Kilimatinde Hospital, Manyoni, Tanzania
Kilimatinde Hospital, Kilimatinde, Manyoni, Tanzania
Kilimatinde hospital is an approximately 80 bed hospital run by the Anglican church on the edge of the Rift Valley in central Tanzania, about 5 hours west of the capital Dodma by truck. It is a village of approximately 500 people that has had a traditional role in the region of providing services largely backed up by the Anglican church (Diocese of the Rift Valley) It has a hospital, 2 schools and a church. It is a very resource poor hospital with the government removing many funds from the hospital 10-15 years ago and it has slowly getting back on its feet since then. It still services a large local community and relies on foreign aid and government funding to survive. It has male, female, paediatric, TB and obstetric wards. Power is via a generator for 3 hours a day in the evening and can also be turned on outside of these hours if an operation needs to be done. Water is pumped from an underground source to tanks and has to be boiled for drinking. There is a lab tech who performs limited services, there is a no x-ray facilities and a pharmacy with a reasonable supply of government and overseas medications. There is a theatre mainly for doing caesareans and other minor surgery.
Tanzania is sub-Saharan country in East Africa and includes the large island of Zanzibar of the east coast (independent from the mainland until 1964). It has a population of 38 million and a life expectancy of 45 years and the economy relies predominantly on agriculture. The local community is a subsistence one relying on a brief wet season and subsequent harvest to provide food for the following year. The Rift Valley, which runs from Lebanon to Southern Africa, runs right past the hospital and this area of Central Tanzania has distinct wet and dry seasons which transform the area from arid to lush green.
The full gamut of patients are encountered from obstetric, paediatric and adult. The most common conditions are malaria and relapsing fever (tick borne spirochaete). Rates of HIV are not as high as urban areas but still constitute a proportion of the patients. Also TB, pneumonia (especially children), schistosomiasis, meningitis, anaemia, malnutrition, skin and soft tissue infections, trauma, typhoid to name but a few. There are many obstetric emergencies such as pre eclampsia / eclampsia, obstructed labour, prolapsed cord etc. and these are predominantly managed by caesarean section. Major surgeries are sometimes attempted and there are many minor surgical procedures. There were many bad outcomes but in the same breath there were far more amazing outcomes of ten in children or young adults that you would not have thought possible but for some simple diagnosis and treatment. The patients were incredibly grateful as were the staff for your time
Main responsibilities involved doing ward rounds of particular wards or potentially all of them if there was a lack of medical staff. Outpatients was handled by medical assistants and you would see the patients once they were admitted. Other time was taken up with operations, complicated deliveries, emergency patients.
Every day would start at 8:30 where all medical staff would meet and handover any problems from the previous night, discuss new deliveries, talk about good or bad outcomes in specific patients. Break in the middle of the day for about an hour and the afternoon would be spent completing rounds or dealing with complex patients. There was no official on call system but there were many cases of working back after hours normally sick children or obstetric cases.
Medical training in Australia was sufficient for me to work in Tanzania and medical certification / visa for me to work was organised by the hospital once I had arrived.
I was one of 4 doctors and the only non-Tanzanian person working at the hospital. One of the doctors ran the hospital and was less involved in the clinical side, one of the doctors did the bulk of the clinical work and the third doctor was new and was building up her clinical experience. While I was there the administrative doctor took some leave (first time in many years) and I helped lighten the load on the other doctors. There were 2 medical assistants who ran outpatients and at any one time 8-10 nurses on the wards. 1-2 nurses / ward (up to 20-30 patients) whose main role was to give out the medications. I was encouraged to do all elements of work and in fact was doing caesareans within a few weeks (assisted and later on my own)
Official languages of the country are Swahili (language of East Africa) and English. Despite all the medical staff having been originally trained in English some of the nurses had very poor English. Therefore I learnt Swahili (especially medical phrases) pretty quickly. This was OK as the alphabet is the same as English and the language is a very logical one structured around key verbs. Simple formulas could be followed to create sentences that weren't necessarily perfectly correct but you could easily be understood. It was a very fun language and the connection with the patients and staff was very rewarding
Kilimatinde is a small village with a small local shop with rice, oil, beans, batteries, soda (an institution for the men was to sit around and drink coke or fanta, much better than alcohol for the rest of the community). That said I didn't buy any food or cook as I employed someone to do all this for me. I paid her what she thought was a vast amount and I thought not and I never had to worry about food or meals and I ate fantastic home cooked food. I provided employment and I couldn't have done the cooking and worked at the same time as cooking on the small stoves or fires takes far too long and it is totally different from anything I knew.
Locally the main highlight was viewing the Rift Valley and the occasional fauna that wandered through. 6-8 hours drive north are probably some of the best parks in the world, namely Ngorongoro reserve and the Serengeti. Along the way are numerous other parks where you can see the 'big five'. Just north of these are other famous parks such as Masai Mara in Kenya. Also on the coast is Dar Es Salaam, one of the nicest capital cities in a developing country I've ever seen and then the boat trip across to Zanzibar with all it's great beaches and history. I did my travelling predominantly at the end in one hit as Tanzania is not really set up for rapid cross country transit
My placement was for 3 months which I organised myself by writing letters to the hospital in a period leading up to my time there. They were flexible about the duration of my stay as I was a volunteer.
Dr Edwin Kiula or 'the Doctor'