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UK Travel Bursary Scheme: Jessica Carroll

BSc (Hons) Pre-Registration Adult Nursing

The first thought I had of Tanzania was wow - it was completely different to any place I had visited before. The city centre was very built up and westernised, and out of the centre were the poorer parts of Tanzania. I had never seen anything quite like it, people roaming the streets, sleeping rough and little shacks as people's houses. It was very busy, with lots of traffic and pollution, and was very dirty.

The visit to the hospital on the dala dala was an experience; a bus packed with people, no personal space in the boiling heat and people hanging out of the doors. It was definitely different to buses back home. The hospital was big and very busy, I was quite surprised to see some of the services they had, for example the diabetic clinic. I spent three weeks on the female surgical ward which catered for gyne patients also. On my first day I realised how good our national health service actually is compared to what I saw in Tanzania. The ward was dirty, with hardly any resources and what they did have wasn't to the best quality. There was one pulse oximeter and BP cuff for the whole ward, the thermometer wasn't disposable so was reused after every patient without being cleaned and vital signs were done but not routinely.

I was amazed to see up to three women sharing a bed with no bed sheets and there was no cleaning down of the beds after each patients use. Sharp boxes were overflowing and a hazard. I was making beds one morning, pulled back the sheet to see a needle just lying on the bed. There is absolutely no infection control or precautions; there are flies everywhere and stray cats wondering around the ward. The nurses don't use aseptic technique in procedures, for example, when inserting a catheter they let it dangle everywhere, they don't use sterile gloves and just do a quick clean of the area. They also pump the balloon up with air rather than water. When inserting cannulas they don't clean the skin first, they smack the veins and use a glove as a tourniquet, and if the cannula was dropped on the floor then it would be picked up and reused. If a patient required an injection, the nurse would poke the needle into the bed until she was ready to give the injection. For a patient to be admitted they had to pay around £4, and no procedure or medical attention would be given until they paid.

The patients had to buy all of their own equipment i.e: syringes, cannulas and fluids, these were then stored at the top of a patient’s bed in a plastic bag. When fluids were put up, drip rate was never calculated and needles were poked in the top to help it drain. If equipment needed cleaning then it would be placed into a bucket of jick solution for 10 minutes, then into soapy water for another 10 minutes and then for a further 10 minutes into clean water. If equipment such as forceps needed sterilising, then it would be placed into a heating device for 10 minutes, taken out and stored in a container. Gauzes didn't come in packets and weren’t sterile - they had to be hand folded and cut and then placed into the heating device.

Ward rounds are never on time and they are very disorganised - they can go from one end of the ward to the other and miss patients out. A patient was fitted with an NG tube, when I asked what sort of feed they used I was told there was no sort of feed and that the family just put anything liquid down it. I saw the worst case of cellulitis I have ever seen. It covered a large proportion of the patient’s thigh and went right down the bone. The doctor shaved the edges of the skin off with a blade and told me that this would help with the healing, and he then cleaned the area with iodine and saline and just wrapped it in gauze. I asked what would happen to the patient and the doctor said that the only thing they could do would be a skin graft.

Nurses didn't really show any compassion or empathy towards the patients. They would yell at the patients if they were moaning because of the pain. Nurses and doctors were constantly on their phones and sitting on patients’ beds talking to each other.

The hardest thing was the language barrier. As nurses, we are constantly talking to our patients so it was very frustrating not being able to show the patient any empathy or support. A lot of the patients hadn't seen a white person before so all eyes were on me wherever I went. Within the ward was a gyne room for procedures such as abortions. The procedures were shocking.

I also spent a day in theatre, very different to theatre in the UK. There was a ventilation machine which I was quite surprised to see and a observation monitor, but not a lot of equipment. All of the procedures I watched were all done under spinal. Their sterile packs with all the instruments in were cloth and the cloth just got re sterilised and used again, so I assume it's not very sterile. Half way through a procedure we had a power cut, there was no backup generator so the obs machine went off, therefore there was no way of telling what the vital signs of the patient were. A nurse stood with her phone as a torch for light over the patient and the op continued.

Whilst in Tanzania I visited an orphanage, the kids were adorable. We took them stickers, bubbles and footballs; they were over the moon with all of the stuff. They loved the stickers and they stuck them all over our faces. They all loved the attention. The living conditions at the orphanage were poor, the kids’ clothes were dirty, they were covered in urine but they never stopped smiling.

For the last week I spent my time in a rural village in Tanzania. What an experience, it's the best thing I have ever done. I was quite surprised at the hospital within the village, it's not what I expected at all - even though it wasn't the best it was still better than expected. They too had limited resources as the wards were small with only about five beds. They had a laboratory which was quite impressive, with microscopes, MSU machine and a HB machine. The doctors and nurses here were brilliant as they explained everything and got us involved. They had a brand new theatre but hadn't been equipped and open yet.

Whilst on placement, we also visited the nearby villages and provided the under fives with vaccinations. The babies would first get weighed, the scale would be hooked onto a tree and the baby would be hooked onto the scale in some cloth. The baby’s weight would then be jotted down on a centile chart to see the pattern of weight each month. The babies would then be grouped ready for vaccination or vitamin tablets. When giving the injections the nurses never drew back and inserted the whole needle, when I commented on the fact the needle could snap off the nurse just said they hold onto the plastic part of the needle so in the case it does snap they could pull it out. The nursing in Tanzania is so different, it makes me realise how hard our nurses work and the quality of care they give. Whilst in the village we visited a primary school which was really good, we got involved in their games which were fun; it was great to see all the kids enjoying school. We also visited a witch doctor, which was very bizarre. A lot of the locals visit the witch doctor to try alternative medication for the treatment of illnesses such as, malaria, typhoid and joint problems.

Although the living conditions in the poorer parts of Tanzania are very basic, the people never stop smiling. It just puts things into perspective that we take a lot of things for granted and we are never happy until we get the new range gadget. The people from Tanzania don't have hot running water or electricity and a hole in the ground for a toilet, yet all they want is family and a sense of community. I feel the trip/experience has changed me as a person, I feel I have gained more confidence and independence, I would definitely recommend this to anyone.