Queen's University Belfast 2012

Medical, Tanzania Dar es Salaam

I have always wanted to spend a summer in Africa but it’s a big place and I didn’t want to go alone, so me and two rafikis (friends in Swahili!) decided to go with Work the World. I think it was the best decision we could have made, they were amazing!

As soon as we booked, we were directed to our own personalised webpage where we could organise our clinical attachments and were given reminders of what preparations we needed to complete by certain dates, such as travel vaccines etc. They were so organised, ready to help with any problems and very accommodating to ensure we were able to do everything we wanted. I spent 6 weeks in Dar es Salaam, Tanzania on my medical elective, with three weeks in Paediatrics and two weeks in Obstetrics and Gynaecology. I also spent one week on a rural healthcare placement. I felt extremely welcome and safe throughout my 6 weeks, and would highly recommend future students doing their elective there.

We were sent off on a long journey from Northern Ireland in our Work the World tee-shirts, with all the possible information we could have needed, including advice on what to do about visas etc at the airport. After a very long delay in Nairobi, and without our bags, we were met in the airport by a friendly face in a matching Work the World tee-shirt! Mark, a co-ordinator, was there to welcome us and take us to our home for the next 6 weeks. He orientated us around the house and the local area, then introduced us to Alpha the other co-ordinator, Edito the security guard and Rehema who cooked for us. We immediately felt at home. There can be up to 32 students in the house, so there was a lot of fun to be had! We didn’t even really mind that we had no bags, but Mark and Alpha were very helpful and managed to get them for us after only one day!

On the Monday morning, Mark and Alpha walked us to the Dala Dala stop and talked us through what we should do every day to get to hospital. Alpha takes students to the tertiary referral hospital and Mark takes the others to the district hospital.

The journey to hospital everyday never disappointed - so much fun! It was a local bus that was full to the brim with people and you had to squeeze on like the rest of the locals - it was a great place to practise your Swahili!

When we got to hospital, Mark showed us around and introduced us to the supervisors. The next day, Mark went with us again to make sure we knew what we were doing and that we were comfortable, then we ventured out ourselves from then on! I felt completely safe the whole time, just like one of the locals! 

I started placement in Paediatrics, which involved daily ward rounds, once weekly general paediatric clinics and visiting the neonatal unit. The doctors all spoke English and were very welcoming. They encouraged us to get involved, asking us questions, examining the children and practising history taking in Swahili! We learnt a lot about the common local diseases such as malaria, but also general paediatric skills applicable to all settings such as emergency care of a sick child. They are very knowledgeable and great at working with the limited resources. I loved the three weeks I spent in Paediatrics.

Our obs and gynae placement involved ward rounds in Postnatal, Labour and Gynae wards, obstetric examinations, general clinics, assisting in gynae theatre and the best bit… delivering babies!  Again the doctors spoke very good English and welcomed us to the unit, encouraging us to get involved. I spent a lot of time in the labour ward and was with the midwives who were willing to help us deliver babies and examine at different stages of labour. Their patient management is very different to home, with the most striking difference being the lack of pain relief! The obstetrics unit test all their patients for HIV on admission, so we were able to check before trying any procedures. I was nervous about HIV exposure risk and although some patients had it, we were aware of who they were and measures were taken such as double-gloving or avoiding high risk procedures. We also had a HIV PEP available to us if needed. The majority of patients spoke the local language of Kiswahili and although Work the World gave us Kiswahili lessons every week, there was an obvious language barrier. However the patients and doctors were very impressed when we made an effort to introduce ourselves in Swahili and I believe this is why they welcomed us and included us as part of the team. The local people also seemed very pleased when we made an effort to speak their language and very quickly, we were able to hold a brief conversation!

We chose to do the Village Healthcare Experience between placements, which I think helped break up placement in the hospital. We went to the village for one week and by the end, I didn’t want to leave! We had a guide called Elias who showed us to the hospital and around the village, introducing us to the villagers and showing us local culture. We stayed with his parents and his sister cooked traditional african food for us each day. They all made us feel so welcome, just like part of the family. The house had no electricity or running water so I was nervous beforehand, but it was so great to see how simple life can be and everyone was so happy! I really enjoyed my stay and learned a lot! Every morning we walked to the hospital and did a ward round of the entire place, although there were only about 15 inpatients! This was followed by a very busy outpatients’ clinic where we got very good at taking blood pressure and examining patients. We also got to observe a few deliveries and assisted with some minor procedures. Every day when we returned from hospital we were greeted by an ever expanding group of local children! We played games with them, taught them some songs and some very basic English! Elias organised activities each evening, including a visit to the local primary and secondary schools where we were treated like royalty! They showed us around their classrooms, sang us a song and showed us the games they play! We also cycled to the Maasai village where they dressed us in traditional clothes, showed us around and let us milk cows! We then spent an afternoon with a natural healer; their medical techniques were very different to ours! I absolutely loved the village experience and would highly recommend including it as part of your elective.

Before going out, we fundraised with SWOT, a medical student organisation at our university. The hospital were very grateful for the medical supplies that we donated. We were able to send supplies to both the district hospital and the Village and I would recommend trying to do this if possible.

Of course the main reason of an elective is the placement, but it’s also a great opportunity to learn about another culture and to relax before finals!

The village was great for this but there were lots of things to do in the evenings and weekends when we were in Dar. Mark and Alpha were great for advice on what to do, where to go and helped us organise trips. It was cheap and easy to get about using the local Dala Dala or Bajaj, which were fun activities let alone where we were going! There were always taxis available as well for longer journeys. In the evenings there was plenty to do, including visiting the local markets, a local orphanage, working on a tan beside our private pool, going to the cinema and of course the famous Thursday night barbecues when Rehema cooked amazing food and we were taught how to dance African style by Alpha, Mark and Edito! Weekends were perfect for longer trips like visiting Zanzibar, private beaches and doing Safari, which are a must-see when in Tanzania! We went to the local church one Sunday and they were so friendly, we were invited to the pastor’s house where his wife cooked us dinner!

I would highly recommend going to Dar es Salaam with Work the World. They were so organised and helpful before, during and after the elective. They assisted with our visa and organised our work permit, airport transfer and orientation of the area and hospital. I felt so safe and comfortable and little things like how to use the local transport, getting local money, learning basic Swahili, 24 hour security, Rehema’s cooking and 24 -7 help from Alpha and Mark made the whole experience so much easier. I was particularly impressed that they could accommodate my gluten-free diet. It was amazing to get to know medical students from all over the world and compare our experiences, making lifelong friends after living with them for 6 weeks. It’s cliché but it really was a life changing experience and I would have loved to have had more time! Most people only get to do one elective, so make it special!

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