Apologies. Firstly for the long gap between posts, and secondly that the coming posts will be quite different from the previous ones. Stanley, James and I had decided that we needed to hang up our travelling shoes for a few months, so this post will tell you nothing about circumnavigating Africa. Sorry.
I had signed up to do a Diploma in Tropical Medicine and Hygiene in Tanzania and Uganda, and this is where we have spent the last 3 months. The course is run by the School of Hygiene and Tropical Medicine in London, in combination with other universities, and this year had 72 participants, arriving from 29 countries but it does have to be said that I was the first participant to arrive overland from England. The purpose of the course is to improve the knowledge of tropical medicine for both western doctors, whose exposure to these diseases is low, and for local doctors to get a chance to hone their skills
After setting up home for 6 weeks in a hostel at the bottom of the slopes of Mount Kilimanjaro, walking distance from the district's hospital – Mount Kilamanjaro Christian Medical Hospital I got to know my course mates. There were almost a dozen Tanzanian doctors on the course, and as we were in their town, they wanted to welcome us the proper way, and by that I mean the Tanzanian way! They organised a huge dinner, held outdoors after school one day and had barbequed two goats on a spit, which is the traditional meal for a celebration. It was one of the girls from the UKs birthday, and so she gained the honour of carving into the goat. I was standing next to the course organiser, watching her stick a knife into their animal, head and all, when he noticed she looked a little uncomfortable. I explained that was likely as she was a vegetarian and this would not normally be part of her dinner plans.
The first few weeks were spent doing lectures on everything from Malaria to Leprosy, and the afternoons were spent on the wards, seeing how the hospitals worked and seeing patients. My only experience of African hospitals had been Sierra Leone and I was quite surprised by how much Tanzania differed. The hospital was better equipped, there were more doctors and nurses. There was still far too many patients, with people lying on the floor and in the corridors, and the colossal impact of HIV could be seen everywhere. Every other patient we went to see was young and had been completely ravaged by HIV, and this in a time when anti-retrovirals drugs are freely available. I was quite shocked by how bad things still are.
After a few weeks on the wards in Moshi, we split up into small groups and went off on field trips. I chose to go up to the mountains to a town called Lushoto on a mission to find out more about traditional medicine and how it is used in these rural settings. We spent a week interviewing traditional healers, and went to one of the small villages. Here we were welcomed by the healers, and they put on a dance as we arrived. We watched and clapped and then carried on with the interviews. What we didn’t realise was this was going to happen everytime we went to a new healer's house. Their followers would come with us and start dancing each time we got to a new house. I was happy as anything dancing away, and each time we got to a new house, the ladies would dress me up with a headscarf, and skirt wrapped around me. By the end of the day we were all exhausted, but it was such a memorable day, seeing the equipment they use and discussing how they would manage patients. Everything from medicine to exorcisms were used as their treatments. The point of going up to mountains and seeing this was to understand why traditional healers are so commonly used and whether there is any way to utilise the respect that the locals have for their healers, and integrate this into conventional medicine, however, yes, I was mostly there for the dancing.
At the end of our week in the mountains, we met up with some of the other groups down on the Tanzanian coast as a little weekend away. We rented a dhow and twenty of so of us sailed off to a sand dune in the middle of the Indian ocean, had some lunch, built some sandcastles and played some games. My favourite part of the trip was something that has become a course ritual – teaching the Tanzanian and Ugandan students to swim. Apparently, a couple of years ago someone was so keen to learn they launched themselves off the edge of the dhow in open water, with no life jackets or arm bands, and one of the teachers had to jump in after to bring them back to the surface. Our teaching methods were a bit kinder and some of the girls taught the basic strokes in the shallows next to the sand dune. It was a bit of a hit and they almost had to be forcibly removed when it was time to leave, but then again if you had learnt to swim in the Indian Ocean off the coast of Tanzania, it might be quite hard to remove you to. Certainly a bit more glamorous than Branstom Sports Centre in Essex...
One of my friends on the course, Jess, had an accident whilst we were in Tanzania, and somehow managed to get a broken piece of glass into her foot. After a few days it became clear that this was slightly more than a flesh wound and that some of her tendons had been cut. With many sad faces, she was shipped back to the UK in order to have an operation and her tendons reattached. Somehow she managed to turn it around and get back with two weeks, but that left her in a bit of a pickle. She was meant to climb Kilimanjaro with her fiancé in the one week half term, but this was clearly out of the question. Do not fret. Stanley, the saviour of many a situation, stepped in. After quietly waiting outside the hostel for the six weeks of the term time, it was his time to step up again, and we planned a week overland trip from Tanzania to Uganda through Kenya with Jess and Cal.
We started it off very nicely with two nights in a posh lodge in Tsavo East as we had the luxury of residents rates and afterwards drove further into the park and did what James and I are better at, camping in the middle. We set up the two tents and a fire and some dinner, and Cal strode off confidently to try and find some firewood. I was looking up at him with my head torch beam when we heard the roar of some nearby lions and watched as Cal moved faster than either of us thought possible, running back to the sanctuary of Stanley. We put their ground tent as close as we could to ours, but I did feel a bit bad climbing up to the roof of Stan in an unfenced campsite leaving them on the floor. I woke up in the middle of the night and whilst an elephant was happily browsing past us, I started imagining all the scenarios – the attack by lions of my friend who was unable to weight bear, the elephants climbing over their tent – and woke James to tell him they’d have to come and get in with us. That was met with a swift and clear response, so I stayed awake and stared at them all night. Really what i should of done is thrown James out and taken everyone else into the penthouse.
We had a lovely week, with nights down at Lake Naivasha in Kenya, moving through into Jinja in Uganda, and eventually arriving in Kampala, to the next stage of the course. We were based in Mulago hospital, which amongst other things, is renowned for delivering the most babies per square metre in the world, with 250 babies delivered a day – really we needed baseball gloves for catching babies rather than midwives. Wandering round these wards, it was startling to see bays of women suffering from complications of long labours that are incredibly rare and I have never seen back home, partly due to the huge numbers of babies being born and the wait for things like caesarean sections or other procedures. Some days on the ward were quite shocking, like seeing a little girl suffering from tetanus with spasms throughout her body for days on end. This in a time when it is completely preventable and all but disappeared from the western world. Tuberculosis was another window into a different world - the TB ward was made of breeze blocks with holes in, in order to ventilate the rooms and keep infection rates down. It did make for a breezy ward round though.
In addition to working in the main hospital in Kampala, I spent a few weeks visiting the smaller establishments of the country. One of the most memorable was a week in Hospice Africa, one of the first hospices in Africa, set up by a doctor from the UK & Ireland, to provide much needed palliative care in Africa. Dr Ann Merriman started Hospice Africa Uganda in 1993 and over the past two decades has overcome huge hurdles in order to initiate and implement an adapted model of palliative care and the hospice in Africa. One of the her achievements that stuck with me was that in 1993 morphine was illegal in Uganda. Not only did she successfully campaign for them to change the law, she also started her own factory with the hospice so they could manufacture cheap and easily accessible morphine. I spent a morning in the production line of her, now quite fancy, factory and we made over 900 bottles of morphine.
For a bit of a break from the city, and a foray into medicine in the more rural areas, a few of us headed up to Amadat, a town in the northeast of Uganda, near to the border of South Sudan and Kenya. This hospital leads the way in the treatment of a rare disease, called Kala Azar and it allowed us to get some first hand experience of this, as well as an understanding of charities such as Medicine sans Frontieres(MSF) and Drugs for Neglected Diseases initiative (DNDi), who fund the drugs and tests that the hospital needs. The hospital we were working at had originally been set up by MSF during an outbreak of Kala Azar and eventually taken over by the Uganda Ministry of Health. The disease is officially classed as a neglected tropical disease, which ultimately means that as it only affects people affected by poverty very little money goes into its research and drug development but the doctors on the ground were really keen to show us their latest research into this disease. It was great to see such a cohesive and competent team, and that the drugs and tests from DNDi were making such a big impact on the ground. As part of our week there, we ran outreach clinics trying to identify children with Kala Azar in the community. I think the only way to describe this experience was as an extremely steep learning curve. The first day we set up our mobile clinic, with a triage desk, a lab with a few tests, doctor stations and a pharmacy and awaited the trickle of patients. Well, the flood gates opened, triage got drowned and then went on to get baked as the sun rose and we realised we had set up triage in the sun with no shade, and no barrier from the onslaught of patients. That night, we limped home after seeing over a hundred patients and went back to the drawing board. The next day went much smoother, after setting ourselves up a tarpaulin up over triage and employing a man with a big stick to take over crowd control. Odd the things you learn on this course.
Uganda was also a sharp introduction to city life after 6 weeks in the sleepy town of Moshi. Every few days there was another bag snatch or robbery, affecting all different nationalities of students. This escalated to on the last night when even the course directors bag was stolen, including his laptop, and upsettingly, all of the transcribed exam results. This made for an interesting graduation where we all graduated without actually knowing whether we had passed or not. This seemed a unique African ending to our quite unique course. We didn’t let this stop us celebrating and the farewell parties went on for days.
This may seem to some like an odd way to have spent 3 months in Africa, but the knowledge and the exposure to tropical diseases which I have minimal involvement with back home was astounding. Working alongside colleagues from all over the world really gave me an insight into how other health systems function, and how similar our education is worldwide. I met exceptionally inspirational people, both students and teachers, who had, to name a few, run centres for Ebola patients, responded to humanitarian crises all over the world and participated in ground breaking research. And that was what people had done before the course. Now I have friends spread out all over the world, working in Sierra Leone, Uganda, Tanzania, Malawi, Australia, Hong Kong, New Zealand... (you get the idea). I can’t wait to see what they all achieve.
Liz Jarman & James Nunan
Our trip from Essex to Cape Town & back again
Km travelled : 50818km
Countries visited: 30