Working with FAME’s Tanzanian (medical) staff was very enriching. In a small series of blogs I’ll take you along on some reflections on my journey through wards, teams and theatres.
One of the first things that struck me at FAME, was how all-round the Tanzanian medical staff is. In the West, everyone has his own field and at some point barely knows what to do with cases that go beyond their scope of expertise. In Tanzania, the doctors and nurses need to address all sorts of cases. At one moment, you will find them doing a complicated surgery, the other moment they are assisting a delivery, managing a premature baby or dealing with a psychotic patient or a kid with a severe viral or bacterial infection. In the relatively short period I stayed as a volunteer, I saw quite a concentration of interesting, sometimes “exotic”, medical cases and I learnt a lot about all sorts of conditions I had no previous experience with.
I clearly remember one of the first neonates I saw admitted at FAME. The little one had a serious grade of jaundice, with signs of kernicterus and suspicion of neonatal sepsis and meningitis. I had not seen such an advanced stage of icterus before in my life, in the West we usually manage to intervene in an earlier stage. For me, it was interesting to observe the symptoms and the management. I found myself being rather skeptical about the chance that this really sick baby would make it, while I found the FAME doctors and nurses rather optimistic and hopeful. I perceived their mentality of believing in healing and recovery to be something very powerful.
Perhaps that mentality wasn’t always realistic, but it made me think about how we in the West are conditioned to use the worst-case scenario as the starting point of our treatment plan. The advantage of our approach is that we handle things with a sense of urgency and that we think in terms of having a plan A, B and C. We don’t want to be surprised by any deterioration in the patient’s condition. This way, however, we also don’t leave much room for being caught off guard by the exact opposite. What if it turns out that the level of faith medical staff has in a positive outcome, has an impact on the outcome? In Tanzania, they believe in staying alive, while in the West, we much more believe in not dying. Somehow, there is a fundamental difference here.
It also results in a different approach in communicating with relatives where the condition of the patient is concerned. We tend to give them a full insight into the patient’s condition and prognosis, we give them the best- and the worst-case scenario. In Tanzania, they seem to prefer to not tell the relatives how bad the patient is actually doing. They will rather say something like ‘the patient is in a serious condition but we are doing our best to cure him, so all that is left for you to do is to pray to God’.
During my stay at FAME, there were plenty of cases in which the synergy between staff and volunteers was useful and contributed to a happy ending or at least considerable improvement for the patient. Sometimes we had puzzling cases and had to put everyone’s knowledge and efforts together to find the right approach. Take the case of a pregnant lady who presented herself with severe joint pain and diabetes. We tried different medications that were available, but to no avail. One of the volunteering internists suggested Sulfasalazine, a medication not standardly available at FAME at that moment. With the help of the pharmacy staff we could get the drug to FAME. It relieved the patient’s pain and we could see her smiling again. This way, we could refer her to a specialized center where they could investigate whether she suffered from an autoimmune disease.
In other cases, we had to accept that even all our efforts and knowledge combined were not enough or came too late. Like in the case of an eight-year-old boy who came in with a rather uncommon story of falling down, having a swollen leg and being unable to walk and to pass stool. The boy’s condition was deteriorating very fast and it were the Tanzanian colleagues who came up with the idea of an Anthrax infection, a possible diagnosis that wouldn’t have come to our Western minds, as to us, it is more of a textbook situation you might read about in your medical training. We had to grab our smartphones for a crash course in different sorts of Anthrax infection, precautionary measures, and ways to control it.
Unfortunately for this little boy, our treatment came too late. We all learned from this case how important a good anamnesis is. It turned out that this boy and his friends had eaten a dead animal that they had found somewhere. Us Western volunteers learned quite a few things about Anthrax infections as well. We all learned that in this type of cases a fast working diagnosis and response is key.
A prime example of this was the case of a lady who was rushed to FAME. The doctors in charge were very fast with diagnosing her with an erupted ectopic pregnancy and even faster with rushing her to the operating theatre and saving her life. The other staff involved also responded on point in finding blood donors and stabilizing the patient after the operation. I was very proud of everyone involved because of how they handled this emergency, from the first call to the hospital up to the aftercare by the nurses, and the way everybody tried to help the husband cope with this rather traumatic experience.
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Want to know more about my journey to Tanzania and the Foundation for African Medicine? Check my travel diary.
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