Medicine & Healthcare, Nursing in Tanzania by Lise Willis
I am a 51 year old registered nurse from Brisbane, Australia. Having always wanted to volunteer in Africa I realised I suddenly had a window of opportunity to come, and within 6 weeks I had departed - arriving in Arusha mid-January 2012.
I didn't know it, but the timing of my departure put me on a collision course with the wonderful Constanze (a German Midwife with 30 years experience). We couldn't have been more blessed and from day one we were united as a team, we worked, laughed, cried and sealed a lifelong friendship.
Communication was not easy at first as Constanze's English was minimal as having grown up in East Germany (her first languages being German and Russian). Somehow though, we understood and respected each other whole heartedly and the language barrier only added to our moments of hilarity. I thankfully had embarked on a 15 hour Kiswahili course, so I became the main communicator for us at our placement, although most of the nurses had some basic English.
The Tanzanian Medical Staff
I have the utmost respect and admiration for the wonderful staff at my placement. The conditions they endure including their very low wages and low resources are very difficult, yet they are ALWAYS cheerful, smiling and calm no matter what the situation. They always find a way to cope with anything thrown at them, then after a hard day’s work they travel long distances home where their work starts all over again at home. In singing their praises I extend the same to the Tanzanian Mumma's, who visit the health centre to have their mtoto's (babies) cared for.
These women attend antenatal clinics (3 times only during their pregnancy), outpatient’s clinic, family planning, 0-5 clinic (immunizations and counselling), HIV department (testing, services and counselling) and the laboratory (for malaria, HIV and Hep B screening). They often travel long distances whilst in labour to reach the hospital and then endure long labours without any pain relief. They then return home 6-12 hours after giving birth. They must also bring their own water, food, and birth supplies (gloves, sutures, syringe/needle, oxytocin, cotton wool) with them.
My Nursing Project in Tanzania
A typical day at the hospital (labour ward) was - arrive 8 am, ward round/handover, Dr's discussion with staff, cleaning/dusting the ward/delivery room, cleaning and wrapping the instruments for sterilising, bed making as the patients are discharged (the sheets and pillow cases were only changed if blood stained - as limited replacement sheets and some days there is no water for washing. There is no laundry and all the washing is done by hand in the patient's bathroom) - these duties all done in between deliveries. I also worked in the 0-5 clinic doing immunizations and documenting - some days you would weigh and immunize up to 300 babies/children.
I spent a few days in the antenatal clinic assisting the midwife with urinalysis, HIV/malaria testing, estimating gestational age and date of delivery, and administering malaria, worm and HIV (where indicated) medications. The hospital also performs tubal ligation's (each month), which are done under local anaesthetic. All the cleaning of instruments, drapes and linen is done in strong solutions of chlorine, this unfortunately is very harsh on the instruments and fabrics - and hence the rusted stiff instruments and the torn and rotting fabrics of the linen and drapes.
The health centre became my life for the next 2 months, totally consuming me. Soon after I arrived I realised how desperate the hospital was for many supplies, equipment, repairs to equipment and general maintenance. Constanze instantly got in touch with the German surgical companies that she is associated with, asking them for donations of instruments, gloves, syringes/needles - to mention a few. These arrived during our time at the hospital and were warmly received (donations like this can't be posted or you are heavily taxed). Constanze was lucky to have people she knew arriving in Arusha who were able to bring them for her.
When I first caught sight of the pillows on the beds I decided the only place for them was the incinerator. They were black with grime and without pillow cases, the sheets were stained, too short and badly stained too. So I emailed my friends at home, launching the Triple P Fundraiser (Purchase a Pillow and Pillow case). Two days later I had raised $3,700 which I knew would buy far more than 22 new pillows and 44 pillow cases.
With the remaining money I also purchased/mended : 2 manual suction machines (1 for the neonates,1 for gynaecological procedures), repair of oxygenation machine, new oxygen cylinder with carriage, new cabinet work and shelving in delivery room, 2 new timber table tops (1 for resuscitation trolley, 1 for sterilizing work table), repair broken bed, 2 solar lamps and charger, 20 stainless steel surgical instruments , indwelling catheters, iv cannulas, 30 new sheets (stamped with hospital initials), a large pot for boiling and sterilizing delivery instruments (power failures are daily), sugar, tea, powdered milk, coffee mugs, teaspoons, saucepan for milk/food, thermos, electric kettle, gas kettle, gas bottle for burner, cupboard for storage, cupboard to house gas burner and gas bottles, repair of labour ward and delivery room sinks, 2 notice boards, and new stainless steel clothes line. These were all so warmly received by the staff and patients. There are still many things that they are desperate for and the most fruitful way to do this is whilst you are here. If you send things in the post they are heavily taxed, if you send cash then you never know if or what it gets used for.
My time at the health centre was professionally and personally fulfilling and rewarding and at times very challenging. Once you adapt to the wonderful ‘easy come, easy go’ ways of the Tanzanian people/staff and begin to beat to the sound of their drum and clear your mind of all the set ways/routines engrained into your heads then you also realise that it is a far nicer working environment to be part of.
Important things to remember:
- Don't come thinking you can change their ways or that your ways are better because their ways are best for the environment here. They are happy to share with you and love to learn from you.
- Bring your sense of humour with you.
- Wipe the words "there is nothing to do", or "I'm bored" from your vocabulary.
- Be prepared to work (if you sit waiting for someone to tell you what to do then you will still be sitting there 5 hours later)
- Show initiative.
- Learn the staff's names (they love this and you will quickly be accepted as a friend).
- Be patient, put your body clock on Tanzanian time - you will enjoy your time far more and be a lot happier for it.
- Learn Kiswahili (Projects Abroad offer lessons - which I did) or carry a little note book and pen with you and write down the Swahili words that you will use in your work. The nurses love to teach you.
- Take your malaria pills (contrary to what anyone tells you, there is malaria in Arusha) If you do evening or night shifts the mozzies are out in force on the ward.
I leave tomorrow to return home to my family in Brisbane, Australia. I will be very sad to leave and have truly loved my 2 months nursing here. I have loved so many things about this beautiful country. During my time here I also visited Zanzibar and went on Safari (best safari company ever - Green and Gold Safaris with Daniel Shamba - the office has his details), Lake Manyara, Tarangire National Park and Arusha National Park. I also contacted the local hiking group and did a glorious walk.
I will miss, smiling faces, my milky morning chai marsala, dinners of ugali, wali, mcicha, marge, mboga, chapatti. I’ll also miss feasting on all the glorious fruits, exploring the markets, searching for the perfect Khanga, the glorious landscape and the happy go lucky nature of the wonderful Tanzanian people.
I can't say that I will miss the dirt, dust, mud when it rains or hand washing my clothes, but hey, if that is all I won’t miss then you can guarantee that you too are going to have a wonderful time.
Thank you to all the staff at Projects Abroad here in Arusha. They were always warm, friendly, welcoming and helpful.
Kwaheri Nitakuja Tena (Goodbye I will come back).