Tanzania
Trip Report - Dr. Melanie Kalmanowicz - Aug, 2007:
General Tanzanians are very friendly people- you can expect to hear the word "karibu"(=welcome) multiple times each day! Many of the hospital staff speak English and most of them understand it at least a bit. Outside of the clinic and especially if you are not working in a touristy town it is a little harder to communicate. Internet access is available in all major cities and touristy places, incl. Dar es Salam, Moshi, Arusha, Mbeya and Sumbawanga. At the time that I was there I couldn't find internet in Mpanda, but I recently received an email from one of the doctors there so there might be internet now.
Mpanda
Mpanda is a nice, but very rural place- you shouldn't underestimate this. It is not only quite a long way to get there, but it is also far away from the kind of environment that most of us are probably used to. It took me 3 days to get there: day 1: ca. 10- 12 hours from Dar es Salam to Mbeya (on the way back it took me over 15 hours due to a bus breakdown), day 2: ca. 8 hours from Mbeya to Sumbawanga, day 3: ca. 7-9 hours from Sumbawanga to Mpanda (this road is really VERY rough and you basically can only use it with a 4WD car). On the way you will have to drive through 2 national parks, thus if you are a little lucky you will be able to see lots of different animals and thereby get a gratis safari. During the time I spent in Mpanda I didn't see any other "mzungu" (=foreigner) thus you can expect to be a little curiosity for the locals. I stayed at the chief doctor's and his wife's house as the hotel (that according to my tourist guide book exists) would have been too far away from the hospital. The Christian mission which is directly next to the hospital was the place where I was supposed to stay, but after my arrival I found out that it was already completely booked by locals. Where I stayed there was no running water, but a sink nearby.
Moshi
Beautiful town in the north just situated on the foot of Mount Kilimanjaro. It's a very touristy place thus you can enjoy various luxuries like tourist style restaurants/coffees, plenty of hostels/hotels, nicer roads and even a night club. Moshi is easily accessible via a pretty good paved road from Dar es Salam. Buses run several times a day in all different classes (economy, luxury, super deluxe...); it takes about 7 hours. Additionally, Moshi is close to all main tourist attractions incl. Mt. Kilimanjaro, Arusha with Arusha National Park and it's not too far away from the main Safari places (Serengeti, Ngorongoro Crater amongst others). In Moshi I stayed at a hostel in walking distance from the hospital- I paid about 8 USD per night.
Pictures from Moshi:
Operating Room for OB/GYN in Moshi Hospital
Main Operating Room in Mawenzi Hospital
Mawenzi Hospital
Hospitals
The Rukwa Regional Hospital in Mpanda is of similar standard as the Kilimanjaro Regional Hospital (=Mawenzi hospital) in Moshi. The only big difference that I realized is that in Mpanda there's no running water in the clinic (at least not in the dry season). Both hospitals basically lack most of the equipment that we take for granted, e.g. there is only a very limited choice of drugs and no "high-tech" things like EKG. The MSD (medical store department) supplies all the hospitals with medical equipment. If they close down for any reason or if the bureaucratic ways were too long then it can easily happen that the hospitals for some time would run out even of very basic things like gloves, gauze, tapes or IV fluids. Patients or their relatives are then usually sent to the closest pharmacy in order to buy these things themselves. But, although there was only limited amount of some basic equipment available, drugs for HIV, TB and Leprosy were available and given to the patients for free.
The set up of the hospital is similar in Mpanda and Moshi (and from my very short glance into the hospital in Sumbawanga it seems to be the same there): there are several buildings on a campus. Each building contains a different ward. There are: female/male internal medicine, female/male surgery, pediatrics (in Moshi divided in diarrhea and non-diarrhea), psychiatric, rehab, radiology (there is one x-ray and one ultrasound machine) and a theatre. Additionally there are dental, HIV, TB and Leprosy clinics and the outpatient department. A ward has about 30 beds, and a lot of times there is more then one patient per bed. They theoretically have an isolation ward, but unfortunately patients with open TB were in the same room like all other patients.
In Mawenzi they recently built a new theatre which was not yet opened by the time that I was there, but hopefully will open soon. Surgeries are performed either in Ketamine, spinal or local anesthesia. Like mentioned before patients cannot be monitored (e.g. with EKG or pulsoxymetry) during procedures and there is no oxygen supply available- no need to mention that there is no machine for mechanical ventilation. Apart from minor general surgeries there are mostly gynecologic procedures performed.
On the wards, the most common diseases that you will encounter are: malaria, pneumonia, HIV, TB, UTI, diarrhea and many burn wounds. Obtaining a diagnosis solely with your head, hands and stethoscope without standard laboratory tests or imaging, can be very difficult at times. I was working most of the time on the female or male internal medicine or the obstetrics wards. Ward rounds are usually performed by one doctor- whereas a lot of them are in fact well trained nurses. He or she has to take care of 30+ patients (as mentioned above, in many beds there was more then one patient). By working together with them on the wards, there was ample opportunity to discuss various topics and address questions from both sides. On the obstetrics ward the nurses usually delivered the babies and performed an excellent job. I then took care of the neonates and also educated the local staff how to support newborns if they show signs of respiratory distress with the limited equipment available.
You are working with very limited resources and often times I felt sad as I knew many things that I could have done in order to improve a patient's condition, but sometimes was just sentenced to observe. On the other hand you will experience that no matter how limited your resources might be and how difficult some of your days will be working under such circumstances, there is always something positive you can contribute! During the time that I worked at Mawenzi hospital, I was the only foreign doctor and I am convinced that it would be very beneficial if some more doctors would go there in order to support and educate the local staff.
Just on the side I would like to mention, that in Moshi there also exists another, more western-style hospital than Mawenzi. It is called KCMC (Kilimanjaro Christian Medical Center) and there you can find several doctors and medical students from western countries. It basically looks similar to hospitals that one would expect to find in a newly industrializing country. It's receiving funds from abroad and thus is much better equipped than Mawenzi. Several of the patients in more severe conditions were thus referred from Mawenzi to KCMC (which also has an ICU). It should be mentioned though, that a lot of patients refused transfer as they weren't able to financially afford treatment there.
Conclusion
I believe that everyone can make a positive contribution, help where it's most needed and improve the conditions to some extend. But: don't underestimate this endeavor! The medical teams, both in Mpanda and Moshi are extremely friendly and helpful. They are willing to teach foreigners the guidelines for the treatment of a wide range of infectious diseases as well as most of them are happy to receive help and advice. I am very lucky that I have met so many nice colleagues and that I was able to work together with them, sharing our ideas and knowledge. I hope that our friendships will last and that we will be able stay in contact. However, I think it is quite difficult and not advisable for medical students to go there unless they are accompanied by a more experienced doctor. You should definitely have someone you can talk to and who is able to explain things to you. On the other hand, if you are together in such a team than I'm sure that you can learn and do a lot. Although this might sound very simple, it truly is highly beneficial if you have a broad knowledge and are equipped appropriately- you will be very grateful for everything. If possible, then you should bring as much of the equipment that you would need for your work along with you. Don't forget to bring basic supplies as well! Additionally, any kind of equipment that you would be able to donate will also be of great help (e.g. an old EKG, pulsoxymetry or CTG machine).
I hope that this little report gave you some basic understanding of the conditions in the Tanzanian hospitals that I worked in- and the way I experienced them- and I wish you all the best! I'd also like to cordially thank the HCV team for making my stay possible and please do not hesitate to contact me in case you have any questions!
Thanks for everything,
Dr. Melanie Kalmanowicz
Apply now
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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
Trip Report - Dr. Melanie Kalmanowicz - Aug, 2007:
General Tanzanians are very friendly people- you can expect to hear the word "karibu"(=welcome) multiple times each day! Many of the hospital staff speak English and most of them understand it at least a bit. Outside of the clinic and especially if you are not working in a touristy town it is a little harder to communicate. Internet access is available in all major cities and touristy places, incl. Dar es Salam, Moshi, Arusha, Mbeya and Sumbawanga. At the time that I was there I couldn't find internet in Mpanda, but I recently received an email from one of the doctors there so there might be internet now.
Mpanda
Mpanda is a nice, but very rural place- you shouldn't underestimate this. It is not only quite a long way to get there, but it is also far away from the kind of environment that most of us are probably used to. It took me 3 days to get there: day 1: ca. 10- 12 hours from Dar es Salam to Mbeya (on the way back it took me over 15 hours due to a bus breakdown), day 2: ca. 8 hours from Mbeya to Sumbawanga, day 3: ca. 7-9 hours from Sumbawanga to Mpanda (this road is really VERY rough and you basically can only use it with a 4WD car). On the way you will have to drive through 2 national parks, thus if you are a little lucky you will be able to see lots of different animals and thereby get a gratis safari. During the time I spent in Mpanda I didn't see any other "mzungu" (=foreigner) thus you can expect to be a little curiosity for the locals. I stayed at the chief doctor's and his wife's house as the hotel (that according to my tourist guide book exists) would have been too far away from the hospital. The Christian mission which is directly next to the hospital was the place where I was supposed to stay, but after my arrival I found out that it was already completely booked by locals. Where I stayed there was no running water, but a sink nearby.
Moshi
Beautiful town in the north just situated on the foot of Mount Kilimanjaro. It's a very touristy place thus you can enjoy various luxuries like tourist style restaurants/coffees, plenty of hostels/hotels, nicer roads and even a night club. Moshi is easily accessible via a pretty good paved road from Dar es Salam. Buses run several times a day in all different classes (economy, luxury, super deluxe...); it takes about 7 hours. Additionally, Moshi is close to all main tourist attractions incl. Mt. Kilimanjaro, Arusha with Arusha National Park and it's not too far away from the main Safari places (Serengeti, Ngorongoro Crater amongst others). In Moshi I stayed at a hostel in walking distance from the hospital- I paid about 8 USD per night.
Pictures from Moshi:
Operating Room for OB/GYN in Moshi Hospital
Main Operating Room in Mawenzi Hospital
Mawenzi Hospital
Hospitals
The Rukwa Regional Hospital in Mpanda is of similar standard as the Kilimanjaro Regional Hospital (=Mawenzi hospital) in Moshi. The only big difference that I realized is that in Mpanda there's no running water in the clinic (at least not in the dry season). Both hospitals basically lack most of the equipment that we take for granted, e.g. there is only a very limited choice of drugs and no "high-tech" things like EKG. The MSD (medical store department) supplies all the hospitals with medical equipment. If they close down for any reason or if the bureaucratic ways were too long then it can easily happen that the hospitals for some time would run out even of very basic things like gloves, gauze, tapes or IV fluids. Patients or their relatives are then usually sent to the closest pharmacy in order to buy these things themselves. But, although there was only limited amount of some basic equipment available, drugs for HIV, TB and Leprosy were available and given to the patients for free.
The set up of the hospital is similar in Mpanda and Moshi (and from my very short glance into the hospital in Sumbawanga it seems to be the same there): there are several buildings on a campus. Each building contains a different ward. There are: female/male internal medicine, female/male surgery, pediatrics (in Moshi divided in diarrhea and non-diarrhea), psychiatric, rehab, radiology (there is one x-ray and one ultrasound machine) and a theatre. Additionally there are dental, HIV, TB and Leprosy clinics and the outpatient department. A ward has about 30 beds, and a lot of times there is more then one patient per bed. They theoretically have an isolation ward, but unfortunately patients with open TB were in the same room like all other patients.
In Mawenzi they recently built a new theatre which was not yet opened by the time that I was there, but hopefully will open soon. Surgeries are performed either in Ketamine, spinal or local anesthesia. Like mentioned before patients cannot be monitored (e.g. with EKG or pulsoxymetry) during procedures and there is no oxygen supply available- no need to mention that there is no machine for mechanical ventilation. Apart from minor general surgeries there are mostly gynecologic procedures performed.
On the wards, the most common diseases that you will encounter are: malaria, pneumonia, HIV, TB, UTI, diarrhea and many burn wounds. Obtaining a diagnosis solely with your head, hands and stethoscope without standard laboratory tests or imaging, can be very difficult at times. I was working most of the time on the female or male internal medicine or the obstetrics wards. Ward rounds are usually performed by one doctor- whereas a lot of them are in fact well trained nurses. He or she has to take care of 30+ patients (as mentioned above, in many beds there was more then one patient). By working together with them on the wards, there was ample opportunity to discuss various topics and address questions from both sides. On the obstetrics ward the nurses usually delivered the babies and performed an excellent job. I then took care of the neonates and also educated the local staff how to support newborns if they show signs of respiratory distress with the limited equipment available.
You are working with very limited resources and often times I felt sad as I knew many things that I could have done in order to improve a patient's condition, but sometimes was just sentenced to observe. On the other hand you will experience that no matter how limited your resources might be and how difficult some of your days will be working under such circumstances, there is always something positive you can contribute! During the time that I worked at Mawenzi hospital, I was the only foreign doctor and I am convinced that it would be very beneficial if some more doctors would go there in order to support and educate the local staff.
Just on the side I would like to mention, that in Moshi there also exists another, more western-style hospital than Mawenzi. It is called KCMC (Kilimanjaro Christian Medical Center) and there you can find several doctors and medical students from western countries. It basically looks similar to hospitals that one would expect to find in a newly industrializing country. It's receiving funds from abroad and thus is much better equipped than Mawenzi. Several of the patients in more severe conditions were thus referred from Mawenzi to KCMC (which also has an ICU). It should be mentioned though, that a lot of patients refused transfer as they weren't able to financially afford treatment there.
Conclusion
I believe that everyone can make a positive contribution, help where it's most needed and improve the conditions to some extend. But: don't underestimate this endeavor! The medical teams, both in Mpanda and Moshi are extremely friendly and helpful. They are willing to teach foreigners the guidelines for the treatment of a wide range of infectious diseases as well as most of them are happy to receive help and advice. I am very lucky that I have met so many nice colleagues and that I was able to work together with them, sharing our ideas and knowledge. I hope that our friendships will last and that we will be able stay in contact. However, I think it is quite difficult and not advisable for medical students to go there unless they are accompanied by a more experienced doctor. You should definitely have someone you can talk to and who is able to explain things to you. On the other hand, if you are together in such a team than I'm sure that you can learn and do a lot. Although this might sound very simple, it truly is highly beneficial if you have a broad knowledge and are equipped appropriately- you will be very grateful for everything. If possible, then you should bring as much of the equipment that you would need for your work along with you. Don't forget to bring basic supplies as well! Additionally, any kind of equipment that you would be able to donate will also be of great help (e.g. an old EKG, pulsoxymetry or CTG machine).
I hope that this little report gave you some basic understanding of the conditions in the Tanzanian hospitals that I worked in- and the way I experienced them- and I wish you all the best! I'd also like to cordially thank the HCV team for making my stay possible and please do not hesitate to contact me in case you have any questions!
Thanks for everything,
Dr. Melanie Kalmanowicz
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
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