Mt. Meru Regional Hospital has multiple wards that include labor and delivery, surgery, pediatrics, and gynecology. As a regional hospital, they see many different types of ailments, sent to them from lower health clinics or dispensaries. While there, I spent four days on the surgical ward observing the physicians caring for patients during rounds and surgeries. I also spent a single day on the pediatric ward, watching physicians taking care of children and learning about the most common ailments that affect the children.
The pediatric wing of Mt. Meru was a two story building with many beds filled with babies and their mothers waiting to be cared for. Four large, very open rooms contained all the patients. Beds were lined up against the walls, one next to the other, and lacked privacy curtains. The women did not seem to mind, as they chatted away with one another and also helped to translate for the few Maasai women who had brought their children to be examined. I shadowed a young, female doctor who was very kind and made many of the children smile. Altogether, there were three doctors who performed rounds and took care of the patients. Most of the ailments I witnessed were either pneumonia, malnutrition, or some combination of the two. Malnutrition was especially prevalent in the Maasai patients, as the doctor explained to us that all the children are really fed when they are younger is cow’s milk and that the women barely breast feed. Among other tribes, malnutrition often occurs because children are fed a traditional dish known as ugali, which is a stiff porridge made from corn millet and water. The doctors explained that when these patients are discharged, they sit down with the mothers and educate them about what kind of things their baby should be eating in order to remain healthy and happy. The majority of my time was spent in the very crowded men’s surgical ward. Throughout my time here, I saw a high prevalence of diabetic ulcers and hematomas. One mode of transportation that can be found in Tanzania is a piki piki/ boda boda. These are small motorbikes that carry a few passengers throughout the city. There are not many street signs or stoplights throughout Tanzania, and traffic can get pretty crazy. These piki piki drivers tend to weave throughout traffic, drive very fast, and not wear helmets. This makes for a bad combination if they are to get in an accident. Usually head injuries as severe as subdural hematomas are taken care of in Moshi, a city located at the base of Kilimanjaro and about two hours from Arusha, but the surgeons explained that they were going to perform their first treatment of the subdural hematoma through burr hole trephination. Ward rounds would begin at 8:30 in the morning, when we would follow anywhere from 3-6 doctors as they examined patients, changing bandages, diagnosing, and discharging as needed. Two of these doctors were medical students in their year of internship, assisting the two main surgeons that worked on the ward. This ward was made up of only two large rooms that again lacked privacy curtains and seemed to have even less resources than the pediatric ward due to a high patient capacity. We occasionally observed two patients sharing a bed when the ward became full, but more patients were still being admitted. The head nurse on the ward, Nurse Shao, explained to us that many times there were not enough bed sheets, bandages and gauze, catheters, and medicines to go around. She explained that the government excuses pregnant women, children under five, those over 65, and many with serious illnesses such as AIDS or cancer from paying their medical bills, but does little to ensure that even with all these people being excused, the hospital had enough money and resources to provide their services. This also seemed to put a huge burden on those who had the most basic insurance policies, and young people who were often times not insured and had to pay a huge price for the services they were receiving. Doctors spent time in the operating room on Tuesdays and Thursdays, and occasionally performed emergency procedures as needed. I had the opportunity to spend all day Thursday observing surgeries. There were to operating rooms, or theaters, and only one contained an anesthetic machine that allowed patients to be put under general anesthesia. In the other room, local anesthesia was used. I saw a total of five surgeries throughout the day, two using general anesthesia and the other three with local. The first patient was a woman with a lipoma (fatty tumor) located under her left arm that was about the size of a fist. The surgeons used local anesthesia for this procedure, but the woman could still feel the removal on occasion. They successfully removed the tumor and moved on to a one and a half year old who had an undescended testis that was fixed under general anesthesia. Next a man with a ruptured appendix was brought in. Surgeons made a very large cut down almost the entirety of his abdomen and removed the appendix. After this, they performed an exploratory laparotomy to ensure everything else in his abdominal cavity was normal and functioning properly. They closed him up, and moved on to a man with a severe diabetic ulcer that had eaten away most of his big toe. They planned to remove the infected skin and bone under general anesthesia, but the patient ate bananas the morning of his surgery, so had to be put under local instead. Luckily, the man had neuropathy to the point where he really could feel nothing in his foot. The surgeons removed the necrotic bone at the joint, took out the rest of the infected tissue, and sewed him back up. The last patient had a few foreign objects lodged in his shoulders and skull that needed to be removed. This procedure was also performed under local anesthesia. My time at Mt. Meru was invaluable and taught me a lot about the limitations to health care that many citizens of Tanzania experience. While one of these main limitations was a lack of resources on the part of the hospital, one of the most important lessons I learned was that the doctors are extremely competent and caring and they treat their patients to the best of their ability given the resources that they have available to them. They were extremely welcoming towards us and made sure we understood what was happening with each of the patients. It also appeared that many patients did not come to the hospital until their injuries or ailments got so severe that they could no longer be ignored. This could be because of a lack of money, going first to a traditional healer that they believed would help them heal, a lack of ability to get to the hospital, or a number of other reasons. Whatever the case, Mt. Meru hospital offered the sick very intelligent doctors who did the best with what they had to provide the greatest care possible.
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6/22/2017 0 Comments Tupendane OrphanageMt. Meru Uhru Vulnerable Foundation and Tupendane Orphanage Center located in Usa River Tanzania serves over 70 underprivileged boys and girls living within the community. We traveled there on Wednesday and Thursday to get a better sense of the support system various community resources offer these orphaned kids. The founders of the center live on site with all the children who are in their care. They have one room for boys and another for girls, both filled with six beds (stacked three high) in which about 25 boys or girls shared a night. They had a nice kitchen and an eating area from which they served the kids meals. Outback there was a long building that contained two classrooms in which some of the children were taught.
We sat down with the founder and his wife, Emmanuel and Margaret, and discussed why the opened their facility. Emmanuel explained that when he was a child, his family was very very poor and could not afford to send him to school. However, another family took him in, fed him, and paid to allow him to go to school. The influence this family had on his life inspired him to do the same for other children. Now he owns and runs a facility that not only gives a home to orphans within the community, but allows children living in poverty to have a chance at an education. Through sponsorships he provides funds for the majority of the kids who come to the center to attend school. Those he cannot afford to send stay at the center and learn in the two classrooms that Emmanuel built and staffed. He explained that while he was meeting the needs of these children in the best way he could, government regulations was demanding he expand his facilities. They were working on fundraising to purchase a piece of land on so they could later rebuild their school and house where the children stay. He also told us that at least eight children on the premises suffered from aids, and it was his responsibility to get them help. Because they are orphaned, they receive their healthcare and antiretrovirals for free. Not everyone in the country suffering from aids receives this same luxury however, and because the antiretrovirals are expensive, often times when Emmanuel goes to get them for the children the pharmacy says they are out of the medication so that they may sell them to someone else instead of giving them away for free. While there seemed to be a lack of resources for a lot of these children, and even come corruption surrounding their health, they seemed healthy and genuinely happy that we were there to spend time with them. We met them all in one of the classrooms at the back of the facility, and they sang us songs and danced for us before we went outside to play. The yard was small but contained a jungle gym which the kids really enjoyed playing on. Most of the younger children really wanted to be held and swung around in all different directions. They would argue who got to sit on our laps until we put one on either knee. All of them have really short haircuts, so most of the girls enjoyed playing with and braiding our hair. Many of them told me all about what they wanted to be when they grew up, lots of the little girls wanted to be teachers, some even said they wanted to be doctors! We played games together, sat together, and even sang together. The simple kindness of spending two short afternoons with them brought them unending joy, which made it very hard to leave. It seemed like the facility offered the community an approach to dealing with sending children living in poverty to school. At the end of the two days, lots of the children would be picked up by a parent to go back to his or her home, while many of them also stayed at the orphanage. However, no matter where the children lived, they all received at least some sort of education funded by outside donations and sponsors. The orphanage offered the children within the community a healthy and happier future, along with the chance to fulfill their goals and dreams. If you’re interested in learning more about the facility, please visit their website at www.tupendanechildren.org. From the Health Center, we moved to a dispensary which is the lowest level of health care within Arusha. Once again, their system of care proved impressive, especially with regards to family planning and reproductive health for women. The Moivo dispensary was staffed by three people, a pharmacist, a nurse, and a single doctor. There were two parts to this facility. The front entrance allowed people with various ailments to walk in and see the doctor right away. The back entrance was specifically for women and children, who the nurse took care of. On the first day we arrived, the doctor was sick, and the nurse, Gubyi, took over all the responsibilities within the clinic. We observed as she ran from the doctor’s office to prescribe medications for the sick, to her office to discuss family planning with various women, to the injection room to take care of the children in need of vaccinations. She saw many patients throughout the day, but took control of the situation and handled each case very impressively.
The dispensary was a government run and own facility, so patients that came for a visit needed to have a health insurance known as Community Health Insurance, or CHI. From my understanding, a family of four could pay 10,000 Tanzanian shillings (equivalent to about 4.50 USD) and receive completely free health care for an entire year through these government facilities. This included imaging, hospital stays, medications, and for women multiple forms of birth control and checkups for newborns. What I observed most often at this facility was family planning meetings and care for children and their mothers. Gubyi weighed each child that entered the facility and recorded their weight on a chart that tracked the child’s growth from birth. She also administered vaccinations, and gave children TB tests whenever necessary. Women could meet with Gubyi to talk about anything related to women’s health. In her office, she had a whole cabinet filled with medications and charts, as well as an examination table used to examine those that were already pregnant. She showed us what was called cycle beads, a ring of different colored beads that allowed a woman to track her menstrual cycle. When a woman began her period, she would move a marker to the red bead on the loop, and continue moving the marker forward to brown beads each day after. When the beads became white, women were instructed to abstain from sex or to use a condom, as they indicated the period that she may ovulate within. When she got her period again, she’d move it back to the red bead. However, if she didn’t reach a certain black bead before she began ovulating again, it meant her period was too short and she should see a doctor. Such a simple tool seemed pretty effective in preventing pregnancy, and along with receiving this, women could obtain condoms and various forms of birth control at the clinic. Regular daily pills could be taken, or Gubyi could give shots of birth control or put an implant in the women’s arm. Each type was completely free for those on CHI. Four to five babies per week were even born in the clinic. Once again, I was pretty impressed with the quality of care this facility offered, especially for women and children. Women had the ability to ensure themselves and their babies were healthy before, during and after their pregnancies. However, as I am learning more and more about the health system and insurance programs, I am beginning to wonder a few things. Namely how far reaching are these medical resources outside of the cities? Some rural areas in Tanzania are still without clean water and electricity, and if this is the case, how do they even have access to health care? Also, because insurance programs are so inexpensive, how does the government pay for the immense cost of healthcare they allow their citizens? Do they rely heavily on foreign aid? Or is the majority of the government’s budget simply put towards the health care costs? I am sure I’ll find answers to these questions as I continue to gain experience within health care, namely at Mt. Meru regional hospital. Gaining insight into these questions will help to understand how sustainable and accessible the health care system I have been so impressed with so far. The Tanzanian public health care system is rather organized with several different levels of facilities that serve patients. The lowest is a dispensary, which treats minor bumps and bruises. Health centers are the next level of care, providing treatment for infections, admissions into their facilities, and a maternity ward. Rural centers follow, and receive referrals from these health centers. District hospitals are the largest throughout most areas in Tanzania and take care of several different health concerns. Most Tanzanians are also covered by a national health insurance called the National Health Insurance Fund (NHIF) that covered all the costs of the patient’s visits to the clinic. I spent the past week at the Bakira Mama Maria Wa Huruma (which translates to Virgin Mother Mary of Mercy) Health Center, which exceeded my expectations in their ability to provide their patients with health care.
The health center was staffed by 22 individuals, including multiple doctors, nurses, lab technicians and pharmacists. Patients would enter the clinic, talk to the receptionist, and then immediately have their vitals taken (blood pressure, heart rate, temperature, and weight). They would then take the paper with their vitals to the doctor. After talking to the patient for a while to understand what was wrong, the doctor would order tests he deemed necessary in order to diagnose the patients, and the patients would visit the medical laboratory in the next room over. They would then return to the doctor with their results and receive a diagnosis along with a prescription. The prescription would be filled immediately by the pharmacy located within the building, right across from the doctor’s office. This process was efficient and expedited the health care process for the patients visiting the center. I spent my first two days at the health center shadowing two doctors that worked at the clinic. Both seemed rather young, and had just recently graduated from medical school (in Tanzania, you enter medical school right after completing secondary school, what is known as their high school). Patients visited the doctors in a small, single room which contained a desk, plastic chair across from it, and an examination table shoved into the back corner. Doctors sat at the desk and faced their patients as they discussed the patient’s ailments. Rarely did the doctor preform a physical examination. They only did so when they were seeing a patient for the first time, or if they had symptoms which made the doctor feel like it was compulsory. Most cases we saw throughout the day involved type II diabetes, hypertension, urinary tract infections, and cases of hook worm. The interaction between patients and physician was always very friendly, and the physician did a fantastic job of explaining what the patient was suffering from along with the necessary steps it took to deal with the diagnosis. Because there was no technology involved in the visit, the doctor could really take his time to understand his patient and ensure their needs were met. I spent the third day in the medical laboratory, observing and helping the lab tech with all the tests that the doctors ordered. The laboratory had a centrifuge, heat bath, biochemical analysis machine, and a microscope. Throughout the day I observed the rapid tests for malaria, HIV, Typhoid, pregnancy, and various others. Most commonly patients needed a urinalysis which gave the lab tech information about pH, glucose, bilirubin, specific gravity, and leukocyte levels in the urine all at once. Sometimes stool samples were taken to help determine if the patient had intestinal hook worms. If they did, hook worm eggs would be visible in the stool under the microscope. Rapid tests allowed for the lab to quickly determine what a patient was suffering from and for quick and effective communication between lab tech and physician. The pharmacy in the hospital was well stocked with medications that helped treat the most common complaints, and offered many types of injections. I spent my fourth day here, assisting in counting pills and filling prescriptions. Pharmacists would count out the amount of medication the patient needed, explain how often they were to take it, and tracked down a nurse when a patient needed an injection so they could receive it as soon as possible. Once again, this part of the hospital was effectual and ensured patients received all they needed to treat their sickness. The health center was a one stop shop for everything a patient needed in order to return to health. On top of all these different resources, the health center also had a maternity ward that helped ensure both mother and baby were happy and healthy after child birth. Patients could be admitted to small wards located on the second floor of the health center to receive fluids, multiple doses of medicine or further treatment for more serious illnesses. There was also a surgical theater that was used about one to four times a month to perform things such as caesarian sections, fixing hernias and fractures, and exploratory laparotomies as visual imaging machines were limited to ultra sounds within the center. While the overall system of the center was impressive, it was still lacking in technology and in some areas of sanitation. However, given the limited access to resources that these facilities may have, the main concern is to treat the patient as well as possible, and they absolutely do this. I am intrigued to learn more about the health care system, as this is one of the lowest levels but is seemingly very successful in helping its patients. Furthermore, the majority of Tanzanians to not even pay for this care, as they are enrolled in the health care service offered by the state. I am excited to learn more over the next few weeks about the various other levels of the health care system. When many think of Africa, they think of poverty, sickness and malnourished children and orphans. The Western media has portrayed this incredibly diverse continent as one that needs help in several different aspects in order to improve the life of its people. However, my experience in the Gambia told a different story. While many African countries may lack resources and the organization that would allow for a more developed way of life, the people here are resilient, hardworking, and resourceful. Their culture is rich and their people are kind. Given direction, resources, and opportunity, they flourish. Child Family Health International is focused on doing exactly this; providing the needed skills and support to make communities self-sufficient. They approach community development through an asset based improvement system. This means they recognize the skills, resources, and talents already found within communities and organize these assets around a mutual developmental goal. This method focuses on strengths found within the community as opposed to the deficits, and leaves communities sustainable, even when outside parties disassociate themselves. This empowers communities by leaving control of development in their own hands as opposed to a resource rich outsider. As I attempt to impact health care systems in underdeveloped communities, I want this asset based community development to be the center of my focus. I want to empower communities in their ability to develop a health care system centered on their communities needs while utilizing their strengths to facilitate these improvements. My role would simply be to facilitate, teach, and learn from each community I am a part of. I chose to participate in a CFHI program because of their approach to community development and their ability to provide me with better tools and resources to also develop communities in a similar manner in the future.
When I got off the plane at Kilimanjaro National Airport, I entered a small room full of people waiting for adventure. Whether it be on the Safari they were about to embark on or the new culture they were about to experience, you could feel the excitement in the room despite the long flight. My own eagerness came from the thought that I would soon be in a clinic increasing my knowledge of health care and that I would be making an impact through my work with a non-profit. Getting through customs, I grabbed my luggage, and headed out the exit to find a driver waiting for me, along with another student participating in the program. We hopped in a truck and drove 45 minutes from the airport to the Tuliv house in Arusha where I will be staying for the next six weeks. When we arrived at about 11 at night, I hopped in bed, full of anticipation for the upcoming days. Our program coordinator, Aloyce, took us on a tour of Arusha as part of our orientation the next day. We visited a Gem House with a museum that explained how precious gems such as tanzanite, ruby, and amethyst are mined. There was a beautiful showroom full of all kinds of jewelry, which was way to expensive for me to purchase, but nonetheless incredible to look at. We continued our tour by visiting the cultural heritage site that had a huge display of paintings, photographs, sculptures and carvings. We also learned about the semi-nomadic Maasai tribe that inhabits parts of Tanzania and still partakes in their very traditional tribal practices and dress. Their lives are centered around their cattle, which they rely on to meet all of their dietary needs. It used to be common practice for Maasai boys to kill lions before entering adulthood, but this tradition has been practiced less frequently due to growing concerns about the lion population. From the cultural heritage center, we stopped to eat lunch and discuss the logistics for our program. We will be observing physicians in different clinical settings, starting with the local dispensaries, which have the fewest staff and resources and therefore treat small medical issues such as minor sickness and cuts. We will then work our way up through the health care system, moving to clinics, and then the regional referral hospital known as Mt. Meru. Throughout this time, we will also have the opportunity to visit orphanages and meet with the local Maasai tribes to understand the limitations to health care that these groups face. We will also be completing different projects for a non-profit known as Child Growth and Development which is based in Arusha and works to educate Maasai women about safer health practices. I am very excited to get started with all of this work, and am hoping that I leave an impact, whether it be substantial or modest, over the next six weeks here. |
AuthorJess Zavadak is a rising senior studying biochemistry and pre-medicine at Juniata College located in Huntingdon, Pennsylvania. Through Juniata College she has traveled to The Gambia in West Africa where she had her first experience with health care systems in underdeveloped areas. Since her time in the Gambia, she has become passionate about creating better health care systems through gaining a combined medical degree and masters in public health. This summer, she travels to Tanzania with Child Family Health International to shadow doctors, learn about the health care system, and gain insight into how she can further make an impact. ArchivesCategories |