Just for your information, Tanzanite is a precious stone 1000 times rarer than diamond, but strangely sells for far less. Nevertheless, my experience in the Tanzanian hospital was a very rich one indeed. The hospital was in the outskirts of the city, meaning most patients were poor and came from the countryside. I spent about a week in each of the specialities: paediatrics, general medicine, surgery and obstetrics and gynaecology. Much to my surprise, the hospital itself was only filled to half capacity. On some days, the staff to patient ratio was close to 1:1!
In contrast to the UK, patients have to pay for all treatments – except for pregnant women and children under 5. Even though the cost is extremely cheap for our standards, it is difficult for the rural population to pay. The end result being that most patients presented very late in their disease process. Whilst bad for them, it results in fantastic clinical signs you can only experience in developing countries. One such case was a smooth tongue and tingling fingers – an easy diagnosis of Vitamin B12 deficiency, if you know it. In the UK, the commonest cause would be a vegan or vegetarian diet. Yet, his food intake was sufficient, suggesting pernicious anaemia, an autoimmune disease.
In addition, the culture was beautiful. People are friendly, kind and full of joy. Yet some practices are obstacles to precise clinical investigations. Patient behaviour could be a field of study in itself. For one, it was a known phenomenon amongst the staff that there were fewer patients on rainy days. Sadly, patient illness behaviour often resulted in visiting the local witch doctor first. One patient needed emergency surgery which left her with a scar from xiphisternum to pubis all because of the witch doctor’s ‘treatment’. Apart from transport logistics, language is a huge barrier. Over 120 languages are spoken in Tanzania, and many cannot speak the national language; Kiswahili. The food has inspiration from all of the world. The famous ‘chapatti’ is of Indian origin.
The following case highlights a problem that may be due to the work ethic, or perhaps the cultural behaviour, or both. An elderly woman presented with pain in her arm after trauma. A Junior doctor zoomed to a spot on the patients arm on the X-ray and reported a small fracture. The consultant agreed. I agreed. However, as was taught in Edinburgh, we should try to ignore the obvious and go through an X-ray systematically. So, I asked whether I could see the whole X-ray, and I noticed she had dislocated her shoulder! The Junior Doctor disputed my claim, saying the patient only pointed to the fracture site. After a couple minutes’ building my confidence in my diagnosis, I told the Consultant what I thought. He was thankful, because this was an emergency in need of immediate attention. Interestingly, only now did the doctors remove her large scarf revealing a grossly deformed shoulder.
All in all, this was a precious experience.
Practicing using the ultrasound machine.
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