Tag Archives: Tanzania

Mount Meru Hospital, Tanzania

Each Friday for the next three weeks, the Tanzania EWH team will  work at Mount Meru Hospital just outside the heart of Arusha.

The Tanzanian health care system consists of larger referral/consultant hospitals such as Kilimanjaro Christian Medical Center, regional referral centers covering several districts, and smaller hospitals covering one district each such as Karatu Hospital.

Mount Meru is a regional hospital with departments for obstetrics and gynecology, pediatrics, surgery, out-patients, and units for ophthalmology and dentistry. The hospital also has a laboratory and an intensive care unit. The hospital typically sees 500 patients per day on an outpatient basis and admits approximately 250-290 patients every day.

Generally there is a fee to be seen by a doctor at Mount Meru; however, as a public hospital, they are obliged to serve all people, and will provide free health care to those who cannot afford  it.

The typical population served by the hospital consists of farmers, pastoralists or industry workers. These are families that earn a low to middle-class income. Some of those who work in the outskirts of the districts covered by Mount Meru Hospital (for example people coming from Ngorongoro or Longido district) have nine hours travelling time to the hospital. Others simply can’t afford the cost of transportation. As a result, acute patients, especially pregnant women and children, often reach the hospital too late for doctors to do anything.

According to hospital staff, the largest barriers to provide health care services in Tanzania are lack of capacity to handle all, but especially acute patients, lack of funding and lack of accessibility to medicines, supplies and health care technologies. These issues are more or less apparent in all across governmental Tanzanian hospitals from the district level up to referral/consultant levels. Handling acute cases is a particularly large problem at district hospitals, which is why regional hospitals like Mount Meru experience a very high occupancy rate and a high number of patients, that do not reach the hospital in time for an ideal outcome of their treatment.

At Mount Meru Hospital, one challenge in meeting the demand is the large amount of donated equipment of which only about half is currently functioning. The entire region has just one biomedical engineering technician (BMET), Mr. Sharif Rajabu Kishakali. As of early 2015, he is the first ever BMET at Mt. Meru Hospital. He is currently working on a preventative maintenance program for the hospital’s equipment. The attached pictures are a collection from the projects he is currently working on.

Elephants Cooling Down

Watching this family of elephants bathing in the mud to cool down is surprisingly funny.

– If nothing just watch from 0:55 –

We were extremely lucky on this safari. Our guide Hilary was a well educated guy from the Mweka Wildlife College and was so passionate about wildlife, that he didn’t just want to show us the Serengeti, he was there for himself as well – he was just as eager as we were to take photos whenever we saw something exciting. Most importantly, he had no ambition to make extra money by saving gas, he took us as far away as he possibly could. We found these elephants at such a time: far away from everyone we were the only ones.

What’s it Like to Work in a Developing Country Hospital?

It is now a little more than a week ago that I returned from and unforgettable journey to Africa. It’s been such a journey that expands horizons, gives new perspectives, creates new visions and changes beliefs and values. During my stay I worked for a month at local hospitals, an experience that was different in so many ways from what I had expected.

Prior to our placements at local hospitals the students of the 2014 EWH summer institute (myself included) took part in a month-long educational course on “Engineering in the Developing World” and an introductory Swahili course – a program which proved to be of considerable advantage as we were soon to develop a trusting relationship with the departments we would come to work for.
After this first month of education I was moved to my placement along with my group, which besides myself consisted of a student from Duke and one from Harvard. We were to work in two hospitals: Kilimanjaro Christianity Medical Centre (KCMC) and Mawenzi Hospital, both situated in the town of Moshi, Kilimanjaro region.
The KCMC is one of the largest and most prestigious institutions in Tanzania and has a biomedical engineering department consisting of 30 engineers and technicians. Despite good will and hard work from the department, it was obvious that we could do much in both hospitals, just as we could learn a lot from them. Our group alone repaired more than 60 pieces of equipment during our stay. Overall, this year’s EWH summer program returned 4,200 pieces of equipment amounting to 8.6 milion according to the latest figures from EWH.
If I was to draw one conclusion about medical equipment in developing countries today, I would say that it simply should not be allowed to donate without informing properly about that specific piece of equipment in the local language (or in English, at the least):
In so many places we found rooms and whole warehouses filled with piles of medical devices. To our surprise, very often these devices could be put back into service by simple mechanical repairs. We even found completely new operating theatres that could not be used because they were packed full of unused equipment. I was left behind wondering if donations do any good at all – or if they do more harm than good. During our month at the hospital we slowly started to learn the reasons why these equipments weren’t in use: How were people supposed know how to use a piece equipment, if they had no manual for it? Or how could they use a machine, if the user interface was in Dutch or in German? When a repair was to be done after all, many reported difficulties and bureaucratic systems when having to acquire replacement parts, such as a lightbulb for a microscope.
The type of problem that could arise when departments were not provided information about new technologies became clear to me one day at the KCMC, when our group was asked to repair an Infant Warmer from GE. We were told the following: The department had received a completely new machine and put it into a small room where they normally observed newborns in the early hours after a birth. But when the staff began to use it, the machine heated the room up to a temperature so high, that it was unbearable to stay in there.
The solution turned out to be immensely simple: the skin-temperature sensor had mistakenly been placed under the bedside, and had to be moved to the skin of the newborn – otherwise the device would constantly work to achieve a temperature of 35.5 degrees under the bed instead of on the baby’s skin. Thus the machine was heating on and on (and on…).
After having cleared out this first misunderstanding, we explained that the machine could not, as some thought, be used to take X-rays images, but that it merely contained a tray for a detector plate so that you weren’t forced to move the baby around unnecessarily,  and that the machine could not calculate an APGAR-score, but that it contains a stopwatch simply to help you with the task. The problem wasn’t lack of education or ability to understand how a machine works. It was simply the fact that people were not provided the necessary information. Even if some information was provided, it was not done properly: How is a nurse going to read a 500 page manual, while working in a ward full of women in labour? Seeing this and other similar cases, one of our main focuses became developing quick start guides in order to provide departments with a fast and simple way of knowing how to use a device.
Another typical issue that we encountered was how departments virtually never took advantage of vital signs monitors and ECG’s because they had run out of the necessary electrically conductive gel. There are a number of alternatives to conductive gel – in principle anything that contains electrolytes, for example aloe vera or ketchup, can be used. It should have been obvious however (as I did not first think of), that most doctors and patients do not want to use these methods, as they are uncomfortable and inconvenient. I remember explaining to a doctor how he could make his own electrically conductive gel using water, flour and salt. His response: “Is that really recommended?”. Imagine his reaction, had I recommended him to use ketchup. In addition, many Africans are proud people to whom one can and should not just offer anything (just as one would probably not do anyone at home). Therefore, developing a gel that is more likely to be used clinically, and in addition could be produced cheaply using local materials, would be an example of a simple and small, but valuable project for developing world hospitals (while you can find alternatives to conductive gels, I still haven’t seen one that actually looks like the gel that is used in clinics). Notably the KCMC already had the means to produce their own ultrasound gel (which is acoustically and not electrically conductive) so they shouldn’t be too far away from being able to produce their own conductive gel too.
This and many other projects are still to be carried out to make the daily life at a these hospitals run smoothly. Here I have given just two examples of what it can be like to work in the developing world. So many ways remain in which one can help this  parallel world of ours, in which resources are so scarce that we are constantly forced to think in new and innovative ways to provide the best possible health care for the all people.

The Greatest Sunset Ever…

As the sun set it lit up the skies from below and turned everything red. We put on music and we were having a great time with the whole staff,  listening to Dimmi, Promesses (the Obama song) – the speach that says:

“it doesn’t matter who you are, where you come from, what you look like or where you love…”

One of the guys told me he gets the chills everytime we listen to it. We agreed that we would listen to it every evening on the rest of the trek. 

The guys on the pictures include Agapit, Rashiti, Kalisti, Thomas, Calvin, Gofrey, Hilary.  

The Serengeti and Ngorongoro Crater

From ‘Maya ya Simba’ the rock where simba was born to baboons finishing off a Leopard, the wildlife in the Serengeti was so much more eventful than what I have seen in any other national park (Ngorongoro, Tarangire, Manyara). We had three days in Serengeti, which allowed for a full day game drive followed by an early-morning game drive the next day. We were able to go to distant areas to see wildlife play out with no one but us being present.

Fixes in Moshi, KCMC and Mawenzi

ewhdtu:

The last couple of weeks have been stuffed with interesting fixes and great experiences in Moshi, KCMC and Mawenzi, Here are some of my favourite photos.

Charging batteries

Goodmorning-battery charge for a paediatric pulse-oximeter:

9 volts / 250 ohm resistor , charging with approximately 40-50 miliamps, yielding charging rate of about 1/20.

Educating, teaching and building parts

Some pictures from a great day in Moshi: We fixed an infant warmer, taught nurses how to use the manual suction pump and made new parts for infant incubator with assistance from the orthopedics/prothsis department.

1: KJ is teaching a nurse at the female medical ward how to use the manual suction pump – which was suprisingly challenging, not just for the locals, but also for us (had to read the manual…)

2: Samson from the orthopaedic department at KCMC is preparing a new piece for an infant incubator that we have been working on.

3: The KCMC has a whole department for creating prothesis – the department is actually a Danida donation from the 70, where approx. 70 danes came to Moshi to do development work.

4: We were (here KJ) teaching one nurse from each department of Mawenzi how to use the manual suctionpumpt. The main points are to put water around the lid to close it tightly and fold the tube for vacuum.

5: Nurse is bringing back the suction pump to the department – now working – this pump is useful whenever there’s a powercut or when the electrical ones breake (which happens quite often..)

6: This guy spent approx. 1.5 hrs showing me around Moshi as we were lookig for a diode that we needed to fix an infant incubator. People in Moshi are reallyreallyreally helpful