{"id":7570,"date":"2011-03-09T12:16:34","date_gmt":"2011-03-09T11:16:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=7570"},"modified":"2011-03-09T12:16:34","modified_gmt":"2011-03-09T11:16:34","slug":"mervyn-dean-on-the-end-of-his-trip-to-tanzania","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/03\/09\/mervyn-dean-on-the-end-of-his-trip-to-tanzania\/","title":{"rendered":"Mervyn Dean on the end of his trip to Tanzania"},"content":{"rendered":"

\"Mervyn_Dean\"This will be my last blog from Tanzania.\u00a0I\u2019m going to spend a couple of days visiting the island of Zanzibar \u2013 pure vacation, nothing to do with work \u2013 and then begin the trek home.\u00a0My time here has not been as fulfilling as I had hoped, which naturally has been disappointing.\u00a0Nonetheless there have been positive aspects, and now I know how things are here I hope I can use that knowledge to ensure a more productive future visit.\u00a0I have no doubt of the great need here for palliative care, although awareness of that need by many healthcare staff, and even by some deserving patients, is somewhat lacking.<\/p>\n

The biggest disappointment has been the lack of opportunity to teach the medical students and junior doctors.\u00a0 Earlier discussions going back a year had led me to believe that such teaching was to be one of the main reasons for my visit, but somewhere along the way the lines of communication broke down.\u00a0The medical school is administered somewhat separately from the hospital, but all negotiations regarding my visit were between the hospital administration and me.\u00a0My assumption that information was being passed to the college proved incorrect, but knowing this I am prepared for next time.\u00a0My positive teaching experience occurred when I eventually made contact with the nursing school, where the senior staff were not only keen to have me help out with their current programs but also to discuss my future involvement.<\/p>\n

Many people who have worked here for a long time, or have previously worked here for brief periods, have tried to tell me that what I have experienced is the \u201cafrican way,\u201d although exactly what that way is varies according to whom you speak.\u00a0 As I’ve previously mentioned in these blogs<\/a>, everything does happen at a slower pace here.\u00a0There no doubt is an African way but I don’t agree with blaming it for everything that doesn’t work out.\u00a0In my case misunderstanding and miscommunication seem more likely. I also recognise now that part of the problem here was that there is not and never has been a palliative care service, so that I couldn\u2019t \u201cslot in\u201d to an existing service, as visiting colleagues in gynaecology and pediatrics were able to do with comparative ease.<\/p>\n

Nonetheless, I certainly value the experience I have had here, both of working in a different medical environment and of experiencing a different social environment and culture.\u00a0There have been a few times when a patient’s comment has taken me aback. For example, in this part of Tanzania there is no shortage of food \u2013 roadside stalls are frequent and loaded with fresh produce – so when, wanting to know if a patient still had any appetite, I asked her if she was eating normally I was not expecting her reply, \u201cOh yes, when I can afford food I eat.\u201d There is a lot of poverty here, and that influences the need for palliative care.<\/p>\n

For example I saw one man in his 40\u2019s who had a total esophageal obstruction due to a tumour.\u00a0 This could not be adequately managed at KCMC, so he needed to go to the Ocean Road Cancer Institute in Dar es Salaam for radiation treatment and\/or stent insertion, but he couldn’t afford to go, leaving him but with one option\u00a0– to go home and starve to death.\u00a0 A gastrostomy tube could have been an option if there was someone to look after it in his home village, but there was not, and the risk of infection or tube displacement is one that from experience the surgeons don\u2019t wish to take.\u00a0What really registered with me was that the patient was quite philosophical about this, and the attending physician did not see the situation as anything out of the ordinary. As time went on I realised that sadly it isn’t.<\/p>\n

Based on my experience I would not discourage anyone wishing to come to work in the developing world. Indeed I would encourage them to go ahead. However, be prepared for disappointments and unexpected challenges. Challenges were partly what I came for, and although the challenges were not the ones I expected, I am hoping that with the experience gained I can plan to return and make a more useful contribution.<\/p>\n

Mervyn Dean<\/strong> is a palliative care physician recently retired from his post in Corner Brook, NL, Canada. He has come on a voluntary basis to the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, northeastern Tanzania, to help provide and teach palliative care.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

This will be my last blog from Tanzania.\u00a0I\u2019m going to spend a couple of days visiting the island of Zanzibar \u2013 pure vacation, nothing to do with work \u2013 and […]<\/p>\n

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