Medicine in Tanzania - KCMC
Trip Start Aug 10, 2006
21Trip End Oct 16, 2006
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Health facilities in Tanzania are typically far away from where people live and are difficult to reach. Many people have to walk 9km to reach a dispensary (local health outpost) and even further to a district hospital - often as far as 60km. People walk by foot to reach most services - not being able to afford the TSH200 to hire a bicycle (10p). Buses and other means of public transport are not reliable or regularly available. The state of the roads around the country add to the problem of supplying healthcare - most are dusty, bumpy roads which in the wet season become impassable.
"Many poor women cannot afford transport costs to health facilities so they sell their food, borrow, use herbs or just wait to die." (Mpapwa 2003) One major problem facing women in Africa is fistula - a devastating childbirth injury that leaves girls and women leaking urine and/ or faeces continuously. It is preventable yet currently at least 2 million African women are affected. Some girls with fistula are abandonned and forced to live in isolation, while others have supportive families but struggle to be accepted within their communities and find medical treatment. Women in labour often cannot afford to go to the hospital or their husbands will not allow it - often they wait 3 days in labour which does not progress then have to walk miles or travel for hours by bus/ wheelbarrow to a hospital where a caesarean is performed and the baby is dead. Often this is at great expense from borrowed money and the family then has enormous debt.
Aswell as availability of care and transport to facilities, another barrier in accessing healthcare for the people is cost. A consultation will cost TSH1000 officially (and that does not include the cost of being 'introduced' to the doctor - if you dont have the money to be introduced you may wait for days before anyone gets to see you). This puts healthcare out of the reach of the poor and they often turn to traditional healers - some of which are good but most give herbs etc. which do not help and they stay at home and wait to die.
"one man told us that he and his wife had been to the hospital with their 3 year old daughter that had malaria; they did not understand that they had to pay bribes in order to get assisted. Neither did they have any money to pay the bribe. They sat 3 days and waited for treatment, their child got worse and then died, in the waiting room at the hospital" (Ewald 2004)
Often patients cannot afford the medicines that they are prescribed so they go without. Those that can afford them at KCMC have to return monthly for their treatments because the pharmacy will not give supplies for more than a month - this is at great cost to the patient in travelling expenses. Many poor people have barely enough money for food and kerosene, if they become ill and need treatment - they go without food - it is one or the other. 80% of deaths in Tanzania occur outside of health facilities because of poverty - most deaths arent medically certified. 50% of Tanzanians live below the poverty line with the majority (70%) visiting traditional healers instead of hospitals. There is a shortage of qualified doctors in Tanzania - 1:26000 people whereas in the UK on average it is 1:500.
The majority of diseases that burden people here are communicable and can therefore be prevented - malaria, diarrhoea, pneumonia, malnutrition and HIV/AIDS. The latter has had a serious impact on life expectancy in Tanzania - it currently stands at 45 years, reduced from 52yrs due to an increase in HIV. Since 2005 the government has promoted the free distribution of ARV's (anti-retroviral therapy) to all HIV +ve people. However only 7% of people eligible to actually receive them.
The paediatric department in KCMC is one of the better run departments, however it too faces many problems. One good thing is that every patient has a mosquito net supplied on the ward. Each consultation with patients or review on the ward round lasts 35-45 minutes so a lot of time is put into the care of patients, it is still very much a doctor centred consultation and patients do not volunteer symptoms etc. Accessing blood tests is frequently unreliable and patients must pay for all investigations ordered - about 50p per test; it takes days for results to come back which makes patient management difficult - kind of like working in the dark! Relatives must buy patients medications from local dispensaries and bring them back for the patients - this can lead to discrepancies in doses. Access to blood for transfusions is limited to a few group types and can take days to order.
he medical wards are overcrowded with up to 15 patients in the corridors on makeshift trolleys. One of the major problems here at the moment is the lack of a reliable water and electricity supply - doctors dont wash their hands between examining patients here even when there is water....
A lot of patients abscond from the wards half way through their treatment because they simply cannot afford to pay TSH1500 a day for a bed, TSH1000 per investigation etc - it all adds up.
The spectrum of disease in paediatrics here is Tanzania is completely different to at home - in fact the books that I brought with me are irrelevant! For example we had a 12 year old boy with Rabies - where you have hydrophobia, foaming at the mouth etc - quite a scarey presentation. There are children with phocomelia - born without limbs, lots of cancers that arent seen often in the UK such as Burkitts lymphoma, Wilms tumour (of the kidney) and abdominal tumours. There are cases of Polio, spina bifida, hydrocpehalus and TB. As well as various congenital heart malformations that cannot be treated because they cannot do open heart surgery here.
One of the conditions that is the saddest is the case of the XP children. Xeroderma pigmentosa is a condition where DNA is unable to repair itself - consequently their skin gets very damaged by the UV light, it is very painful to use their eyes and a lot of cancers form on their skin, these children dont live long and unfortunately because most african children play outside a lot before the disease becomes noticeable there is nothing to do to prevent it. Several children (but not as many as I expected) suffer from either Kwashiorkor or Marasmus due to malnutrition. On the whole people out here are on the larger side because of the high carbohydrate diet of ugali or rice. (nice not to feel too out of place!!!)