Tanzanian Health care Perspective
Urban ER
This week I thought I would tell about what we are seeing related to Health care as that is what this program is about and why I am here. We are learning about the Tanzanian system of health care we will work in as well as words and phrases regarding health and illness in Swahili. The past few week we have been exposed to many diverse health care providers and facilities.
Ministry of Health and Nursing Council:
Medical, nursing, and midwife education in Tanzania is overseen by the Ministry of Health, the Ministry of Education and the Nursing Council. We had to get medical and nursing licenses in Tanzania as well as a work permit. This has taken awhile thus why our orientation is longer while we wait. We just received word that we have our nursing license but not yet the work permit. Tanzanian hospitals and providers are primarily government workers though some have private practices as well and there are private hospitals.
Hospitals:
We have had the opportunity to visit 2 urban hospitals (one in Dar es Salaam and one in Dodoma), a rural health center which also had a small hospital and then a non-traditional doctor and midwife all which were very different. In Tanzania there are 241 hospitals, 742 Health centers and 5,680 Dispensaries.
Urban Hospitals:
We did not go inside the first urban hospital in Dar but toured the outside. There was an ER, and a Rotary Pediatric Cancer building. At the second urban hospital we saw units for those who paid for care themselves and another with a new building that was for those with insurance and were able to go inside and see some of the rooms. In both there were men and women’s wards, and the surgical room. Though we did not take pictures of patients one patient took a picture of us:)
Village Community Health Center and Providers:
We visited a rural village about an hour outside a big city where a regular peace corps volunteer (2 year commitment) who had been a career marine was working. He was an older volunteer and had left his wife in Maine and lived in an isolated village where was not access to stores or other volunteers unless he came to town. He gave us a tour of the rural health center and primary school where he worked and did projects. At the clinic he helped weigh and measure babies who came in for checkup. We had an introduction of the village officials and introduced ourselves in Swahili. At the rural health clinic they had a small but organized and clean small hospital where they delivered babies, had a men’s and woman’s ward and an outpatient clinic where saw pregnant and postpartum mothers and their children. They had a food program for the mothers and children with those very small babies getting more food primarily a porridge type food for the mom and baby when older. They had an outdoor kitchen area where families and mothers in labor could cook their food when waiting. There was one room for TB and Leprosy patients separate from the other wards. They also had a lab for HIV and malaria testing and even though they had the knowledge and equipment could not do some other tests as they did not have the reactive agents to do some tests. The required reportable diseases posted were: malnutrition, children’s diarrhea and pneumonia, animal bites, Tick born fever, typhoid, Trachoma (eye infection), Onchocerciasis (river blindness caused by parasites from black fly) trpanosomliasis (sleeping sickness caused by the tsetse fly). Animal bites is the only one of these on the U.S. list of reportable diseases.
If we compared these facilities to the U.S. there are definite differences. There are mosquito nets over the beds for use at night. We saw hard copy charting in the hospitals and learned that these files can be lost if the patient moves or goes to a larger hospital. Though some staff spoke fluent English, at one hospital there were few staff who could give us the tour in English so our translators interpreted during the tour. This gave me more motivation to work on Swahili in my spare time even though that is going very slowly. Going to the rural health clinic gave perspective on “access” to care in rural areas. Some services that were offered at the rural community health center would be similar to U.S. Public Health Departments and rural hospitals combined though not really a comparison. It is apparent how the lack of physical and human resources limit care that can be given.
Health Care Providers:
One of the reasons the Global Health Service Partnership program existence is to develop through the educational system the capacity of human resources for health for Tanzania of Doctors, Nurses and Midwives. At the village community health clinic and hospital they have clinical officers and assistant clinical officers (similar to physician assistants), nurse and lay midwives and midwives in training. Though varied, I read from various sources that the actual Tanzania Doctor per patient ratio is .02/1000 and the U.S. 2.3/1000. The country spends $40,000–60,000 to train one doctor but then 4/10 of these stop practicing or leave to practice in better paying countries (mostly North America, Kenya, and Uganda). One retired Family Medicine Dr. in our group will work the year training clinical officers. Three in our group will train nurse midwife students. Five other doctors and one surgeon in our group will work in medical education and six in nursing education.
Mganga =traditional medicine or witch doctor (a term ok to use in Tanzania to use)
We rode on a bus for about an hour out into a very rural area on somewhat of a dusty bumpy road to get to the Mganga’s village area and home. He spent an hour or two explaining his practice and answering our questions. He learned the trade from his father and will pass it on to his grandsons. It is not something he learned from books but from others and his experiences. There was mention of some research being done on his methods. He had 3 wives who seemed to co-exist happily and had a lot of children and grandchildren living near. They were very friendly and welcoming to us. He said some patients come from very far away as they have heard of his reputation. In terms of cost, some he does not charge but if he is successful in the conception of a baby that is worth a cow. He showed us his medicine (see the pictures) and explained how he mixes them from plants and bark from the area as well as from other areas of the country. He was very open that he refers patients who do not respond to his treatment to traditional medical doctors. One of his wives took us on a tour of their home which was interesting to see how they stored grains they had harvested and where they prepared food.
We then visited a lay midwife in another rural area who has practiced since the 70s and said she was 98 years old and had delivered 2 babies earlier that morning. She sees woman during their pregnancy and delivers in her 2 room clinic area. Her granddaughter is interested in nursing and she hopes will take over her practice. She also refers complicated deliveries to the traditional medical system. We were welcomed into her village by some older woman beating drums and many very cute and friendly preschool children who came to greet us.
Both places it seemed the entire community wanted to observe our visits in the rural areas. All were so friendly and proud of their homes, families and practices and willing to share with us so that we have a better understanding of their health care system so that we can better serve.
This weekend we have a short home stay with a Tanzanian family both for culture and language training. So I met my host family last Saturday. They are about my age, retired but have a farm near town and the husband had a career in agricultural business with the Tanzanian agriculture extension office. So again my past life experiences will give me conversation starters. Stay tune for next week’s blog.
Disclaimer: This is a personal weblog. The thoughts and opinions here are those of Jennie Van Schyndel. The information does not in any way represent or reflect the opinions of the Peace Corps or Global Seed Health.
