Hospital Placement Week 1

Day 3 - 5

Jambo!

We have completed our first week in the hospital and what a first week it’s been! We go on safari for the weekend tomorrow (YEY) so we have tomorrow off to travel 5-6 hours to Mikumi National Park.

It’s hard to put into our words our experiences from the first week but we’re going to try. In Tanzania, ambulances are mainly used to transport patients between hospitals or solely for the wealthy, who need emergency transport to the private hospital with minimal on board care. So the next best place for us to learn during our time here is in the Emergency Department at Muhimbili National Hospital.

In the ED, there are four Resus bays, each bay has a maximum of two monitoring machines, oxygen, a drawer for cannulas and a few other bits and bobs and two computers where doctors keep comprehensive notes written in English using the ABCDE approach. However, the ED is extremely busy so each Resus bay usually has about 6+ patients in it and all of the patients are what we call ‘big sick’ at home. As each bay only has two monitoring machines, only two patients can have their vital signs monitored and they usually switch patients around depending on the level of ‘big sick’.

We’ve seen a range of presentations even in the short space of time we’ve been here; Red flag sepsis, diabetic emergencies, opioid withdrawals, suspected heart failure, chronic breathing difficulties, tracheostomy replacement and various malignancies. We have also had a lot of exposure to trauma patients, with differing mechanisms of injury which we don’t see on a regular basis in UK. For example, the first patient we attended to was a young male who had been in a gas canister explosion in a garage with significant injuries to the lower half of his body and hands. From what we have heard many of the patients who attend ED with trauma injuries are from motorcycle accidents and other RTCs (as the roads are pretty crazy over here) and incidents at work, due to the lack of health and safety protocols.

Strong improvisation techniques are a key part of getting by in Resus, cardboard boxes for splints, gloves for tourniquets, scalpel blades for scissors, the list is endless. Adult oxygen masks are also MIA, so paediatric masks are used and oxygen is only given to patients when their sats are below 92% or sometimes even as low as 80%… They do however have ECG machines (albeit with suction electrodes) up to date ultrasound and xray facilities, defibrillators and ventilation machines.

We have been able to assist in delivery of care to many patients, within our scope of practice but it hasn’t been without it’s challenges. We’re still trying to get our head around some of the reasoning behind treatments and interventions given (and withheld) but appreciate the department’s restrictions compared with the NHS.

A highlight of our week was stumbling across two Tanzanian Paramedics in Resus who have been mentored by Paramedics from the UK. They had a decommissioned UK Ambulance which we had a cheeky look around and instantly felt at home!

Anyway I’m sure we’ll have plenty more to report from the hospital next week. We’re just about to have our Swahili lesson then it’s BBQ night tonight!

We’ll be a little quiet on the blog for a few days while we enjoy our safari weekend, but expect an influx of photos and updates on our return!

Jennie & Laura x