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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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 |