Tuesday, 30 September 2014

Doctors and Hospitals in Dar

Many people have asked us if we have good medical care where we are in Tanzania.  

I shall start by explaining what it is like for the Ex-Pat, the Mzungu, living in Tanzania.
Well, we are amongst the ‘fortunate’ who live in Dar so we are able to get to a western type hospital if necessary, if you need to see a Doctor here there is no separate Doctor’s surgery – you have to face the hour or so drive into town to go to the ‘hospital’. MAF personnel in Dar es Salaam tend to go to IST – (The International School of Tanganika) which has a hospital (doctors surgery with a couple of beds in case they need to keep anyone in overnight) built on the outer school wall – not far to go if you are at school here and need the nurse!! . This hospital has doctors from all over Europe and India as well as national staff, is well stocked with medicines, has  a pathology dept (essential when dealing with malaria) and looks generally quite Western – although you soon realise that they are actually dealing with much less equipment and less up-to-date facilities than a doctor’s surgery or A&E Dept back in the UK  would have. 

Firstly let me say that we have been very healthy since being here. Jack had an amoeba which needed a trip to the hospital/doctor, blood test and strong medicine to kill the little blighters in his stomach  and Robyn was accidentally bitten (a scratch which broke the skin) so we had to take her to get the final 2 rabies shots (we were so thankful we had all had our Rabies vaccinations in the UK before coming out, this meant she only needed 2 shots instead of 5 and we were able to wait until morning to take her rather than rush her in during the peak traffic nightmare time).  We are still waiting for Harry to get really sick. With him he kinda just self destructs - scrapes, cuts etc but on a fairly huge and dramatic scale!!

Because of the traffic you have to be really  sick to warrant being taken into town to the hospital, and I mean Really Sick! Most of the time you just self medicate.  Our kids will tell you that if they get sick; stomach problems mean starving and drinking coke, head colds etc mean no sympathy just take a couple of paracetamol and some tissues and get on with it, fever needs to be brought down and stabilised as quickly as possible by whatever means, and the best cure (I’ve found) for suspected malaria in our 3 is to show them the self-test kit needle. 
Joking aside sickness in children is a really worry for parents, especially in the young as they are still eating dirt etc and just seem less able to fight stuff off. Children go downhill fast here as they dehydrate so quickly and therein lies the danger.

You can buy almost anything over the counter here that would need a prescription for back in the UK (the same goes for veterinary medicine too which is quite useful!). The pharmacists are great; most medicines including antibiotics can be bought at any local pharmacy without the need for a prescription, just say what you need and how many we are also blessed with many nurses and the odd Doctor in the Missionary community.

So this is Dar – we still have our worries, and children (or indeed adults), often get sick and may even need medivac-ing out to Niarobi, Kenya or South Africa. But at least we do have that option and a reasonable level of medical care that can help or move you out fast to somewhere that can.

 We have learnt the valuable lesson of just trusting God and praying every day for His protection and healing hands on our lives. You can never underestimate the power of prayer and having to totally rely on God as you just haven’t got the resources often to do things on your own.

Those that live in villages are not so fortunate. They have to trust on what is available to them, friends or people they may have living and serving in their community or face the trip to Dar which could mean at the very least a day’s travel by road.

But at least there is help if you can get there.

Hospitals in Dar for nationals are very different from those that the Ex-Pat community and wealthy Tanzanians use. When one of our guards, Robert, was very sick and taken to hospital it was 2 days before there was any information as to what it might be.

I went to visit him with our 2 other guards. I took some fruit – no food is provided for the patient that is the responsibility of the family, as is the day to day care – there are no nursing staff to do this. A nurse is there to hand out medicine and keep records up to date, she may also change a bandage or other dressing but other than that care is the responsibility of the family.

On entering the hospital - which I mistook initially for a local house as it was so small, run down and very dirty – I found Roberts wife lying down on a bench outside his room trying to get some sleep. She immediately got up upon seeing us arrive and showed us into his room.

My first thoughts were “This cannot be a hospital”. The room was small, only just big enough for a single bed, a wooden bench seat and a cupboard full of junk where patient records were also kept. The paint on the walls was peeling and there were several indentations were they had been knocked and they had begun to crumble. There was dust from brickwork and the eroding concrete floor everywhere. The old metal hospital bed had a plastic coated mattress, no sheet, and a plastic hard cube for a pillow. The sun was beating down through the window that had no curtains to provide protection from its rays so the searing heat made the plastic bed unbearable. The window had the usual bars but the mosquito screen was torn in several places so unless the mosquitoes were larger than a small person they had an open door to enter. The net above the bed was so dirty and torn that again it afforded little protection.

Whilst we were there I learned Robert had a very bad case of Malaria – whether this was contracted in hospital or before we don’t know. 

No information is given to the patient about their condition, treatment or future prevention. Knowledge is power, if the patient learns too much he will have the power and not the doctor.
This is one of the major problems with sickness and disease here in Tanzania. People do not even know basic hygiene skills. The thought that living amongst so much rubbish could make you sick comes as somewhat of a surprise. Washing your hands frequently with soap as a preventative measure is news that many have never heard.

Our workers think I have great medical knowledge because if they have a burn I tell them to use Aloe Vera; a headache means a couple of paracetamol, wear a hat and drink both the bottles of water I am giving you! I clean and dress the kid’s cuts and scrapes, give them coke for an upset stomach and monitor their temperature rather than rush them to a hospital every time they get sick in case of Malaria. I am aware I can panic less because my very basic knowledge allows me that comfort. We are much more aware of how to prevent getting bitten by mosquitoes and have protected ourselves accordingly, many Tanzanians don’t have this luxury as roofs, even the one on the hospital, do not meet the walls so there is a gap of at least a foot between wall ending and roof overhang. There is often no ceiling as such just wooden joists to support the metal roof.

I digress from hospitals to building regulations but hopefully you get the picture. On the surface there is healthcare in Tanzania, if you live in a city, are wealthy or work somewhere that pays your medical bills. There is no free healthcare. No NHS to care for the young, elderly or vulnerable.
On a final note there is also disparity between available medicines. If you can afford them there are UK, European and US medication or for a cheaper alternative (let’s say for your worker), medication from India or other more dubious places where it is copied with less controlled care.

Getting sick in Tanzania is a bit like playing Russian Roulette : but if you are wealthy you own the wheel!

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