My time in Tarime as a Medical Doctor by Jane James
Where to start?
Back in Launceston Emergency department, in March 2010 after I broke my leg sliding down Mt Ossa On the overland track? This was after I’d walked 7 hours on it, to arrive at the hut in the dark at 11o’clock at night. I had been reluctantly helicoptered out next morning and taken to The Launceston General Hospital There this amazing nurse rescued me from the sidelines, and as we chatted whilst my plaster dried, she asked me if I’d be interested in going to Tanzania?
How I gulped, remembering all my idealistic plans to work in the third world one day, even doing a Diploma in Tropical Medicine in 1974 to prepare, but then chickening out of going to Africa because it was too hot and had such nasty diseases, and microbes and insects- never mind the ‘lions and tigers and bears’. I dabbled in India for 6 months with Tibetan refugees living in the Himalayas, nice climate, lovely people. Then I got immersed in small town rural general practice in Western Australia (Denmark) for 35 years, raised a family, stayed in my comfort zone. Now here is Diana asking me to come to Tanzania. ‘Yes!’ I said. I went home, and told my husband David: ‘We’re going to Tanzania, dear’. Our son Sebastian said he’d come too.
I still can’t believe we really did it!! I tell you also. I could never have done it without Diana’s faith, enthusiasm, confidence and encouragement. So: I faced my demons, what would happen?
First of all when we arrived I somehow imagined that a day or two’s supervision and I would be expected to consult alone in Kiswahili, with patients with illnesses with which I had no experience. Thank heavens I had 2 wonderful medical assistants to hold my hand, and Dr Winani of course, who really did hold my hand, and they gave me the courage to step out into uncharted waters. Malaria was rife. I soon learnt the Kiswahili words for: What is your problem? Is it diarrhoea, headache, abdominal pain, fever, chest pain, and a new “symptom” general body weakness? All patients were sent off for malarial blood slides, urine and stool specimens, before further physical examination was done. The lab technicians were brilliant, processing 100s of specimens a day. Microscopy only, no culture or incubation. Syphilis, pregnancy and HIV testing kits were available and quick. Blood grouping and crossmatching could be done and Widal test for Typhoid, in an hour or so the patient was back with their results, examined if necessary, and sent off to the Pharmacy for treatment or admitted to the wards if very sick. Inpatients seemed to recover quickly in 1-2 days and go home or discharge themselves if they couldn’t afford treatment or weren’t going to get better. Ward Rounds in the morning were grand. About12 people would trail around the wards, Dr Winani, medical assistants, the wonderful tall head nurse Tatu, Lab techs, nurses, pharmacy staff, and clerical staff, crowding into each room as Dr Winani assessed each patient and marked them as improving ,or in need of surgery , or a change of treatment. Fortunately all hospital notes were in English, so by craning my neck I could generally see what was wrong with the patients from their notes as we went around, and Dr Winani would keep me informed .The nurses put up all the intravenous drips and arranged all the intravenous injections, fluids and blood transfusions.
In the afternoon Dr Winani would operate, in his major theatre. I watched one upper abdominal hernia repair, and was amazed to hear that one of the patients had her 2nd extrauterine pregnancy. ‘A bloody mess’ I gathered from Alicia, who was present at the surgery for her first operation 12/12 before. Extraordinary. There were many lunch time curettes for early miscarriage often due to malaria, and criminal abortions. The equipment from Australia had obviously made a huge impact on the hospital, a good transport trolley, proper Launceston Hospital beds, Theatre operating table, scales for babies, an ECG machine, good theatre instruments.
Dr Billie, also new on the scene, picked up her Swahili more quickly and went out to the communities with the nursing team, worming the children and seeing the sick children and adults. This was a bit chaotic at first but we got a good system going, and eventually were proceeding in a smooth and efficient manner. One day at Sonbamyasoko, we wormed 490 children, medically examined 94 sick ones: those we couldn’t treat on the spot, (33), came into the hospital for lab tests and treatment. 30 had malarial parasites on their blood films, 8 had typhoid on their Widal testing, and stool examination picked up 6 with Ascaris Lumbricoides worms, and 3 with hookworm .
What we need to do in the future, is roll out regular worming clinics and check all the children, including the 0-5s and also the adults in each community. It’s all a pointless drop in the ocean, one might say, but for each child treated, it’s a miserable and potentially life threatening illness thwarted.
For us volunteers it was an invaluable experience. We became very close to our African helpers and our patients, at times becoming part of their families, and feeling very loved and accepted by them. They are amazingly resilient, cheerful, hospitable people and we can learn so much from them. I feel very privileged to have been/ to be, part of Care for Africa and overwhelmed by the generosity of the people of Launceston for making the lives of these very worthy people , better.