by Work the World

Student talk, the site provided by the Society of Radiographers, has run a great interview with David Evans, the winner of the Work the World and SCOR competition last year. David provides an amazing insight into what his placement in Dar es Salaam was like, and the reality of studying radiography in the only specialist cancer hospital in the country. Have a read below.

Why did you enter the Work the World competition and why Tanzania? The idea of spending an elective placement in a third world country seemed completely out of reach. I had no idea how to organise such a trip, so the possibility that the SCoR and Work the World could provide that opportunity was just too good to miss. When deciding what to write for my entry I began to look at what radiotherapy facilities were available to the poorest nations and the whole thing went from there. While Work the World offer several destinations worldwide, not all of them have radiotherapy facilities. Tanzania seemed to offer the perfect mix of clinical and recreational opportunities.

How simple was it to organise the placement and what was the level of support you received from WTW and the SCoR? The support from everyone involved was amazing. Work the World try to tailor your stay to you, so by telling them what you want out of the experience and where your interests lie, they can recommend the perfect package. The pre-departure information is invaluable in helping you to prepare, but they also have local people in place to ease you into what is a very different culture. As I was the first radiotherapy student they had taken, they had to do a lot of work with myself and the SCoR to organise a placement and they helped provide an amazing experience.


Where in Tanzania did you stay and at which hospital(s) did you work? I spent four weeks in Dar es Salaam, which is the largest city in Tanzania. My placement was based at the Ocean Road Cancer Institute, which is the only hospital in Tanzania to offer radiotherapy treatment.

Before you went, what was your perception of cancer treatment/healthcare in Tanzania? Through what I had read and what Work the World had found out, I knew the throughput for each machine was much higher than we are used to in the UK. I expected the equipment to be basic and the speed of work to be much faster than I am used to.

What was the reality? The machines were Cobalt-60 units rather than linear accelerators, but were only a few years old as they had been donated by various companies. Each machine works from 8am to 10pm and treats around 90 patients per day. However, the pace of life is actually quite slow and there was never any rush to reduce treatment times or increase throughput.


Did you quickly feel part of the communities you worked with? English is spoken by educated people, but Swahili is most definitely the preferred language. Most of the patients were not highly educated and therefore did not speak English so my colleagues would act as translator. However, it is expected that you make an effort to speak their language even if it is only the basics. Work the World prepare you for this prior to your departure so you can learn a few phrases, plus they provide weekly Swahili classes once you are there.

There is little tourism outside the safari parks so a white face is very conspicuous – don't expect to blend into the crowd. But go with an open mind and a willingness to learn and the Tanzanian people will welcome you.

How would you describe your placement in terms of a clinical learning experience? Basic! Aside from the technological limitations they face, the techniques and levels of care are very different to that of the UK. Over 90% of patients were treated without imaging, permanent skin marks or immobilisation. Nearly all treatments are either direct single fields or parallel opposed pairs and patients are not set up as we would know it. Because there are no facilities for infection control (including at times no soap or running water) radiographers did not touch the patients and accuracy was extremely poor.

Those radiographers who were trained in more developed countries such as South Africa had a great deal of theoretical and practical knowledge. However, those who were trained in Tanzania had very little knowledge of even the most basic techniques, but they were incredibly keen to learn and ask questions about what we do here.


And in terms of personal development, how did it rate? It was an experience I will never forget and something I am incredibly grateful to the SCoR and Work the World for providing. It may sound like a cliché, but it has made me look at my practice completely differently and will hopefully help to make me a better radiographer.

What surprised you most during your placement? The level of interest of the radiographers in their patients' side effects. There was very little communication throughout treatment and virtually no support offered to the patients in order to manage their side effects, which, due to the large fields and inaccurate placement, were often extreme.

What were your greatest successes or high points? Raising awareness of the importance of personal protection. When I got there I discovered that many of the radiographers did not wear their TLDs because they were not being changed for up to two years. Working with live cobalt sources they had no way of measuring their exposure. As a result of seeing my protective equipment they now all wear their badges which are exchanged regularly.

Any lows? Sadly too many to mention. The two that stand out are a six-year-old girl being treated for a retinoblastoma with large non-shaped fields, no immobilisation, and no attempt to save the sight in her contra lateral eye; and many women who after one to two weeks of treatment for cervical cancer could not continue due to a machine breakdown and their intent being changed from radical to palliative.


Did you manage to go on safari? What did you get up to in your spare time? There is lots of time for fun outside of placement. The Work the World house accommodates up to 35 healthcare students at any one time so there are plenty of friends to be made. I spent one weekend on the island of Zanzibar, one weekend on safari at Mikumi, along with loads of day trips to white sandy beaches and tropical paradises where you can go snorkeling, scuba diving, or just enjoy the sunshine. Combine that with really good (and cheap) food and drink and you have the perfect trip.

What would you say to someone thinking about entering the competition? Do it!! I honestly thought I had no chance of winning but it was worth a try...and here I am.

Would you do it all again if you had the chance? Any plans to go back? I would go back in a instant. There is so much to see and do, and the clinical placement offers you something that you would never get to see in this country. There are no plans to go back as yet, but I am still in touch with the staff at the hospital and I hope to go back and see vast improvements in the not too distant future.

In five words, describe the experience... Incredible, fascinating, frustrating, exhilarating and life changing.


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