I knew that I wanted to experience Paediatric medicine in a low resource setting during my elective for Liverpool University but I was also aware that having not done a huge amount of travelling previously, it would be difficult to organise everything and I really wasn’t sure where to start! This was one of the big attractions for me with a Work the World elective; right from the start they helped to plan my trip including visa’s and hospital placement etc.
Getting off the plane I was met by Alpha and Mark who took us back to the house allowing us to get settled in before giving an induction to the house and local area including places to eat, the nearby beach and shopping: pharmacy bureau de change etc.
One of the most useful little extras provided the first few days were Swahili lessons with teacher Joe, we learnt a few basic things like how to introduce yourself, parts of the body and numbers, which are particularly useful when you go shopping to the market as haggling is an essential part of that experience!
On an average day we’d get up around 7am and have breakfast served up by Reheema before walking about 10-15 minutes to the bus stop to get the Dala Dala (Swahili for glorified van) to the hospital. This is an experience in itself as it’s how the locals get around town; its often crowded and everyone is friendly though be prepared to be called a ‘mzungu’, Swahili for ‘white person’. It’s also a really eye opening experience as the route takes you through some of the more deprived areas of Dar you wouldn’t normally come across as a tourist.
Arriving at the Regional Hospital at 8am and the ward round with Dr Doulla would begin. It was very different to UK hospitals and the lack of resources shaped much of my experience as diagnostic testing wasn’t always available e.g. Blood Cultures. As a result clinical findings and vital signs had to be relied upon to make a diagnosis, I certainly felt there was an over-reliance on antibiotic therapy from some of the interns (equivalent to F1) when any chest sign was heard which didn’t seem like good medicine as a diagnosis wasn’t really there. However Dr Doulla was very good at correcting this practice and showed that low resources doesn’t have to mean poor outcomes if you use what you have effectively.
During my time at the hospital I also came across the work of the local ‘Witch Doctors’, one example was ‘Uvulectomy’ as a treatment for cough. Seeing babies who had undergone this was obviously distressing and the Doctors did their best to educate patients on this; it was an aspect of medicine I really didn’t expect to see and seemed so ingrained in the culture that change was unlikely which was frustrating.
At the end of each day it was great to be able to return to the house and relax by the swimming pool. On Thursdays there was always a fantastic barbecue prepared by Reheema and Alpha gives a great Tanzanian dancing demonstration if you ask him nicely enough! Afterwards there are several bars within a couple of minutes walk of the house I would recommend, the area is very safe and we had no problems being out late at night.
Your weekends are free on elective and there is scope for trips to several places near Dar es Salaam. Firstly safari is a must when visiting Tanzania and Mikumi National Park is close enough for a weekend visit but we weren’t able to see any Leopards or Rhinos. If you want to make sure you see all of the big five a trip to Arusha might be the way to go as it’s nearer to the Serengeti and Ngorogoro crater.
One of my favourite day trips was one a group of us took to Bagamoyo, the old capital of Tanzania. After about an hour in a taxi organised by Alpha we arrived and were met by the self titled ‘Mr Universe’, who was to be our tour guide for the day. We started by visiting the bicycle rental stand to get our transport then we were off in a Mzungu convoy along the dirt tracks surrounding the town. We travelled to the 13th Century Kaole Mosque for a history lesson in the town’s role as a major port and the English and German occupation of the 19th and 20th Centuries before cycling up the beach to visit the first Christian church in East Africa. Our guide was very knowledgeable and it was a great experience and good exercise!
A weekend trip to the island of Zanzibar was one part of my elective I was most looking forward to; the ferry takes about an hour and a half and depending on the weather can either be plain sailing or vomit inducing, though it’s absolutely worth it when you arrive and find a tropical island with a completely different culture to the mainland. The port of Stone Town is a maze of narrow streets with a spice market and a night-time fish market, we were also lucky enough to watch a performance from the 90’s ‘icon’ Shaggy in the ‘Old Fort’ during the islands annual music festival. Many people head out to the beach resorts on the coast after arriving at stone town, you’ll have a great time there, the only thing to remember is that ATMs are scarce outside of stone town so bring all the money you need!
I had a fantastic time on my elective in Dar es Salaam, it combined the experience of studying medicine in a resource limited, developing country with the opportunity to go on safari and experience the beaches of Zanzibar, all of this with the guidance of people who know the area well and can help you get what you want out of your trip.