News and events

UK Travel Bursary Scheme: Justine McKinven

BSc (Hons) Pre-Registration Adult Nursing

On reflecting on my time in Tanzania, I have learnt a lot about their culture and the differences between our health care systems. When I first arrived in Tanzania I felt a bit lost. The hospital was bigger than I expected, but did seem to be limited on resources. I was on the outpatients department, which was equivalent to our accident and emergency. After spending six weeks in an A&E in Lancashire I could see very clearly they had very few resources. In the resuscitation room there was no equipment and a staff member had to go and get oxygen if needed. In the UK, we have everything in arms reach to treat the patient. Even if a patient was in the resuscitation room they would give minimal assistance until all the medical supplies were bought, as they don’t have supplies. The hospital also did not have scanners, so patients needing a scan had to be requested and then transferred to the national hospital. Again this is a lengthy process for someone that is critically ill. I spoke to my mentor about this, and the differences in our hospitals. She said that the department had already developed a lot of the last few years and that she hoped one day they would be able to get more resources but she doubted it would happen. She said they just get on with things as best as they can.

In Tanzania the patient can wait a long time to be seen, even if they are seriously ill. This is due to Tanzanians having to pay for their health care. A patient can be prescribed medication but has to wait for it, whilst a family member goes to the pharmacy to buy it. This has made me value the NHS a lot more and what our health system provides for us. In the UK the health care provided is also a lot more compassionate than in Tanzania. Nurses very rarely talk to their patients and didn't really seem to empathise with them. When speaking to one nurse she told me that they didn't really have time to sit with patients and that's what families are for. This is completely different than in the UK as we try to improve our care and compassion consistently and always try to make time for individual patients. I found this part of nursing difficult in Tanzania as I wanted to spend more time with the patients. The nurses didn’t really understand when I tried to communicate with people. This was very hard at times due to the language barrier. I feel that my communication skills have improved with my international placement because of this. The majority of patients didn't speak English and my Swahili was very limited so a lot more body language was used to communicate with the patients.

At times I found this placement very hard and upsetting during some of the procedures that you wouldn't see carried out in the same way in the UK. As I mentioned they have limited resources in Tanzania, and they cannot afford general anaesthetics. With limited resources and patients paying themselves, I saw Cannulas being reused when dropped on the floor, and they didn’t really have sterile fields like we do here. There isn’t infection control, and if the hospital was busy, patients had to share beds and there were very rarely sheets on the bed.

I also got to spend a day in the orthopaedic clinic. I found this very interesting, as I’ve never done this before. The staff were very friendly and showed me what to do and then let me have a go, whilst being supervised. It was very busy and they had to be quick as they had a full waiting room, which never seemed to empty.

During my time in the village I learnt a lot about the Tanzanian culture, in the afternoons we got to do activities, to see the village and their culture. I got to spend time with the Masai tribe, to see how they live and learn about their heritage. This was very interesting, they let us try on their tribal clothes and we helped to milk their cows. They were very welcoming, friendly and enjoyed teaching us about their culture. At the primary school the children were amazed by us, it's not often they see Caucasian people. They called us mzungos, which is what they say got a ‘white person’. Some were fascinated by us. Going to a country like that makes me realise how lucky we are that we live in a multi-cultural society, as the Tanzanian people couldn't believe that we had black people living in Britain and couldn't understand how they could be British and that they live alongside Caucasian people.

The other activities involved spending time with the village people, and we joined in with the African dancing, which was a lot of fun. We saw a witch doctor, although the villagers are not using them as much now as they are using the health care systems. We also spent time weaving baskets. The people can spend days making these and they were sold for £2! We went to a market where handmade souvenirs were crafted and carved out of wood. We went behind the scenes to see the workers. They are very talented people, and it can take them weeks to carve something by hand yet it is sold so cheaply. When you see all the hard work that is put in, again, it makes you think about the United Kingdom and how we have a set minimum wage to ensure people are paid enough to live on. The village was an amazing place, with beautiful scenery and at night the sky was just covered with stars and just looked amazing.

In the village they had no electricity. The hospital runs on solar power to provide a limited supply. The hospital catered for the 4,000 people in that village and the next village with the same amount of people. At the present time they are trying to build onto the hospital to cater for all the people it has to provide health care for. They showed us to their new theatre, which was nearly up and running. This would save people having to go to the main government hospitals, which would cost them more due to travel prices. They were very grateful at the hospital supplies we took them and showed us around their laboratory as to what they used certain things for. As there are a lot of people over such a big area, they have a lot of outreach clinics at the Masai village for vaccinations. During one of these clinics for under five year olds, they ran out of a vaccine. They said this happens frequently as there is such a large number of children needing vaccinating and that they can’t get hold of enough vaccinations. This was my first time working with children, as I’m a general adult student, and I found this hard because the children were so tiny and cried and screamed, which I wasn’t used to.

Living with no electricity was hard to get used to. It's dark by 7pm so torches are needed. All the cooking is done on a fire outside and is then eaten in torch light. The majority of people spend their nights playing cards. We did this every night with the family we were staying with. They showed us the card games they knew and then we taught them the ones we know. Again at times there was a communication barrier as the family couldn’t speak English and I knew little Swahili. I had had lessons for three weeks but it wasn’t an easy language to learn.

I was lucky enough to see some of Tanzania sightseeing during my time off placement and to see what a beautiful country it is. I went on safari which was amazing to see the national park and to see animals roaming around free in their land. I got to see a lot of elephants which are my favourite animal. I also had the chance to go to the island of Zanzibar - their old stone town was amazing to see and to learn about their history. I also saw some of their amazing beaches.

Whilst there, I spent time at an orphanage where the children had nothing, and they were so excited to see us and play with us. We took them some toys and colouring things and they loved it. They liked to take photos of themselves to see what they looked like. It was very sad to see some of the children, whose clothes were too small and dirty and beds were just mattresses piled up on the floor. It was good to see them so happy whilst we were there.

Overall Tanzania has broadened my mind as to what is out in the world and how you can be quite ignorant to what is going on in other countries. I had the best time of my life in Tanzania, and have a lot of memories from it. I met some lovely people; all the staff at the two hospitals were very friendly and welcoming, and let me participate in a lot. Also the people I lived with in the ‘work the world’ house, who were from different countries and it was good to talk about what had happened that day and how it was different to our experiences back home. This meant I didn’t just learn about the Tanzanian health care system but also American, Canadian and Spanish health provisions. I feel that this placement has made me a more confident person, which I think will help me within my nursing career - talking with patients and their families. I also feel my communication skills have improved, through my body language skills but also finding how to communicate with people when they may not speak the same language as I do. I hope that in the future I can go back to Tanzania as a qualified nurse and hopefully see the improvements and changes that the staff want to improve patient care.