The four weeks I spent at St Augustine’s, the District Designated Hospital for Muheza district (or as the locals call it, Teule) were a long time in the planning, yet they flew by in what felt like an instant and will live long in my memory.

Muheza is a town situated in the north-east of Tanzania and is somewhat unflatteringly described by Lonely Planet as, ‘a scrappy junction town’. It was here that I lived for four weeks, spending the weekdays in the hospital and the weekends in the surrounding area. The hospital, St Augustine’s, was originally set up by the Anglican Church of Tanzania, but is now run by government employees. This, however, did not detract from its Christian ethos, with morning worship and prayers being conducted at 7:45am, which was a joyous way to start each day. Additionally, many members of staff were devout Christians, as I found out through discussion or when I attended the local church.

For my first two weeks, I engaged with, and worked alongside, the hospice department, as palliative care provision in Tanzania was to be the focus of my report for the university. These weeks, spent with the highly dedicated and hard-working staff that make up the Muheza Hospice Care, were challenging, inspiring, illuminating and humbling. I was blessed to work alongside a young, male, Christian nurse, who spoke very good English and had a passion for providing exceptional palliative care in this resource-limited setting. He was able to explain to me the culture in Tanzania which affects healthcare provision and the barriers which must be overcome to ensure adequate delivery of care. His insight and care in helping me understand the challenges of: poverty, lack of food security and limited health education, were invaluable, as I sometimes struggled to come to terms with the great level of need and the desperate situations that I witnessed in patients’ lives.

The days with the palliative care team often began with a meeting, conducted fully in Swahili, to which my only contribution would be saying my name, if I was requested to introduce myself. I would then go for ‘chai’ with a member of the staff, which inevitably indicated tea and a large breakfast! (I tended to just stick to a couple of chapattis)! We would then commence our home visits, which would entail bouncing, off-piste, over muddy, bumpy and windy red-dirt roads before arriving at a patient’s house. We would always be greeted very warmly by the patient and the family present, so much so, that all the team numbering normally five or six (but on one occasion thirteen - and yes, all in one vehicle) would be given a chair, even if this meant the patient would sit on the floor. I found this display of hospitality to be a humbling challenge to accept, but I was never allowed to give up my seat. A discussion with the patient would then ensue (again in Swahili – my proficiency in which did improve a little during my stay, but never enough to understand the discussion). The necessary medications would be provided and, in some cases, where needed, food, soap and other essentials.

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 5^th 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.

During the third week of my elective, I received my exam results…and by God’s grace, I passed! Praise the Lord! This enabled me to remain in Tanzania for a few weeks after my elective, to travel around that beautiful country and to attend the International Christian Medical and Dental Association (ICMDA) World Congress, before flying home. This was a really wonderful experience. To meet with over 1,000 medical and dental professionals and students, from over 100 countries was incredible. The teaching we received was both encouraging and challenging and has left me with much to think and pray through, in regards to my calling in medicine and in mission.

Through this medical elective experience, I was pushed out of my comfort zone in many areas and forced to live very differently to how I have for the last 27 years of my life. However, in all the uncertainties and difficulties I was amazed and grateful to see God going before me and revealing Himself as all I need. I found Psalm 121 to be of great comfort and encouragement throughout my time in Tanzania, in times of uncertainty, doubt and difficulty, I could reflect on the wonderful truth, that ‘my help comes from the Lord, who made heaven and earth’, therefore I need not fear as ‘the Lord is my keeper’.

I would like to take this opportunity to thank all of you who prayed for me and to thank MMN for supporting me financially and prayerfully. I thank God for your support and I was very aware of your prayers as I went on this journey. I cannot thank you enough.

Here are a few final prayer points as I leave my elective journey behind:

• Praise God for this experience and His protection throughout my time in Tanzania
• Praise the Lord that He gave me strength to pass my exams and I was able to stay in Tanzania and attend the greatly encouraging ICMDA World Congress
• Please pray that I will have time to reflect and process this time away and that the Lord, in His timing and through His grace, will reveal where and how He would like me to join Him in His mission in the future