Work in Tanzania has started. After a long time of preparation, Erik and Jiska left on Saturday 29th January for Tanzania. They are dedicating themselves in the coming years to providing better medical care, accessible to the entire population, and continuing to build the bridge between the Netherlands and Tanzania.  More on this later. After a long flight, they were also allowed to travel almost 1100 km to reach the Sengerema Hospital. Before they started this car journey, they had already completed a lot of work, such as 3 trips to a tax office for a sort of BSN number, 4 times to the bank to open an account, and pick up a bank card. Then to the port to pay port tax, 6 times to a 'forwarding agent', taking out insurance for the car, having a number plate made, final assembly of the Toyota in the garage, handing over papers for the container to the 'forwarding agent'.  All in all, it was quite a job before they could start their work in Tanzania.

The Container House

The garden is beautiful. Everything is in full bloom. However there is still a lot to do inside the house. A piece of the ceiling has fallen down in one of the bedrooms .The fridge and oven are broken, so no bread and no cold drinking water or soda/beer available. Also the toilet is leaking badly, involving much work and looking for the necessary rubber parts in Mwanza .A legion of bats has come to live in the roof, so there are faeces everywhere and a foul smell of urine.  Erik and Jiska have found someone who has a special herbal concoction, which has been sprayed everywhere and they are now waiting for the bats to die. They are unsure of the best material to use to plug these “bat holes”. Possibly pieces of foam from an old mattress? Or buy PU foam in Mwanza?

The Sengerema Hospital

After arrival Erik & Jiska toured the hospital. Staff greeted them here and there with discussions about ongoing studies, education programs and also some patient consultations. They were met with a lot of enthusiasm and a willingness to think and fully participate in future developments. Erik and Jiska are busy with searching, organizing, and making inquiries into the hospital needs. Getting acquainted with staff, working methods, seeing bottlenecks, and realising how seriously appalling the care is in the trauma and emergency care department... There are so many neglected trauma patients!  Further the situation in the rest of the hospital.  Departments do not have a thermometer, blood pressure monitor, oxygen monitor, or nursing supplies. The medical ward rounds are still quite dramatic. The doctors are largely guided by their experience, the smells (!) and the clinical picture. There are no standard patient vital parameters checks available. The staff must bring their own gloves, gauze, scissors, disinfectants, bandages and tape if they want to inspect and care for a wound. The basic facilities of the hospital are vulnerable

The St. Clare Hospital

There has been an enthusiastic response to the arrival of Erik and Jiska in the St Clair hospital. Martin, a German trauma and orthopaedic surgeon colleague, is working here. He has already achieved much in the organization of the OR and other departments. Furthermore there is a Tanzanian internist and a number of basic grade doctors working here. There is a reasonably good structure and for Tanzanian standards, good facilities. In terms of the number of patients, the hospital is not nearly as busy as in Sengerema.  Fortunately, there is a lot of willingness to cooperate with other hospitals in the region. They have already taken advantage of this by sending a number of patients, who could not be adequately treated in Sengerema, to St. Clare with support from the 'poor fund”. For one of these patients it saved his life and for another (young) patient they are still fighting to save his leg after 5 operations ,due to a neglected open fracture.

A First Step Towards 'Structure'

In consultation with the two management teams of the hospitals, Erik and Jiska have made a provisional agreement concerning their time/deployment allocation.  This will be a trial start-up phase for 2 months. They will be available for Sengerema Hospital from Sunday afternoon to Wednesday morning. Then from Wednesday afternoon to Saturday they will be working at the St. Claire Hospital. It is really important that they first build up trust and continuity for the staff and patients. Also observe the skills and quality of the current staff.

Challenges

The basic facilities of the Sengerema Hospital are starting to falter. The old generator, which was donated by Simba ten years ago, no longer has enough capacity to meet the demand. There is only one operational ambulance (Toyota hardtop) which is already 38 years old and does not contain any facilities to support a patient. In the hospital there are concerns in the field of 'safe surgical and anaesthesia care'. There is a shortage of qualified personnel and some medication which combined with the frequent failure of electricity, sometimes creates a dangerous situation for patients.

Positive developments

It is good to have short lines within the organisations, so that action can be taken quickly with smooth results.  The foundation of the outdoor kitchen for the container “team house” was ready within a few days. The container with goods from the Netherlands has been cleared through customs and arrived on 21 March. A busy time of unpacking and organizing followed for Erik, Jiska and the local helpers.

Organization

There is a new full-time surgeon on site. This surgeon is here through CUHAS (training institute of University Mwanza). There has already been a meeting with all the surgeons concerning their duties, daily schedules and the first step towards working in the departments. There was also a consultation with the anaesthetist concerning patient safety and what improvements would be needed?
A successful cooperation with St. Clare has taken place, two patients have been referred and treated there by Erik. Joseph Shija also is doing well with his anaesthesia training 

The Bridge

The medical airlift between the Lake Region in Tanzania and the Netherlands is thus in use. We see that the network in Tanzania is moving and growing. After the strenuous start for Erik and Jiska in the last few months, we have more free time to pay attention to our friends and supporters and network. The board committee is grateful for an intensive but certainly very encouraging start. We are interested to see how the bridge will continue to develop, what the future may bring and how we can be involved in concrete medical improvements and development in Tanzania.

Asante Sana.

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