Tanzania - Voluntary work at Haydom Lutheran Hospital

The Main Entrance to Haydom Lutheran Hospital

During our year off, Iren wanted to spend some of the time doing some voluntary work in an underdeveloped country. After contact with various aid organizations, it became obvious that it wasn’t go to be so easy to do some medical voluntary work and find something for Phil to do. Eventually Iren found out about Haydom Lutheran Hospital in Tanzania. They also said that it wouldn’t be a problem to find something for Phil to do in the Administration Office. So, after Iren had filled out a lot of forms and sent them off to the Tanzanian Medical Association we were ready for our next trip; to Tanzania. The plan was to work at the hospital in Haydom for one month, then climb Kilimanjaro, go on safari and finally spend the last week relaxing on Zanzibar.

The shops and street outside the Hospital's gate

The hospital was started in 1955 in a fairly remote area that the British wanted to establish a hospital but didn’t have enough resources to fund. The Norwegian Mission agreed to fund and run the hospital. The hospital has been lead by a Norwegian ever since and much of the funding continues to come from Norway. The village/town of Haydom has grown with the hospital and the hospital is the biggest employer in the area. The hospital has about 400 beds and is very busy. Before 1955, the area was infested with Tsetse flies. Forest clearance to enable the building of the hospital also resulted in the eradication of the Tsetse fly in the area

Iren and our luggage and food in Arusha

A week before leaving Phil decided to check the KLM baggage allowance since we would need quite a lot of different clothing and equipment with us. He was surprised to find out that KLM allows two bags per person of 23kg each to most African destinations. Therefore, including hand luggage, we could take over 100kg with us. We suddenly had more than we needed. Iren was aware that the hospital had very few Pulsoxymeters and so contacted the Medical Technical Department at Rikshospitalet in Oslo (where she works). They said they had an old one that was no longer in use and she was welcome to take it. She then contacted the supplier of the machine in order to get some new sensors. They kindly donated some.  Several kind people at Oslo University Hospital also donated several things so that we were able to fill our luggage quota with toys, children’s cloths, bandages and other medical equipment.

The first wheel change

 The start to our stay in Tanzania was very African. Shortly after we landed at the Kilimanjaro Airport the electricity stopped and stayed off for the rest of the evening. This, we later learned, is very common in Tanzania. We stayed a couple of nights in Arusha, a large town close to Kilimanjaro Airport, before heading off to Haydom.  Arusha is the Safari capital of Northern Tanzania and has lots of hotels, restaurants and Landcruiser garages. We talked to some of the numerous operators selling Safaris and Kilimanjaro walks and got a few offers and contact details. We also bought several bags of various food items to take with us to Haydom since we were told that the availability of food there was limited. This actually proved not to be the case as it was possible to get hold of most of what we wanted after we become familiar with the town.

Only 104 km remaining!

The journey from Arusha to Haydom carried on in the same African style. First, the brakes of the Toyota Landcruiser failed on the outskirts of Arusha so we had to drive slowly and carefully to find a place that sold the appropriate spares and then a garage that could replace them. Two hours later we were on the road again but it wasn’t long before one of the back tires had a puncture. We stopped at the road side and as if by magic several local people appeared and helped the driver change the wheel. About twenty minutes later we had to stop again because this time the front tire had a puncture. Some more people appeared and helped change the wheel. As we later witnessed, it’s not uncommon to see Landcruisers, Lorries and busses stopped on the road side changing tires. We had used the two spare wheels that Landcruisers have on the back doors and so we drove slowly to the next town where the two punctured tires could be could repaired. Not surprisingly the journey took about 12 hours instead of the 5-6 hours it normally takes if the roads are good (no rain). When we arrived at the hospital there was some confusion about where we were supposed to stay but this was quickly resolved by putting us in a temporary room and we were then able to have a good nights sleep before our first day at work at Haydom Hospital. Two days later we moved into one of the Family Houses in the hospital grounds for the rest of our stay.

Iren and a hard working nurse

 Iren’s first impressions of the Lena Ward (Children’s Ward) were of strong smells and overcrowding. There are no nappies for the babies to wear so they are just wrapped in a cloth. They often get cold even though the climate is warm and so I was glad that we had brought some children’s clothes with us that could help.  The smell is pretty bad before you get used to it, but luckily it didn’t take very long before Iren forgot about it. The patient rooms are very crowded. Most of the beds are occupied by two children and two adults. This also gave problems in terms of infection control. It’s difficult to understand how they managed to sleep. Another difference is that the patient’s relatives have the responsibility to provide food and general care. Only the malnourished children get special milk from the hospital. The treatment also has to be paid for. If the relatives can’t afford to pay then they do the appropriate number of hours work in the fields of the hospitals farm. We liked that.

Patient receiving oxygen

The availability of antibiotics and other drugs was better than expected and lots of children’s lives are saved by the treatment they receive and most of them are discharged in good condition. There are, however, a large number of children that die. Most of these children have infections, in particular pneumonia. These children seem to succumb quickly to the disease despite of antibiotic treatment. In the west they would receive sophisticated, costly and demanding intensive care treatment. This level of treatment is just not available in Haydom. This, in combination with late presentation at the hospital, means that the children die. Many present late because of the distance they live from the hospital and the practical logistics required to get people to look after their often numerous number of siblings. Therefore, the journey is put off until it is often too late. It’s sad to know that they could have been saved with better health care. An example of both the lack of staff and equipment and is the fact that there are no doctor Anaesthetists and before I got there no pulsoximetry to use during operations. The only monitoring is a stethoscope taped to the chest. The German doctor, Theresa, had a lot of equipment brought over in a container whilst we were there including pulseoximeters so the sitatuation is a lot better now. In the month that I worked at Haydom I had taken part in more resuscitations than in many years at Rikshospitalet. Although we did manage to revive many of them the end result was still very bad. They have all made a big impression on me. There are really not the resources available in terms of staff, medications, equipment and tests. The oxygen is, for example, in short supply (and it is not pressurized) even though there are many children needing it.

Children carrying out their chores

The children may not have become so ill if their nutrition and living standards had been better in the first place. Most live in mud huts where the food is prepared indoors by burning firewood. There is no chimney and as a result the air quality is very poor. Many people live in crowded conditions and this also contributes towards poor respiratory health.

Iren only spent a month working at Haydom, but managed to learn a lot and saw a number of conditions such as TB (Tuberculosis), malaria and malnutrition which are rare in the west. Whilst there she worked with Anette, a Norwegian Paediatrician in training and Theresa, a German Paediatrician in training. It was wonderful to work with such dedicated professionals. I admire the people who work there long term both locals and foreigners. It must be so demanding to keep up the good work with so overwhelming needs knowing that it is not possible to save them all. The numbers of doctors in Tanzania is very low. In Norway there are about 25 000 doctors which is about 1 per 200 whilst in Tanzania there are about 1 per 50 000 or less than 1000 for a population of 44 million! Life expectancy in Tanzania for women is 56 and in Norway it is 83. Haydom is in a very lucky position in that it gets a lot of volunteers. We had not expected that we would meet so many Norwegians volunteering there. It meant that there were experienced colleagues to discuss difficult cases with.

Typical mud hut just outside the town

The daily task of collecting water

 The village of Haydom is just how you imagine rural Africa to be like with dusty dirt roads and mud huts with straw roofs. The way of life for most people looks like it has not changed significantly over several hundreds of years. Whilst we were there the area was very green and beautiful due to the recent short rain season.

The walk around "Haydom Mountain"

They always wanted us to take their picture

We often went for walks around Haydom Mountain that took about 90 minutes. The children were friendly and curious and looked happy. They didn’t appear to have any toys except sticks to play with and they were also looking after younger siblings. They would often ask us to take their photos and they wanted our empty water bottles.  

Iren and Rachael on the way to Hanang

Posing in front of Mount Hanang

In the mornings we could see the sun rise over the horizon with the huge Mount Hanang in the background. Mount Hanang is 3417m and the 4th highest mountain in Tanzania. Most of the volunteers seem to climb it at some point in their stay and we were no exception. We climbed it one weekend with some of the other volunteers.

Eli showing the way to the top

View from Haydom of Hanang

 It was a long hot walk and

we used 12 hours all together. The views from the top and along the way were great. The Great African Rift Valley is a dominate feature. The walk was planned one week before our Kilimanjaro climb to help get our legs used to walking and our bodies used to the higher altitude.

Phil working in the Admin Office

Relaxing after work outside the house

Phil was working in the Administration Office. Haydom gets a lot of visitors/voluteers and there is often confusion as to who should stay where, as we experienced when we arrived. Phil was given the task of trying to improve this process. They currently used a simple Excel spreadsheet to keep track of who was coming and when.  

Phil decided that they should continue to use Excel since that it what they are used to but designed several other interlinked worksheets allowing them to have a total overview of which rooms were occupied until the end of the year, showing who was staying where at any given time, etc. They also wanted to be able to plan better and needed to know, for example, how many volunteer doctors were registered as coming each month so that they would not exceed a given number of doctors or other specialties at a given time.

Dinner at our house with colleagues

Phil handed it over to Amon who was going to be the main person responsible for holding it up-to-date. Amon was hopeful that this would make his life much easier and understood that it will only help if they are disciplined and enter the information and allocate a lodging as soon as a volunteer has confirmed that they are coming. There was always a lot of stress when the housing information is not up-to-date. This was highlighted during our last week when 41 Norwegian doctors and their partners were taking part in a Third World Medical Course. Several people had to be moved at short notice from their current accommodation and share with others. We shared our spare bedroom with Rachael, an American Nurse, for the last week. A new Internet site was also under construction for the hospital and Phil did a lot of work correcting the English and made several suggestions such as how to improve the Donations page. Iren also did some teaching to the Norwegian Doctors on the medical course. This added an extra dimension to the last week.

Children playing outside the hospital

Typical shop in Haydom

After a month at Haydom it was time to move on. We really appreciated the experience of working in a Third World Country and are grateful for meeting so many lovely people both volunteers and permanent staff. One of the people we met was Eli. He took us on the Hanang walk and whilst we were walking we talked about our plans to climb Kilimanjaro and go on Safari. Eli had contacts with a company that arranged these tours. He was able to get us a good price and he also wanted to come with us as an assistant guide for Kilimanjaro and a guide for the safari. So, Eli was to be our travelling companion for the next two weeks.