Case Notes:
Will Ball
(Medicine, Tanzania )

The placement

I was placed at Mt Meru Hospital, Arusha for 5 weeks in the surgical department. On the first day I was thrown straight into the thick of things by being asked to scrub in for an appendectomy. The theatres are very different to England they have few resources and organisation is almost non existent but you won’t be short of things to do. There are two theatres- one for majors and one for minors- and you are free to walk between the two to fill your time but don’t go in unless you are willing to be involved as the surgeons are keen to teach. It is not necessary to have lots of surgical experience as the doctors will guide you through the procedures. Examples of procedures I had an active role in are as follows: -

Majors: Thyroidectomy (lots as goitre is common), Gastrojejenostomy, appendectomy, ORIF (femoral fractures are very common), Liver abscess, amputations.

Minors: Reduction of wrist fractures, re-dressing burns, POP casts and debridement of wounds.

I also saw a c section and a natural birth.

The Hospital is severely under funded and as such has only one anaesthetic machine, two oxygen cylinders, no recovery room and no monitoring on the wards. Despite this the doctors are highly skilled and make the most of the resources they have.

If you are anything like me you will probably be worried about the HIV risk. I can tell you that as long as you protect yourself and take HIV post exposure prophylaxis you should have very few worries. You will be provided with two pairs of surgical gloves for every procedure and full gowns and goggles (you may like to take your own).

All the doctors speak very good English and are very happy to talk about the differences between Tanzania and England they even encourage your input on ward rounds. Like all hospital placements you get out what you put in and the more enthusiastic you are the more you will learn. I think the best part about the placement is the clinical skills you will gain and the surgical signs you will see, as investigations are costly and patients present very late.

The WTW house and staff

The Work the World house is massive and always stocked up with fresh fruit, veg and various other foodstuffs that the super chef makes into culinary masterpieces. Breakfast normally consists of pancakes, fresh fruit, freshly squeezed juice and tea/coffee but you can request anything you want the night before. Lunch is a do it yourself job (if you aren’t at hospital). Dinner ranges from delicious traditional African cuisine (Ugali, mchicha and my favourite nyama choma) to old English favourites (Chips and steak).

Baptista, the Programme Director in Arusha, will go out of his way to make sure you have everything you need. If it is organising safari or getting buses to Dar he knows where to go and when for the best deals and service. All the staff always have a huge smile and lots of enthusiasm which certainly helps you get going in the morning.

Paradiso Orphanage (where we helped out in the afternoons)

Paradiso orphanage has 17 children ranging from 3 to 9 they have lost their parents through HIV or child birth, some parents just couldn’t cope. The orphanage is run by an elderly couple (Baba and Bibi) who get money through sponsorship. We visited this orphanage twice and took everyone out one Saturday for a day trip to the snake park. I think we had just as much fun as the kids!! Baba and Bibi love having visitors even if its just to play with the children who are so lively you’ll need a day or two to recover.

Travelling in Tanzania

Safari
An absolute must whilst in Arusha and it can easily be organised over a long weekend. 4 days is the minimum I would recommend if you want to go to the main areas of Ngorongoro, Serengeti and Lake Manyara. We went with SOK who have safe cars, friendly service and very reasonable prices. I proposed to my fiancé in the Serengeti so I have particularly fond memories of this experience.

Maasai Medicine
The Maasai medicine experience was well worth the money. We chose to spend 3 days travelling in the hills around Monduli Juu staying in traditional Maasai huts and tents experiencing Maasai culture and learning how Aang Serian (the NGO) that run the trip are trying to raise awareness of HIV/AIDS and female genital mutilation to promote health in the community. This coupled with drinking fermented milk, making medicinal teas and the amazing landscape ensures a memorable weekend.

Zanzibar
I recommend flying to Zanzibar from Arusha as I travelled by coach then ferry which was very time consuming and only marginally cheaper. Zanzibar needs a couple of weeks to explore fully but you can certainly see a lot in a shorter space of time if you are limited. The full moon party at Kendwa takes place every month on or near the full moon. Travellers and locals all rock up for a beach party that lasts till sunrise. When the party is over Kendwa is a beautiful place to chill out after an exhilarating few weeks of placement. Scuba diving, snorkelling, fishing and some water sports can be arranged from here.

Stone Town deserves a couple of nights stay to visit the fish market and go on a spice tour (with Mitu's spice company). It gives you a taste of real Zanzibar and getting lost is inevitable and helps you explore the streets and orientate yourself.

Dar es Salaam
Having only spent 2 nights here I haven’t much to say other than you can get great food and try paan (look it up on the internet).

Some ideas of things to take (other than the obvious)

Mobile phone-unlocked capable of roaming
Scrubs, goggles, face mask
N.B a sleeping bag is not necessary as tour companies will provide them and all hostels have sheets.

Things to donate to the hospital

Spinal needles, LMAs, ET tubes, cannulas, portable pulse oximeters, surgical gloves, antibiotics.