Lydia Staples, MD, MPH is set to complete a four week rotation in Dodoma, Tanzania. Lydia leaves for Africa on Sunday, March 4th and plans to return to Minneapolis on Saturday, March 31st. Stay tuned for some of Lydia's reactions to her time spent abroad.
Pamela Mills, MD, MPH completed a 4 week rotation in Dodoma, Tanzania. Pamela left for Africa on Monday, November 28th and returned to Minneapolis on Saturday, December 24th. Below are some of Pamela's reactions to her time spent abroad.
Today was my first day working at DCMC. The schedule and style is very different than what I am accustomed to in the United States. The pace is more laid back and the schedule is much more fluid. We started the day at 0700 hours with a group devotion/signing service which is designed for staff and patients at DCMC. This is followed by morning report where all of our patients are discussed. This is tricky to follow sometimes as it is mostly in Swahili with some English and rapid changes between the languages.
I went on rounds with one of the house officers. There were 10 patients and it took about 2 hours to see them all. Many of the discussions were in Swahili, so I read the patient charts while the officer spoke with the patients. Luckily all of the charts are in English!
Follwing rounds we had a break for tea and breakfast followed by seeing clinic patients with Dr. Majinge. There are a wide variety of clinic patients and there isn't really a labor and delievery triage like we have in the United States.
One thing I've found really nice is that patients sent to lab and ultrasound early in the day return later in the day to discuss results. It is really nice to have this continuity of care.
Our day wrapped up around 1800 hours. Tomorrow will be my first day operating. Typically patients arrive at the hospital a day prior to a major surgery in order to prepare.
The last few days have been pretty busy. Sunday was my day off and I spent it with a some of the locals. Everyone here is so generous and not only did they have me over for a meal, they gave me a wrap and showed me how to wear it depending on the weather! They also gave me fabric to take to the tailor to have my own dress made. The fabrics are beautiful and I am so grateful for the kind gifts.
On Monday I had an 18+ hour day because I was called in for a c-section at 0430 hours. On this day, Dr. Majinge made an observation that really stuck with me. He noted that at DCMC you have to constantly plan ahead. When something happens and we need to call in the anesthesia team, it can take up to an hour for the DCMC driver to pick them up from their houses and have everyone in place for a procedure. It made me think that in the United States, we have people available at a moments notice, so we have the luxury of waiting and delaying procedures that you don't have while working in Africa. I appreciate this type of insight. Sometimes it is easy to just default to what you know in medicine, but context is key.
The DCMC team works so hard to see everyone that comes here. On Saturday, I was at clinic until nearly 2100 hours when the last patient was seen. In the first part of the day, we see patients and make a plan, similar to investigations in the United States. The patient then undergoes testing and returns later on that day to discuss the results and make additional plans. I really like the continuity, but combining that with paperwork all being hand written and it makes for a long day. I asked one of the house officers about the schedule and essentially everyone just keeps seeing patients until there are no more patients to be seen. I am humbled by the dedication here and the patience/gratitude of the patients. There is never a complaint about waiting and schedules are very fluid, so some people wait all day to be seen.
The hard part about the work is the language barrier. I have an interpreter for part of the day which helps me see more patients, but Swahili is not the quickest language for me to pick up and I would say 70-80% of the patients I see do not speak enough English for me to see them independently. The other tricky part of the work is there is a very different practice style in Tanzania. I know how to treat and care for patients in the United States, but here I find myself asking a lot of questions. The standard treatments and medications used can be very different. There are some medications used that I have never heard of. I am feeling like a primary care physician at times and have learned a lot about pediatrics as well. Overall, the house officers are very kind and I appreciate how they treat their patients.
Today was the first full day in the operating room. We scheduled many of our cases just the day prior. I have had great learning experiences here, but it can be much more challenging than in the United States. I feel a little weird giving suggestions in the operating room about technique, but the officers seem really receptive when I do. They are happy to change suture and ask me what I prefer. My time in the operating room is great for learning and teaching. Everyone is taking really good care of me, making sure I eat and drink (bringing me food and drinks) and also trying to teach me Swahili. I try my best, but I am certain I have a notable American accent.
I am waiting to hear about a 6 day community trip to the villages that the community health team at DCMC is currently planning. We are just waiting for the funding to come in before we go. The hope is to go next week sometime. I will likely be away from the internet during that time, but will try to blog when I return.
Justin Boeke, MD completed a 5 week rotation in Dodoma, Tanzania. Justin left for Africa on Tuesday, September 6th and returned to Minneapolis on Tuesday, October 11th. Below are some of Justin's reactions to his time spent abroad.
Hello all, overall Tanzania has been great so far. This is one of the friendliest, most welcoming, and safest places I've ever been. Just walking down the street, I’ve experienced people willing to go out of their way to be helpful all the time.
Even though the hospital has been keeping me busy, and it feels somewhat like a normal rotation, I feel like I haven't been this relaxed in years. The first weekend I was here was a holiday, so I took the opportunity to travel south to visit Iringa and Ruaha, and see a little more of Tanzania. This trip was amazing. I was able to see tons of native wildlife including hippos, leopards, cheetahs, and rare African bird species.
DCMC itself is a bit of an anomaly. It is a small, but busy and relatively well funded and a very well run hospital. It predominantly serves a mix of poor and rural people, as well as some more economically secure families. This wealthier patient population is likely to expand as more of the government transitions to Dodoma. This is exciting as it would allow the hospital to provide more routine care in addition to emergent care. The hospital is fortunate to have an IM physician, a surgeon, and two gynecologists. The staff here is well trained, despite the diagnostic resources being very limited. Few labs are available and there’s no equipment to run cultures.
I visited a much larger nearby regional hospital which made DCMC look even more luxurious. The regional hospital has 3,000 deliveries per year (compared to about 400 here), yet no OBGYN or surgeon! The regional hospital lacks many basic medications, and is primarily funded by patient payments; many of whom are experiencing extreme poverty.
At DCMC, I have been operating frequently, mostly minor procedures and Cesareans, with a few laparotomies. There is staff in the room, but the cases are yours to do as you see fit and you have the opportunity to teach the medical officers at times. It is challenging to learn to operate with fewer instruments than I’m accustomed to. In addition to operating, I have been leading rounds with the medical officers, seeing patients in clinic, and performing ultrasounds. The language barrier can be a challenge in clinic, however, the patient's concerns are identical to what we see and know in the United States, and so the evaluations tend to run smoothly.
My experience has been generally positive and worthwhile. I even found a fetal heart tracing monitor in storage, hooked it up, and have been training the staff on it. The training of staff at DCMC is good, but I feel there is a lot of room for improvement, just like anywhere else. The medical officers present new patients to me once they've seen them which has provided a good opportunity for staff and I to discuss assessments and plans, and for me to do some teaching.
By the end of the trip I am hoping to also do some formal teaching with the fetal well-being assessments, I am working with Professor Majinge on scheduling. It has taken a few days to get settled in and figure out my role, but I am now identifying many ways that I can be involved, gain experience working in a resource-poor setting, and have a significant impact on care and training in Tanzania.