Kara spent two weeks with us in Tanzania on a nursing placement. Kara was a healthcare assistant but wanted to gain experience of nursing in Tanzania before her post graduate nursing course. Kara shares some of her most memorable experiences – some challenging and some amazing. 

The start of my project was tough. On my first day I saw a still birth, which obviously upset me and how their culture differed so much from the UK. Another upsetting moment, was arriving onto my shift and finding a baby who had passed away during the night – the nurses were aware of this, however, left him in the cot with the others (I presume this was to allow mum and family to visit and pay their respects). I stroked the baby once I realised and covered him back up. 

I went to theatre and saw two c-sections where I was able to gown up and observed the birth of two children. This was an incredible experience as I was able to see the effort they put in, how sterilised they could be, the drugs used as this wasn’t often observed. 

I also witnessed a lot of natural births, some having complications during labour and some without. This again was a phenomenal experience as I witnessed a new life being born into the world. I was also able to cut the cord of a baby; again, another memory I won’t forget.  

There was a few times too, where the volunteers and I would be left on our own. From this, we used our initiatives and reassured the mums, tried to speak to them in English to gain an understanding of the language barrier, check the mothers to see if they were opening and whether they needed to push, listening for the baby’s heartbeat with the equipment available and assist in the delivery of the births when the nurses had finished their meetings. 

The second week I was on minor injuries – where I looked after a little girl who had been hit by a motorbike and broke her tibula and fibula, she was heavily sedated and needed an X-ray which I assisted with. 

Another little girl who broke her elbow and a doctor held her waist whilst the other doctor put her elbow back in place. I held her hand, reassured her and calmed her down as she screamed throughout it. 

A baby of 6 months had an abscess on his arm and came to the department for it to be drained. He looked very worried as he was crying and mum had to stand back to allow the professionals work. I used my skills and knowledge and sung nursery rhymes to the little boy to settle him and make him feel at ease with the care he was receiving. After this, mum approached me and said “Asante sanar” which means thank you very much.

 
There was also a few dressing changes which I participated in. Playing with the children after the treatment they received with bubbles, balloons and the torches used for neurovascular observations. 

I also had the opportunity to visit the local orphanage for a day. I participated with the general care of the children; feeding, nappy changes, putting them down for a nap and playing with them in the garden. Around the room there were stories of what had happened to the children to make them attend the orphanage: some stories were; died during or shortly after child birth, abandoned in the market, Mum or families could not cope due to a number of children in the household and to return when they are eating solid foods.

I would like to thank you very much for the opportunity volunteering as a nurse in Tanzania. The time I spent there was definitely an experience that consisted of very high highs and at times very low lows! I really did enjoy the experience and met some amazing people along the way.

To follow in Kara’s footsteps, you can find out more here about our nursing project in Tanzania.

The practice of medicine in Tanzania is very different to our own.  Kasia’s awesome blog really highlights the differences in nursing practices in Tanzania where facilities are limited and treatments rationed according to the patient’s ability to pay.

My children’s nursing / maternity elective in Tanzania

Kasia

First day at the hospital

My first ride on the Dala Dala to placement was not as bad as I thought, although I felt bad for the man who had a rather plump lady sat next to (or rather on top of) him due to the drivers cramming in passengers like a tin of sardines.

Arriving into the hospital the first thing you notice is the large sign saying what forms of payment are accepted! My first stop would be paediatrics. On entry to the ward I had no idea what to expect. The ward staff did not check my ID, showed me where to get changed (an old disused patient room) and were happy for me to just sit with the doctor listening in on consultations. The doctor reviewed all the patients in the morning, with the mum and child going to the doctor for this.  No equipment was cleaned between patients, nor hands (there were signs in Tanzanian showing thorough hand washing, however the hand gel had run out and there were no towels to dry hands with either!), yet nobody was allowed to walk on the floor whilst it was being cleaned!! A bizarre experience coming from a busy children’s ward in England where patient care is first and foremost – the nurses in West Meru ate lunch before doing IV medications which were due and although due to a language barrier I did not understand the specifics of what they said to mothers who approached them whilst on lunch, I did observe they did not move to speak to them or pause having lunch.

I helped the nurse with a child who’d had a burn covering almost 1/2 their body. The water was first sterilised by boiling it, however cold water was then added which completely defeats the object of sterilisation. The child was placed in a tub of this water to soak the skin.  For the gauze, the nurse had to go to another department as it was not kept in the paediatric ward. Wearing gloves, the nurse began rubbing the child’s skin to clean it and remove dead skin. I offered to hold the child as I could see that mum was very distressed also, however the nurse shook her head at this.  The child was crying. She hadn’t received any pain relief prior to this.  The nurse used a razor blade to cut off large amounts of dead skin, however there had been no incisions made to prevent compartment syndrome occurring and the blade was not sterilised. Mum was comforting the child by rubbing their arm (the badly burned one) – I tried to explain to mum to rub the other arm as she could introduce infection to the open wounds as I had not witnessed anyone else informing her of this.

After a while, Mum walked off almost crying with her baby. The nurse didn’t look finished with the wounds however I think it had been too much for both mum and baby.  After the debriding the nurse applied silver nitrate cream to the burned areas and Mum gave some paracetamol and ibuprofen to her baby which she’d had to bring from home along with the creams.

Walking to get the gauze we saw a man whose hand was dripping with blood. The nurse guided him to minor theatres. Despite the depth of the wound on his hand and proximity to the bone, no X-rays were done.  Pain relief was not given immediately from what I saw, however I left soon after his arrival.

After this I helped with some observations on a baby who had stopped feeding. They were having IV medications administered as an injection. There were unsheathed needles scattered across the desk and no sharps bins or clinical waste bins. I could not take the baby’s blood glucose level as although there was a meter, there were no testing strips to use with it.

After this I headed back to USA river on the Dala dala to the nursery which helps mums to go to work by looking after their children, charging them in relation to their salary.

The children were at first obsessed with me, pulling my hair (which kind of hurt!!). It was difficult to tell them not to as I did not know how! I soon learned the word Acha “Stop”!

After nursery I checked out the swimming pool at Green Hills Lodge. It again was freezing but I managed 1.5km!!

Day 2 at the placement

Went to ward round in paediatrics. Child with burn still attending for daily debriding and still appears to be in pain.

Left soon after ward round to go home to X-ray and see if anything was happening there. There was a lady having her ankle reset without the use of X-ray and being plaster casted without knowing the bones are in the right place for sure. Just another day of medicine in Tanzania.

Went to the nursery again today. Very hot and children still allowed outside sans hats and suncream – surely they must still burn no? In England it’s no hat, no play, no fun today! One little girl latched onto me. She is new at nursery and kept saying “lets look for mama” and kept crying. I learned “baasi, mama badaye” loosely translated to “its okay mama will be here later”, which I seemed to be saying all day, calming Charity down… then when I had to leave all hell broke loose and I couldn’t prise her off me so I had to wait another hour until she could be distracted with lunch!

I then went to the river trees hotel, where there’s a pool and I was meeting some medical students from Arizona and Belgium who I had seen at the hospital. Again we braved the cold water… with the surprise of this pool having HOT showers!!  Finally shampooed AND conditioned my hair!

Back to the house before nightfall for Swahili lesson and to do clothes washing (by hand and no doubt still drying full of washing powder as used too much) before going to meet the staff at the orphanage with Joshua…

Walking there it was loud with a tapping sound in the drains, Joshua told me it was frogs – I looked to see loads of big frogs croaking away! Crazy how the sound just filled the streets!

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I went to a local orphanage in the morning then to a Masai market in town in the afternoon and out with some medical students in the evening to what I was told was one of the best bars in Arusha for foreigners – The Empire.

At the orphanage I helped with breakfast then was left to look after 6 under 3 year olds alone! Hell! They were not allowed to play outside but the door had no lock and I had no way of keeping them in, plus it seemed it was potty time every ten minutes which was a trip outside with all of them who after would run in different directions and not listen to my telling them to come inside even though I knew they were understanding my Swahili.

I tried to occupy them with colouring, but no matter how many colouring pencils each child had they still wanted the ones the others had, and would hit, bite, scratch and attempt to strangle one another to get them and this always ended in tears. I felt like screaming with them at times!

It was difficult to keep them entertained for any period of time because like most two-three year olds they got bored quickly and there were no toys other than a tennis ball!

I managed to escape around 12 as after 4 hours I was exhausted.

After I got the dala dala to Arusha to go to the Masai market where I literally was pulled from shop to shop to try and get me to buy things… Ended up buying 3 pairs of harem trousers at 15000TSh each (about £5). It was hard bargaining as most shop owners started at 40,000 Tsh for these!

After a few hours I finally managed to escape and found a guy selling fruit salads for 2000 TSH! Like a whole plate full and the fruit here tastes so much fresher! If it wasn’t a risk for smushing all over my suitcase I’d be tempted to smuggle a watermelon home!!!

Got home just before dusk and had a few hours before going back out again. Spent some time with Lillian, Beatrice’s daughter, who is the same age as me but still in high school. She’s been off school sick but goes back on Sunday until December! Apparently even at 21 she has to have permission to go home and see her parents?! And parents aren’t usually allowed to visit!!  Lillian asked me about my birthday – I had gone ice skating which she hadn’t heard of! I showed her some YouTube videos which her reaction to was amazing! She was in disbelief at how people can balance!!

Peter, the taxi driver arrived and took me to Arusha, charging 40,000 for what I later learned was a 20,000 tsh trip!!!! Still not as bad as UK taxis though. Got to the bar and spent the night dancing and singing with the other hospital volunteers and orphanage volunteers.

Home by 3am ears ringing and desperate to go to bed but met some cool and some “interesting” people!

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I’m writing this from the dala dala hence typos! Just been to Meru District Hospital and spent some time in major theatres! Finally one place which has handwash and running water! A lady came in for “emergency” c-section… There was meconium stained amniotic fluid and the baby’s heart rate was dropping. From making the assessment of the baby being in distress and getting the baby out it took thirty minutes!

I watched the c-section – with the whole procedure much less dignified than in the UK. The sterile field was small, and the woman lying naked completely uncovered (in the maternity ward too there was a whole bay of women lying naked with no curtains between – a stark contrast to British culture!).

When the incision was made, the skin was then stretched to prevent making a larger incision and then after one more incision, the baby’s head became visible and lots of meconium stained fluid came out. The umbilical cord was wrapped around its neck. This was unwrapped quickly and the baby’s mouth cleared of the meconium fluid to prevent aspiration. Within minutes the baby started crying – a good sign!!!

Mum saw her baby girl briefly before the baby was taken back (I got to carry her!!) to the maternity ward to be weighed and warmed up using a heat lamp as she was shivering. For the surgery the mum had just received fluids and an epidural! She began complaining of pain however the nurses said she would have to wait to go to maternity as they do not administer the pain relief in theatre as they don’t keep the injections! On return to maternity about 45 minutes later she would receive basically a weaker form of morphine, pethidine.

After this I went to the orphanage/nursery via the pharmacy to get cream for my mosquito bites 🙁 when I got there the children were all asleep!!! It was bliss! They woke up one by one and the routine starts – potties, feeding and then all hell breaks loose! Luckily today there was someone else helping me 🙂 still, when the older (5-7yr) children finished school and came back they were fighting over my hair and god knows how I will get all these mattes out!! Maybe I will get dreadlocks after all!

After 4 or so hours I decided it was me time and went for my first run since arriving. The roads are rocky so it was difficult to keep grip, and since Tanzanians on the whole do not seem to be as into keeping active as us westerners, I got a few odd looks and people humouring me pretending to run alongside and others clapping. Overall it was a good run, exploring new places and finding a cute little stream tucked away behind the houses.

And another day flown by!

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Another day at the hospital – got there and there was a large police presence – the senator was in town meaning the whole hospital came to a standstill!! After the speech was finished I was hoping to spend another day in major theatres however they had no planned surgeries. Instead I followed an American trainee advanced nurse practitioner around maternity and together we did ward round assessing the women who had given birth and their babies in the postpartum ward!

I mainly took on the assessment of the newborn role (as the nurse practitioner, Tess, was not specifically paeds trained) and then just helped with manual BPs (automatic machine was broken) for the Mums.  Three of the babies had low temperatures (below 35) however only two were dehydrated, both with sunken fontanelle and one difficult to rouse with a heart rate of 120bm.  It was frustrating as there was no glucometer on the ward and no glucose to give the babies! The only thing we could do was encourage the mums to feed more!

One more thing to mention is that most beds were occupied by 2-3 women!! Some only 1 though, for example a woman 1 hour post c-section who was still haemorrhaging and experiencing rigors.

Later on I observed the nurses giving vaccinations to the babies – oral polio and BCG, which is in line with World Health Organisation advice for African countries!! What did make me a little uneasy was the disposal of sharps… By the time all 30 ish babies had been vaccinated, there was one very overfull and uncovered cardboard box with needles sticking out :-S

At 2pm it was time to go and help at the orphanage. I decided to stop en route to get my side braids redone with rasta… I thought 10,000 tsh was cheap so I tipped 5,000 however apparently it should only have cost me 3,000!! Still 15,000 is only £5 which I’m happy with!!

At the nursery again the children were asleep. This time when they woke up I decided to use technology and put into practice a few phrases I have learned “mtoto/watoto turia” – “child/ren behave” and “cheza visuri” – “play nicely”. Using my phone I showed them (and attempted to teach them) the song Hakuna Matata since the phrase is actually swahili for “no worries” as the song says. This kept most of them happy for almost one hour. When the battery was about to die however it was time to leave for swahili lessons anyway!!

After the lesson I went running and en route popped to a shop. Within 5 minutes it was almost pitch black and so the run home along jagged rocky roads was interesting to say the least!!

Time to get some sleep for the day ahead.

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Today I went with a tour guide and Mary (our swahili teacher who decided to tag along) to the hot springs. It was a two hour drive along very rocky and bumpy roads where you could barely drive 15mph.

The journey was interesting with Masai men walking with donkeys carrying water and we saw them herding goats and sheep as well.

The springs were in the midst of barren desert like farmland (with baobob, acacia and cactus trees sparsely scattered alongside aloe vera plants), and was surprising to find in such terrain.

The water was warm ish, around 32 degrees celsius, with lots of the fish that used to be kept in tanks in the UK for eating the dead skin off your feet. If you stayed still too long (by sitting on one of the rocks for example as the water was too deep to stand) the fish would come and start nibbling so it was best to keep moving. I stayed in the water for a few hours, chatting to other British tourists and intermittently having a go on the swing over the water which took me a few attempts before I could actually jump!! First time was a disaster because I forgot to hold my nose and not breathe underwater so I felt as though I was going to drown.

I explored through the narrow gap in a row of trees lining a narrower stretch of the spring and found the lagoon where the source of the spring was – looking into the water there was a really deep hole in the sandy bed of the lagoon! Apparently it would be dangerous to swim down there as it is quicksand in the hole from what I understood.

We left around 2:30pm, after checking out the turtles/tortoise? in the shallow stream behind the shack like bar at the springs… I had no idea Tanzanian waters had turtles/tortoise?.

On the way back we stopped at the petrol station where there was a coffee place… It was amazing to have a coffee after a whole week of not one!!! Even if the cup was leaky.

When back in Usa river I went for a mooch around the market then home.  Beatrice had organised to go out for dinner. The place had a buffet with some suspicious looking things so I got Joshua to check everything to make sure it was not meat!!! Still a stray piece of beef landed on my plate which left me paranoid for the rest of the meal and since it was dark in the room to eat I just had to double check it using my phone torch. Must’ve looked like a right nutter, but I think Beatrice understood (as I almost cried this morning when I saw they had bought chickens from the market which were not going to be used for eggs and were still alive…) So she got her phone torch out and double checked too!!

Nelly, one of Beatrice’s friends children, came with us which was funny because he is only 5 and kept running to random people’s tables and grabbing them playfully… Beatrice and the others laughed when I said “Mtoto njoo hapa” which is swahili for “child come here” as she did not know I knew as much swahili.  The problem is that Nelly is so funny it is difficult to get annoyed with him for running off… So even telling him to behave I could not keep a straight face…

And that is it up to now…. Bed time again at last!!

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Went to Arusha today to go to Africafe and get good coffee and wifi… ended up having “Hot Stepper” – a ginger, lemon and honey drink which really was “hot”. Sat there updating this blog for a few hours then walked to central market around mid dayAfter this I walked back to Africafe, stumbling upon an Asian supermarket on the way where I found Cadburys Bourneville dark chocolate! The only dark chocolate I’ve found in Arusha so far!!! I also bought soya milk and when desperate times call for desperate measures I went back to the cafe and ordered a soya cappuccino with my soya milk! 😀 Happy days.

After lunch I went go the palace hotel gym on the tenth floor overlooking mount meru – stunning but forgot to take a picture. After a lot of sweating and a good lukewarm (yay not Baltic Sea cold) shower I headed back to the dala dala.

I walked back to the house once in USA river and dropped my bags. Nobody was home but I heard a noise. I looked behind and the chickens had followed me into the house. I shooed them out then went to change my shoes… They had followed me back in!! Shooed them out again and locked up.

Went to the market in USA, with the usual walk involving the children across the road coming to hug me, where I bought some hoodies since I left my only one at the bar the other night accidentally.

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Got to the hospital today just in time to see another c-section! After this I went to paediatric ward round where again it is much of the same – pneumonia and burns!

After the hospital I went to the nursery which helps by looking after children so the mothers can go to work. I learned how to carry babies African style today!!! Actually is quite easy once they’re on your back!! Planned with the owner to make an outdoors mud kitchen for messy play like in England as this will be relatively inexpensive! Will also at some point show them how to make play dough…. But in the recipe it says you have to put in fridge which I’m unsure as to whether they have.

I helped feed the children lunch (they offered me some but the lump of white corn maize flour stuff just doesn’t look all that edible!) then left to go swimming at the nearby hotel before having a Swahili lesson.

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Been to the hospital today and although today is the day for planned surgeries there were none so I went to maternity instead as it’s much busier than paeds and still I get experience with care of newborns (or how not to act) and vital signs. Saw two babies born today! Again very different I’ve been told from European practice since the birth rate per woman in Tanzania is almost three times that of the UK… And there is a shortage of beds for women in labour… So if the baby isn’t ready to drop out then there’s “no bed for you”… And if the Baby is coming too slowly or isn’t out in a few pushes… There’s no patience… They are much more inclined to make cuts.. Which was rather gruesome (don’t read on if you’re squeamish) with the scissors being blunt and not sterile so acting more as pliers to rip the woman with, and the midwife trying again to cut the woman when the next push (although the baby progressed closer to being out) didn’t result in the baby being delivered.

When the baby was born it was wiped down, weighed and swaddled and left on the table while the mum was being stitched up… So I picked the baby up because it was crying and nobody was taking notice… I showed mum her baby but was not allowed to put the baby on the mother as is encouraged in UK. And here I’ve yet to see any skin to skin practice plus mums don’t get their babies to hold for up to two hours post delivery…Which inevitably results in delays in milk production and more difficulties for some… With some newborns becoming very cold and lethargic very quickly… I couldn’t say for sure whether this was due to low blood glucose as the meter to measure this is broken and there is no spare. As a precaution for a few babies who were <34 degrees Celsius and not flexing to pain, we gave 10ml of 10% glucose fluid (as that was all which was available) and held them near a heat lamp and hoped for the best. Nobody seemed at all concerned about the baby’s clenched fists and overlapping fingers distinctive of a syndrome such as Trisomy 18. An eye opening experience as to potential reasons why the newborn death rate is higher in countries such as Tanzania compared to Western countries.

After the second birth I left to go to the nursery. I played ball with the children and one of the Nannies outside, managing to pass Charity (the little girl who every day cries for her Mum and latches onto me to pick her up) to Abel, a man who works within the nursery… I pointed at Abel and said “Baba” (dad) and Charity latched onto him surprisingly well, with him even having to sit her in the minibus whilst it was cleaned. It was quite comical.

Afterwards it’s home for Swahili lessons then out for an evening run…

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Just as I got to the hospital today there was a baby who had just been resuscitated after stopping breathing during delivery!  Amazing.  I went round the postpartum ward helping with taking vital signs of mum and baby… Lots of mums had high pulse rates due to pain, however if they didn’t have the money they could not get pain relief!  One mum had a history of pregnancy induced hypertension… Her BP was slightly elevated at 145 systolic… However there was no baseline to compare this to!!!!! I gave her an IM injection of Pethidene… The strangest injection I’ve given as the nurse just hands it to me and points to where without giving me chance to change gloves or wash my hands… TIA (this is Africa) has become the general saying around here.

After going back round and checking all the babies reflexes, checking for spinibifida, cleft palate and other signs of abnormality I went over to the paediatric ward and helped with admissions there. On admission they try to cannulate all of the babies and children (mostly unsuccessfully resulting in IM injections of medication) and they test all of them for HIV.

In the resuscitation area alone was a young (possibly 1 year old) boy on humidified oxygen sat with his mum. The boy had nasal flaring, head bobbing, was using all accessory muscles and still grunting. He was trying to cry but no sound was coming out. No doctors or nurses were overseeing. The situation seemed wholly uncomfortable as if this were in UK the nurse looking after the child would most likely be there all the time, with outreach nurses being called and potential transfer to PHDU or such like. Vital signs would be taken regularly, not 6 hourly, and the child would most likely be on continuous pulse oximetry.

After we had got through the admissions I went to the nursery to make play dough with the older children (4-6year olds). Then went for a short run before having a Swahili lesson to learn animal names before going on safari this weekend.

Very busy second to last day in USA river.

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Went to the hospital in the morning to help out in the postnatal ward… Now got my manual BP skills down to a tee. All the babies today were fine – well hydrated with good reflexes.  One of the mums with pre-eclampsia had a BP of 158/100… I told the doctor and he questioned “it’s too high?” to which one of the Dutch midwifery students (who had got so frustrated with the inaction on the doctors part) just told the doctor “F you” and walked off. Emotions were running high as after two weeks in a foreign hospital where you see people suffering because there is a lack of compassion and unwillingness to go the extra mile for the patient it does become mentally draining!! It’s the questions of “why go into a caring profession and not put in 100% as these are people in need!” and “how do people survive here?”. According to the doctor the literature says to recheck BP six hours apart in this time. When I asked where he got his sources from he stumbled and said references. I told him he had to understand how frustrating it is that in England people would be acting quickly, and monitoring vitals more closely when there is an anomaly, not sitting back and waiting 6 hours. I explained to him a few of the things I’d seen here and what would have happened back in the UK and he began to comprehend the major differences in the systems and perhaps why there have been differences of opinions at times – I told him I respect they don’t have so many resources, but monitoring vitals when you already have a BP cuff doesn’t cost anything. He laughed and said yes and that the blood pressure would be rechecked 2 hourly, result.

There was a woman in labour crying in pain asking for a c-section because it was too painful.  The nurse was shouting at her and laughing about the fact she was asking for a c-section as there was no indication (yet they did a c-section on another woman on the premise they “thought” the baby was going to be big… It was 2.7kg). No pain relief was offered and the nurse then walked away from the woman. Later on this woman was on the floor rolling in agony and going in and out of consciousness. BP and blood glucose were fine.  It took 8 people to lift her (no hoists and definitely not what is taught in manual handling training) onto a wheelchair and back to the bed. The doctor concluded it was a panic attack and after ten minutes (checking foetal heart rate etc.) all hospital staff again left her alone without support, so the student midwife went over to hold her hand. I’d been able to listen to the foetal heart rate using the Doppler which is placed on the tummy. A downside of long hair is when the bun you’ve placed it in falls out at a very inconvenient time and your hair goes somewhere you really did not want it to. Go figure.

After the situation had calmed down I left for the last day at the nursery. I was exhausted by this time.

I spent some time sitting with the little ones. Namely Salha who unfortunately I haven’t been able to discuss her visa arrangements yet with her mother (joke). I’m going to miss that little one!!!

After this I went home to pack, then swim in icy cold water. After which I went up to the hotel bar in search of coffee! Filter coffee – result! None of the crappy instant stuff. Good coffee.

Back to the house to chill and watch Netflix and say goodbye to Joshua and Beatrice as tomorrow when I leave they will be out!!

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Early start from Meserani snake park to our next stop at Twiga Camp near Mto Wa Mbu where we would see the Masaii people.

In the morning we dropped our bags and then went on a walking tour of the banana plantations (who knew there were more than 30 types of bananas?!) and the brave tried some fresh banana beer which did not look suitable for human consumption due to the layer of millet still being present. I only tested the banana wine… Which was nowhere near as nice ad it sounds!! Debating whether the “factory made” banana beers are worth 0.7kg of my luggage allowance now!!

After this we went to see some tribe men carving the wooden animals which are sold at the Masai Market in Arusha town. While there we noticed there were lots of lizards (actual wild ones!).

Then it was onto see the painting which is also sold. Amazing artwork but am holding fire on buying anything as currently I already have to sit on my suitcase for it to close!

After this we went for a traditional Tanzanian lunch with all sorts of dishes (2 out of about 12 plus were NOT vegan!!) – that left spinach, cabbages and vegetables, okra, aubergine, bananas, sweet potatoes, and an extremely hot chilli sauce plus various bean dishes and sweet corn and beans called Makande.

Then onto visit Mto WA Mbu where we looked at the cooking project going on which enables the Masai to have a clean cooking fuel source by teaching them to build chimneys. The Masai children were very shy and they did not like having their photos taken. There were lots of children, and the Masai women ha lots of jewellery.

After this was time to go back to the camp and those of us who signed up for the mountain bike tour set off for a journey across amazing scenery to Lake Manyara where we saw lots of flamingos, Impala, gazelles and storks. On the way back I passed through the market to buy a bunch of the red bananas we had sampled earlier, which taste sweeter yet more citrusy than normal yellow bananas!

The terrain was bumpy and I was shocked the bike held up the whole distance (and shocked they had no idea what a helmet was), yet it got me all the way back to the camp where I cooled off in the warmest pool yet in Tanzania which I’ve swam in (probably due to the sun shining

On it all day as it was still not heated), then went for my first hot shower in a long time… Amazing!!! After this it was dinner time and a glass of red wine before bed which worked wonders to help me sleep!

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We arrived in Serengeti around 1pm on Saturday. No signal at all. At the entrance there were Masai children trying to get you to give them money in return for a photo, but we had been encouraged to promote responsible and sustainable travel and not give them anything at all.

There was a cool chameleon and lizard at the main entrance when we arrived, and lots of superb starlings trying to get scraps of people’s lunches.

The road the whole way was bumpy and loud, much like using a vibration plate at the gym.

En route to the campsite we went on a game drive where we saw hyenas, ostrich, lions, a leopard, warthogs, elephants, gazelle, zebra, giraffes and probably more which I cannot remember!

We arrived at our campsite for the night where we were warned of hyenas and not to go to the toilet block overnight unless absolutely necessary… which for me it was twice, however with the tent surrounded by hyenas one has to improvise, but what happens in Africa stays in Africa.

The next day was a full day gamedrive best described by the photos to be uploaded when I’ve returned to UK. Back to the same campsite again for the night. Hyenas still audible all night, difficult to sleep! Woke up in the morning to giraffe less than 50m from the tents – amazing!

The following day was a gamedrive before heading to Ngorogoro crater campsite, where the dangers in the night were buffalo. Again, no toilet trips in the night.

This day we only saw cheetah! Still, amazing!

Spent today at Ngorogoro crater… freezing!! Saw lots of zebra, buffalo, wildebeest, warthogs, lions, jackal and vervet monkeys. Not much more to say.

Back at Meserani snake park by 3pm. Not feeling too great after the long journey so headed for a walk and then to bed!

Great Job Kasia.  To follow in Kasia’s footsteps, find out more about our nursing electives in Tanzania:

Children’s nursing electives in Tanzania

Maternity nursing electives in Tanzania

My Project in Tanzania

Jack Grierson

My name is Jack and I’m a 2nd year BSc biomedical science student preparing for postgraduate entry into medicine. Of the many choices that Global Medical Projects offer – I chose to take the 2-week volunteer project away in the small village of Meru, Tanzania.

The arrival

After the longest flight I’ve ever taken, I was thankful that the time difference in Tanzania isn’t too different to that in the UK! (2 hours ahead). Kilimanjaro airport is a small airport but nonetheless – landing in a country halfway across the world can be daunting! Thankfully, due to the planning of GMP, it was organized for us (I was with my friend Luke) to meet GMP’s Tanzanian contact -Elias and our host who we would be staying with – Zablon.

The trip to Zablon’s house in Usa river (pronounced oosa – we were calling it the USA river!) took some time but it passed quickly as Zablon was cheerfully explaining the names of all the mountains and why they were named that way. Zablon then went on to explain how he had just got married and was excited for us to meet his new wife Pretty!

Upon arriving at Zablon’s (and Pretty’s) house on the Friday, Elias took our passports and photos to go and get our work visas sorted for the following week – leaving the weekend for us to settle in.

Settling in

Zablon and Pretty were fantastic hosts and cooked us meals every night. I wont ruin the experience for you by telling you what they made us, but I will say that we tried some of the traditional Tanzanian dishes and they were delicious!

It wasn’t long before I was given the title of Mr. Bean as I couldn’t stop making our hosts laugh – part of this was because my Swahili was pretty awful and I often mispronounced words so that they started meaning very different things to what I was trying to say!

Zablon and Pretty are two of the most happy and kind people I have ever met. Zablon is an examiner for trainee teachers and pretty is a teacher at the local school in Usa near the house. Zablon and Pretty met when Pretty was training to be a teacher and Zablon was assessing her – before long they fell in love and got married. Luke and I had the privilege of watching their wedding video (which they were very proud of).

First weekend

During the first weekend, Luke and I decided to rest for half of it to get over our lack of sleep on the flight, and then visit the market in Usa River. Zablon came with us to show us around and find our feet. He also showed us where we would be taking the Dala Dala (the public transport) to the Meru district hospital on the Monday. From this point onwards we could find our way round Usa relatively well.

Luke and I discovered that Mango juice is relatively cheap and tastes delicious but the chocolate was really expensive!

The Hospital Experience

Luke and I were given the choice of whatever department we wanted to work in. We aimed to cover most of the hospital’s departments (there weren’t many) within the 2 weeks we were there.

To begin with, Luke was placed in the Male ward and I was placed in the female ward. My first impression was that compared to the hospitals in the UK, the facilities (as expected) were very limited. Privacy was a luxury and had to be paid for, ward rounds and scheduled times were rarely stuck to and everyone there had a serious problem (you generally wouldn’t find a local going into hospital unless it was of great importance).

Here are some of the things I saw in the female ward:

• Anaemia due to immunocompromisation – given antiretrovirals
• Secondary criminal abortion attempt – resulting in infection – Amoxicillin given
• Cervical cancer – X-ray confirmed metastasis of cancer – referred to palliative care
• Possible ectopic pregnancy – patient was 37 and had 6 children – refused pregnancy test
• Child with a broken femur – plaster casts are not available so the leg was immobilized and suspended
• PVB – with denial of being pregnant despite urine test proving +ve
• Diabetic patient with very high blood sugar
• 91 year old patient with hypertension
• A woman with a diabetic foot which was amputated – unfortunately this lead to impaired lymphatic drainage and she got generalized bodily swelling – she also had liver cirrhosis
• Psychiatric patient who had to be sedated several times but still wouldn’t stop shouting – referred to psychiatric nurse
• Patient with dysentery

Interesting note – many women get pregnant in Tanzania due to incorrect use of the contraceptive pill. They take it just before or during the act – hence they often get pregnant.
After the female ward, I made my way into major surgery and was shocked to see that they were performing surgery with the window open!

Some of the things I saw in Major surgery:
• C-section – patient given a similar injection to an epidural – the uterus was pulled out of the body to be sutured! The baby had to be removed by C-section as it was obliquely oriented and was pressing on the aorta causing hypertensive crisis
• Total Hysterectomy – this had to be done as the patient had over 7+ uterine myomas! The uterus weighed 2.5kg and was 22cm wide!

Paediatrics was next after major surgery:

• Severe pneumonia – fluid in lungs – unable to feed – antibiotics given
• Bronchiolitis – viral infection
• Trauma above ear and Vitamin K deficiency
• Immunocompromised child – exposed to mother with HIV (placental HIV) – given antiretrovirals
• Severe burns – 50% of torso! Given ketamine to relieve pain and rehydrated – also antibiotics as a preventative measure
• Child that had drunk kerosene due to it being put in a soft drink bottle (apparently a common thing to happen in Tanzania!) – caused pneumonia

After Paediatrics I decided to spend the afternoon in Minor surgery – having said this – some of what was thought as minor surgery there could be deemed as major surgery in the UK! (I have only put in what I think are the minor ones):
• Circumcision under no anaethetic – baby was starved before surgery and then breast fed to stop crying
• Plaster removal

After Minor surgery it was the male ward:

• Spinal TB with bed sores – Anti TB drugs and dressing/rotation for bed sores (Potts disease)
• Distal 1/3 of clavicle fracture – head of humerus dislocated – caused by car accident
• Hepatic Encephalopathy – suspected Hepatitis B
• Lacerated head and swollen right eye – head x-ray taken – from car accident
• Chronic asthmatic
• Swollen leg – Elephantitis – lymphatic obstruction
• Stroke with hemiplegia

I then went on to spend a few days at the C.T.C (Care Treatment Centre) for those with HIV with Luke. We learned that the C.T.C mostly consisted of treatment counseling and that villagers were recruited and trained in special HIV treatment schools to care for their own at home. The HIV clinic/CTC was there to ensure that HIV wasn’t spread between patients. We were told that anaemia was a common side effect of antiretrovirals. We also learnt that all HIV +ve patients were given a form confirming their condition and all the drugs they are taking

I also managed to visit radiotherapy, the maternity wards and the outpatient’s clinic, but I don’t want to ruin all the experience for you so I will only say that you need to visit them yourself! The one area of the hospital that Luke and I didn’t manage to visit was the TB clinic – this was due to the risk of us catching TB!

Donations (coats, books etc.)

By the end of our hospital visit, Luke and I thought we would donate our white lab coats, a few of our medical books and some antibacterial hand wash (all of which is hard to come by in the hospital!)

The school (Pretty)

Before we left Zablon and Pretty, Pretty gave us the opportunity to sit in on a friend of hers class. Somewhat fittingly, they were learning about first aid! Luke and I explained some of what we had learned about treating burns to the class as the teacher translated – the class then asked us questions.

Conclusion

Tanzania is an amazing place and the sheer quantity of things you can do there is practically limitless! Luke and I thought we would take advantage of the fact we were so close to the Serengeti and after our final week working at the hospital we went on a safari.

Why this project was good and why I recommend it

This project will open your eyes to what all those charity programs are trying to raise money for! You will experience what its like to be a Doctor in Tanzania and see what its like to be a patient there too. You will see what limited resources the hospital has and what they do the try and get round their limitations. You will have hands on experiences with patients and apply some of the things you’ve learnt in the past. You can’t get a purer project than this when it comes to the basics of medicine!

On top of this you have the opportunity to get to know the community at Usa River and perhaps even go on a safari like Luke and I did.

I’d like to thank all those who helped me pay for this life changing trip, those who helped me organize it (Kevin Dynan in the UK and Elias in Tanzania) and of course the wonderful Zablon and Pretty, whom without them – I would have not left the country feeling nearly as cultured and satisfied as I did.

To follow in Jack and Luke’s footsteps and join the medical project in Tanzania here

My Hospital Internship in Tanzania

Emily Haines

My name is Emily Haines, and I have embarked on two unforgettable experiences in Africa. My life-long ambition is to become a doctor, and watching medical volunteers in Africa on BBC news TV channel one day motivated me to get in touch with Global Medical Projects to find out more. I was instantly hooked on the idea of embarking on an unforgettable lifetime experience in a Third world country! Although my trips took much planning in terms of finances and dates, it was certainly worthwhile. On my gap year prior to university, I took a month long trip for a medical and orphanage project in Ghana. Central Regional hospital in Cape Coast was where I spent the majority of my time, and it really opened up my eyes to the large differences between developing healthcare systems and the developed. Two years after reflecting on my time in Ghana, I could not wait to begin another project in another African setting, so I chose Tanzania. I was in Tanzania for 3 weeks, where I did another project, set in Meru District Hospital, and ‘Cradle of Love’ orphanage. People may think the two African projects I did were almost the same experiences, but I would definitely disagree. I came back from both experiences having learnt different practices, cultures and languages!

You can read about Emily’s medical and orphanage project in Ghana here.
My 3 weeks in Tanzania was certainly another eye-opening experience, which I completed this summer before my final year of my Pharmacology degree. As the plane touched down in Kilimanjaro international airport, seeing the peak of Mount Kilimanjaro was absolutely breath-taking. By this point, I was eager to meet my host family. Arriving in Usa River, the children in the street were already greeting me and I knew I was going to settle in well. Pretty and Zablon, a couple who were hosting me made me feel at home right away, Zablon told me and the other volunteers about his sugar cane growing in the front garden, which was delicious! One thing different from Ghana was the cold shower and a hole in the ground for a toilet, which wasn’t such a bad thing as I may have expected. The food I was given by the lovely house maid, Neema, were in such generous portions, and I found myself eating a lot of rice, chicken and avocado! Chips mayai- a chip omelette was definitely a popular option with 4 of us volunteers staying in Zablon and Pretty’s house. Being called part of their family throughout the weeks was a great feeling and frequently watching the world cup with them during dinner time was always a good laugh! Sometimes we joined our host family and their friends in choir practice, I was overwhelmed by the amazing voices I heard, and it was great fun. Pretty also showed me and the other volunteers her and Zablon’s wedding photos and told us stories of how they met, I was very interested to hear about the culture of relationships in Tanzania.

For my medical placement in Meru District Hospital in Tengeru, I was told to catch the Dala Dala bus with the other volunteers, which was an interesting; sitting close to Tanzanians was a great way to meet the locals! A journey from Usa River to Meru hospital cost only about 300 Tanzanian shillings, this was about 10 pence, so very cheap. I had some expectations of what the hospital may be like since previously working in Ghana, but it was different in some ways. It was a lot smaller and underprivileged than Cape Coast hospital. There were also some problems I noticed such as dangers in transporting the female patients from the maternity ward to surgery for their Caesarean sections, but building a safe walkway was funded by an American charity. Throughout my medical project, I visited the male ward and encountered various conditions, with HIV/AIDS being the number one disease in terms of occurrence. From speaking to the nurses I picked up a lot of medical terms in the native language- Swahili. This helped me to understand medical notes to find out what patients had and what treatments they were on. The follow up of a malnourished, heart failure patient with a doctor and medical student is one that will stick in my mind- devising a treatment plan using our combined knowledge, really gave me a chance to learn some clinical skills with a patient-based approach. Another patient that stays with me was a victim of a motor cycle accident with major brain injury; his affected memory meant it was impossible to contact his family and he could not afford an MRI scan, which was a serious problem that we aimed to tackle. Using a clinical handbook and the BNF as a prescribing guide, me and the other volunteers formed a strong relationship with the doctors; they taught us the practice of medicine and we discussed best treatments for patients.

Diabetes was a common ailment in the area; a diabetic clinic was held twice a week and I could see some issues related to patient compliance, on being leg amputations from necrosis as a result. I resorted to suggesting to the matron maybe creating some simple posters to educate patients regarding their condition. Observing the cervical screening procedure was intriguing, the methods employed by using acetic acid to detect cancer cells were as a result of limited resources. Seeing women getting diagnosed with a HIV rapid test was very sad and overwhelming for the patients, but the doctor’s approach was very empathetic and thorough in investigating reasons. Visiting major surgery was an exciting opportunity, I was lucky enough to observe a C- section, and the intricacy required to stitch the incision back up was amazing.  I spent the majority of my time in minor surgery, what me and the other volunteers called ‘minor ops’. Here I had the chance to treat patient wounds, such as stitching and bandaging. I also carried out emergency treatments, fracture diagnoses and castings. Children were given ketamine as a general anaesthetic, showing some treatment limitations. The different causes of people’s wounds was nothing I had seen before, severe wounds from gang fights, dog bites and farming equipment were some I encountered. Working in the hospital pharmacy was a completely different experience to my summer part-time job as a dispenser in the UK. There was a shortage of staff so I had to give patients advice and their medications in the absence of the pharmacist. There was also lack of drugs which was a problem for patients as it delayed many of them receiving antibiotics from hospital acquired infections. However, despite the lack of resources, many of staff in Meru had a persistent, caring attitude with patients, which was very admirable. In my last week, I was lucky enough to learn about Meru and it being a government-run hospital. An anthropologist from the US spoke to me about funding for her project to improve the hospital infrastructure, which was a common issue there. This motivated me to donate some money to the project, to improve the safety of the hospital buildings. There are many experiences in the hospital I had that will be hard to forget, and I truly appreciate the willingness of the doctors in the hospital to teach a complete stranger like me. Applying my knowledge on different treatments in the hospital, I really felt I made a contribution to the healthcare, and because of the lack of drugs in the hospital, educating the nurses and doctors of ones they did not know of, I was giving something back to them, which was especially fulfilling.

I always looked forward to volunteering at ‘Cradle of Love’ Orphanage every day from 2 til 5pm. I would catch a Dala Dala from Tengeru to Usa River, and walk 5 minutes to the orphanage. One thing I did not expect when I arrived was the security of the orphanage; there were iron gates with a security guard outside, which were certainly reassuring for the owner! Being introduced to the toddlers and babies was an exciting experience and I had never looked after children at such a young age! I was told some of the children in the orphanage were abandoned or some parents could not afford to keep their babies, the latter made me realise many of the parents put their children in Cradle for good reasons. Some children had HIV infection and one had rickets, but the dedicated attitude of the nannies provided the best care for them. Usually when I arrived the toddlers and ‘wobblers’ would have woken up from their afternoon naptime, when they were full of energy to say the least! The babies loved attention from all the volunteers there, and this made me feel I was making a difference. Playing in the garden was a favourite activity for the children; this was obvious from their immediate excitement when we got out the shoebox to put on their shoes! One thing I did find challenging whilst working in the orphanage was dividing my attention to the different children, and many wanted a turn on the swing-set at the same time. But there were other activities for the children to do, such as playing on the slides or with the toys inside the home. Once I had the chance to change a little boy’s nappy, which to be honest, I had never even done before!  Throughout my time at the orphanage, I got to know the children’s personalities very well and so I knew what they did and didn’t like, which was essential to make their day a happy one. Seeing the children laughing from a small game of ‘chase’, I noticed even in a place with little resource the children could enjoy themselves. Dinnertime each day was very eventful. With the other volunteers, I would assemble the table and chairs for the toddlers to sit at a small table together. Some days if the children were in a mischievous mood they wouldn’t want to sit down but make me catch them first! This was initially difficult, but through learning each child’s preferences and from gaining their trust, it became a lot easier. The words ‘Jakula’ meaning ‘food’ in Swahili was always a trigger for their excitement! Being at Cradle of Love, I realised that giving some attention and loving communication to the children was definitely a way to brighten up both mine and their day.

But again, my time in Tanzania was filled with many fun activities outside of working! Once a week, Joshua, our Tanzanian Volunteer coordinator gave me and other volunteers I lived near Swahili lessons, which was a great help in terms of constructing sentences to speak to the locals, and even the patients in the hospital. Learning some basic greetings such as ‘Habari’, ‘Shikamoo’ and ‘Jumbo’ were different ways to greet different ages of people. We were also taught the names of different foods such as Orange being ‘Chungwa’, making it a lot easier when buying food in the markets! I visited a few Safaris, which were a highlight of the trip! The first weekend I visited Arusha national park, where I managed to see a lot of monkeys and even giraffes in the distance! Previously hearing about safaris and seeing them were completely different; Tarangire and the Ngorongoro crater were so beautiful it felt surreal, and seeing the elephants, zebras and lions was my favourite part. At this time, from staying at a campsite in Africa, I got a real feel of the African night-time air. Visiting a snake farm, I learnt about a wide range of the different species and some, about their lethal abilities. I even held a snake for the first time. Moshi hot springs was very enjoyable for me, despite the bumpy journey to get there!  Swinging off a rope to fall into the warm waters was exhilarating, and if I stayed still, I could feel the fish nibbling my feet, I couldn’t complain about a free pedicure! A regular activity was visiting the local bar in Usa River and making friends with some locals, after this a group of us volunteers and some locals went onto Via Via, a club in the central town of Arusha. A mix of western and African music created an amazing laidback atmosphere, and was the perfect chance to meet other volunteers from all over the world. I will never forget our driver, Peter, who gave me advice on where to go and took us volunteers to places at a discounted price compared to taxis, and despite a small language barrier between us, I considered him a close friend.  My experiences in Tanzania were unforgettable, and not only did I feel myself develop as a person, but I made some life-long friends that I hope to see again one day. Staying with Zablon and Pretty were most definitely the best hosts you could ask for. I have a parting gift from them that reads ‘Karibu’, meaning ‘Welcome’ and I think of this as a symbol for them welcoming me back there some day. They taught me that people coming from two completely different parts of the world can be as close as a family.

I definitely recommend taking a trip to Ghana or Tanzania, these were both life-changing experiences that really put aspects of life into perspective. I have definitely grown as a person as a result of these trips, and I will forever cherish my memories and the many things I have learnt.  I chose Global Medical Projects because they really do care about you making the most of your experiences. Throughout my stays in Ghana and Tanzania I felt a great sense of security with Global Medical Projects, despite being in a foreign area. I’d like to thank Kevin Dynan for giving me so much advice prior to my journeys and for making the application process a smooth one. I also thank Eric and Mary Essuah, who were fantastic in ensuring my stay in Ghana was safe, organised and enjoyable. Zablon and Pretty Mgonja were two amazing people who made sure I made the most of my stay Tanzania, which I am very grateful for.

Many people combine time at the hospital with time at the orphanage and this combination often works well. Combined placements are only £100 – $160 – €120 extra to cover the additional donation to the orphanage.

To follow in Emily’s footsteps read more about the medical project in Tanzania.

You can also read more about our orphanage placements in Tanzania.

My Medical Work Experience Project in Tanzania

Dan Hazelton

My name is Dan Hazelton, a second year Biomedical Science student, and I spent three weeks on a combined medical and volunteering project in Meru Hospital and Cradle of Love orphanage in Tanzania. Both were located in Meru, a small area in the shadow of Mt. Meru, to the west of its ‘older brother’, Mt. Kilimanjaro. My girlfriend and I stayed with a family in the small village of Usa River, which slowly became our home over the coming weeks.

On the first day, after 16 hours of grueling travelling through three countries, I arrived at Kilimanjaro airport, in dire need of the weekend to recover. However, a fellow volunteer had other ideas, and I ended up at Arusha National Park the following day, a thoroughly enjoyable trip, even if I was asleep for half of it! After being collected from the airport by Charles, a local taxi driver who we would see many more times around Usa River throughout our trip, we made our way to the Mgonja household in Usa River. We were met there by two of the loveliest people I have had the fortune to meet- Zablon and Pretty. Pretty was pregnant while I was visiting, and I hope to go back soon to meet the latest member of the family! Throughout the first weekend, I noticed the stark contrasts between daily life in a country such as this and what I was used to back in the UK. However, the close knit community feeling was apparent from the beginning; from the way everyone greeted each other as they passed, to how well Zablon and Pretty knew their neighbours from all over Usa River!

My combined project saw me visit the hospital in the morning each day, after which I would make my way to the orphanage for the afternoon- a long but fulfilling day! At the beginning of my first week, Joshua Kuboja, the local coordinator, introduced us to the Dala dala. I had heard about transport such as this prior to leaving, but to experience it is another thing entirely. Although a full dala dala could be quite cramped, I loved how regular they were, so much so that I rarely saw the Usa River dala dala stop without one! Using one to reach the hospital, I began my first day by meeting the matron, who was very friendly, and quite evidently wanted to improve the hospital by asking for our feedback at the end of the trip. She proceeded to give the other volunteers and I a tour of the various wards, including paediatrics, female, male, minor and major surgery, outpatients, and family planning. I immediately noticed that the wards were allocated based on necessity; the most common diseases had their own wards, such as Diabetic clinic or the TB ward. I realised that this was a consequence of the general lack of resources in the country; the hospital treated the majority first, then allocating resources to other areas when they become available, the most sensible approach.

I visited every ward, but spent most of my time in Minor Surgery, as I loved the hands on aspect there. The doctor on duty, or a medical student on her elective, would always be happy to teach me basic procedures, such as wound dressing removal/changing, plaster cast application/removal, and stitch removal, and help me complete them myself. In addition, being ‘in the thick of it’ allowed me to apply knowledge that I had already learnt, and to build upon it. For instance, I changed the dressings of a patient nicknamed ‘Babu’ (Swahili for grandfather), then watched as a final year medical student advised the doctor to change his antibiotics, as it was evident from the state of his wound that his infection was resistant.

Viewing major surgery was another major highlight for me; seeing my first caesarian section was exhilarating, the baby’s first cries were wonderful to hear, as a new life was brought into the world. Again, differences between here and the UK were on show, with some aspects such as equipment and drugs used completely different to those used in the UK. For instance, I was initially surprised to see ketamine used as a local anesthetic, but was quickly informed that the one in use here was the non-recreational type. I also saw a vaginal cyst removal during my time in Major ops, and was impressed with the speed and precision with which the doctors completed the procedure.

After spending the majority of the first week in Major ops, the following weekend was a bank holiday (lucky!), so we decided to go to Arusha for the weekend. Taking the dala dala further than I had previously, as the hospital was at the halfway point in a village called Tengeru, was a bit daunting but not a problem at all in the end. Once in Arusha, I realised just how large a city it was- a sprawling, chaotic, but ultimately amazing, concentration of people from all over the world, with buildings that all looked different. You could literally have bought anything in Arusha; shops selling motorcycle parts sat next to diners, which were situated opposite souvenir stores. Over the weekend, we visited the Maasai market for some haggling and buying of souvenirs, and Meserani Snake Park just outside the town for some reptile viewing and interaction. A very enjoyable weekend indeed.

The following week, I began work in the Male ward, and moved between the other wards as the week progressed. Viewing and assisting in wards rounds allowed me to monitor progress of patients over time, and see the journey that a patient took through it- from outpatients, through the wards, and into minor or major surgery if necessary. Outpatients was particularly interesting; the sheer breadth of diseases on show was astonishing, with many eradicated or far less common in the UK, such as HIV, TB, and Hepatitis B. Doctors used preliminary tests for the these diseases, and allowed me to test patients myself in due time. Often, diseases such as diabetes that are prevalent in the UK had progressed further than I had ever seen- a man came in with an amputated foot due to gangrene. I found out that progression of diseases such as these were often due to poor compliance and nutrition, a situation common in the country. My time in outpatients was topped by fulfillment of a small childhood wish- to learn how to use a stethoscope. I always remember having one when I was young, and am grateful that I finally got the chance to use a real one!

Overall, my work experience in the hospital was a truly amazing experience, both teaching me a great deal about all aspects of medicine and healthcare, whilst allowing me to grow as a person in confidence, making some great friends and, ultimately, helping people. However, as you would expect, there were several areas of possible improvement within the hospital, some with fairly simple solutions, others with more deep rooted causes. Therefore, in my feedback, I tried to target only the problems that could be easily solved, to try to make an impact during my short time at the hospital. Also, some doctors were less approachable and less willing to share their knowledge that, although it was initially more difficult to learn at times, it taught me to use my initiative more- a surprising silver lining in the situation.

In addition to the hospital, I visited a local orphanage in the afternoons, which offered a different experience entirely. Cradle of Love, an orphanage halfway between the hospital and Usa River, was fairly well funded, with good facilities and plenty of staff and volunteers, which surprised me initially, as I was expecting a far more degraded infrastructure. After visiting a far less privileged orphanage later on the trip, I realised that the children at Cradle were lucky to be here, but no less deprived of the most innate human craving- attention and care. Over the next three weeks, I cared for children from babies to around age 3, playing with them and assisting feeding. I had worked with children before in the UK, but not this young, and was surprised in many ways. The children were split into four groups depending on walking ability (and age): babies, crawlers, wobblers, and toddlers. I spent most time with the wobblers and toddlers, as I enjoyed the more hands on and busier style with the older kids. Full of energy and very clingy as children of that age are, I proceeded to build such strong relationships with some kids that I didn’t want to leave at the end of each day! I can honestly say that there are not many better feelings than giving attention to children that are so obviously deprived of care, and not many worse feelings than leaving at the end! Unfortunately, some of the kids weren’t used to men at all, and proceeded to cry whenever I went near them, which was the opposite of what I intended! Ultimately, although I know the kids won’t remember me, I will always treasure the time I had with them, as they brought out my inner child, and made me realise how lucky I am to have parents.

On another note, before I began to research Tanzania as a country, I didn’t realise how rich it is- not in monetary terms, but in culture, in natural wonders, and in surprises. Unfortunately, I could not visit the Serengeti, or climb Kilimanjaro, or stay on Zanzibar, but I plan to do all these things when I go back, as I have heard amazing things about them. In fact, I wouldn’t have been able to do all those things in the time that I had even if I tried! Instead, I went on safari to Tarangire and Ngorogoro National Parks, and can honestly say it was unbelievable. The pictures don’t do it justice; you must visit yourself!
In the evenings, the volunteers and I would have Swahili lessons, taught by Joshua, which offered a glimpse of the culture of Tanzania. I enjoyed learning the language, as it was surprisingly easy to learn once you knew the basics. It also helped no end in the hospital, as I was soon able to pick up bits and pieces from the conversations between doctors and patients, making the experience easier and more satisfying.

One day, I wish to go back to Tanzania and stay with Zablon and Pretty (and hopefully their son/daughter!), but I’m so glad that I chose to organize my first visit through Global Medical Projects, as it offered safety and security that I would have struggled to find myself. Therefore, I’d like to thank Kevin Dynan and Joshua Kuboja for their help, as I could not have had this wonderful experience without them. Also, I’d like to thank Zablon and Pretty, who were the perfect family to live with; friendly, kind, and welcoming, I can’t thank them enough for putting up with me for three weeks! Also, the friends I made out there will stay with me forever- the staff at my places of work, and the volunteers that I spent my time with, they all contributed to my amazing experience.

In conclusion, I’d definitely recommend the combined project that I chose, as it provided two different aspects of Tanzanian society, offering a more comprehensive view than I would imagine a single project does. It was a wonderful life experience, and one that will stay with me for life, but is also very useful to those prospective medical students, as it taught me a great deal about the profession, its successes and difficulties, and helped me grow as a person.

Many people combine time at the hospital with time at the orphanage and this combination often works well. Combined placements are only £100 – $160 – €120 extra to cover the additional donation to the orphanage.

To follow in Dan’s footsteps and join the medical project in Tanzania here

You can read more about our orphanage placements in Tanzania here

My Pre Graduate Entry Medical Project in Tanzania

Chris Wisnik.

My name is Chris and I spent one month volunteering on a medical project elective in the village of Meru,Tanzania. During my time in Africa, I worked in many different departments at Meru District Hospital, but I enjoyed my experiences in the ER and major surgery theater the most. Meru District Hospital was situated near the heart of third world Kilimanjaro, Tanzania, an area impoverished with limited resources in many aspects of health care, whether it be the medicine distributed, sterilization supplies, or the way the public was educated on healthcare. In an area where health insurance didn’t exist, people of all shapes and sizes would crowd the emergency room daily with many different health concerns. It was during this month I learned exactly what it would take to work as a medical doctor in an area of unwarranted variation.

When I arrived in Africa after a day and a half of flying halfway across the globe, I was exhausted. If I didn’t have the weekend to rest, I’m not sure if I would have been ready to work that first Monday. It was during the weekend though that I was able to embrace a bit of the Africa feel. One aspect I really appreciated right away was the community bond I felt between all members of the village I stayed in, Usa River. As I drove on the main road to get to the village from the airport, my host family Zablon and Pretty Mgonja explained how thick the soil was throughout the Kilimanjaro area, and as a result it was extremely dry and clean water was often a major issue. Right away I realized that it was these little things that would begin to make an impact on me throughout my trip.

As my first week at the hospital began, I was introduced to the Dala Dala, a public transport van that would travel from village to village to take me to work. At the hospital, I was greeted by the hospital matron and after reviewing my resume, the matron requested I deliver a presentation on immunology to the entire hospital. Before the matron gave me permission to begin my work, she showed me every department within the hospital. As we walked along the district hospital I saw how every department resembled a piece of a puzzle; it was like the hospital was a village in itself. Some of the departments included pediatrics, major and minor surgery (ER), female and male ward, AIDS ward, and even a TB ward. The matron permitted access to every department, but because of my passion to become a surgeon, I immediately dove right into work at the ER department. When I began my work, the staff  treated me very much like a medical student; the nurses and doctors were so
welcoming and eager for me to learn and practice new skills. At first, much of the staff was very instructive, teaching me the basics of suturing and injecting needles, but by the end of the first week there was nothing or nobody to hold me back, I was caring for dozens of patients all on my own every day..it almost felt too good to be true.

As my time in Africa grew, I was finding myself more and more involved in the ER and surgery department, so much that even ethical issues in medicine were starting to surface amidst my experiences. One of the most startling issues was that many of my patients were young females who had given themselves abortions. Because abortions were illegal in Tanzania, young women would often damage their bodies by giving themselves an abortion; it was my duty to make sure to clean out the reproductive tract and make sure the woman would not have any further health issues down the road. These kind of situations made me aware of how politics and social situations can influence certain factors in healthcare and it made me understand how my only view was simply to help a person in any way that I could. My time in the ER helped me deal with injections, POP casts from broken limbs, auscultations, catheters, stabbings and wound cleaning, seizures, gunshots, and even motor vehicle accidents. I was getting so involved  and with the amount of trust and responsibility that was bestowed upon me, it just felt right to keep going. Sometimes I would clean out an infection, whether on an infant or an elderly man, I knew how bad it would hurt to make that incision to flush out the abscess, so I would sometimes just let the patient hold onto me and squeeze my arm whenever it would hurt them just so I could hurt a little bit too and feel their pain. In my mind It was all definitely a case of learning fast, being confident, and embracing any challenge with a grain of salt, but I wanted all of that so bad…I wanted to keep learning; It was like I had something to prove. The ER shaped me the most out of all the departments, but it was being able to assist with both suturing during a cesarean and hernia surgery in the major surgery department that really made my experiences most memorable.

Easily the best thing about working at the Meru District Hospital came in my last week of work. Of all the time I spent working, I felt the most experienced in my last week, and as a result the matron and staff allowed me to do rounds in the male and female ward. I would show up to work and begin my rounds around 8am and would finish up by 11am. Some of my cases included stroke, malaria, and AIDS patients. I remember sometimes being amazed at how different such cases were than the standard patient one might see at a hospital back in the US. I took each patient as a lesson, spending time with them, analyzing their treatment regimen, and making sure their condition was on its way to being stable. I must have looked like such an alien to some of those people, but that never stopped me from giving them my best care. My most memorable moment though was when I had the opportunity to deliver a baby in the female ward. It was perhaps the most exhilarating moment in my life, being able to take charge in such a situation. It felt completely natural. I look back on my achievements and realize that I would not have been able to do some of these things in the US. These are some of the moments that I will remember for a long, long time.

On my last day at the hospital, the entire hospital staff showed up to listen to my presentation. During my placement I truly felt that infectious diseases and unwarranted variation prohibited many of the people from being healthy, so I decided to base my presentation on the basics of innate and acquired immunity.The entire presentation lasted about 45 minutes, followed by a series of questions asked by several staff members. Near the end of my presentation, some of the doctors and head staff members made me feel humbled by acknowledging all the work I did in the last month at their hospital. As I write this 3 months since I returned from my trip, some of the faces still stick with me. These people really gave up their time to teach a stranger. Of all the feelings I felt during this trip, I realized that there really are a lot of good people in the world, you just have to carry an open heart. I found that ultimately if you truly pour your heart into what you believe in, even if it makes you vulnerable, amazing things can and will happen.

Even though the application process and the gruelling flight hours may have seemed like a challenge at first, going through this experience with Global Medical Projects helped me to meet some really amazing people that I consider a part of my family now. When you share the same meals, experiences, and a roof under your head with people who are there to take care of you, you establish this connection that can truly last a lifetime if you let it. At first I was a bit concerned being the only volunteer to stay with my host family, but both were fantastic in meeting any of my needs/requests, including picking me up from the airport, assisting me with my bus fare to work when I needed it, and even helping me plan an excursion to the island of Zanzibar for a weekend trip. Perhaps the thing I valued the most that they showed me was an orphanage down the road from where I was staying called “Good Hope.” After visiting the orphanage 2 weeks into my stay, I told myself that I would visit the kids everyday after work no matter what. Seeing those smiling faces really made the trip worth it, and because of the orphanage I made a promise to myself that I would go back to Usa River once my journey to becoming a doctor is complete.

Like Chris, you can combine the medical project with time in the orphanage. This is only an additional £100 / $160 / 120€. Read more about the orphanage projects here

I assume you can organize your own placement directly with Meru hospital if you wanted to, but I would strongly recommend going through a company such as Global Medical Projects the first time around, as this provides you with the safety and security which, in my opinion, truly matters when you may seem like a complete stranger to the country and it is easy to stand out. I am truly grateful for all that the staff at Meru District Hospital went through to teach me how to be a better medical professional and I am forever humbled to be so warmly welcomed by the entire village of Usa River during my placement. When I arrived to Usa River, I remember going to the village church on my second day and feeling like a stranger completely lost in the culture, but as I think back on my journey, I think of Usa River and Tanzania on a whole as a hidden place, tucked safely away from the world, concealed by the high walls of the Meru and Kilimanjaro mountains. It all almost felt like being in a place rich with strange beauty, like being in a dream.  I would like to further extend a thank you to my family and friends for supporting me through my journey, the staff at the Commonwealth Medical College for inspiring me to strive past any limit, and to Kevin Dynan of Global Medical Projects for helping me through the entire application process. All of these amazing people have helped me grow in ways unimaginable, but my warmest gratitude goes out to the Mgonja family in Usa River, Zablon and Pretty – for teaching me that you don’t have to be blood related to be a part of a family, I promise to hold onto that bond no matter where my experiences may take me.

To follow in Chris’s footsteps and join the medical project in Tanzania here