Tanzania: The Morning Report- 'Gives you the long and the short'

This account is based on my experiences on elective in 2004 in rural Tanzania (Nachingwea). Roads, hospitals and hospitality may have changed significantly (or not…) in that time

 

Every working day in Tanzania started just after daybreak with the ‘Morning Report’ – which used to immediately remind me of the Lion King song so I always had to suppress giggles, but was basically a run-down of all the patients in the hospital and the total deaths overnight. It was a surreal experience as the Morning Report was spoken in the most non-plussed, matter-of-fact way and would just list the facts and figures of the patients. I always wanted to know, which patients had died, why and what of; but as I came to learn in Tanzania there was no time for sentimentality and there was little point in learning from the causes of mortality as practically the only things vaguely treatable were Malaria or Gonorrhoea.

This slightly detached handover meeting takes me directly to another unemotive experience. This was when we tried to watch women giving birth to gain experience of this process. We waited and waited, much as you do as medical students in the UK trying to observe women in labour, but this is where the similarity ends. We were finally ushered in to see the woman, but as we rushed down the corridor, we heard the cries of an infant. The baby was already born, cleaned and wrapped up! We were perplexed as we had not hung around just to see the baby in all its pink, screaming glory as if we were the 3 kings. Instead, we wanted to witness and ‘experience’ as much of the labour process as possible. Only in retrospect, many years later, can I postulate why this may have happened. I fear that it is due to the number of neonatal deaths in Tanzania.  There, it is not so much about the birth experience or birth plan for the woman, but the chance of a baby arriving alive.

 

One of the joys of the Tanzanian hospital was the fact that its entire workings ground to a halt in the afternoons, meaning we could stay cool by reading, writing diaries, or generally relaxing. Not only were all the doctors and medical students turfed out, but any patients too regardless of how sick, to sit under the shady columned walkways. The purpose of this was so the nurses could supposedly clean the wards. But since the wards were totally open to the elements with pane-less windows and no doors so the red Tanzanian dust (mud) could just blow in, this never seemed very effective and since most of the nurses were larger than the average Tanzanian, I was never convinced how much cleaning actually went on or whether it was really just an excuse for some peace and quiet for the nurses. Anyhow, it was one of the many quirks and one which would be wonderful but impracticable to introduce into the NHS!

On a side note, if you are planning on travelling to Tanzania, be warned that the roads are dire, potholes abound and at some times of the year the roads are impassable. We did not go on a single method of transport that did not break down at some point. Fortunately, most Tanzanians are able to fix their own vehicles as they go so you do not even have to wait for a mechanic. Although on one journey we did end up on the back of an open top truck in amongst chickens and wicker baskets full of tomatoes

Tanzanians are extremely hospitable, though one particular gentleman shall always be remembered as he insisted he found us somewhere to stay for the night after yet another disastrously long journey. Having discovered all local hostels booked up or closed for the night, he found us a lovely room in a ‘house’ where the lighting was red, the sheets satin black and a lady standing on the doorstep of the opposite house in her dressing gown. Needless to say by that point we were too tired to care and slept soundly…

 

Neonatal mortality rate per 1000 live births in Tanzania (in 2012) is 21 (13-35) compared to 4 in United Kingdom

Further Reading

http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_tza_en.pdf 

http://www.ons.gov.uk/ons/rel/vsob1/child-mortality-statistics–childhood–infant-and-perinatal/2012/sty-imr.html

Dr Ellie Glenday