education of the people living here. Many of them dont know much about HIV ( e.g. the opinion that HIV can be transmitted through moskitos is common), are ignorent and don't use proper protection. Also many people come to the hospital very late. Of course there are people who cannot afford the treatment, too.

But all these problems shouldn't cast the hospital in a too negative light. Here one can see the improvment almost every day. There are big deficits, but therefore it's also easier to make changes. For example, up until last year, last year, there was only one (!) MD for the whole Hospital, now there are three of them. In the period I worked they purchased a lot of new equipment: a new operating table, two new OP lamp (one from Germany, I think they didnt have any lamp before) etcetera. Additionally,I hope they will get an ECG soon. I gave a basic lecture about that topic. It's very new to them.

Summarizing, I can say that there's still a long why to go, but help is coming, whether from the Government, NGOs or from personal commitment. Working there is a good way for a medical student to gain experience and also the hospital profits by learning how things are done in Europe, receiving knowledge or just being encouraged in their work.


The unforgettable impressions I made surely will accompany me all over my medical career.

I hope you go there too. All the best wishes for your work!

Rob