Case Notes:
Fiona Harvie
(Physiotherapy, Tanzania )

 

So, here I already well into my placement at Mount Meru Hospital in Arusha. I’m amazed by how comfortable I feel here after just one week when I think about my initial culture shock!

The house in Arusha takes up to twenty students, and the six of us here at the moment are split between two hospitals; three are working at Mount Meru Regional Hospital and three at Meru District Hospital. We’re currently a mix of nurses, medics and physios.

When I arrived I was met at the airport and taken in a taxi back to the house, where I met the other students awaiting the newcomer!  On my first day I had orientation in Arusha, wandering around town checking out where the banks are internet café, bureau de change and other practical stuff. We also had a brilliant lunch at the Police Officers Mess, traditional African style ugali eaten with the fingers- don’t imagine that you will come to Africa and come back skinny!

On my second day Baptista took me to meet the Director of Mount Meru Regional Hospital, where I am now working.  I had a tour of the hospital, which has approximately 450 beds, a triage, medical and surgical wards, outpatient clinics (including physiotherapy, dentistry, HIV / AIDS), a mental health unit, a small TB and leprosy ward, obs and gynae and the maternity ward. I started on the third day after getting here: ample time to get my bearings and get over my culture shock.

A typical day – although there haven’t been too many yet – starts at 6.30 am for breakfast. I leave the house at 7.30 am after pancakes, porridge or fresh fruit. Everyone here either walks or takes a dala-dala to work, which is a VW campervan sized minibus containing far too many people. The record so far is twenty-nine people in one, plus livestock. The streets are busy on the way to work and there are plenty of “jambos” called on the way.

 The working day for the Physio department is officially 8.30 – 12.30, but I have been returning to continue in the afternoon. We can’t treat between 12.30 and 2.00 or after 4.30 due to the crowds of visitors who arrive to provide lunch for the patients.

Mr. George is the physio, along with his assistant Mr. Kaaya. Both are really friendly and used to having students around. Their English is excellent and patience for teaching Swahili phrases endless (thankfully!). Both are really knowledgeable and keen to exchange ideas and techniques – and they also know everyone in the hospital, which is handy.

The Physio dept relies very much on manual skills. There are no electrotherapies and the gym has four plinths and an exercise bike, along with a small collection of fit balls, a cervical traction machine (used frequently) and some walking aids. Cuff weights are available for strength training. In total there are around three walking frames in the whole hospital and one is a paediatric one. Patients are expected to purchase their own crutches, so some will have to wait for some time before they can be discharged safely.

There are two outpatient days each week. There are no appointments: patients just turn up and wait in line. There is lots of work rehabbing patients post fracture: for the kids, supracondylar fractures and adults, mainly femoral fractures. Time on the wards tends to be longer than in the UK, as the main treatments are skin or skeletal traction meaning that some patients are around for months. We also see patients with neurological problems in out-patients, mainly GBS and stroke patients.

In my second week I have been mostly on the paediatric burns and fracture wards. Burns are particularly common here, due to cooking methods and cramped living space. Lots of children have burns caused by hot water, food or oil. In Tanzania an open wound method is used, so the main priorities are keeping the children moving to encourage functional scar tissue formation, along with preventing contractures. A number of the children are currently waiting for visiting plastic surgeons from the US to perform contracture release surgery.

The children are great fun to work with, particularly if you take things for them to play with or incorporate games into their treatment. This can make painful treatment bearable, although I am not the most popular visitor to the ward for some of the children as you can imagine! Pain relief is not really used beyond paracetamol; due to lack of funding in all areas of the hospital, so other distraction tactics such as games are really useful. The mums are great too helping me out with treatment and continuing it as needed.

We have 2 – 3 hours of Kiswahili lessons each week at the house, but I would really recommend taking some time to learn key phrases and greetings before coming out.  It’s made me realise just how much communication contributes to a physio’s job! My basic Kiswahili and sign language skills are coming along nicely though and I’m picking up key physio terms every day.

It’s a good idea bring out any equipment that you think might be useful on the wards, as not everything is in endless supply out here.  I go through about 12 pairs of gloves a day, and lots of alcohol rub.  If I could have fit a walking frame in that would have been really useful too!