Tanzania
Trip Report - Dr. Samuel Feinstein - May, 2007:
4.1 Were there challenges or difficulties with your internship that HealthCare Volunteer should know about? In country travel is quite arduous. The roads are bad to non existent in most places. Traveling to western Tanzania, other than the one stretch form Dar to Mbeya, one should expect difficult and, in some places, somewhat dangerous conditions. Bus travelers must be aware of the differences in bus lines and to avoid all but the most “luxurious� (a euphemism for tolerable.) Remember the line called “Sumray� and try to stay with it.
4.2 How could your internship have been improved? There is nothing that the organization can do. Medical volunteers must be prepared to “wing it� in almost all situations. There is little, materially to work with. I would not suggest sending anyone to Sumbawana that does not have enough clinical experience to be proactive. Under current conditions technicians, other than surgical, would be of no value. I would not suggest sending medical students there unless they are in a group with someone to organize their experience and teach them.
4. 3 How likely are you to volunteer through HealthCare Volunteer again? Why or why not: Very likely. HCV (my abbreviation) has been easy to work with, very helpful and has enabled me to find a place to work where my skills are uniquely helpful and the opportunity to live among people who are a pleasure to know.
Continuation of Written report
A good deal of what I have to report has already been stated above. In summary I would like to state that this has been a wonderful experience. I have gotten to know some extraordinary people and, I believe, contributed in some measure to their well being
Specifically: 1. The work: Sumbawanga, though an area comprising some 250,000 people and having a government hospital of 250 beds is a medically primitive place. Surgical equipment and supplies, including anesthesia, are on a level corresponding to the 1920’s. Drugs are few and only three or four of the oldest, generic antibiotics are available. There is no available oxygen, pulmonary assistance, ward suction or any of the conveniences we take for granted. Wound care dressings are scant and haphazard. That being said there are great people there with various degrees of training that have developed methods and skills to work around the deficiencies. The chief physician there (there are only 3) is a surgeon named Jasper Duwasindi. He is marvelous. We bonded from the outset and as I taught him modern techniques and decision-making processes, he schooled me on the nitty-gritty of dealing with such things as malaria, typhoid and picking up the pieces after a local traditional healer (read witch doctor) had screwed things up for a week. I got to perform the following:
Several cases of intestinal perforation secondary to typhoid. (Never seen that before)
` Many pediatric hernias – some threatening to become incarcerated
Open removal of bladder stones. This procedure is done only when cystoscopy equipment is not available.
Hysterectomies for benign (presumably as there is no pathology service available) tumors.
Cesarean sections. These are usually performed there by what we would call physicians assistants. After observing their techniques I jumped in and did some for demonstration purposes and hopefully made some improvements.
There were 3 very serious, life threatening burn cases on the wards. My biggest frustration was that there were no drugs or equipment to treat them properly. We were reduced to covering the burns with honey (yes. honey!). I learned that actually works fairly well. There was no dermatome available so small free hand or pinch grafts were applied. Though alive when I left I do not have much hope for 2 of the 3. The only treatment for fractures was closed reduction an cast application. For fractures requiring more there are various, sometimes ingenious, traction rigs made from all sorts of materials. Though neither Jasper or I are orthopods we would have and could have done some simple open reductions if the plates, screws or wires were available. They were not. If HCV wants to do something great send an orthopedic surgeon there with equipment.
Even with the variety and severity of procedures performed we only lost one patient. This was a young girl of 16 who we operated for intra-abdominal abscess. She was recovering nicely and on the 5th post operative morning died suddenly – probably form pulmonary embolism. In a modern situation she would have been treated with DVT prophylaxis as a matter of routine but, of course, this was not available.
Medical Students Stephanie and Mayching were terrific. They were eager, bright, attentive and knowledgeable. We arrived within a day of each other and were staying at the same place. This worked out well because it enabled us to start each day with a breakfast conference, during which we reviewed a different surgical topic each day. Our driver came for us around 9 and we would then make hospital rounds and perform our procedures. We worked closely with Jasper. He often had administrative duties and left us to work on our own which was good. Our anesthetist, a trained nurse named John, was terrific at his job and also taught the girls a lot. Since spoken English was highly variable (Most hospital people know little or none) we came to rely on certain individuals to get us through ward rounds. Since modern diagnostic methods (x-ray and even basic lab) were generally unavailable it was a great opportunity to school the students in the lost art of physical diagnosis. – that is actually placing hands and stethoscope on the patient to determine what’s wrong. Hopefully they will use the skills. Of course we were scrupulous with gloves and hand-washing, even using bottled hand disinfectant we had brought along. Overall I think it was a good experience for the students. They certainly got to do and see things that they would never have at home. Also I think I detected a growing sense of compassion and obligation to help that is not often a characteristic of modern medical students. For me, having the opportunity to teach under close and difficult conditions was a real treat.
Where do I go from here? I was fortunate to have made contacts there that will last a lifetime. The place I stayed is a hub where important people coming through spend the night and have a meal. I got to meat cabinet ministers, regional governors and local officials and business men. The governor of the Rukwa region has asked me for a report on the health care system there as I see it. I intend to submit it in a complimentary non-critical way suggesting a few inexpensive changes that can vastly improve the flow of supplies. My aim is to threaten no one, maintain friendships and try to make improvements. It is likely that I will return there in 2008, possibly for two months, as I feel there is much I can do. Hopefully Medical Care Volunteers will be willing and able to help me do that. In the meantime I have already been in contact with a group called Operation Cure that specializes in moving donated equipment to third world counties. I think I mentioned that Ian also a professional photographer. The pictures I took are amazing! My plan is to put together a calendar and offer it for sale on the internet with proceeds to be donated to the hospital. That’s it for now. If you need any more information please let me know.
Thanks for everything,
Samuel M. Feinstein, D,O,, FACOS
A.K.A. Skip, Dr. Skip, Professor, Professor Skip, Prof or Zum-Zum depending on who you talk to in Tanzania. Apply now
How Do I Apply?
Follow this 3 step process:
1. Create an account and then login to your account. Next Fill out the Online Application.
2. Next, Print/Fill out the Paper form (PDF or DOC) and mail it to us with supporting documents.
3. Upon receipt of your materials, we will process your application, obtain necessary work permits and deploy you to your volunteering site. Filling out the volunteering form is not a guarantee of placement, but we do try to accommodate as many volunteers as possible during the times you request. Please remember you will have to pay your own visa, temporary licensure or other governmental fees necessary. In the mean time, please gain the latest recommended immunizations
US Citizens: Follow CDC Guidelines | UK Citizens: Follow NHS Guidelines | Other Citizens: Follow Local Guidelines
Trip Report - Dr. Samuel Feinstein - May, 2007:
4.1 Were there challenges or difficulties with your internship that HealthCare Volunteer should know about? In country travel is quite arduous. The roads are bad to non existent in most places. Traveling to western Tanzania, other than the one stretch form Dar to Mbeya, one should expect difficult and, in some places, somewhat dangerous conditions. Bus travelers must be aware of the differences in bus lines and to avoid all but the most “luxurious� (a euphemism for tolerable.) Remember the line called “Sumray� and try to stay with it.
4.2 How could your internship have been improved? There is nothing that the organization can do. Medical volunteers must be prepared to “wing it� in almost all situations. There is little, materially to work with. I would not suggest sending anyone to Sumbawana that does not have enough clinical experience to be proactive. Under current conditions technicians, other than surgical, would be of no value. I would not suggest sending medical students there unless they are in a group with someone to organize their experience and teach them.
4. 3 How likely are you to volunteer through HealthCare Volunteer again? Why or why not: Very likely. HCV (my abbreviation) has been easy to work with, very helpful and has enabled me to find a place to work where my skills are uniquely helpful and the opportunity to live among people who are a pleasure to know.
Continuation of Written report
A good deal of what I have to report has already been stated above. In summary I would like to state that this has been a wonderful experience. I have gotten to know some extraordinary people and, I believe, contributed in some measure to their well being
Specifically: 1. The work: Sumbawanga, though an area comprising some 250,000 people and having a government hospital of 250 beds is a medically primitive place. Surgical equipment and supplies, including anesthesia, are on a level corresponding to the 1920’s. Drugs are few and only three or four of the oldest, generic antibiotics are available. There is no available oxygen, pulmonary assistance, ward suction or any of the conveniences we take for granted. Wound care dressings are scant and haphazard. That being said there are great people there with various degrees of training that have developed methods and skills to work around the deficiencies. The chief physician there (there are only 3) is a surgeon named Jasper Duwasindi. He is marvelous. We bonded from the outset and as I taught him modern techniques and decision-making processes, he schooled me on the nitty-gritty of dealing with such things as malaria, typhoid and picking up the pieces after a local traditional healer (read witch doctor) had screwed things up for a week. I got to perform the following:
Several cases of intestinal perforation secondary to typhoid. (Never seen that before)
` Many pediatric hernias – some threatening to become incarcerated
Open removal of bladder stones. This procedure is done only when cystoscopy equipment is not available.
Hysterectomies for benign (presumably as there is no pathology service available) tumors.
Cesarean sections. These are usually performed there by what we would call physicians assistants. After observing their techniques I jumped in and did some for demonstration purposes and hopefully made some improvements.
There were 3 very serious, life threatening burn cases on the wards. My biggest frustration was that there were no drugs or equipment to treat them properly. We were reduced to covering the burns with honey (yes. honey!). I learned that actually works fairly well. There was no dermatome available so small free hand or pinch grafts were applied. Though alive when I left I do not have much hope for 2 of the 3. The only treatment for fractures was closed reduction an cast application. For fractures requiring more there are various, sometimes ingenious, traction rigs made from all sorts of materials. Though neither Jasper or I are orthopods we would have and could have done some simple open reductions if the plates, screws or wires were available. They were not. If HCV wants to do something great send an orthopedic surgeon there with equipment.
Even with the variety and severity of procedures performed we only lost one patient. This was a young girl of 16 who we operated for intra-abdominal abscess. She was recovering nicely and on the 5th post operative morning died suddenly – probably form pulmonary embolism. In a modern situation she would have been treated with DVT prophylaxis as a matter of routine but, of course, this was not available.
Medical Students Stephanie and Mayching were terrific. They were eager, bright, attentive and knowledgeable. We arrived within a day of each other and were staying at the same place. This worked out well because it enabled us to start each day with a breakfast conference, during which we reviewed a different surgical topic each day. Our driver came for us around 9 and we would then make hospital rounds and perform our procedures. We worked closely with Jasper. He often had administrative duties and left us to work on our own which was good. Our anesthetist, a trained nurse named John, was terrific at his job and also taught the girls a lot. Since spoken English was highly variable (Most hospital people know little or none) we came to rely on certain individuals to get us through ward rounds. Since modern diagnostic methods (x-ray and even basic lab) were generally unavailable it was a great opportunity to school the students in the lost art of physical diagnosis. – that is actually placing hands and stethoscope on the patient to determine what’s wrong. Hopefully they will use the skills. Of course we were scrupulous with gloves and hand-washing, even using bottled hand disinfectant we had brought along. Overall I think it was a good experience for the students. They certainly got to do and see things that they would never have at home. Also I think I detected a growing sense of compassion and obligation to help that is not often a characteristic of modern medical students. For me, having the opportunity to teach under close and difficult conditions was a real treat.
Where do I go from here? I was fortunate to have made contacts there that will last a lifetime. The place I stayed is a hub where important people coming through spend the night and have a meal. I got to meat cabinet ministers, regional governors and local officials and business men. The governor of the Rukwa region has asked me for a report on the health care system there as I see it. I intend to submit it in a complimentary non-critical way suggesting a few inexpensive changes that can vastly improve the flow of supplies. My aim is to threaten no one, maintain friendships and try to make improvements. It is likely that I will return there in 2008, possibly for two months, as I feel there is much I can do. Hopefully Medical Care Volunteers will be willing and able to help me do that. In the meantime I have already been in contact with a group called Operation Cure that specializes in moving donated equipment to third world counties. I think I mentioned that Ian also a professional photographer. The pictures I took are amazing! My plan is to put together a calendar and offer it for sale on the internet with proceeds to be donated to the hospital. That’s it for now. If you need any more information please let me know.
Thanks for everything,
Samuel M. Feinstein, D,O,, FACOS
A.K.A. Skip, Dr. Skip, Professor, Professor Skip, Prof or Zum-Zum depending on who you talk to in Tanzania. Apply now
How Do I Apply?
Follow this 3 step process:
1. Create an account and then login to your account. Next Fill out the Online Application.
2. Next, Print/Fill out the Paper form (PDF or DOC) and mail it to us with supporting documents.
3. Upon receipt of your materials, we will process your application, obtain necessary work permits and deploy you to your volunteering site. Filling out the volunteering form is not a guarantee of placement, but we do try to accommodate as many volunteers as possible during the times you request. Please remember you will have to pay your own visa, temporary licensure or other governmental fees necessary. In the mean time, please gain the latest recommended immunizations
US Citizens: Follow CDC Guidelines | UK Citizens: Follow NHS Guidelines | Other Citizens: Follow Local Guidelines
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