Emma Kelly - Medicine in Tanzania
Four weeks ago I traded in my teaching notes for my white doctor’s coat, and it has been the most eye opening four weeks of my life. St Elizabeth Hospital, Arusha comprises of many departments including Medical Ward, Theatre and Surgical Ward, Dental, Ophthalmology, Communicable Diseases Centre and Out Patient Departments. This makes it sound like quite a big hospital with many facilities, however each of these departments is incredibly basic. There is no Intensive Care Unit, so patients in serious condition or who require daily dressings are placed in the Surgical Ward, even though they do not require surgery. In Medical Ward, patients with highly contagious disease such as Tuberculosis are bedded right next to patients who are Immuno-compromised Tuberculosis are bedded right next to patients who are Immuno-compromised-compromised patient as there just is not enough room to isolate patients with HIV. The wards are dingy and dark and if a doctor needs to inspect a patient’s wound, they use the torch form their phone so that they can see more clearly.
A surprising number of complicated procedures are performed at the hospital for there being such basic resources; two cases I have found most impressive were a very large skin graft covering a mans entire leg taking successfully with no complications what so ever, and a 9 year old girl with a parasite that grew dozens of cysts in her liver, all cysts being removed in surgery and the girl making a full recovery. Even more impressive, I think, are the patients them selves. The patients that I have seen come in and out of the hospital have more strength and resilience than any Westerner I know. They suffer through long surgeries on only a spinal block anaesthesia which begins to wear off after 2 hours, they endure painful cleaning and dressings of nasty burn wounds and lacerations on only Paracetamol as pain relief and they have broken bones set with no pain medication what so ever. Despite the huge amounts of pain these patients must be in, they never seem to complain.
A typical day for a Medical Volunteer consists of joining ward rounds with the doctors, then helping the nurses with their daily duties in the Surgical Ward. Everyday in the hospital is different, some days we are run off of our feet helping the nurses, because there has been 3 surgeries that morning and the patients all require post-op medication and vital signs checked, as well as the daily dressings done. Other days, we fold gauze for 3 hours straight because there are no jobs for us to do.
I have also spent some time in the Eye Unit, where I have been invited to watch cataract removal surgery on a number of occasions. The Eye Unit at the hospital has it’s own Operating Theatre, the facility and the microscope donated by the Fred Hollows Association. Fred Hollows has also assisted to train the Ophthalmologist, and to build a factory in Africa where the replacement lenses used in cataract repair are made, cutting the cost for patients considerably as the lenses do not need to be imported from Europe or Australia. The patients who visit the Eye Unit amaze me; last week we saw one man who claimed to be 97 years old (many elderly African people do not know their exact age). He had walked 15km to see the eye specialist that day, and when we tested his vision he had no light perception in one eye, and could only register hand movements 30cm from his face in the other. He was almost completely blind – yet he had managed to walk 15km into the bustling city of Arusha to visit a specialist, and at 97 years old. Incredible! And the most amazing thing; we can correct his vision to near perfect, almost 20/20 vision with just a 45 minute operation to remove his cataracts.
I have one week left at St Elizabeth Hospital before moving to work at another hospital, a clinic specialising in maternity, labour and deliveries, which will be an exciting change. Working in a hospital has made me realise how lucky we are with our health care system in Australia, and has also made me even more excited to begin Medicine next year so that I can learn about all of the amazing things I have been lucky enough to see in my time here.