Our room at the accommodation organised for us by our hospital elective co-ordinator

Nungwi beach

We were adopted by a local football team and play for them each weekend - somewhat out of our league but good fun

Sunset from 'Sunset bar' - Africa House

Kitchen and lounge room at our accommodation

Surgical ward

The surgical ward at Mnazi Mmoja hospital is not dissimilar to the medical ward in layout and function however as with most surgical wards the morning rounds are generally briefer, as the surgeons need to get to theatre. The layout of the ward is basic; surgical wards are separated into male and female (I've been on the male ward/team). The male ward is divided into one large room containing about 30 beds, and a smaller room containing about 10 beds. The larger of the rooms takes all surgical cases for the hospital except for urological cases which are all in the smaller room.

Surgery days for the male general surgical ward are Tuesdays and Thursdays, except for emergency cases which will be operated on as required. On these days there seems to be either a very brief round, or no round at all, before the surgeons go to theatre. Mondays consist of a standard round which usually takes up to 2 hours and Wednesdays are a teaching round including local students which usually takes slightly longer. Fridays involve another ward round and an outpatient clinic, which is beneficial as this provides probably the greatest opportunity to practice examination and history (with the aid of the doctor translating) skills and to formulate diagnoses. As with the medical ward, the greatest barrier is the language difference with most patients only speaking Swahili and translation required by the doctors (who all speak and write notes in English).

The ward itself is fairly ill-equipped and as with the medical ward patients are required to obtain medications and other necessary supplies from the local pharmacy as the ward does not stock them. This being said equipment such as dressings, needles and syringes, cannulas, antiseptic, gloves and saline/IV lines are stocked by the ward. At times been difficult to differentiate who are doctors and who isn't, as it seems that everyone except the nurses are addressed as 'doctor', including both local and international students.

In comparison to the ward, the OT was surprisingly well organised and relatively comparable to home regarding equipment and procedures to retain sterility. Students are encouraged to attend and observe operations but it's advisable to bring your own scrubs (which we all wear on the wards anyway as it's too hot to wear a white coat over pants and a shirt) and mask/cap as it seems that these are in relatively short supply and aren't as readily available as in western hospitals. All staff are required to remove their outside shoes before entering the theatre wing and to put on theatre shoes as there are no shoe covers. Fortunately there is an abundance of spare crocs and sandals around, but it's still worthwhile checking with someone so as not to inadvertently take someone's personal footwear. There are at least two operating theatres which are used by the general surgical team and another used by the obstetric/gynaecological team. Procedures performed are common procedures which you'd see in most western general surgical theatres; appendicectomies, laparotomies for perforated bowel, herniotomes, cholecystectomies etc. Along with other procedures not done so often in western theatres including TVPs (trans-vesical prostatectomies) and open nephrolithotomies. There is no laparoscopic equipment so all surgery is done via laparotomy, but all surgeons appear fairly highly skilled and all procedures are performed in sterile conditions with full scrub attire and drapes (albeit that there isn't much disposable equipment, most is sterilised and re-used).

Students in the surgical team aren't expected to stay at the hospital all day, however are invited to make an effort to get involved as much as possible in assisting procedures in theatre and on the wards. There isn't much to do on the wards after rounds, and on theatre days students aren't expected to observe all day, however interest is appreciated and surgeons are obviously more likely to invite keener students to assist where possible.

Week 2

The hospital placement is going well. We're now divided up between Gen Med and Surgery. All three of us rock up at around 8.00am for the ward rounds.
On the Gen Med floor, usually the doctors are ready to go by about half past, after the nurses and nursing students (we think) have documented the names and diagnosis of all the patients in the beds. There's 26 beds in the larger ward with the heart, respiratory, neuro and everything else patients, and about ten in the infectious ward - mostly immunocompromised patients. We work our way through all the patients in the order of the beds..reviewing progress and everything else just like any other ward round in Melbourne hospitals. The main difference is there's no hurry, kind of like everything in Zanzibar. The doctors are very good at the illnesses they see often (malaria, diabetes, HTN, pneumonia, various infections) but we've found that they are very impressionable to our suggestions especially with interpreting investigation results like blood tests, ECGs, xrays and CT scans. This could be because these investigations are relatively new to them, and although they order them frequently, it seems like they are lacking the skills to understand them fully. Just guessing there but it seems likely.. So, we feel kind of useful when we are asked for our opinions on these things.
Probably the biggest difficulty here for us is the language barrier. Swahili is the native language. The locals predominantly speak no English. The doctors write all the notes in English, however, so at least we can read them. And also the doctors have a pretty decent grasp of English so (when they feel like it, or are pressed) they can usually fill us in on what's happening. However, history taking doesn't seem to be a major priority, so there isn't too much Swahili for us to try to follow. The note taking is brief and to the point. Examination findings, meds, plans are documented every day.. all pretty standard. On Tuesdays and Fridays the students from the local med school join us for the round. There are quite a few that follow us around which makes it a bit harder for us to get in on the action on these days. The interesting thing about the students is that they learn from Cuban teachers (the school is part of Cuba's program to train more doctors worldwide, apparently) who speak to them in Spanish..then they write their notes in English..and they are speaking to the patients in their native Swahili. Given the broken nature of their English in conversation, one can be pretty sure that quite a lot of information is either lost or confused in translation. But it's good to see that the students are keen to practice their skills, and willing to learn, occasionally asking us for guidance too.
On the topic of skills, due to their being so little in the way of medical technology to reach Mnazi Mmoja hospital it is a good place to hone your clinical skills. We're a bit reluctant to put our hands up to take blood etc..that said, the rate of HIV is very low on the island. We've been told its 0.6% which we think is about the same in Melbourne. Not too sure about the rates of other transmissible diseases, but there's a lot of hepatitis we see on the ward.
Actually probably one of the best things for the ward would be chlorhex spray or ethanol gel to sanitise hands between patients. We carry our own bottle of sanitiser, but it would probably be a simple and effective way to reduce infection and cross infection on the wards..
There are lots of opportunities, its really up to us how much we want to get out of each morning. The round takes about 3 hours..after it's done we generally head home. The doctors don't have a heap to do until a new patient is admitted, so they're happy for us to leave once the round is done. This is pretty great for us, because by this time we've worked up a massive sweat, and we're hungry. The day only gets hotter from here on, so we generally retire to our room for a while then go out for lunch somewhere. Then the afternoon is ours to enjoy the life on the island. In that respect, this is a pretty cool place to be doing a med elective.
 

First impressions..

Firstly, thanks for reading our blog. If you're a friend or family, welcome. If you're a medical student hoping to find some information about doing a placement at Mnazi Mmoja, hopefully you find this blog useful.
We're three med students from Melbourne who are doing a six week placement at the major hospital on the island of Zanzibar, off the coast of Tanzania. Two of us are deferred for the year, and the other is doing it as his uni elective for final year.. we've now been in Zanzibar just about a week, so we thought we'd start a blog to put some information out, and also keep anyone else at least mildly informed as to what we're doing over here.

We'll probably blog a bit sporadically whilst we're over here, if anything particularly worthy happens we'll try to write about it. Also hopefully get up a few photos. And also, cause we found there wasn't too much info around when we were planning this ourselves, to try and help out anyone who is considering coming here in the future.. 

The three of us are divided over the departments of paeds, surgery and internal medicine, and we're planning to swap around over the placement and get a feel for each over the 6 weeks. In the meantime, living in Stone Town and exploring the areas around the island will keep us pretty busy. It's an extremely vibrant place to live.

First impressions are that this hospital is a pretty interesting place. The medicine is very different to anything we've experienced before.

The internal med department has two wards, one for 'infectious' cases and the other for everything else, which encompasses a fair bit of cardio and resp illnesses, diabetes, musculoskeletal, and everything else.. the infectious ward is a bit smaller and there is a lot of HIV pts, malaria, TB etc. There are not too many doctors around the hospital, but there are heaps of nurses. The patients speak pretty much zero English, and the doctors have varying abilities of English. Hence, translating information is a bit of an issue. That said, all the hospital notes are written in English, so at least we can read them, and gain what info we can from that and the doctors' efforts to translate to us. There is what you would call a scarcity of resources..when the doctor decides the patient would benefit from a drug, they write the name on a scrap of paper, and then a family member of the pt will run into town to find a pharmacy that stocks it.. there is one CT scanner in the hospital, which seems to get used quite a lot, and there are ECG and XR facilities available, so that's good. Blood tests are done regularly and there is a lab on site, but it can take a little while to get the results..Apart from that, there is very little in the way of electronic or other tools, so it is largely down to history and examination - and clinical decisions and plans are based on a most likely diagnoses.