In Programs

7:30 am – Wake up and get ready

The early mornings in Mwanza, Tanzania are unexpectedly cold, especially when it rains the night before. The red dirt that covers most of the land around the house can turn into red mud and makes me want to choose boots over sandals. Living on the border of the city means there are less paved roads and more cattle, goats, and roosters outside of the gates of the house. This has created a few problems when I want to go into town. After the first week of attempting to describe in a few broken phrases in Swahili to the nearest land mark to various taxi drivers, I decided it was just easier to keep the number of for the same taxi driver to call every morning. His name is Jonas, he has two kids, 3 and 8, who are doing well in school. He moved here a few years ago and doesn’t mind when I play my Spotify playlist in the morning commute. He usually teaches me a new word in Swahili every day and always tells me how much easier Swahili is compared to English.

8:30 am – Breakfast

Jonas drops me off at the same coffee shop every morning. Ever since starting medical school in Miami, caffeine has been a permanent fixture of my mornings. This coffee shop not only serves the best lattés in Mwanza, it is within walking distance of the fire station. A pancake, a crepe-like pastry, is my usual go-to as I work from my laptop and organize my to-do list for the day. I am in Mwanza for two months, enough time to learn about the issues the prehopsital program is facing and possibly to implement a few solutions. My goal is to help them evaluate their system and build a reporting system to capture more accurate data in the future to help them secure funding from their government. I know that since I’m only here for a short time, it will be up to the leadership whether or not the ideas I suggest will change the way they record their data.

9:00 am – Fire Station

At the fire station, I spend my time in the control room working with the dispatcher, Josaphati, who’s assigned to answer the emergency hotline for the day shift and dispatch emergency alerts to the boda boda and fire department via Beacon. Josaphiti has been a fire fighter for a while, applying for a Masters in Fire Safety Engineering in the UK. A part of the job I had was to train the dispatchers on the technical changes to the Beacon platform that records their times and coordinates the local community responders who can help transport patients during traumas or fires. The dispatcher’s job is extremely important; they are managing the incident from above, able to allocate the resources needed or decide how to prioritize resources if multiple incidents are happening at the same time. The dispatchers are directly responsible for the efficiency of the system, and working with them ensures faster response times for patients who are experiencing emergencies in the field.

12:00 pm – Bugando Medical Centre

After the morning, I head to Bugando Medical Centre to work at the Tanzania Rural Health Movement office. After spending most of my time the last three years on different medical campuses in Florida, Bugando Medical Centre feels the most familiar to me. I pass medical and nursing students in short coats, complaining about upcoming exams or rushing between rounds, and the familiarity of it all assuages the home sickness I have. I understand their struggle at the bottom of the medical hierarchy, as we walk the fine line between being useful or being in the way. One of the future doctors I’ve met here has one more year of school and volunteers with TRHM. I’m interested in Emergency Medicine, so I asked him about his opinion on the specialty, which is still a very young medical specialty in Tanzania. He told me about the option of rotating through the ER at Bugando and as interesting as it is there are only a few residencies and none of them are by his family. He’s thinking of becoming a cardiologist and believes the programs that TRHM has been working on will have a positive impact on his community.

1:00 pm – Meeting with ER Doctors

Today I am meeting with the doctors at the Emergency Room to hear about their experiences with the prehospital program. They see the potential of the program and are interested in helping with training and medical review. The head of the department, Dr. Suleman, spoke about what she believed should be would prioritized and how the prehospital program can benefit the Emergency Department. Hearing what they want, I feel hopeful that they are invested in the future of EMS in Mwanza and are a possible ally for creating the roles of medical direction for this program. The doctors are a valuable resource that could help the responders prepare for traumas and review the cases with them. This will help the the system to grow and improve patient outcomes over time as the responders are better equipped to handle more complex emergencies. Responders with hospital-based direction and support can more confidently work within the community and have a greater impact.

2:30 pm – Working at the Community Health Building

At the TRHM office within the Community Health Building, I meet up with Faith and Aziz, the project managers for the prehospital programs in the cities of Mwanza and Iringa respectively. Aziz has just started in Iringa and will be moving from the capital of Tanzania to Iringa in order to work with the community responders there. Faith and Aziz handle the day to day logistics of the programs and are ultimately responsible for the execution of it all. Working with Faith and Aziz is a great opportunity since they are the people who can affect the most change within their programs long after I am gone. They are in constant contact with both the drivers and the fire department. Part of my role was to evaluate the current system and to create a record keeping system for the project that more accurately describes what is happening in the field. My goal was to help them set up an easier way to analyze their prehospital metrics from every level in order to identify ways for them to improve over time. This is a system that needs to be self-sustainable and scalable to the needs of Mwanza. This needs people like Aziz and Faith who live in the community to monitor the system and step in when some part of the process stops working or becomes inefficient. They want their prehospital service to be data-driven to bring life-saving care to more people.

5:00 pm – Leaving for the day

The best surprise of working in East Africa was learning how fast the internet is over cell phones. I’ve never had better service in my life. My cell phone is my life here, it acts as a translator, taxi car app, and electronic wallet as I navigate through the city. M-Pesa is the name of one of the electronic money transfers people in Tanzania use from their cell phones. It helps make money transfers accessible to everyone and has help me out more than once. Putting money in the account means going to a Wakala, found on every street corner, and having them transfer the money to my account attached to my cellphone. Once it’s on my phone I can use it to pay for the internet, taxis, or food. Around this time, my family is starting to wake up and head into work. I try to catch them on their morning commutes due to the 8-hour time difference.

7:00 pm – Dinner

I’ve met so many people from around the world during my time here, working for English schools, the hospitals, or other non-profits. I was invited to meet with a group from the UK dedicated to reducing deaths in Mwanza secondary to drowning in the fishermen community that works on Lake Victoria. At the dinner, I meet another group of ex-pats from the Netherlands working in solar energy and a woman from the Royal College working on data for vaccines. The food takes a long time to prepare, but there’s no rush. Everyone is extremely invested in the work and the night and conversations jump from discussing systems of health to where the best Indian food can be found. It’s exciting being around the energy of people who are passionate about the change they are helping to implement, looking forward to what the next 5 to 10 years will bring. I head out of the restaurant around 10 pm, tired but ready for the next day in Mwanza.

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