During these home visits I saw a wide range of clinical cases. For example: from one lady we drained 7 litres of ascitic fluid from her abdomen (as a result of hepatocellular carcinoma); a young boy with HIV who had suffered from pathological fractures in both legs (no known cause, as yet) and many suffering the affects of HIV or the anti-retroviral medications. Interestingly, one patient was under the palliative care team with hypertension and sadly, on one occasion, we arrived at a house to discover that the patient had died a few days prior. As we travelled to and from the home visits I was struck by the disparity of housing in this area of Tanzania, with some living in rather grand brick-built houses with tin roofs and others in mud huts made up of a single room. Tragically, the lady who was suffering from hepatocellular carcinoma and the associated ascitic fluid was living in a mud hut with a leaking roof. As we drained her fluid, it began to rain and to see it dripping through onto the bed of this lady was deeply saddening.
Alongside the home visits, I also sat in on a few clinics with patients in the palliative care department, where I was struck by the limits of medical care in Tanzania. Many patients presented with conditions which have relatively good prognoses in the UK, but here they were on the palliative care pathway, as they were deemed incurable in this setting. Additionally, I attended a Saturday morning kids’ club for children who were diagnosed with HIV. At this club, they are educated about HIV; have their regular monitoring undertaken; are provided with medication and with food and also get the chance to have some fun. (I spent much of those mornings playing football!) Whilst working with the palliative care team, I was also entrusted with assisting the team as they got to grips with a new piece of software, to help them move all their paper notes to a digital format. As someone who is not highly skilled in IT, I did what I could and was pleased to see that, despite my lack of IT experience, this had been helpful and will be beneficial, long after I departed.
For the remaining two weeks of my stay, I spent my time in the main hospital, observing various specialties and clinics. I saw my first caesarean (we do not study Obstetrics and Gynaecology until our 5th
year in Birmingham), a wide variety of debridements, a hernia repair and a few other surgeries, mostly undertaken by the same surgeon! I was amazed by the versatility and diversity of the skills of the few surgeons at this hospital. This enabled them to complete complex surgery in a relatively stark environment. The work of the hospital, and especially that of the surgeons, is regularly compromised and affected by the frequency of power cuts in Muheza. These outages would occur most days, sometimes multiple times a day and could last anything from a few seconds to many hours. This can be a challenge to the surgeons as they operate at night. Hence, when I asked before visiting, if I could bring anything from the UK, a head torch was top of the list.
I also managed to spend a short time in the laboratories, observing pathologies that are more unusual to see in the UK (e.g. TB; malaria). When in the radiology department, I diagnosed my first case of TB from a chest x-ray, which was educationally rewarding but miserable for the patient. During my visit to both the labs and the radiology department, I was once again struck by the frustration of the constant power cuts!
I attended a number of clinics, but the most memorable, was the albino clinic. Before coming to Tanzania I had scarcely thought about the struggles that albino people face in daily life. However, since meeting individuals with this condition whilst on my elective, I shall never have the same perspective again. Not only do they suffer from issues arising from reduced melanin in a high-UV, almost equatorial country, they also suffer high levels of abuse, community rejection and in some cases murder, as witch doctors have been known to request specific body parts of an albino person, for their nefarious purposes . (This has mercifully been reduced in recent times, thanks to the excellent work of a number of great charities),. The clinic I attended was being headed up by the charity Standing Voice and I was deeply encouraged to hear of the amazing work they are doing throughout Tanzania, in hospitals, schools and communities.
When not in the hospital, I lived in a house on the approach road, that was looked after by two wonderful Tanzanian women. They had some English, but it was limited, which encouraged/forced me to get learning a few words of Swahili. They were even kind enough to teach me how to make chapattis! So, I leave Tanzania upskilled in more ways than one! During the weeks I was out in Muheza, a group of three other medical students from Edinburgh University joined me, which was encouraging, as I appreciated the company during the weeks of work and on adventures at the weekend. Also, I found out early on that they were not Christians, but by God’s grace, I was able to talk to them about my faith whilst I lived alongside them and I even managed to give them a copy of John’s gospel each, before we went our separate ways. I am grateful to God for their presence during these weeks and for the friendship we formed during this time, I will continue to pray for them.