An Introduction to Global Health: a Tanzanian Experience
by Natasha Caminsky
The month of August for a third-year medical student represents an important milestone. It marks the beginning of clerkship, and is typically characterized by both the excitement of leaving the classroom to enter the hospital world, and the anticipation of the accompanying responsibilities of patient management, consulting other specialties, and navigating the health care system.
At 4AM on Sunday, July 30th, I arrived in Dar es Salaam, Tanzania. I hopped into a taxi and made my way to the apartment that my colleague, Alexis Semeschuk, and I would call home for the next four weeks. After sleeping off the jet lag, and feeling a little lonely without my sidekick around—she was scheduled to arrive later that evening—I sought out another tenant who was willing to help me get groceries and set up my phone. In retrospect, I had the good fortune in my selection, because it turned out that this helpful individual was a visiting neurosurgeon from Spain, and was working at the same hospital as us: the Muhimbili Orthopaedic Institute (MOI). MOI is the leading neurosurgical and orthopaedic referral centre in the country, while all other specialties are covered by the Muhimbili National Hospital, located just across the street from it.
On Monday morning, Alexis and I split ways; I was to do my first 2 weeks in anaesthesia before joining her for a final two weeks in orthopaedic trauma surgery. After being introduced to all of the anaesthetists and respiratory therapists on service that morning, it was straight to the operating theatre (OT) for me. There I would spend my days with both adult and paediatric patients, performing spinal anaesthesia or administering general anaesthesia throughout the course of the day. Two weeks later, I was in Orthopedics, where my routine was similar to what I was used to at home—morning rounds, then either directly to the OT or the clinic.
The main difference with my rotations in Anaesthesia was that everyone met before going to the OT to discuss the cases of the day. These discussions focused particularly on those patients most likely to have complications while sedated, as well as how to manage these complications.
In Orthopaedics, there were also a few differences with home. For example, when orthopaedics cases were presented to the National Hospital, they were transferred to the Casualties Department, rather than to an emergency room that paged us. Casualties was therefore mainly meant for triage. Will the patient be treated and discharged, admitted and wait for a scheduled surgery, wait in the hallway until the end of the day and get surgery overnight, or sent directly to the emergency OT? Furthermore, morning rounds were preceded by morning presentations that consisted of discussing overnight cases and surgeries. Since the emergency operating theatre ran 24 hours/day, discussions also included emergency cases handled overnight and those on the waiting list for the next day.
The most common cases encountered in Anaesthesia were shunt placements for patients with hydrocephalus, usually secondary to neonatal infection, to which babies are at increased risk because they’re often born in unsanitary conditions. There were also many cases that required treatment for infected shunts, which consisted of using antibiotics to literally wash the area of the brain surrounding the shunt.
As for Orthopaedics, the most common cases we saw were fractures due to motor vehicle collisions, and advanced cases of cancer. Unfortunately, the roads are very poorly lit in Tanzania (especially in small towns), the traffic codes are not typically obeyed, and there are few repercussions for reckless drivers. As for cancer patients, they tend to seek help from a traditional healer over Western medicine and, in cases of a gross mass, avoid leaving home altogether out of shame and embarrassment resulting in very late-stage presentation by the time they reach the hands of MOI physicians.
Our four weeks in Tanzania flew by quickly, yet looking back it feels as though we were there twice as long because of all the things that we did and discovered, including exciting cases in the OT, daily breakfast with the surgical team, traveling to Zanzibar over the weekend, and savouring the delicious food that Tanzania had to offer (especially the spiced coffee!) The innovation, hard work, enthusiasm, and warm-heartedness of our colleagues left the biggest impression on me. It goes without saying that the physicians, although employed at the largest hospital in the country, unfortunately lack both the technical and material resources to practice medicine to the best of their abilities.
Our experience certainly included some challenges and many learning points. For the first time in my life I experienced what it was like to be a visible minority and an outsider in a country with a very different culture than what I am accustomed to. Finally, there were several takeaways that I brought back home with me. For one, I would have liked to know more Swahili before arriving, to better integrate with my colleagues and serve my patients. Second, knowing what types of material and human resources the hospital does or doesn’t have will better allow me to arrive prepared for my next trip. Finally, knowing a bit more about the epidemiology of a given disease or complication would be useful, as this was often a question that came up in discussions.
I would like to take this opportunity to thank the Global Health Program and the Ashworth Family for supporting me in this wonderful experience. The fact that a student can receive funding for most of their international student elective course thanks to their university and alumni speaks volumes about their values relative to global health. As a further testament to this fact, I am writing this blog entry from my temporary home in Nalerigu, Ghana, where I am completing a 4-week Rural Family Medicine rotation with the Baptist Medical Centre. Once again, I have the McGill Global Health Program and Luger-Mikelberg family to thank for giving me this unique opportunity, which has already been an academically and culturally enriching experience that is shaping how I will approach my medical practice and patients in the future.
Until next time.
Natasha is a native Montrealer who is currently in her 3rd year of medical school. Prior to commencing the MDCM program at McGill, she completed a BSc in Genetics (Hon) and Physiology (Maj), as well as a MSc in Biochemistry, all at Western University. The latter allowed her to contribute to a project regarding hereditary breast and ovarian cancer in patients with genetic variants of uncertain significance. Natasha enjoys filling her free time with activities involving sports, travel, and education, among others. Since learning how to row while at Dawson College, Natasha took her rowing career to the next level in university, winning national titles both in Canada and in the United States in her role as women’s varsity coxswain. She continues to remain involved with the sport at McGill, only this time with the men’s team. Her passion for travel and the discovery of new cultures has lately been paired with medicine during trips to Thailand, Tanzania, and Ghana for global health-related projects in conjunction with the Centre for Global Surgery at the Montreal University Health Centre. Natasha hopes to pursue a career in surgery and continue to have a global health component to her practice, ideally through medical education and training, so as to provide a sustainable and lasting impact on the communities with which she’s involved.