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Mervyn Dean on adjusting to work in Tanzania

3 Feb, 11 | by BMJ Group

Mervyn_DeanIt used to be, and may still be, that in the tourist shops here one could buy a T-shirt bearing the words, “No hurry in Africa.”  I now understand what it means, and I’m sure that many reading this who have worked in Africa will not be surprised at my experience to date. I am a palliative care physician recently retired from my post in Corner Brook, NL, Canada.  I have come on a voluntary basis to the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, northeastern Tanzania, to help provide and teach palliative care.  The medical director is very enthusiastic about palliative care but although a few others here share his enthusiasm a formal service does not exist, and it seems not all understand the concept of palliative care (although, there are some back home for whom that could be said!).

My first day here was to start with a 09:00 appointment with the medical director, for which I arrived 10 minutes early despite having been warned that he’d almost certainly be late.  We met at 11:15.  There was no apology for keeping me waiting, but he welcomed me enthusiastically and I received over two hours of his undivided attention as we discussed my role here and he introduced me to various relevant people. A colleague told me that during his time with me one or more other people were likely kept waiting. The same colleague also told me to expect my first week or two to be slow and not to be impatient. It was good advice, although the bit about not being impatient was difficult for me to follow.

From my point of view I’ve had a lot of wasted time, sometimes waiting an hour or more to meet with someone. But once we do meet the outcome has mostly been productive. I keep reminding myself that one reason for my coming here was to experience medicine in a different culture. I am experiencing that different culture and some of it is clashing with my culture in ways I did not anticipate.

I want to respect the local culture and not impose my Canadian practices and values, but talking to other CFAs (Newfoundland term – “come from away”) here it seems that one does have to be proactive to achieve anything. So, by being a bit pushy and making contact with a nurse with an interest in palliative care I have managed to see a few patients. It was gratifying to come back to one patient the next day and hear from a nurse on that floor that “for some reason” his pain was much better. I also managed to arrange three teaching sessions to either medical students or a mixture of students and junior doctors. Morphine is a relatively new drug here, and few have experience of using it, so I hope I can give enough physicians and nurses the knowledge and confidence to use it appropriately. The need is there.

So, I’m slowly learning the African way, and trying to gently but firmly promote my agenda. To that end, next week looks promising. I met with my “preceptor” and we have agreed to change the manner of my clinical involvement. In addition, arrangements are in hand for me to meet with some of those in charge of education at the attached medical college. I have another six weeks here and am gaining optimism that that will be long enough for me to achieve some of my aims.

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  • Marion Taylor

    Dear Mervyn,
    How brave! I'd like to know what your aims are in the time that you have. I've long been interested in the idea of working in palliative medicine in Africa, and I'll be following your blog with a great deal of interest.
    Marion (palliative care doctor in New Zealand)

  • Mervyn Dean

    Hello, Marion,
    Sorry about the delay in replying but internet access was intermittent and not always reliable when I was in Tanzania. My aim was very broad – to help with palliative care servcies in KCMC. I had hoped that this would include clinical work and teaching, both formal and informal. If you've been following my postings you'll know that things didn't go quite the way I planned, but I'm optimistic that I can now arrange for a more satisfying return next year. Good luck with your ambitions.

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