AMANI HOSTEL

I am a final year student from England and struggled to find contacts for an elective in Tanzania who would respond within the uni deadlines, were helpful and affordable. Kivolex offered all and Innocent was incredibly helpful, responded rapidly at all times of the day (I am fairly sure he messaged me on his literal wedding day about an admin question I had). He was able to get all required university forms signed off and has contacts across a range of hospitals in Tanzania and subcontracted the local supervision and organisation of our elective to Eduu from Amaani volunteers. I certainly wish I had known about the informal nature of arrangements in Tanzania before going. Online it appeared that lots of things were not possible (for example certain hospital placements or climbing Kilimanjaro) but it turns out that all these things are possible with local contacts. Eduu was invaluable. He was there from day 1 with him and his team being instantly welcoming, helping us orientate ourselves around the city, guiding us on how to get around (and how much to pay the Bhijajia) as well as helping us to organise big trips to experience the non-placement side of Tanzania. He was able to be very flexible helping us organise a 4-day Safari on 2 days notice, a 5-day Kilimanjaro climb which we had thought wouldn’t be possible due to the rainy season and a day trip to the Moshi hot springs and water-falls. He was able to explain the tipping system to us, find good local prices for rental of hiking gear and helped us withdraw money so we could avoid our bank exchange fees and was able to sort any issues that arose with placement. Our placement was at St Elizabeth Hospital Arusha (SEHA) and is a small regional hospital with an internal medicine ward, outpatient department with a two bed acute A and E (normal beds just in a side room closer to the Drs office), paediatrics, obstetrics and gynaecology, surgery on certain days and other outpatient/nurse clinics. There are around 3-5 doctors on site in the day and they tend to do a bit of everything. There were other volunteers/health care workers from abroad who were all very friendly and at levels of training varying from secondary school to final year of medical school. SEHA is extremely resource poor compared to the UK and this is exacerbated by patients being unable to afford investigations or treatments. It was common to see saturations in the 70s with nasal cannula only due to the cost of oxygen, antibiotics courses curtailed due to lack of funds or referrals refused by patients due to the cost. The cases included a variety of conditions but a large amount of HIV related disease (including TB so I would bring PPE), upper GI bleed, heart failure, paediatric sepsis and burns and DKA/HHS. Having completed finals the doctor on my ward largely treated me as an extra pair of hands and I was able to discuss cases with her, examine patients, help interpret investigations and formulate managements. However, there was never a point I felt left unsupervised and expected to act beyond my abilities. It is certainly a place you will see the extreme end of conditions often only presenting after reduced GCS or very significant symptoms. It was at times frustrating to see how little could be done to establish the cause and then manage a condition within the constraints of the system but it was also very rewarding to see and play a part in the care SEHA could offer. The language was a barrier when communicating with patients. A small minority spoke English but the staff all speak excellent English and in the afternoon (ward round and jobs are usually done by 1:30 or earlier) would be happy to translate for me. The staff are very happy to teach and explain their thinking behind cases which was especially helpful as, although they document in English, the histories and many discussions about care happen in Swahili and it can feel that there is a lot happening not documented. The staff are wonderful and welcoming (especially on internal medicine) and were an absolute delight to work with. They taught us Swahili, we did team socials playing pool at the nearby pub and I learned a great deal of medicine from them, especially about managing patients in the presence of huge diagnostic uncertainty. Our week with the Flying Doctors fell through due to weather which was disappointing especially as it had initially been declined but Innocent had reversed this assuring that it would be possible. I would certainly always trust the Flying Doctors about their timetables, it is one part of Arusha organisation that is not endlessly flexible. However, Eduu and Innocent were able to arrange a placement at Mount Meru the regional referral centre. There were some issues from the Meru side which meant we started late, but I would highly recommend a week or two there in A and E or other departments you are interested in and wouldn’t let these small organisational issues put you off. It is the regional referral and offers a very different experience of Tanzanian medicine. They have specialist doctors and what seems an abundance of resource compared to smaller hospitals such as St Elizabeth which are largely staffed by generalists. However, you will still see the issue of extreme poverty with patients being unable to afford full investigation or managements and resource scarcity (basics such as ECG stickers were missing rendering lots of expensive equipment useless and meaning there wasn’t continuous cardiac monitors of functional defibrillators even in A and E or on ITU). Additionally, specialists are often very scarce and you will see doctors managing unstable and chronic patients unable to access specialist care (at St Elizabeth the only surgeon has been on call since he started work there). Even as the regional referral centre expect it to be miles apart from the medicine in more developed health care systems both in presentations often being in more critical conditions than the UK, work ups and managements. The Doctors were largely friendly but very busy. The documentation and clerking are briefer than in the UK and it was often hard to understand what the Doctor’s diagnoses and plans were. I found it could often feel not very supervised and I had to be continually proactive in seeking support and input from the Drs and nurses which was then forthcoming. During my stint there were other medical/nursing students and qualified doctors/nurses from abroad there which can be great when it comes to learning and working together. I routinely helped with A to E assessments for most patients under the supervision of the Doctors or reporting back to them and in clinical skills I felt confident in. I had the chance to discuss diagnosis and management with Doctors. Whilst I was only able to join for 3 days I had the opportunity to see (and in most cases be involved in the assessments or managements) of Cardiac arrest, DKA, HIV AIDS PCP, asthma exacerbations, airway emergency from oropharyngeal cancer, pneumoconiosis, ACS, low GCS, RTA, hypoglycaemia, PUD, upper GI bleed, sickle cell crisis and extradural haematoma. Non-medically Tanzania was incredible. I would recommend staying at Amani hostel in Sombitini which Eduu works closely with. It is a very affordable, welcoming and comfortable hostel 20-30 minutes from the city centre and hospital with lots of fellow travellers to meet but also really lovely staff who are willing to show you local spots. Plus, Swaumu cooks a banging dinner and Poppati and Amir do a great night out. Get ready to hand wash your clothes (or pay someone to), we didn’t meet anyone with a washing machine. I would definitely bring lots of scrubs to throw away any ones that get really mucky instead of wash them. Arusha had great food with BBQ meats, rice dishes, street food, plenty of restaurants to try and was cheap (we could get a basic rice and meat lunch with extra samosas and skewers for £1.50 at St Elizabeth). The beers have great names, taste good and are cheap. The excursions we did were incredible and a great break from placements. The locals at the hostel and hospitals were really, friendly and welcoming and happy to show us round and socialise. The hostel team were happy to take us to a good local spot, make sure we didn’t get ripped off and get us home safe in exchange for paying for their food. There were also lots of other travellers and elective students to meet up with. Clubbing was great fun and cheap (I would go as a group or with a local). In terms of safety, we followed the advice given not to walk around after dark but to take the Bhijaji’s instead and had no problems. I did hear of some cases of muggings, but these were always tourists walking around at night against the advice, during the day it was just a case of declining sales offers which most sellers accepted first time. I would recommend trying to learn a bit of Swahili while you are on elective (the nurses taught me) as it can help with patients, but the locals also seemed to appreciate it and be more inviting if you knew anything more than mambo, poa. In summary, I would 100% go it was incredible and I learned and saw so much (medical and beyond). Do it with a local contact as lots of websites were out of date and having someone you could call or text to sort things was much, much easier. Try figure out a bit about different hospitals you want to attend whilst there and I found even the little time the second site hugely enriched the elective. Be prepared to see loads of diagnostic uncertainty, resource and financial poverty impacting care, fulminant diseases, really sad cases but also incredibly hard-working doctors who are keen to have you involved if you’re a little proactive, wonderfully fun and welcoming people, great food, great weather and loads of non-medical stuff to do. I also think it’s a place you can make a difference while you are there even if it’s just being another helpful set of hands on the ward.

My friend and I booked a trip to climb Kilimanjaro short notice. We had originally thought that we wouldn't be able to due to online information about the rainy season but found out that it was possible when we arrived. Eduu was able to quickly organise a climb that fit into our elective plans and was amazing at helping us find affordable quality rental gear (I had almost nothing as I was not expecting to climb). The route itself was day 1 to Mandara, day 2 to Horombo, day 3 to Kibu, midnight of day 3 summit with descent on day 4 to Horombo after a short nap and descent to the gate on day 5. Walking through the different terrains is wonderful and I have to recommend watching the stars at night as they were incredible. For me I found it physically doable despite the fact my last real exercise was 3 years ago and I have no real mountaineering experience. The style was "pole pole" which means slowly slowly. You walk at a glacial pace, slowing for any steep sections, which eats up the miles but leaving you feeling like you are always only slightly exerting. The altitude was a struggle for me especially on summit day where we had ascended 2000m in about 24 hours. Even with the retching and feeling generally terrible for the summit it was incredibly worth it. Our guides Mrope and Richie were amazing and I would definitely recommend them! I would also recommend asking Eduu for help understanding the tipping conventions. The whole team were lovely and I think the only thing I would change is that the food was variable, although the altitude didn't help my appetite.

I had a 4 day safari arranged by Eduu. It was incredibly easy and flexible to arrange and done on 2 days notice. The first day was tirengire which was stunning and possibly my favourite. It has such a unique landscape and loads of safari routes which cross the park meaning you can often get closer to the animals than other parks. This place is a must see for elephant fans!! The accomodation on night one was a comfortable lodge style place with simple rooms and very nice warm showers! Serengheti was much more open and animals perhaps less frequently seen but with its unique landscape, migrating Wildebeast and zebras and leopards was still an incredible destination! The sunrise is a must!! Camping in serengheti and ngororo was comfortable and fun but I would say bring a jumper as the mornings can be chilly especially ngororo which is higher up. Ngororo was stunnign with amazingly close lions that were literally under the car. Food throughout was basic but tasty. Make sure to plan tips! Eduu was very helpful in helping to understand amounts normally tipped! I would definitely go again if I had the chance!