Returning from a small village to the busy streets of Dar es Salaam seems a bit like a rude awakening from a peaceful dream. We arrived late at night and hopped right out of the bus and into a bajaji (a small, three-wheeled taxi) to our hostel, unable to escape the weight of the familiar mixture of smoke, fuel exhaust, and dust along the way. As I lay down for bed, I could not help but notice that the chickens I had become accustomed to outside of my window in Nzega had been replaced by the pulsing bass of loud music playing some distance away.
At the same time, returning to Dar has been like finding an old friend. I have stayed here every weekend now for the past month and I know my way pretty well through the areas nearby and can find what I need at most of the local shops. Two other interns, medical students from Canada, are also staying in the guesthouse here, and they have been so kind to let me tag along as they explore and enjoy the city.
With the visit to these two digital library sites complete, most of my traveling for work is done, however I will continue to work to coordinate fundraising efforts, draft a report summarizing our findings and sharing the digital library model, and identify and evaluate potential future digital library sites in Tanzania. My schedule is self-paced, though, so for a couple of days the students from Canada insisted I join them to see the hospital where they have been working. I don’t have any real experience with medicine or public health, but they loaned me a pair of scrubs, and even assigned me some background reading from their medical guides, then allowed me to shadow them in all of their work!
I really and truly thought I had no expectations (because I have no previous experience) going into the hospital to observe, but I must-- somewhere in my mind-- have had an idea of what I expected to see, because by the end of the day I was truly blown away. The medical needs of the patients who came in, the severe limitations of fundamental treatments and supplies, and patient-doctor relationships painted a clear picture of the stage that this country is in, and the long road ahead to bring about improvements.
I joined my friend Xavier in the Internal Medicine ward for most of the day. This large room reminded me a lot of the military hospitals that I have seen in films: one long space filled with many beds and patients of a wide variety of needs, and very minimal resources, otherwise. There was one striking difference, though: The room had very few machines or equipment. IV stands were placed next to a couple of beds with medicines and bags to relieve patients unable to get up to use the bathroom. But blood transfusions and monitoring equipment were nowhere to be found. The hospital (funded by the government) can’t afford these, a doctor explained, and they cannot be dependent upon electricity to keep blood donations or to monitor patients. As the day wore on, the gravity of the limitations that a lack of blood donations produced really blew me away. So many patients come in and are not well nourished. They have severe anemia, many have sickle cell, among other things, but there are no blood transfusions available, so they lie in bed and wait. Transfusions are given only in the most critical cases, and with priority to women and children. Sometimes family members will be asked if they might be willing to donate, however I was surprised to learn that many family members will not give.
Most of the time, this is due to the prevalence and stigma of HIV/AIDS. Of the patients in the ward, the majority were there from HIV-related illnesses. Often, unfortunately, if their families knew they had the disease, they would not come with them, and not give blood to them. Some individuals were also nervous to give blood because they would be tested and find out their status, then. While lifelong HIV treatment is free and provided by the government, the social isolation that often results from the test results can be a huge price to pay.
Patient – doctor interactions were also a huge surprise. As I know very little about medicine, I closely followed an intern, who followed a doctor throughout the day. The doctor made rounds in the ward, examined patients and taught us along the way, but almost never addressed the patient as he did so. Patients, it seems, are given a diagnosis and a bed, and that is about all. They are responsible for purchasing and bringing their own medicine and food—both totally foreign concepts to me, and impossible if you are seriously ill and lack the support of your family. I worry that some patients were ill and could have lay there for days without food before anyone knew. This is absolutely not to say the doctors did not care about the patients—they really did show a lot of concern for them. But ultimately, they felt helpless and overwhelmed, trying to accomplish their job without the resources they truly need.
At the same time, returning to Dar has been like finding an old friend. I have stayed here every weekend now for the past month and I know my way pretty well through the areas nearby and can find what I need at most of the local shops. Two other interns, medical students from Canada, are also staying in the guesthouse here, and they have been so kind to let me tag along as they explore and enjoy the city.
With the visit to these two digital library sites complete, most of my traveling for work is done, however I will continue to work to coordinate fundraising efforts, draft a report summarizing our findings and sharing the digital library model, and identify and evaluate potential future digital library sites in Tanzania. My schedule is self-paced, though, so for a couple of days the students from Canada insisted I join them to see the hospital where they have been working. I don’t have any real experience with medicine or public health, but they loaned me a pair of scrubs, and even assigned me some background reading from their medical guides, then allowed me to shadow them in all of their work!
I really and truly thought I had no expectations (because I have no previous experience) going into the hospital to observe, but I must-- somewhere in my mind-- have had an idea of what I expected to see, because by the end of the day I was truly blown away. The medical needs of the patients who came in, the severe limitations of fundamental treatments and supplies, and patient-doctor relationships painted a clear picture of the stage that this country is in, and the long road ahead to bring about improvements.
I joined my friend Xavier in the Internal Medicine ward for most of the day. This large room reminded me a lot of the military hospitals that I have seen in films: one long space filled with many beds and patients of a wide variety of needs, and very minimal resources, otherwise. There was one striking difference, though: The room had very few machines or equipment. IV stands were placed next to a couple of beds with medicines and bags to relieve patients unable to get up to use the bathroom. But blood transfusions and monitoring equipment were nowhere to be found. The hospital (funded by the government) can’t afford these, a doctor explained, and they cannot be dependent upon electricity to keep blood donations or to monitor patients. As the day wore on, the gravity of the limitations that a lack of blood donations produced really blew me away. So many patients come in and are not well nourished. They have severe anemia, many have sickle cell, among other things, but there are no blood transfusions available, so they lie in bed and wait. Transfusions are given only in the most critical cases, and with priority to women and children. Sometimes family members will be asked if they might be willing to donate, however I was surprised to learn that many family members will not give.
Most of the time, this is due to the prevalence and stigma of HIV/AIDS. Of the patients in the ward, the majority were there from HIV-related illnesses. Often, unfortunately, if their families knew they had the disease, they would not come with them, and not give blood to them. Some individuals were also nervous to give blood because they would be tested and find out their status, then. While lifelong HIV treatment is free and provided by the government, the social isolation that often results from the test results can be a huge price to pay.
Patient – doctor interactions were also a huge surprise. As I know very little about medicine, I closely followed an intern, who followed a doctor throughout the day. The doctor made rounds in the ward, examined patients and taught us along the way, but almost never addressed the patient as he did so. Patients, it seems, are given a diagnosis and a bed, and that is about all. They are responsible for purchasing and bringing their own medicine and food—both totally foreign concepts to me, and impossible if you are seriously ill and lack the support of your family. I worry that some patients were ill and could have lay there for days without food before anyone knew. This is absolutely not to say the doctors did not care about the patients—they really did show a lot of concern for them. But ultimately, they felt helpless and overwhelmed, trying to accomplish their job without the resources they truly need.