Throughout his time at St Augustine's Hospital, located in the Muheza district of Tanzania, Jumpei encountered various healthcare challenges. Despite the difficulties, he describes his elective experience as profoundly insightful and life altering.
Touching down in Dar es Salaam, Tanzania's largest city, I was immediately enveloped in its humid, dusty air and the constant hum of urban life. The air buzzed with Swahili greetings from the friendly locals, marking the beginning of an exhilarating adventure.
The journey to Muheza was an eight-hour bus ride from Dar es Salaam. The trip offered a glimpse into the lives of rural Tanzanian people, with views of beautiful tropical terrains and vast sisal plantations unfolding along the way.
Muheza, a rural town in northeastern Tanzania, is situated along the road leading from Dar es Salaam to the northern coastal city of Tanga. It's a town with vibrant local populations from diverse tribal backgrounds. As 'Muheza' translates to 'valley people' in the local tribal language, the town was encircled by towering mountains, and a blend of occasional mountain breezes and a persistently trapped humid atmosphere.
The mornings at St Augustine’s Hospital began at 8am with morning handover meetings, discussing overnight admissions with the on-call doctors. Despite its location in a rural town, the hospital serves as the primary healthcare centre for over 300,000 residents, covering an extensive area. With no primary healthcare system like Australia's GP practices, the hospital is constantly bustling with new admissions. Patients from across the district, unable to resolve their health issues at local pharmacies, travel all the way and seek care at the hospital. The hospital, composed of multiple single-storey buildings, houses a variety of departments including medical, surgical, obstetrics/gynaecology, paediatrics, radiology, intensive care, palliative care and HIV care. Open windows and long verandas welcome the shade and breeze, where patients waiting to be seen often sit on the grass and gather, creating a sense of community.
During my elective, I shadowed and assisted doctors and clinical officers across various departments. This experience, combined with insightful discussions with healthcare professionals, has yielded three pivotal learning points: 1. Healthcare mistrust, 2. Resource scarcity, and 3. The unique sociocultural characteristics of the people in Muheza. These aspects collectively contribute to a more profound understanding of the intricate challenges involved in delivering medical care in Muheza, Tanzania, and similar contexts worldwide.
In the Tanga region, traditional medicine is prevalent, often preferred by a significant portion of the population over Western medicine. This cultural preference sometimes results in patients seeking hospital care reluctantly as a last resort, and being non-compliant with medical advice post-discharge.
One morning, I was introduced to a patient whose journey embodied this struggle. He was an elderly man with a weathered face and eyes.
He expressed a consistent reliance on traditional medicine, having never sought treatment at the hospital. It was only at the urging of his friends and colleagues that he reluctantly agreed to visit the hospital. He had diabetes, a condition new to his understanding, and he came to our hospital only as a last resort. He was talking about how traditional medicine has been healing most of his physical and mental health issues. However, his faith in herbal remedies wavered after they failed to ease his suffering from diabetes. As we examined his condition, I couldn't help but notice the severe late-stage manifestation of his diabetes: a severely ulcerated diabetic foot. He was severely fatigued and cachectic, and his vision was significantly compromised. It was a sobering illustration of the consequences of the division between Western medicine and traditional medicine. The doctors mentioned how they feel helpless about the situation. Despite their continuous effort of bridging the gap between the two, a more systemic effort is required. The encounter with this patient was more than a medical challenge; it was a cultural dialogue.
The hospital's efforts to integrate traditional medicine and learn from indigenous wisdom provided a valuable perspective. It underscored the importance of cultural sensitivity in healthcare, a lesson equally applicable in the diverse Australian healthcare landscape where indigenous knowledge often remains underappreciated.
The resource limitations of St Augustine’s Hospital became evident when compared to Australian healthcare settings, often making the clinical experience confronting and challenging.
One day, a middle-aged woman arrived, her face etched with the fatigue of a long journey and the anxiety of sudden, gripping chest pain. Her story was one of resilience and desperation, having travelled miles to seek care, sparing no expense from her little savings to consult with us. Her symptoms were alarmingly indicative of ischemic heart disease, a condition we in Australia diagnose and manage with thorough investigations and comprehensive interventions. But here, in this resource-limited setting, the significant limitations to healthcare access were painfully evident. Despite our strong recommendations for an ECG, a standard procedure back home, the financial burden was insurmountable for her. With a heavy heart, we watched her leave with nothing more than painkillers – a mere band-aid over a potentially life-threatening condition. This encounter was confronting; it represented the healthcare privileges I took for granted back home against the harsh realities faced by many here in Muheza.
Tanzania's healthcare insurance system, a mix of public and private schemes, leaves a substantial portion of the population uninsured. Overall, only around 32% of Tanzanians are insured, with high out-of-pocket expenses constituting a major barrier to healthcare access, especially in rural areas. Many people rely on out-of-pocket expenses, supported by their friends, families, and communities. Consequently, many cannot afford necessary medical procedures, posing a challenge for healthcare professionals. Despite efforts to secure funding, financial constraints often limit the best patient care. This contrasts with the privileges in Australian healthcare, where clinicians can offer comprehensive care, supported by a robust system often taken for granted. It was a moment of realisation and a call to global health awareness that I will carry with me throughout my medical career.
In Muheza, I observed and identified one distinct sociocultural trait which formed the unique healthcare service, and how residents coped with resource scarcity and challenging situations: a relaxed attitude towards time.
This relaxed attitude towards time in Muheza culture, often characterised by the phrase 'pole pole' (slowly, slowly in Swahili), is a notable aspect that contrasts sharply with the time-oriented cultures seen in many Western countries. This culture emphasises living in the present and nurturing the relationships, rather than sticking to fast-paced schedules and constantly worrying about the future. I observed how this culture significantly influenced the healthcare delivery as well. I remember vividly the day a patient was diagnosed with end-stage liver failure, a life-threatening condition. Yet, the patient and their family received the news with a serene acceptance that was as baffling as it was enlightening. They spoke not of the years lost but of the moments yet to be cherished, a poignant embodiment of living in the moment that starkly contrasted with the often future-focused anxieties of patients I have seen in Australian contexts. This tranquillity, however, presented a unique challenge. Convincing the patient to eschew alcohol, a preventative measure critical to manage his conditions, was a dialogue more complex than I had ever encountered. It wasn't just about communicating a medical necessity; it was about understanding and respecting a culture where immediate comfort was sometimes valued over distant tomorrows. Through this experience, I learned that providing the best care possible wasn't solely about the medicine I practised; it was deeply rooted in the cultural tapestry of the community I served. In this elective, patients, and their culture, taught me the true essence of culturally appropriate care.
My colleague and I often discussed with local staff about how to effectively support the healthcare in Muheza. People tend to oversimplify the intricacies of providing sustainable and culturally appropriate aid to resource-scarce settings, for example, by suggesting provision of short-term volunteering, without questioning its true effectiveness. The sociocultural landscape here is vastly different from Australia, significantly shaping the notion of patient welfare. Short-term healthcare workers may struggle to provide meaningful care without a deep understanding of these nuances. Sustainable, culturally aware approaches are crucial.
We've witnessed successful initiatives, like the semi-annual albino clinics at St Augustine's Hospital. With albinism common yet stigmatised in Tanzania, these clinics offer essential medical and sociocultural support, funded by the UK charity Standing Voices and governance and management guided by local leaders. This model showcases how long-term, community-driven aid can work.
Inspired by these examples as well as the learnings about the complex cultural differences of the patients’ needs, I aspire to be a community-focused doctor, committed to serving underprivileged groups and embracing a model of care that's both sustainable and sensitive to cultural intricacies.
My four-week journey in Muheza was a tapestry of insightful and inspiring experiences. It underscored the importance of understanding, learning from, and respecting diverse sociocultural and religious backgrounds, realising our privileges, and learning from local healthcare professionals and people.
The warmth, friendliness, and resilience of the Tanzanian people, coupled with the invaluable lessons learned, will forever influence my approach to medicine, shaping me into a compassionate and culturally sensitive future medical practitioner.
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