Welcome to the Chronicles of Daraja Archives!
Here you will find stories from our volunteers since the beginning of the Daraja Foundation in 2013.
These reflective experiences will take you through the inspiration and vision of creating Daraja Foundation, our successes and challenges, providing a real view of volunteerism and how we keep moving forward. For our latest updates and photos, please visit our social media pages.
Our Volunteers make Daraja Foundation a family, here are their stories...
Here you will find stories from our volunteers since the beginning of the Daraja Foundation in 2013.
These reflective experiences will take you through the inspiration and vision of creating Daraja Foundation, our successes and challenges, providing a real view of volunteerism and how we keep moving forward. For our latest updates and photos, please visit our social media pages.
Our Volunteers make Daraja Foundation a family, here are their stories...
PAINTING THE FUTURE BIKE SHOP
Posted by Jennifer on 05 September 2015
Posted by Jennifer on 05 September 2015
It’s heartbreaking because I wish I could do more to help them, and I wish I could stay there longer. |
Writing this blog post for the Daraja Foundation has proven very difficult for me. How do I pack so many memories and experiences into one blog post? Because travelling to Zanzibar was the first time I’ve traveled outside of North America, the differences in environment, culture, and people left quite an impression on me. The part that has left the most lasting impression is how friendly and kind all the people were, and despite the many differences we, as people, have many more similarities.
I went on this journey with one of my best friends from high school, Madie. Together we participated in several Daraja projects such as helping set up the Daraja and PLCI Bike Shop, introducing cooking classes at Mazizini Orphanage, and initiating the Hujambo Sijambo Global Connections Project with students from PLCI. We also wanted to shadow at Mnazi Mmoja Hospital, but since we do not have clinical training were unable to; however, Dr. Naufaul invited us to volunteer with ZOP (Zanzibar Outreach Program).
Overall, having the opportunity to meet and get to know so many people from Daraja, PLCI, Mazizini, and other miscellaneous places was my favorite part. We, like so many other Daraja volunteers, stayed in Bi Shemsha’s house in Lebanon Brother’s Square. I loved spending time with the Hundert Family and other travelers staying in the house (especially playing cards at night), learning Swahili from the shop owners in the square, and eating the infamous urojo street soup with Shah. Meeting the children in Mazizini was such a heartwarming and heartbreaking experience. They are so friendly, welcoming, and joyful. I felt like I could connect with them even though we may not speak the same language. It’s heartbreaking because I wish I could do more to help them, and I wish I could stay there longer. The students at PLCI gave me the same feeling of being welcomed. It was fun painting the future Bike Shop and meeting with the Bike Shop Team to discuss preparations for the arrival of the container of bikes and opening the business. I’m happy that I am able to keep in touch with several PLCI students and get updates about their progress.
The most unique part of my month trip was participating in Zanzibar Outreach Program (ZOP). With ZOP we traveled to Tumbatu Island to provide basic medical and dental care. I want to be a dentist, so I was very fortunate that I got the opportunity to shadow some dentistry with ZOP. I was even more fortunate that one of the volunteer dentists invited me to shadow at his practice the next day! So, not being able to shadow at Mnazi Mmoja Hospital did lead to a great opportunity. I’m very grateful that Daraja helped me gain this experience and make this connection possible even though dentistry is not their focus.
I am so thankful that I had the opportunity through the Daraja Foundation to go to Zanzibar, meet many incredible people, and have unforgettable experiences. A month there was not enough time for me! I look forward to returning in the future.
Jennifer :)
I went on this journey with one of my best friends from high school, Madie. Together we participated in several Daraja projects such as helping set up the Daraja and PLCI Bike Shop, introducing cooking classes at Mazizini Orphanage, and initiating the Hujambo Sijambo Global Connections Project with students from PLCI. We also wanted to shadow at Mnazi Mmoja Hospital, but since we do not have clinical training were unable to; however, Dr. Naufaul invited us to volunteer with ZOP (Zanzibar Outreach Program).
Overall, having the opportunity to meet and get to know so many people from Daraja, PLCI, Mazizini, and other miscellaneous places was my favorite part. We, like so many other Daraja volunteers, stayed in Bi Shemsha’s house in Lebanon Brother’s Square. I loved spending time with the Hundert Family and other travelers staying in the house (especially playing cards at night), learning Swahili from the shop owners in the square, and eating the infamous urojo street soup with Shah. Meeting the children in Mazizini was such a heartwarming and heartbreaking experience. They are so friendly, welcoming, and joyful. I felt like I could connect with them even though we may not speak the same language. It’s heartbreaking because I wish I could do more to help them, and I wish I could stay there longer. The students at PLCI gave me the same feeling of being welcomed. It was fun painting the future Bike Shop and meeting with the Bike Shop Team to discuss preparations for the arrival of the container of bikes and opening the business. I’m happy that I am able to keep in touch with several PLCI students and get updates about their progress.
The most unique part of my month trip was participating in Zanzibar Outreach Program (ZOP). With ZOP we traveled to Tumbatu Island to provide basic medical and dental care. I want to be a dentist, so I was very fortunate that I got the opportunity to shadow some dentistry with ZOP. I was even more fortunate that one of the volunteer dentists invited me to shadow at his practice the next day! So, not being able to shadow at Mnazi Mmoja Hospital did lead to a great opportunity. I’m very grateful that Daraja helped me gain this experience and make this connection possible even though dentistry is not their focus.
I am so thankful that I had the opportunity through the Daraja Foundation to go to Zanzibar, meet many incredible people, and have unforgettable experiences. A month there was not enough time for me! I look forward to returning in the future.
Jennifer :)
EVERYTHING IS HAPPENING SO FAST
Posted by Tennille on Friday, 03 July 2015
Posted by Tennille on Friday, 03 July 2015
It is the labouring women who are heading to these trenches that deserve this apology, not me.... these women have very little choice. And in of terms being able to shift the reality... these women have just as little voice. |
Welcome to Mnazi Moja Hospital "Martenity", or, the trenches as they are affectionately known by some. This department is in the main public hospital on the island of Unguja, Zanzibar where, as one local told me, when your wife goes into labour, you either get a wife or a child, but often times not both. Fortunately, those are not the real statistics. The real stats are much better that that. Though this seems to be the general sentiment on the island. Those anticipating delivery are afraid to go there. Those who have delivered seem to have had a fine enough experience, but then one tends to wonder how much of the experience they actually remember.
When locals gain awareness that working in maternity at Mnazi Moja was the purpose of my arrival in Zanzibar, they go out of their way to make it known that they are sorry, "Pole". Sorry for exactly what is unclear. Sorry for the experience? Sorry for the state of the department? Sorry for the fact that one should chose to embark upon this in first place? All of the above? Yet, it is the labouring women who are heading to these trenches that deserve this apology, not me. Seeking the best options in health care given to them, these women have very little choice. And in of terms being able to shift the reality before them, and to rouse the powers that be into making real change, these women have just as little voice.
The maternity unit of Mnazi moja hospital is something to witness. In the months working there, I saw both young interns and well experienced obstetricians come and go, many of them gritting their teeth determined not to feel a sense of shock in regards to what they witnessed, or at the very least to not show it when they did.
Perhaps it has to do with the introduction to the place. The day begins with morning meeting where the interns and senior doctors from both the maternity and gynaecology departments discuss current cases and reports are given. These meetings take place in a cramped hallway between the surgical theatre and the delivery room, though, to get there, one must first make it through the labour room.
On many an occasion I have heard the antenatal labour room described as a "war zone", and certainly at different times during the last seven months this description seems fitting. The ward is a large room, 18 beds, each bed separated by about a foot. In those beds, on a busy day, there can be as many as 40 labouring women, which means, up to three women in a single hospital bed. The beds are rusty, the canvas of the mattresses stained, the floors and walls are bloodied, the few windows that once had glass are now broken, none of the windows have screens. Mosquitos and flies are everywhere. There are even one or two cats weaving under the beds, darting out of the way of the hospital gurneys. The chaos is palpable. The beds are not numbered. Equipment is scattered here and there, some of it broken, little of it in working order. There is almost no structure as to which patients go where. Here, emergency cases are readily placed among the patients that are having healthy pregnancies. Among the normal labours, one can see labour complicated by pre-eclampsia, eclampsia, infection, diabetes, multiples, severe anemia, hemorrhage, grand multi parity, to name a few examples. To top it off, it is difficult on any given day to find out who is the intern in charge, even if your Swahili is perfect.
So, if one can brave the march passed these women, after seeing their circumstances, after hearing them cry out, "doctari, doctari" and manage to guard against the desire to jump in and try to be of assistance, any assistance. If one can push passed this sense of urgency in order to make it to the morning intern meeting, part of the battle has been met, at least the part it takes to simply show up and be there. Though, that being said, encountering the opponent does not mean that the battle has been won.
Maternity is 24/7. On average there are thirty babies born in a 24 hour period at Mnazi Moja. Which would be fine if babies came like clock work, by the hour or so, but nature has it own plan. Babies come when they will. It is surprisingly common to finish a round, check that everyone has been reviewed only to turn and find two, three or four new patients ready to deliver or even, that those babies are on their way. Like now! STAT!
Night shifts are insane. Finding a neonatal nurse in the middle of the night is nearly impossible. And if you dare to wake a sleeping intern seeking help for a complicated case, they will look you dead in the eye and say, "the more work you do, the less they will". The people referred to here are the likes of nurses, midwives and traditional birth attendants. Neglect is a problem. Not purposeful neglect, the place is a quagmire. There are simply not enough hands on staff, and even at that, the number of employed drops by one third after 4pm. One has to wonder how the staff manage day after day, night after night with their own families at home to care for. Surely, there must be an element of shell shock. This ward with all its challenges, is at the very least, shocking.
Supplies are a problem. Sometimes there are sterile gloves, sometimes not. Sometimes there are blades to cut umbilical cords, often times, none. Mostly ampules of oxytocin are available, other times, not a single one. Occasionally suture packs are on hand, many times not. Every once in a while, all of the above supplies are lacking. It is at such times, that one witnesses either the triumph of human creativity or feels completely overwhelmed by the incessant nature of human procreation, the sheer volume of the women enduring its processes, and the realization that even large donations are merely a drop in a very large bucket.
The hospital is a revolving door of foreigners which only adds to the chaos. Some volunteers come for as little as five days. Most are not speaking the language and more often than not, they have never seen anything like this before; a woman delivering in the hallway, eclamptic fit in the corner, labouring woman vomiting on the floor, stray cats carrying pieces of placenta in their mouths, dead babies wrapped in fabric in the delivery room, septic shock, maternal death. At times the moans can be so prevalent in every part of the room that they seem to be coming from the walls. Can you blame the interns for hiding in the corner looking confused? Standing around pale and grey? Everything is happening so fast. The sheer volume is too much, the inconsistency of supplies is angering; the chaos, dizzying.
Yet, in the face of all of this, these women respond. It is obvious that they appreciate the extra attention that comes with the extra hands. Even a small amount of care in this environment, goes a long way. And who wouldn't appreciate additional support, whether it be physical, emotional, or psychological? Especially at such a time in ones life and place, where there is not enough space to invite the natural support that most labouring women would turn to: husbands, mothers, aunts, friends, doulas.
Mnazi Moja maternity department, though it may be called the trenches or the "war zone" by some, is the birthplace of so many Zanzibaris. These labouring ladies, who are often without a voice, exemplify pride and quiet strength. They remind us of the micro when we feel like a spinning cog in the macro. They stand with their backs straight, their heads high and their modesty close. Though they may be the neglected demographic, they are who this work is all about. No matter how dire the situations of these women become, they remind with gentleness that the individual counts. It is the maternal death that did not happen that reminds us of the purpose and gets us through this overwhelming fight. It is the woman who asks to hold and grieve her dead child, who shows us the deep importance of solitude and sorrow. It is the woman whose premature baby who just won't latch, whom exemplifies a tenacity of spirit that never quit. And it is the mother, quietly bonding with her babe at breast, who shows us what peace may be found in chaos.
The sheer effort of a sincere smile, a look of gratitude in the midst of nonstop struggle is enough to drastically alter ones perspective and top up ones heart full to brimming. Yet, as the world, for the most part, does not see that these women are among those bearing the planet's brunt of infant and maternal mortality, it notices even less that these women have more to give to us than we could ever give to them. Regardless of how much one gives, be it , in time, in supplies, in skills, and no matter how much one feels that there is left to give, what is received, what is learned, what is taken away remains much more than what one could ever replace.
Xo Tennille
When locals gain awareness that working in maternity at Mnazi Moja was the purpose of my arrival in Zanzibar, they go out of their way to make it known that they are sorry, "Pole". Sorry for exactly what is unclear. Sorry for the experience? Sorry for the state of the department? Sorry for the fact that one should chose to embark upon this in first place? All of the above? Yet, it is the labouring women who are heading to these trenches that deserve this apology, not me. Seeking the best options in health care given to them, these women have very little choice. And in of terms being able to shift the reality before them, and to rouse the powers that be into making real change, these women have just as little voice.
The maternity unit of Mnazi moja hospital is something to witness. In the months working there, I saw both young interns and well experienced obstetricians come and go, many of them gritting their teeth determined not to feel a sense of shock in regards to what they witnessed, or at the very least to not show it when they did.
Perhaps it has to do with the introduction to the place. The day begins with morning meeting where the interns and senior doctors from both the maternity and gynaecology departments discuss current cases and reports are given. These meetings take place in a cramped hallway between the surgical theatre and the delivery room, though, to get there, one must first make it through the labour room.
On many an occasion I have heard the antenatal labour room described as a "war zone", and certainly at different times during the last seven months this description seems fitting. The ward is a large room, 18 beds, each bed separated by about a foot. In those beds, on a busy day, there can be as many as 40 labouring women, which means, up to three women in a single hospital bed. The beds are rusty, the canvas of the mattresses stained, the floors and walls are bloodied, the few windows that once had glass are now broken, none of the windows have screens. Mosquitos and flies are everywhere. There are even one or two cats weaving under the beds, darting out of the way of the hospital gurneys. The chaos is palpable. The beds are not numbered. Equipment is scattered here and there, some of it broken, little of it in working order. There is almost no structure as to which patients go where. Here, emergency cases are readily placed among the patients that are having healthy pregnancies. Among the normal labours, one can see labour complicated by pre-eclampsia, eclampsia, infection, diabetes, multiples, severe anemia, hemorrhage, grand multi parity, to name a few examples. To top it off, it is difficult on any given day to find out who is the intern in charge, even if your Swahili is perfect.
So, if one can brave the march passed these women, after seeing their circumstances, after hearing them cry out, "doctari, doctari" and manage to guard against the desire to jump in and try to be of assistance, any assistance. If one can push passed this sense of urgency in order to make it to the morning intern meeting, part of the battle has been met, at least the part it takes to simply show up and be there. Though, that being said, encountering the opponent does not mean that the battle has been won.
Maternity is 24/7. On average there are thirty babies born in a 24 hour period at Mnazi Moja. Which would be fine if babies came like clock work, by the hour or so, but nature has it own plan. Babies come when they will. It is surprisingly common to finish a round, check that everyone has been reviewed only to turn and find two, three or four new patients ready to deliver or even, that those babies are on their way. Like now! STAT!
Night shifts are insane. Finding a neonatal nurse in the middle of the night is nearly impossible. And if you dare to wake a sleeping intern seeking help for a complicated case, they will look you dead in the eye and say, "the more work you do, the less they will". The people referred to here are the likes of nurses, midwives and traditional birth attendants. Neglect is a problem. Not purposeful neglect, the place is a quagmire. There are simply not enough hands on staff, and even at that, the number of employed drops by one third after 4pm. One has to wonder how the staff manage day after day, night after night with their own families at home to care for. Surely, there must be an element of shell shock. This ward with all its challenges, is at the very least, shocking.
Supplies are a problem. Sometimes there are sterile gloves, sometimes not. Sometimes there are blades to cut umbilical cords, often times, none. Mostly ampules of oxytocin are available, other times, not a single one. Occasionally suture packs are on hand, many times not. Every once in a while, all of the above supplies are lacking. It is at such times, that one witnesses either the triumph of human creativity or feels completely overwhelmed by the incessant nature of human procreation, the sheer volume of the women enduring its processes, and the realization that even large donations are merely a drop in a very large bucket.
The hospital is a revolving door of foreigners which only adds to the chaos. Some volunteers come for as little as five days. Most are not speaking the language and more often than not, they have never seen anything like this before; a woman delivering in the hallway, eclamptic fit in the corner, labouring woman vomiting on the floor, stray cats carrying pieces of placenta in their mouths, dead babies wrapped in fabric in the delivery room, septic shock, maternal death. At times the moans can be so prevalent in every part of the room that they seem to be coming from the walls. Can you blame the interns for hiding in the corner looking confused? Standing around pale and grey? Everything is happening so fast. The sheer volume is too much, the inconsistency of supplies is angering; the chaos, dizzying.
Yet, in the face of all of this, these women respond. It is obvious that they appreciate the extra attention that comes with the extra hands. Even a small amount of care in this environment, goes a long way. And who wouldn't appreciate additional support, whether it be physical, emotional, or psychological? Especially at such a time in ones life and place, where there is not enough space to invite the natural support that most labouring women would turn to: husbands, mothers, aunts, friends, doulas.
Mnazi Moja maternity department, though it may be called the trenches or the "war zone" by some, is the birthplace of so many Zanzibaris. These labouring ladies, who are often without a voice, exemplify pride and quiet strength. They remind us of the micro when we feel like a spinning cog in the macro. They stand with their backs straight, their heads high and their modesty close. Though they may be the neglected demographic, they are who this work is all about. No matter how dire the situations of these women become, they remind with gentleness that the individual counts. It is the maternal death that did not happen that reminds us of the purpose and gets us through this overwhelming fight. It is the woman who asks to hold and grieve her dead child, who shows us the deep importance of solitude and sorrow. It is the woman whose premature baby who just won't latch, whom exemplifies a tenacity of spirit that never quit. And it is the mother, quietly bonding with her babe at breast, who shows us what peace may be found in chaos.
The sheer effort of a sincere smile, a look of gratitude in the midst of nonstop struggle is enough to drastically alter ones perspective and top up ones heart full to brimming. Yet, as the world, for the most part, does not see that these women are among those bearing the planet's brunt of infant and maternal mortality, it notices even less that these women have more to give to us than we could ever give to them. Regardless of how much one gives, be it , in time, in supplies, in skills, and no matter how much one feels that there is left to give, what is received, what is learned, what is taken away remains much more than what one could ever replace.
Xo Tennille
A FACE FULL OF EXPRESSION
Posted by Jaffar Pandu on Monday, 20 April 2015
Posted by Jaffar Pandu on Monday, 20 April 2015
I was shocked to see his mouth hung open, his eyes rolled back, his chest moved quickly struggling for oxygen. I reached out and held him in my arms; he was so light |
I have been a partner and a Director with the Daraja Foundation since it began, and I'd like to tell share where I'm at with my own growth and experience. I worked very hard at Mnazi Mmoja Hospital and Muembelado in the maternity ward, I worked 6-7 days a week, because we only have a few doctors on staff. I work mainly in the operating room completing c-sections. There are on average 50 deliveries a day just in this hospital, and of course, with the lack of resources, supplies and monitoring, our main referral hospital is busy and challenging. There are many causes for our high maternal mortality rates, with postpartum hemorrhage, eclampsia and severe anemia being at the top of the list. I was in charge at Mwembelado Hospital last year and decided I wanted to continue my education and complete a masters program on the mainland so I can be one part in the efforts to improve maternal health care. I have every intention to continue my efforts through Daraja, my heart is set on sharing my medical knowledge and skills to benefit my colleagues and the people of Zanzibar. I think every little contribution counts. Many organizations are involved and are working together towards better working conditions, and I want to represent Daraja in doing this, I want to not only help make the hospital care better, but also work with other organizations on prevention in the community. We plan to bring in medical volunteers, share ideas, create change and over time work together to help our mothers deliver safely and help save lives. Last year I applied to complete a masters program over 3 years, and I was supported by Daraja Foundation.
In September, I will have been on the mainland for a year. In this first year we are studying basic subjects including clinical skills and teaching methodology. In our second year we will have options for our specialties. I passed all seven subjects in our first semester and I promise you... I will do my best to pass the second semester and everything beyond that. I hope that one day I will be a Director at Mnazi Mmoja Hospital, and I hope to also expand our activities to Pemba. I also want to be a primary physician visiting orphanages to ensure the kids are looked after. Since I joined Daraja Foundation, I had the opportunity to be available to assess the children. We saved Hadir's life last year. This is what Leah, a volunteer, wrote about about the youngest boy at the orphanage when we were there:
"Waiting in the living room the children sat on the floor anxiously for their shoes. They had grown so much in a year; young girls became little women, the toddlers into rambunctious boys. Scanning the room I noticed an older woman holding a baby, I hadn’t seen him before. Curious, I walked over and looked at his hidden face. I was shocked to see his mouth hung open, his eyes rolled back, his chest moved quickly struggling for oxygen. I reached out and held him in my arms; he was so light, maybe 7 pounds. I asked the lady how old he was and she said 4 months. Looking back at him I touched his face with the back of my hand, it was burning hot. With urgency I looked to my team. We had to help him. We surrounded him and continued our assessments. With the help of the workers we learned that his name was Hadir, he was abandoned on the street by his parents when the orphanage took him in, he had been sick for over a week with dehydration, he was losing weight and his fever rising, he was vulnerable, he needed intervention. We drove Hadir straight to Mnazi Mmoja Hospital’s pediatric ward. As we waited in the hallway Dr. Jaffar took him to the observation room with the other medical staff. Minutes later the doctor informed us that Hadir had a high-grade fever, was anemic, dehydrated, and malnourished. He was admitted to the hospital, put on IV fluids, had a blood transfusion, and was fed nutrient rich formula. We went to visit him a couple times making sure he was ok. A week later he was discharged from the hospital, I didn’t even recognize him when I went back to the orphanage. His cheeks were chubby, his eyes vibrant, and his face full of expression" - Leah
My dreams are coming true, I hope soon to finish and to go back to Zanzibar to work effectively with our hospital, with orphanages and with Daraja.
Dr. Jaffar Pandu
In September, I will have been on the mainland for a year. In this first year we are studying basic subjects including clinical skills and teaching methodology. In our second year we will have options for our specialties. I passed all seven subjects in our first semester and I promise you... I will do my best to pass the second semester and everything beyond that. I hope that one day I will be a Director at Mnazi Mmoja Hospital, and I hope to also expand our activities to Pemba. I also want to be a primary physician visiting orphanages to ensure the kids are looked after. Since I joined Daraja Foundation, I had the opportunity to be available to assess the children. We saved Hadir's life last year. This is what Leah, a volunteer, wrote about about the youngest boy at the orphanage when we were there:
"Waiting in the living room the children sat on the floor anxiously for their shoes. They had grown so much in a year; young girls became little women, the toddlers into rambunctious boys. Scanning the room I noticed an older woman holding a baby, I hadn’t seen him before. Curious, I walked over and looked at his hidden face. I was shocked to see his mouth hung open, his eyes rolled back, his chest moved quickly struggling for oxygen. I reached out and held him in my arms; he was so light, maybe 7 pounds. I asked the lady how old he was and she said 4 months. Looking back at him I touched his face with the back of my hand, it was burning hot. With urgency I looked to my team. We had to help him. We surrounded him and continued our assessments. With the help of the workers we learned that his name was Hadir, he was abandoned on the street by his parents when the orphanage took him in, he had been sick for over a week with dehydration, he was losing weight and his fever rising, he was vulnerable, he needed intervention. We drove Hadir straight to Mnazi Mmoja Hospital’s pediatric ward. As we waited in the hallway Dr. Jaffar took him to the observation room with the other medical staff. Minutes later the doctor informed us that Hadir had a high-grade fever, was anemic, dehydrated, and malnourished. He was admitted to the hospital, put on IV fluids, had a blood transfusion, and was fed nutrient rich formula. We went to visit him a couple times making sure he was ok. A week later he was discharged from the hospital, I didn’t even recognize him when I went back to the orphanage. His cheeks were chubby, his eyes vibrant, and his face full of expression" - Leah
My dreams are coming true, I hope soon to finish and to go back to Zanzibar to work effectively with our hospital, with orphanages and with Daraja.
Dr. Jaffar Pandu
TODAY WAS A NEW DAY... I WAS WRONG
Posted by Sharmeen Mahmood on Tuesday, 27 January 2015
Posted by Sharmeen Mahmood on Tuesday, 27 January 2015
The overcrowded maternity ward smelled like blood, sweat and chemicals. The sheets looked like they had never been washed. Each patient was given their own piece of tarp to sit on |
Medical school is tough. After studying from textbooks for a year and a half without seeing much of the clinical aspect of medicine, I was feeling burnt out. Why am I studying so hard? Is this worth it? Should I have chosen an easier career? All these questions swam around in my head as I left the comforts of Canadian living with the hopes of putting my medical education to use. In order to disprove these doubts and alleviate my fears, I sought out on a mission to dedicate myself to something greater than the knowledge aspect of medicine. Zanzibar is a gorgeous tropical island frequently visited by tourists. The Mnazi Mmoja hospital was situated right on the beach and was a beautiful new building. While the hospital itself was relatively new, it was painfully understaffed and continuously running out of supplies. Mnazi Mmoja is also a teaching hospital, so I had the opportunity to make many friends my age that acted as translators and mentors for me. I felt welcomed by everyone and was excited to learn in such a positive environment.
The first week I started out in the Pediatrics ward, shadowing doctors with other students as they explained common childhood illnesses, their complications, and treatments. As I expected, I saw a lot of illnesses that you would rarely see back home, tetanus, TB, malnutrition. I got to listen to a patent ductus arteriosus- it’s a childhood heart defect that makes the heart sound like a whirring machine. Several babies had such defects and required surgery, but they cannot be treated anywhere in Tanzania. I was surprised to learn their cases were referred to hospitals all the way in India. I enjoyed spending time with my international counterparts; we studied together, and exchanged enlightening and humorous stories. I was especially keen on their experiences with clinical medicine so early on in their medical education; it seemed they already had much more responsibility as students in two years then a Canadian or American student. But also to my amusement, the other students were just as lost as I was at times with the overwhelming amount of information there is to know, I guess that’s just a universal trait for medical students.
The second week I moved to the maternity ward. This was a whole different world. There was a delivery room with three beds down a hallway from where the other pregnant women waited until they were in active labor. The overcrowded maternity ward smelled like blood, sweat and chemicals. The sheets looked like they had never been washed. Each patient was given their own piece of tarp to sit on, and often they had to share single beds. There were no dividers between the beds unless a pelvic exam was being conducted. Family members were not allowed in the maternity room due to overcrowding. While outwardly the women expressed no emotional anxiety, except the physical pain of birth, they must have been terrified. As a health care provider in training, I was also terrified. . The culture shock was immense, and although I read up on obstetrics and gynecology to prepare, nothing I had studied could have truly prepared me for what I encountered. As the days went by I got used to the fear and I pushed it to the back of my mind in order to focus on what was happening around me. I learned that when we ran out of clamps we used rubber gloves to tie the umbilical cord. When we ran out of sterile razors we used a sterile needle to cut it. Sometimes there was no room for women undergoing labor to be moved to the delivery room. Sometimes there was just no time. When this happened, one woman would begin giving birth right where she was sitting while the rest of the women watched, and staff ran over to help. I had a lot of questions about everything and one doctor’s comment pretty much summed up the answer, “welcome to Africa.”
In medical school we place a great deal of emphasis on patient rights. The patient gets a say in health care decisions and ultimately has the right to accept or reject treatment options based on their personal beliefs. The changes I had to make from what I had learned to the realities of healthcare practices in this hospital were shocking to me, but necessary. Due to the understaffed and under-equipped nature of the maternity ward, it simply wasn't feasible to give each patient more attention than necessary. Things happened really fast, but at the same time it felt like time was moving too slowly. I’ll give you an example. After learning the procedure and helping with several deliveries, one of the residents said the next time a woman gave birth I would be allowed to deliver the baby by myself. The woman I was assigned was already overdue for her delivery and she was given medication to increase her contractions. For hours I waited with her, holding her hand, wiping her sweat, offering her porridge to keep up her strength and water to keep her hydrated. I wanted to feel connected to this patient, it was the first time I would be delivering a baby on my own so it was special to me. The resident would come in every once in a while to see if she was ready to deliver, and would increase her medication and leave again. Then he came in and told me he had to do an emergency C-section on another patient, and with no signs of any baby yet with my patient, he said he would be back soon. Within the next ten minutes I saw the top of the baby’s head. There was no one else around, this baby was coming out--NOW. So a nursing student and I proceeded to deliver the baby, everything went smoothly up until the point the entire head was out and we saw the cord was wrapped around the baby’s neck, twice. A nurse walked by at that moment and immediately started screaming directions at us. Unwrap the cord! Put gauze in the baby’s mouth! Rub it’s back! Give the mother this injection! I was blindly following directions and after about 5 minutes of panic the nurse stated matter-of-factly, “tell the mother the baby is dead” and walked away. I could not hold back my tears and I walked out of the room in a daze. I took the rest of the day off.
The next day I didn’t want to go back. I thought about it for a long time and decided that I needed to do this and that today was a new day and nothing like that would happen again. I was wrong. I walked into the maternity ward and to my left, one women was tied to the bed by her arms and legs and had gauze wrapped around a tongue depressor in her mouth, she was having seizures. All the other women sitting around her watched but didn't say anything. Another woman was covered in her own blood waiting for her turn in the surgery room. The women also saw this, but no one said anything. I find people here are not meddlesome. They mind their own business and worry about themselves. They just wanted to be in and out with their baby. They didn't expect comfort and they didn't complain when they didn’t receive anything either, not even a kind word. It was hard to accept that medicine is practiced here, and I'm sure a lot of places without the empathy component. As an American medical student I am trained in the art of talking to patients’, to be kind and empathetic and make sure the patient is involved in the decision making for their healthcare. In a place where supplies are low, it is understaffed and the line of waiting patients is ever growing it’s the only way the hospital survives. The hospital keeps running. The babies don’t always survive. That was by far the most difficult thing I had to experience. Watching a woman give birth to a child that was not living after hours of labor and having to hold that child and not being able to communicate my sorrows to her, that was hard.
I chose to spend two weeks in Zanzibar, and it passed by so quickly. Even at the hospital everyone kept asking me why I didn’t want to stay longer. By the time I had established a routine, it was already time to go, so I really recommend staying for at least a month. I almost feel guilty for saying what kept me going is the thought that I would go back to the comforts and privileges of a Western healthcare system, that I wouldn’t have to be traumatized everyday by a new disaster. The health providers here, this was their daily grind, and making do with what you have is just common practice. I appreciate the broadened perspective I gained from this experience and truly recommend it to anyone in the health care profession. I know that throughout my years of practice I will continue to travel to under-serviced communities and I hope one day I will come back to Zanzibar with more knowledge and confidence to help as many patients as possible. The Daraja Foundation is also amazing. I spoke with the coordinators of the program and they purchased new fetal heart monitors for the hospital, since this was a big problem with assessing the health of the babies before labor. They also constantly provide essential medical supplies obtained through donations. I certainly gained the motivation to continue through the years of training required. Even more than that, I discovered this isn’t just going to be a job to me, more like a calling to pursue my passion and follow my dreams.
The first week I started out in the Pediatrics ward, shadowing doctors with other students as they explained common childhood illnesses, their complications, and treatments. As I expected, I saw a lot of illnesses that you would rarely see back home, tetanus, TB, malnutrition. I got to listen to a patent ductus arteriosus- it’s a childhood heart defect that makes the heart sound like a whirring machine. Several babies had such defects and required surgery, but they cannot be treated anywhere in Tanzania. I was surprised to learn their cases were referred to hospitals all the way in India. I enjoyed spending time with my international counterparts; we studied together, and exchanged enlightening and humorous stories. I was especially keen on their experiences with clinical medicine so early on in their medical education; it seemed they already had much more responsibility as students in two years then a Canadian or American student. But also to my amusement, the other students were just as lost as I was at times with the overwhelming amount of information there is to know, I guess that’s just a universal trait for medical students.
The second week I moved to the maternity ward. This was a whole different world. There was a delivery room with three beds down a hallway from where the other pregnant women waited until they were in active labor. The overcrowded maternity ward smelled like blood, sweat and chemicals. The sheets looked like they had never been washed. Each patient was given their own piece of tarp to sit on, and often they had to share single beds. There were no dividers between the beds unless a pelvic exam was being conducted. Family members were not allowed in the maternity room due to overcrowding. While outwardly the women expressed no emotional anxiety, except the physical pain of birth, they must have been terrified. As a health care provider in training, I was also terrified. . The culture shock was immense, and although I read up on obstetrics and gynecology to prepare, nothing I had studied could have truly prepared me for what I encountered. As the days went by I got used to the fear and I pushed it to the back of my mind in order to focus on what was happening around me. I learned that when we ran out of clamps we used rubber gloves to tie the umbilical cord. When we ran out of sterile razors we used a sterile needle to cut it. Sometimes there was no room for women undergoing labor to be moved to the delivery room. Sometimes there was just no time. When this happened, one woman would begin giving birth right where she was sitting while the rest of the women watched, and staff ran over to help. I had a lot of questions about everything and one doctor’s comment pretty much summed up the answer, “welcome to Africa.”
In medical school we place a great deal of emphasis on patient rights. The patient gets a say in health care decisions and ultimately has the right to accept or reject treatment options based on their personal beliefs. The changes I had to make from what I had learned to the realities of healthcare practices in this hospital were shocking to me, but necessary. Due to the understaffed and under-equipped nature of the maternity ward, it simply wasn't feasible to give each patient more attention than necessary. Things happened really fast, but at the same time it felt like time was moving too slowly. I’ll give you an example. After learning the procedure and helping with several deliveries, one of the residents said the next time a woman gave birth I would be allowed to deliver the baby by myself. The woman I was assigned was already overdue for her delivery and she was given medication to increase her contractions. For hours I waited with her, holding her hand, wiping her sweat, offering her porridge to keep up her strength and water to keep her hydrated. I wanted to feel connected to this patient, it was the first time I would be delivering a baby on my own so it was special to me. The resident would come in every once in a while to see if she was ready to deliver, and would increase her medication and leave again. Then he came in and told me he had to do an emergency C-section on another patient, and with no signs of any baby yet with my patient, he said he would be back soon. Within the next ten minutes I saw the top of the baby’s head. There was no one else around, this baby was coming out--NOW. So a nursing student and I proceeded to deliver the baby, everything went smoothly up until the point the entire head was out and we saw the cord was wrapped around the baby’s neck, twice. A nurse walked by at that moment and immediately started screaming directions at us. Unwrap the cord! Put gauze in the baby’s mouth! Rub it’s back! Give the mother this injection! I was blindly following directions and after about 5 minutes of panic the nurse stated matter-of-factly, “tell the mother the baby is dead” and walked away. I could not hold back my tears and I walked out of the room in a daze. I took the rest of the day off.
The next day I didn’t want to go back. I thought about it for a long time and decided that I needed to do this and that today was a new day and nothing like that would happen again. I was wrong. I walked into the maternity ward and to my left, one women was tied to the bed by her arms and legs and had gauze wrapped around a tongue depressor in her mouth, she was having seizures. All the other women sitting around her watched but didn't say anything. Another woman was covered in her own blood waiting for her turn in the surgery room. The women also saw this, but no one said anything. I find people here are not meddlesome. They mind their own business and worry about themselves. They just wanted to be in and out with their baby. They didn't expect comfort and they didn't complain when they didn’t receive anything either, not even a kind word. It was hard to accept that medicine is practiced here, and I'm sure a lot of places without the empathy component. As an American medical student I am trained in the art of talking to patients’, to be kind and empathetic and make sure the patient is involved in the decision making for their healthcare. In a place where supplies are low, it is understaffed and the line of waiting patients is ever growing it’s the only way the hospital survives. The hospital keeps running. The babies don’t always survive. That was by far the most difficult thing I had to experience. Watching a woman give birth to a child that was not living after hours of labor and having to hold that child and not being able to communicate my sorrows to her, that was hard.
I chose to spend two weeks in Zanzibar, and it passed by so quickly. Even at the hospital everyone kept asking me why I didn’t want to stay longer. By the time I had established a routine, it was already time to go, so I really recommend staying for at least a month. I almost feel guilty for saying what kept me going is the thought that I would go back to the comforts and privileges of a Western healthcare system, that I wouldn’t have to be traumatized everyday by a new disaster. The health providers here, this was their daily grind, and making do with what you have is just common practice. I appreciate the broadened perspective I gained from this experience and truly recommend it to anyone in the health care profession. I know that throughout my years of practice I will continue to travel to under-serviced communities and I hope one day I will come back to Zanzibar with more knowledge and confidence to help as many patients as possible. The Daraja Foundation is also amazing. I spoke with the coordinators of the program and they purchased new fetal heart monitors for the hospital, since this was a big problem with assessing the health of the babies before labor. They also constantly provide essential medical supplies obtained through donations. I certainly gained the motivation to continue through the years of training required. Even more than that, I discovered this isn’t just going to be a job to me, more like a calling to pursue my passion and follow my dreams.