Apply Now!
 Tanzania
Trip Report - Dr. Danielle Schindler, M.D. - May, 2008:
UCLA Emergency Medicine M.D.
Trip Report to Sumbawanga Regional Hospital
April, 2008
Traveling to and from:
I flew into Dar es Salaam, and was fortunate to have the assistance of HCV volunteer Carolina Mayans, who was extremely helpful in arranging a pickup from the airport, initial hotel booking, and bus tickets for the following days.
Sumbawanga is quite far – in the Rukwe region of Tanzania, which is in the far west and very rural. The region itself has over 1 million people, and Sumbawanga itself about 70,000, but the population is spread over a vast area and the density is generally low.
To reach the city, a 2-day bus ride is required. The first day involved a 14-hour bus ride to the city of Mbeya. The length of the bus ride is variable, based on poor road conditions, travel, multiple stops, and other factors. I would certainly recommend having a place to stay in Mbeya booked in advance, and taking the first available taxi there. All plans – where to stay, which bus to take – should be confirmed and re-confirmed, as plans are often subject to change without notice – for instance, no fewer than 3 people had been assigned the same bus seat that was ‘guaranteed’ to me ahead of time.
The second day involved an 8-hour bus ride on mainly unpaved, poorly maintained roads from Mbeya to Sumbawanga – again, the duration of the trip is highly variable based on road conditions and other factors. On arrival, I took a taxi to the hotel – Sumbawanga is small, and easy to get around after a day or two of orientation.
Living in Sumbawanga:
There are a few places to stay in Sumbawanga – I stayed at the Moravian Conference Center, which is a church-owned hotel about a 10-minute walk to the hospital. The center had hot water, seated toilets and a small restaurant, and was very safe.
In general, because the area is so remote, all foreigners become something of a curiousity and attract quite a bit of attention – some wanted, some unwanted. It’s impossible to walk down the street without being spoken to (usually in very limited English) by several people. The Tanzanians are, in broad brush strokes, an extremely warm, friendly people and welcoming of visitors. Children learn some English in primary school, and love to practice on foreigners.
In general, walking alone down the main streets, even the smaller dirt roads, I felt very safe. In some of the downtown areas I received attention that felt a bit more threatening or unwanted, but most was benign, and I never had any problems when walking with other people, foreign or local. I did not go out alone after dark, and would not recommend it, particularly for female or solo volunteers. Talking to locals, and seeing several assault cases come into the hospital during my few night shifts, I would recommend to always take a taxi or walk in a group at night.
Because the city is so remote, there is very little tourism, and few people (other than the physicians) speak English. There is remarkably good cell phone coverage, but limited internet (two public sites, both of which are often incapacitated by daily power outages). However, the city is overall safe, with a beautiful, rural surrounding and very friendly population.
The Hospital: resources, organization, patients
The hospital staff – from the medical director, Dr. Kabuma, to the physicians, nurses, lab technicians and medical officers, are all very welcoming and it was a great pleasure to get to know them. The hospital, despite being the regional referral hospital of over 180 clinics, and  several district level hospitals, is extremely low on resources and funding, which is a constant impediment to providing care. At the time that I visited, there were only 3 full-time physicians, with some part-time (physicians whose main responsibilities were teaching at a local training program) and much of the medical care being delivered by medical officers, with a variable level of training and experience. The physicians are therefore extremely busy covering all the wards, surgeries, and clinics, and after the first few days of getting oriented, I felt welcome to jump in and see patients. In the second week, I spent time rounding with and training some of the clinical officer students (who will go on to work in the clinics and pharmacies of the rural areas), and we developed a relationship by which they would help with patient communication and translation, while I would teach clinical skills and medical decision-making while we rounded. Fortunately, the medical charts and orders are in English.
The hospital is organized in a series of wards: pediatric, adult male, adult female, surgical male and female, and OB/Gyn, each of which had about 10-20 patients at any given time. There are also clinics, but I found my time best spent with inpatients – almost none of the patients speak English, and there are no designated translators – I had to rely on learning a few words of Swahili along with the generosity of physicians, nurses, students and occasionally patient families to translate.
Since there are so few physicians, a broad knowledge of many fields – pediatrics, internal medicine, procedures – is extremely helpful. The hospital doesn’t have the resources to spend on teaching and training, so I would recommend placing volunteers who already have a broad level of knowledge and skill unless accompanied by someone able to teach. I was very fortunate to work closely with Dr. Hans Ulaya, one of the general practitioners, who is extremely talented and dedicated, sometimes rounding together on patients and discussing differential diagnoses and treatment options, other times working independently then reviewing more challenging cases.
The spectrum of disease includes malaria, which is extremely common, typhoid, amoebiasis, AIDS and opportunistic infections (including tuberculosis), along with the infectious diseases more typical in the US – general skin and soft tissue infections, pneumonia, meningitis, gastrointestinal infections. There are also, less commonly, other diseases that I’ve rarely seen – two infants with cholera, a family with measles, and many cases of infants and children with AIDS who had never been previously diagnosed. Additionally, there were plenty of non-infectious conditions with which I’m more familiar as a ‘westerner’ – asthma, fractures, lacerations and burns, and, though rare (given that life expectancy is only 48), there is a growing level of conditions such as hypertension and diabetes.
The most frustrating part of the experience related to the lack of resources – for representing the whole Rukwe region, the lack of resources is dire. While the hospital was supposed to have X-ray, the machine was indefinitely broken while I was there, necessitating patients (who could afford it) to transport themselves to and from a private hospital for an x-ray. While the hospital was supposed to have basic lab tests such as a CBC and metabolic panel, coagulation studies and liver function tests, the reagents for all of these were ‘out’ the whole time I was there, again with no end in sight.
The hospital does have a good supply of antiretrovirals, which are offered to many patients free, and a few antibiotics (chloramphenicol, penicillin, amoxicillin, ciprofloxacin), and quinine (oral and IV) for malaria – but a very limited number of medications apart from these. Sadly, medications are included in the cost of hospital admission if they are oral, and if they happen to be available in the hospital pharmacy. IV medications, or those unavailable in the pharmacy, were the responsibility of the patients’ families to buy separately, and many were unable to do so.
I was fortunate to receive a hand-carry donation of several different oral antibiotics from the nonprofit organization Direct Relief International, which provided medications to several patients who would otherwise have been unable to afford them. For future volunteers, I would certainly recommend bringing medications (such as antibiotics) and supplies if able.
Conclusion
I had an overall excellent experience at Sumbawanga Regional Hospital, and hope there will be an opportunity to return. I do believe that the opportunity is best-suited for highly trained practitioners who can work relatively independently and are familiar with a wide range of medical conditions. The largest barriers are language and the lack of resources, thus, its essential for volunteers to be creative and proactive about their experience. I would be happy to speak with any future volunteers or answer additional questions about my time there.
Dr. Danielle Schindler
May, 2008
I’d also like to cordially thank the HCV team for making my stay possible!
Apply now
How Do I Apply?
Follow this 3 step process:
1. Create an account and then login to your account. Next Fill out the Online Application.
2. Next, Print/Fill out the Paper form (PDF or DOC) and mail it to us with supporting documents.
3. Upon receipt of your materials, we will process your application, obtain necessary work permits and deploy you to your volunteering site. Filling out the volunteering form is not a guarantee of placement, but we do try to accommodate as many volunteers as possible during the times you request. Please remember you will have to pay your own visa, temporary licensure or other governmental fees necessary. In the mean time, please gain the latest recommended immunizations
US Citizens: Follow CDC Guidelines | UK Citizens: Follow NHS Guidelines | Other Citizens: Follow Local Guidelines
|
