Tanzania August 2011
ANGUS PATERSONAt the end of my Lower Sixth year at Merchiston, I was very privileged to have received the Bill Wilson Memorial Prize for traveling with charitable endeavour that helped fund my travel in August 2011 to gain medical work experience in Tanzania. As an aspiring medic, the chance to experience healthcare provision in a third world country, whilst also benefiting from the eye-opening benefits of being able to travel independently to a different continent was a wonderful opportunity. My placement was for two weeks in Tosamaganga Hospital, Iringa, in northern Tanzania during the summer holidays prior to my application to read medicine. The placement was organised and facilitated by Gap Medics who have student accommodation nearby in Gangilonga.My main objective in this trip was to understand more about the differences in the standard of healthcare in an undeveloped country compared to that which we, arguably, take for granted here in Britain with the NHS. I also had a particular interest in learning more about Paediatric and Obstetric medicine, as these were areas of particular interest for me sparked by my other work experience undertaken back at home. From the very first day of my Obstetric placement, through the experience of undertaking basic physical examinations and also the use of foetoscopes on the ward rounds, I learned a little of how to monitor a fetus' orientation in the womb and how the staff measured the general health of both the mother and fetus during pregnancy. A definite highlight of my first week was seeing a successful caesarian-section and examining the newborn baby - this was a very special moment for me as the week sadly also saw several miscarriages and stillbirths.With Tosamaganga being a poor rural area very close to the Equator, the prevalence of HIV/AIDS, Tuberculosis and clinical malaria was shockingly high - nearing epidemic proportions. I found this particularly hard to adjust to as the town has such a high number of orphans who are born not only into abject poverty but also with poor health as a result of these diseases. The relative scarcity of assets - both equipment and skilled staff - in the hospital was stark. This highlighted for me why exposure to such situations cannot help but challenge the visitor with the clear inequality between a western and a third-world country. It was painfully obvious to see the huge benefit that greater funding would have in tackling the lack of the most basic medical equipment.In my second week of work I managed to fit in not only my planned Paediatric ward rounds but also General Surgery and a day at Ngome health clinic. In paediatrics, I was able to draw several parallels to a previous NHS orthopaedic placement I had been lucky enough to undertake at home. As children arrived with severe fractures and burns from road traffic accidents, I was amazed to see the same injuries being treated differently or not at all due to a lack of money, the risk of infection and a lack of surgeons. Again, perhaps this should not have come as a big surprise to me but the reality of seeing such differences, especially in many that were so young and vulnerable, was sobering. It was also fascinating to see how cultural differences played their part in what issues are presented to the doctors. Whilst in general surgery, it quickly struck me the extent to which male pride prevents an African man from acting so that a small problem does not develop into a larger one. In practice, this meant tumours were larger, infections were wider spread and people generally only came when they were much more ill! Clearly the ethical difficulties around third world aid make the balance of western funding a more complicated issue. However, through visiting one of the many African countries in need of aid, it seemed clear that even a small rebalancing would have a disproportionate benefit to the quality of life for the thousands of poverty-trapped people.Away from work, I was fortunate to be accommodated in a house close to the locally famous Gangilonga Rock with around thirty other students wishing to apply for medicine. In our time off, we visited the local town and worked at the local orphanage. The chance to give some small toys to the children and to play games with them showed me that, whilst compared to others these children were lucky to have an orphanage to attend, they sadly lacked stimulation outside of their daily routine to learn practical skills like sewing or wood carving. Working with the children and doing such handicrafts was thus a hugely fulfilling aspect of my trip as we found their gratitude for a few hours play quite overwhelming.When in Iringa, or indeed the other parts of equatorial Africa I saw when traveling around the towns, blue skies, red soil and interesting wildlife made a lasting impression, as they were common factors of the huge landscape. Iringa's picturesque landscapes are a result of being very close to Tanzania's largest national park (22000 km²) - Ruaha National park - and I was very fortunate to spend one of my weekends on safari and to visit a Masai village. We were very lucky to see both a pair of leopards and also to meet the Masai Chief when visiting their tribal village.I am extremely grateful to have had this placement supported by the Bill Wilson Memorial Prize for all it enabled me to experience, and I would recommend both this sort of activity and Tanzania as the country of choice to anyone thinking about medicine or charitable work abroad.