Award Report - Lauren Cheers

Lauren Cheers reports on her medical elective to KCMC hospital, Northern Tanzania, to which the alumnae fund contributed.

In August 2013, I undertook a five-week medical elective placement at Kilimanjaro Christian Medical Centre in Moshi, Tanzania.  The hospital is located in the foothills of Mt Kilimanjaro and serves a population of over 11 million people.  As a tertiary facility, the hospital is one of the largest in Tanzania; it has over 450 beds, employs over 1,000 members of staff and provides medical services through twelve different departments.  I chose to undertake an elective in general medicine, as I wanted to gain an understanding of common diseases that affect the Tanzanian population and tropical diseases that I am unlikely to encounter in the U.K.

During the first five minutes of my placement at KCMC, I was faced with the harsh consequences of health care in a low-resource setting, as I learnt that seven patients had died on the ward the previous day. I quickly realised that even though the hospital was a tertiary level facility it was still under-resourced and could not provide simple blood tests and investigations, which would provide information that could save an individual’s life. 

The general medicine ward consisted of six bays – three male and three female – as well as two separate bays for high dependency and intensive care patients.  Despite the allocated bed space, the bays were overcrowded with patients on stretchers which overflowed into the corridors outside.  There was a private room that could be used by patients; however at the cost of $100 per day, this was nearly always occupied by a tourist who had recently attempted to climb Mt Kilimanjaro.  Mosquito nets hung over beds in place of curtains so there was no privacy for patients during clinical examinations. 

Whilst at KCMC I attended ward rounds, teaching sessions and clinics, and performed ward duties.  Since very few patients spoke English, I learnt basic Swahili phrases so that I could communicate with patients during clinical examinations.  I often became frustrated during ward rounds by the lack of prioritisation and slower pace compared to the U.K.; the most critically ill patients were rarely seen first and important investigations were not ordered until late into the day.  I found it particularly difficult to see how ineffectively pain was being managed compared to in U.K. hospitals, and took it upon myself to liaise with the nurses to make sure simple analgesics were being given appropriately.  

However, limited by tests and technology, I was impressed by the doctors’ confidence in diagnosing and treating diseases based on clinical signs and symptoms alone.  It made me appreciate how technology has changed the way medicine is now practiced in the U.K., as well as the NHS resources we often take for granted both as patients and medical practitioners.  As a privately run hospital, all patients at KCMC paid out-of-pocket for their medical treatment which had major implications on their medical management.  For example, in the U.K., patients suffering from a stroke would receive an urgent scan to determine whether they can be treated with life-saving medications, preventing further brain damage.  At KCMC stroke was a common cause for admission, however, patients could rarely afford $150 to pay for this life-saving scan.  Families would therefore be told they could only ‘watch and wait’ to see whether their loved one survived.

Whilst the hospital provided an invaluable medical elective experience, its prime location in Northern Tanzania meant I also had the opportunity to explore the Serengeti National Park and climb Mt Kilimanjaro during my stay.  Climbing Mt Kilimanjaro proved to be an overwhelming experience, during which my two friends and I (just) made the summit after 6 days of hiking, altitude sickness and lots of tears! We were all glad we’d decided to end our trip with a few days of relaxation on the idyllic beaches of Zanzibar.

Looking back on my elective in Tanzania, it was an incredible and fulfilling experience.  I would like to thank the LEH Alumnae Award for providing me with this opportunity.

Lauren Cheers, LEH 1997-2008