Asante Sana Tazania

Half-term holiday. What an excellent invention. If you’re asking, like me, what exactly I have done to deserve this having spent 6 weeks sitting back receiving world-class teaching, living in a fantastic city with a view of Kilimanjaro out of the window and going on obligatory nights out, safaris and trips in order to complete my ‘hidden curriculum’ – the answer is not much. But I’m not complaining. As here I am on Zanzibar with the very difficult decision of whether to spend the day on the picture postcard white sands of Paje beach, swimming in the bath-warm crystal clear water, or taking a wooden Dhowe trip to snorkel round the corals. It does feel a little wrong.

So has this joker ‘diploma’ crew achieved anything in 6 weeks? Well, apart from making a thorough assessment of most of the restaurants, cafes, music and dancing venues in Moshi, we have definitely learnt a good bit of tropical medicine and done a fair amount of grappling with issues of access to healthcare in resource-limited settings such as Tanzania. This is a constant underlying theme of every module. Inevitable really when studying together - Tanzanian doctor, whose national health expenditure is around 2.4% that of the UK doctor’s they’re sitting next to.

It makes for some interesting discussion on the gold standard management of stroke when a head scan is unlikely to be an option, or for the treatment of malaria when first-line medicines are just not available. Inevitably we have to come up with 2 solutions to every problem: this is what we would like to do (and what would probably happen in the ‘West’), and this is what’s ‘appropriate’ for a ‘developing’ country like yours. It does not feel comfortable. But it is, sadly, real life.

And then there is the other dichotomy of experience between African and Western doctors. A definite highlight so far was when half way through an interview about access to healthcare in mountain villages the group realized the lady was actually in labour! One of the Tanzanian doctors, without any fuss, monitoring, sterilization or equipment calmly delivered the baby and carried on the interview. The ‘Western’ doctors looked on in wonder.

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I will really miss Moshi. Tanzania is a truly beautiful country. The people I met, despite their militant insistence that I speak Swahili at all times, were incredibly friendly. They took time to show us the best priced tailors, crossed the road to tell us to be careful with our bags (ok – so not everyone is friendly) and threw us an amazing party when we left to say thank you for our custom! I will miss the warm but breezy climate, my (downhill) run home from hospital along Jackaranda lined roads with the mountain overseeing, and the flamboyant wedding parades complete with roaming brass bands around town every Thursday, Friday and Saturday. It is a quirky town, well worth a visit, and was an excellent place to settle in to the diploma. Somehow I think the capital cities of Nairobi and Kampala will have some very different quirks on offer… I’ll let you known how that goes.

An extremely serious situation in the Serengeti

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Tropical Medicine is amazing. Two weeks into my diploma I find myself on Safari in the Serengeti with 6 men! Our learning objectives: to have an adventure (oh and complete a project on rural healthcare, but that will come later). A large emphasis of this course is on the ‘hidden curriculum’ of sharing life, academic interests, medical experiences and beer with our African colleagues. There are 20 doctors from East Africa on the course and 39 ‘Westerners’, and so far we have been blown away. While the ‘wazungos’ tend to gabble away analyzing this and that, fumbling over new terms and concepts, boasting about their ‘near miss’ clinical cases and NHS disasters, the East Africans tend to sit back, nod wisely and speak softly, silencing us with nuggets of profound wisdom. Some of the most interesting discussions have been over clinical case reports that we have all been asked to ‘bring and share’. A Ugandan microbiologist was asked what he would do with a case of internal bleeding that the NHS with its defensive and under-experienced docs, and over-advanced scanners had spectacularly missed. ‘Well actually I had a very similar case,’ he says nodding wisely and we lean in to hear what happened ‘I was the only doctor in the town and we had no scanners… so I opened him up’. Wide-mouthed we look at each other to check he must be joking because a microbiologist providing life-saving surgery would never be heard of in any of our ‘resource-rich’ countries.

I was a little concerned about how well the cultural exchange would go on safari, when our Tanzanian colleague started reeling off ways we should avoid meeting any dangerous predators whilst in the park. He was well kitted out for the experience with black shined shoes and brief-case and liked to tell us at regular intervals of the various ways that we might not survive the trip and what are chances of escaping alive were likely to be. I wondered how he’d react when he realized we were actually going with the sole purpose of seeing dangerous animals and so asked him what he thought of the situation as we were sitting watching some lions lolling about a few metres from our open-topped car. ‘Well’ he said, shaking his head, and with a glint of fun in his eyes ‘this is extremely serious, we are unlikely to make it out alive’.