Mark Lister spent his elective with a flying medical team in Tanzania and tells us what it was like
You need a strong stomach to work with the flying doctors. Firstly, five flights in a light plane each day churn up your insides; secondly, what you see when you land can be a bigger shock to the system.
Tanzania is east Africa's largest country and one of the world's poorest. Its area of 943 000 km2 is home to over 100 tribes each speaking their own language, the largest wildlife herds in Africa, and a medical team of eight people who are the flying medical service.
Key facts
- Population--29.7 million
- Languages--English and Swahili
- Capital--Dodoma
- Currency--Tanzanian shilling
- International dialling code--+255
Most (90%) of Tanzania's population is sparsely distributed across the sub-Saharan mainland, with the remainder living in urbanised settlements in the developing towns. Consequently, most people have no access to modern medicine, hindered by huge distances, hostile geography, and no idea of what is available. The flying medical service has an unrivalled role in taking medical services to the people.
I saw medicine at its rawest. Armed with just a stethoscope, weighing scales, and a handful of syringes and pills, we flew to remote settlements where the patients may never have had contact with a Western doctor or even a white person.
A typical day included several clinics, perhaps a trip across the border to Kenya to transfer a patient to a city hospital if they were lucky enough, and a stop at a rural hospital to deliver some basic medical supplies--for example, cotton wool. My first day was serving the Simanjiro district, populated by the Makonde, Chagga, and Maasai tribes (who are notorious for their intimidating height and outrageous body adornments). On board were a German pilot and an American engineer (both trained in basic nursing skills), a Dutch doctor, and an out of his depth third year medical student.
From the base of the service in Arusha, our 40 minute flight to Aladalu crossed tea plantations, maize fields, and neat strips of woodland. For 10 minutes it could have been Europe, and then the dry landscape changed to savannah, bush land, and thickets. As we approached our destination, I asked why we were landing here. I saw no sign of life whatsoever--no people, no huts, and no crops--just a herd of zebras standing by the airstrip. "They'll see us," the pilot replied.
After a dangerously low flyover to inspect the improvised airstrip for holes and bumps, we landed and were soon setting up our mobile clinic under the wing of the plane. It was no sooner than we were on the ground that people emerged from the grasses, and within 15 minutes, 100 or more tribal people had been attracted by the roar of the engine. Adorned in dramatic Maasai jewellery and carrying spears they showed huge respect for the staff, waiting quietly for their turn.
Limited by diagnostic tools, treatments, and the compliance of the patients, it provided challenges that a Western doctor would never encounter at home. Each patient was charged the equivalent of 80 pence ($1.25; a1.27), and we treated most for malaria or tuberculosis. With no laboratory tests, however, diagnoses and treatment were crude; should they fail no one would ever know.
Over the summer, many disturbing issues came to light. To our despair--because of deep rooted tradition--women and children were forbidden to see a doctor by their husband or father if they had misbehaved. Repeated, common, and somewhat distressing cases were female patients who were hoping they were pregnant. In Britain they would quickly be labelled as time wasters; in Tanzania there were more alarming consequences. The news of no baby would normally result in a beating. Next time, the patient would ask the same questions hoping for different answers.
As the sun grew stronger, the crowd grew smaller, and soon it was time to depart to Narakao--a six minute flight. It was the first visit the team had made to this area, and people were patiently waiting next to the airstrip they had dug and smoothed over with their herds. As we approached, people didn't know what to make of our light plane and dived into bushes and hid behind trees, terrified by the noise. As the engines shut down, they gradually emerged from their spots of safety and approached the plane with their spears drawn.
The doctor and I did chest examinations under one wing and the pilots administered vaccinations and weighed babies from the other. On the agreement that the landing strip was maintained, we agreed to return on a fortnightly basis. We had a 10 minute stop for a sandwich and then a 20 minute flight to Longoong, where we were able to work in a nearby mud hut providing welcome relief from the burning midday sun. We made one further stop at another rural outpost then headed back to relative normality.
There are other opportunities for those wanting elective or pre-elective work in Tanzania. The town hospitals and rural clinics are full of surprises. I saw three women sharing a bed and five premature babies to a bed in a room with just a radiator. In rural settings, doctors train for only two years, but in this time they learn dozens of practical skills. This way they can recognise conditions, but without any understanding of why the body is reacting in such a way. It might reassure you to know they use a book of flow charts to help them make their diagnosis; it might not. The doctors work hard with restricted means. None the less they had habits which might fall foul of the guidelines for Tomorrows Doctors. One morning all the staff took me on a walk to see the gorge, apparently unperturbed by the fact that no one was at the clinic for several hours, but as they say in Africa, "There's no rush."
