Case Notes:
Vicky Atley
(Physiotherapy, Tanzania )

 

I decided to come to Tanzania as I wanted to escape my hectic lifestyle and over-urbanisation of the UK. Plus, after a stressful year at uni I thought it would be the adventure I needed. I can certainly say that it was the best decision I have ever made and I would recommend it to anyone who is considering a work placement abroad.

The Placement

The physiotherapy placement at Mount Meru Hospital has been the most eye-opening experience of my life. Because the medical management of patients differs incredibly from that in the UK, the physiotherapist’s role is also different. There are 2 physiotherapists at the hospital, Mr Kaaya and George. They work on the wards on Mondays, Wednesdays and Fridays, and have outpatients on Tuesdays and Thursdays. The working day is generally 08:30 – 12:30 and then 14:00 – 15:00. The working day fits around visiting hours but on several occasions I have been able to stay later if I wanted to.

In the outpatient department there are a number of beds/ plinths, cervical traction, a pulley system and a small selection of walking aids, weights, mats and exercise balls. There is no electrotherapy equipment available here so exercise is the main form of treatment. I have found it an interesting challenge to treat patients using the very basic equipment as we have become reliant on technology in UK.

My First Day

My first day was very scary; I knew very little KiSwahili, had no idea what to expect from the hospital or the placement, and I was the only white person in the entire hospital!

I was given an introduction to the various wards and patients and then told that I would be working on the paediatric burns ward and one of the adult fracture wards that morning. I was then left to get on with it. Yes, a very daunting situation, and ‘Aaaargh Help!’ was about all I could think for the first 5 minutes. However, I decided to brave it and to my relief the sister on the ward handed me a pair of gloves and pointed to my first patient on the ward. I had no experience of burns and so the sight of them alone shocked me. I had checked with the George (the physio) that I was simply carrying out passive and active movements with each child, and so began to move the child’s ankle. As soon as I began to move it he began to scream and pulled his leg away from me. This went on for 5 minutes, and I was too scared to take his foot and continue because of the distress he was in. However, with the reassurance of his mum who ensured me that this was normal, I was soon carrying out passive movements. Before this placement I disliked the sight any wounds, blood or anything similar, and I was so proud of myself when I was treating a child with vast, uncovered burns. When I was happy with the movement I had got with the little boy’s knee I slowly worked my way round the ward.

The focus here is cost, and so almost all fractures are treated with traction, unlike the internal fixation used in the UK. This was a great shock to me when I walked into the ward to be faced with 20 patients on skeletal traction, comprising of carrier bags containing sand and rocks attached to ropes. All that can be done in these cases from a physio perspective is leg positioning to ensure the correct angle for reduction and static quadriceps exercises for 6-8 weeks. Sounds simple enough, but I had no idea how to ask someone to tighten their quads though so it was a very long morning of trying to demonstrate to patients! However, I survived it and was able to meet before lunch to say that I had completed both wards. In the afternoon I was introduced to some paraplegics and was also able to enquire about some much needed KiSwahili terms so that I would be more prepared for the next day. Even though it was an overwhelming experience, my first day gave me huge insight into the health care system in place in Tanzania.   I left the hospital feeling like I would actually make a huge difference to the patients and the hospital in general.

Arusha & the House

Having never been to Africa before I had no idea what to expect. Any ideas I had were based on images and films on TV and I was clueless as to how it would be in reality. Any fears of what to expect were relieved though when the Work the World Co-ordinator, Baptista, gave me a really useful induction to Arusha.

The Work the World house is amazing! It’s easy to forget your in a developing country when you are relaxing on the balcony of huge house after a days’ work, with an amazing view of Mount Meru drinking Konyage (which is a local gin – like spirit and is incredibly cheap) and bitter lemon (which mixes brilliantly with it)!. Marian, who is the housekeeper/ superchef, makes the most amazing fruit juice and cooks incredible food, which is all local and means you can try all sorts of things you would never dream of at home. I think that being in this house gives you a good compromise between traditions and comfort whilst you’re here… When you’re working in poor conditions all day it is definitely nice to come home to a modern house with running water!

I have been on two safaris whilst I have been here; Arusha National Park and Tarangire National Park. They were both fantastic experiences as they had different animals in each. Arusha was brilliant for seeing giraffe, buffalo, waterbuck, warthog and black and white colobus, whereas we got unbelievably close to elephants and zebras in Tarangire, which was incredible. We did both as day trips and had amazing time on both but in Arusha we got to hike in the park, which is something I would definitely recommend if you get the chance.

And Now...

Well, I am now 2 weeks into my placement and I love every minute of it. Thanks to Baptista and George, my KiSwahili is improving and I can give basic but essential commands to patients. I work on the burns ward daily as I really like it there as I get to interact with children and it is so rewarding when a child achieves a goal, even if it is something as small as opening or straightening the fingers of their burnt hand. The children and relatives are very friendly and I can now laugh with them and play with the children. I also have 3 paraplegic patients who I was introduced to and see daily for passive and functional movements. I don’t work on the fracture wards often unless I have some free time, but that suits me because I prefer more active, hands on physiotherapy and love working with my children on the burns ward.

The outpatient department is an area that I have little involvement in as I usually go to the wards instead. Personally, I feel this allows me to develop my interpersonal and clinical skills more than is possible in the outpatient setting here. I do have a couple of outpatients though who require more input than instructing them to do straight leg raises.  One in particular is a young cerebral palsy baby, who I was keen to work with as I have had experience with similar patients in the UK. It’s quite upsetting that, in comparison to the UK, the support network here for parents with physically and mentally impaired children is minimal. Because of this the families are so dependent on us, as physiotherapists, for advice and help. I am currently investigating any support groups within the area so that I can suggest them to the child’s mother.

Everyone in the hospital has been great in helping me with any communication difficulties I have had with any patients and Mr Kaaya and George are happy to translate any words or phrases I’ve needed. Thankfully the medical notes are all in English though!

Although it is large in terms of Tanzanian hospitals, in comparison to those in the UK it is fairly small. The physiotherapists tend to work independently to cover all the wards and only pair up in a small number of cases, for example sitting a paraplegic up for the first time. Having said that, my caseload is large enough and varied enough to challenge me clinically. Mr Kaaya is very approachable, will answer any questions I have and frequently checks in on my progress.