OUT with a BANG!

[above: mentoring Team TZ – Jenny, me, Guy]

My LAST week of fellowship and work in Tanzania is now OVER!

We came back to Moshi to do direct mentoring at the Mawenzi Hospital HIV clinic. Mawenzi is dreadfully representative of the broken health care system in Tanzania. It’s the regional referral hospital for all of Kilimanjaro, i.e. the northeast part of the entire country. The director of the HIV/AIDS clinic at Mawenzi Regional Referral Hospital is an eye doctor. EYE doctor. With no training in HIV/AIDS care and treatment. ‘Nuff said.

Needless to say, it was a busy week with many gaps to patch. Hopefully we did something good here. Hopefully the 18 year old young man with ataxia, fine motor weakness and loss of sensation in his right arm and leg will get better after empiric treatment for toxoplasmosis while we figure out how to get him a CT scan. Hopefully the 40 year old woman who can’t walk because she lost her position sense and has a horrible burning sensation in her legs up to her thighs won’t get worse since we switched her from stavudine to abacavir… and gave her some pain relief medications. Hopefully the 35 year old woman with rip-roaring cryptococcal meningitis will get the repeat lumbar punctures she needs to relieve the pressure in her cerebral spinal fluid and improve on high-dose fluconazole.

Fortunately, I was able to work with Imelda, a clinician who was eventually receptive and happy to learn. And the eye doctor, Dr. Temba, was eager to improve the quality of care at the clinic. Both are relatively new to the clinic. Mawenzi can only go up.

My very last day of fellowship… and training… was quite insane. As soon as I showed up, I got pulled into seeing two complicated, sick patients. They were too sick to defer evaluation, so the teaching session got delayed and delayed. I felt horrible about this but didn’t feel that I could do a half-arsed job seeing these patients. On top of that, in the process of seeing patients, I got short with Jenny and said something disrespectful to her – which (rightfully) upset her, upset me, then delayed things further and of course I felt bad again. It’s difficult to realize that I am exhibiting the behavior of nasty arrogant doctors. I felt terrible and spent some time apologizing and processing. I am unlearning the bad habits that have arisen from years of hierarchical abuse.

I recovered enough to work with Jenny and Guy to teach for a couple hours on six HIV antiretroviral cases. Most cases were based on patients I saw at Mawenzi that week. On the whole, it went well, and hopefully the 20 or so participants learned something in the process.

We ended with some chai and bites (snacks), lots of warm handshakes, and big hugs and appreciation from Imelda. Imelda did a great job discussing one of the cases with the group and demonstrating the peripheral neuropathy exam that I taught her earlier in the week. That was gratifying.

And then I had a cathartic cry, unleashing some of the pain of fellowship, university hierarchy, misogyny and racism. I was lucky to have Jenny and Guy there to listen through some of my processing.

Out with a bang – and a stream of tears.

Now that I’ve had my catharsis, I contemplate the prospect of not coming back to East Africa for a long, long time.

2 thoughts on “OUT with a BANG!”

  1. Hi !
    M name is Julie Weiss, I’m french and I’m studying medicine. I wanted to go to the Regional Referral hospital in Mawenz to do an internship for two months.
    I know you had working in Tanzania, and you were in this place. How did you do with the working permit ? Do you need it ?
    What did you think ?
    Thank you very much for you answers,

    Julie Weiss, from Strasbourg.

    1. Hi Julie,

      I am no longer working in Tanzania, and have not been there since 2008, so I am not sure what the requirements are currently for working there.

      I worked at Mawenzi hospital through the Elizabeth Glazer Pediatric AIDS Foundation, so we had an international agreement to teach and support work at Mawenzi as part of charitable humanitarian work.

      I believe that each case may be a little different, depending on your country of origin and the relationship your institution has with Tanzania and Mawenzi. If your medical school had a relationship with Mawenzi, it would be most applicable to find out what permits they may or may not require.

      It is an amazing, eye-opening experience to be in the Tanzanian medical system. I found the culture and people of Tanzania in general to be exceptionally friendly. The work was challenging. On one hand, providing extra support and hands can be life-saving for individual people… on the other hand, you really truly experience the devastation of poverty and lack of resources on families and individuals. A true openness and willingness to be present and able to see what is there and be helpful and supportive in whatever way you deem sustainable will allow you to contribute to the community and learn a great deal from the experience.

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