Mvumi Hospital, Tanzania
This placement was organised with the Church Missionary Society of Australia. Mission organisations are a great starting point, as they have links with many mission hospitals throughout the developing world, and have resources to help you prepare and debrief afterwards. However, you do need to be a Christian to go with them.
Mvumi Hospital is located in a rural area of central Tanzania. It is a general hospital which has to cope with the wide variety of medical and surgical presentations encountered in this area of East Africa. Delivering health care is limited by distance and the endemic poverty of the population. Common presentations include malaria, anaemia, meningitis, cholera, dysentery, tick-borne relapsing fever, severe malnutrition in children, and complications of HIV/AIDS. Helping to provide the pharmacy service during a 6 month period of voluntary work was a rewarding experience which could be highly recommended for pharmacists wishing to broaden their global perspective.
Scope of Work:
I helped manage the pharmacy, under the supervision of one of the doctors (as I was not registered as a pharmacist in Tanzania). The pharmacy dept had 4 staff and included a main store, a smaller dispensary and an infusion unit. Before I arrived, the hospital had been without a pharmacist or pharmacy technician for 18 months, so they were pleased to see me!
Being the sole pharmacist meant that I had to juggle all aspects of pharmacy work. I was part of the hospital management committee (and they kindly held their meeting mostly in English), involved in stock control, dispensing, counselling patients, developing guidelines and managing staff. Of these roles, stock control was probably the most frustrating and challenging - but not for the reasons I had imagined. All essential drugs, and many non-essential drugs, are available in Tanzania through a government controlled Medical Supplies Department. The drugs are also surprisingly inexpensive. My constant challenge, however, was to get money from the hospital administration to purchase more stock.
One of the highlights in Mvumi was to be involved in the project to introduce antiretroviral therapy (ART) to the hospital. HIV is having a devastating effect on sub-Saharan Africa, and Tanzania is no exception. The area surrounding Mvumi is particularly hard hit with about 25% of potential blood donors positive for HIV after one test. Prior to this program, no anti-HIV drugs had been available in the region.
It was a fantastic experience and a privilege to be involved in the planning of all aspects of the program - including medication adherence, education and drug supply. I wish I could have been there to see it come together at the beginning of 2005. The HIV care and treatment clinic is now operating at Mvumi hospital and is apparently going well.
The rewards of my time in Mvumi were numerous. From the first day I could see what a difference I could make to the hospital. The staff were very welcoming and were keen for me to stay longer - to the point of offering me inducements such as a salary, and if that didn't work, 'How about a husband?'. Being able to live in the village and be a part of the community was an amazing experience. I gained a much better understanding of Tanzanian culture that would not have been possible as a tourist. I was invited to weddings, confirmation parties and funerals. To feel a part of the village, to join in their celebrations and to see their joy, despite such poverty, is something that will stay with me forever.
The experience also stretched me professionally. I had no formal training to prepare me for working in a developing country. After specialising in drug information, I found myself having to manage all aspects of the pharmacy - stock control drug use evaluation, dispensing, manufacturing and sterile manufacturing, drug information, staff management and budget management.
There were of course hardships. The village was small and isolated, with no telephone facilities. The poverty was hard to come to terms with, especially the constant stream of people at my door asking for money. There were times without electricity, there was a constant threat of running out of water, bouts of loneliness, and first-hand experience of malaria early in my stay. Having said all that, it's still one of the best things I have done.
I encourage all pharmacists to consider doing something similar. Even though the more prominent aid agencies, such as Medicins Sans Frontiers and the International Red Cross, do not have many positions for pharmacists specifically, there is undoubtedly a need for us in the developing world. You would be amazed at just how valuable your skills are. Do it - it will change your world.