From Finland to Tanzania

A nursing adventure

My last post and advice to you

If you are thinking about going to Tanzania to do your practice…..Do it!

It was an amazing, crazy and fun experience.  From a nursing point of view, I have learned that you see a lot of things, good and bad,  and nothing will surprise me anymore.  I have seen plenty of good nursing care and some not so good nursing, but I think that is the same wherever you go in the world.

From a personal point of view, I think I have learned to enjoy life, to enjoy my friends and not to take things in life too seriously.  Whatever happens will happen!

If you were to come here, be prepared for a culture shock.  Everything is different. The way people are, the goats and cows on the side of the road, the way you will live, the food, the transport, the way of nursing and a million more things. But if you embrace the unknown, you will have a fantastic time and I wouldn’t change it for the world! 🙂 Also, Tanzanian people are some of the nicest people I have met!

I also learned an important lesson not to take life and friends for granted.  Just after I came back to Finland, a close Tanzanian friend of mine passed away because of malaria in the hospital where I worked.  Malaria is  still a big health problem in East Africa and usually it is easily treated if caught early, but sometimes it isn’t.  So, there is still much work to do in preventing malaria deaths and as a nursing student in Tanzania, there is much you can learn and do there.

 

 

 

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Back home

My bags are unpacked and my winter clothes are back in my cupboard. It felt quite unreal to come back to Finland.

I have already realised how much I miss the friendliness of Tanzanians, my friends and the sunshine and beaches of course!

Classes have already started again and I will be starting Nursing in International Fields module -the final module before I graduate! It feels quite strange to have been in practice the whole of the autumn in Tanzania and then come out of the other side (theoretically) almost ready to graduate!

I think there have been some advantages and disadvantages to being on exchange in a place so different from Finland.  The main disadvantage being that I haven’t learned many technical skills, such as using advanced electrical equipment or documenting on computers, as my classmates who stayed in Finland have learned. But these skills can be learned later, I think! On the other hand, it feels as if I have seen a great variety of cases and learned about diseases and illnesses not so prevalent in Finland, such as malaria, HIV and sickle cell anaemia.  Also, it was interesting to see the creative use of equipment in Tanzanian hospitals and being able to do your job with very little.

 

 

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The long goodbye

After more than 4 months in Tanzania, it really is time to go home. The last month has been full of mixed experiences.

I had a bit of a problem with my operating theatre practice. There weren’t operations everyday and there were similar operations most days.  The main problem was the scrubbing and circulating nursing, largely due to the language barrier. During the anaesthesia nursing, I had many good opportunities assisting and working with the anaesthetist. So it was disappointing that I didn’t get to learn as much as I was hoping for the scrubbing and circulating part.  The theatres are VERY basic compared to ones in Finland.  The only electrical equipment was a diathermy machine and suction.  The drugs and gases are the same to anaesthetize the patient and the care is the same.  It seems that most surgeries are caesareans, gynaecological operations and smaller procedures such as tonsillectomies.  Seeing as this was a small hospital with only a handful of surgeons, I think that more complicated surgeries were done in the national hospital in the city centre.

My last day at the hospital was a really tough day.  I was in the delivery room helping out and the doctor realized there was something wrong with the baby.  We all listened to the heartbeat (with the old-fashioned listening device, there is no electrical monitoring equipment) and the heartbeat was weakening.  When the baby was delivered, it had the cord around its neck, was blue and wasn’t breathing.  The midwives took the baby to be resuscitated and everyone left the room.  I stayed in the delivery room with the mother.  She was bleeding heavily and she was obviously very worried about the baby. She was asking me where is baby and if he is ok. It was difficult for me to know what to say.  I tried to reassure her that the midwives were doing everything they could.  When I went to the resuscitation room, the baby was dead.  It was quite confusing because it seemed like it took a long time for the doctor to tell her that her baby had died.  I hope I made things a bit easier for her, even though I was just holding her hand and trying to calm her.  The matron weighed and wrapped up the baby in a kanga (traditional cloth) and we both cried a little.

To add to my sadness, it came time to say goodbye to many good friends I had made over the last few months.  I have met people from Finland, Sweden, Denmark, Canada, America, UK, and of course Tanzania!

On a happy note, I spent christmas day on my favourite beach with my friends. Mahaba beach is a short piki piki ride from Bahari beach.  We spent the day sunbathing, drinking and having fun 🙂

Some of us had more ‘fun’ than others, pole sana Aleksi!

All in all, it was a fun, happy day with my Bahari Beach family 🙂

 

 

 

 

 

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Cultural differences

No exchange blog would be complete without saying something about the cultural differences between Finland and Tanzania.

I’ve been here long enough now to get over the culture shock and go with the flow.  If you come to Tanzania, you will realize a few things:

1. Everything is ‘pole pole’ (slowly slowly) – Time management goes out of the window somehow.  If you arrange a meeting at 9am, it won’t actually be 9am.  You might get there before lunch, though.  So, I have spent a looot of time waiting for things to happen.  Then everything else is late for the rest of the day. Even small things like going to the atm or taking a bus to  work seems to take five times longer than at home.

In the beginning, it bothered me so much as in Finland, we are very punctual and it is a big no-no to be late for work or to anywhere, actually.  Now, I quite enjoy knowing that wherever I go, i will get there…..eventually 🙂 You never know where you’ll end up or when!

Also, when someone says ”I’m coming’, they’re not actually coming.  They mean that they might just be leaving their house and they might stop by somewhere then come.  It means between 20 minutes and 1 hour 🙂  On rare occasions, I get into trouble when someone actually turns up on time as I just assume I still have maybe half an hour!

2. Everything is ‘pole pole’, except for traffic (in Dar)

Maybe I have mentioned this before, but the traffic is crazy, dangerous and and fast.  There are traffic jams all the time and people drive as fast as they can and will do just about anything to get a bit ahead in the queue.

Also, sadly, drink driving is quite normal here and I have seen accidents on the roads and patients in the hospitals so many times. The police are not good at enforcing the rules (I don’t even know what the rules are)

3. People are so inviting, friendly and warm…….

In the beginning, this confused me a lot!  Living in Finland, people can be distant and not so inviting to strangers.  Here in Tanzania, everyone will say hello, shake your hands (for a very long time), share their food with you and offer drinks.

4. ……But be prepared to be called ‘mzungu'(white person/foreigner). All the time.

No matter where you are, at work, in a bar, at the beach or just walking down the street, people of all ages will shout ‘mzungu’ at you.  In the beginning, it was a bit unnerving and annoying and it didn’t feel so good.  But it is  almost always people being friendly and just distinguishing you from all the Tanzanians around 🙂

5. There is so much inequality

Everywhere you look there is inequality in wealth and in terms of health.  Tanzania has a lot of positive things about it, tourism etc but it feels like the money doesn’t get to normal people. There can be a large expensive hotel with beautiful beaches and expensive food and next door to it is a village where people literally have nothing.  Being in Bahari Beach which is located outside the city centre and not in any real tourist areas really gives you the chance to see how people live.  I think that tourists are sheltered from how life is really like here when they spend their time in nice hotels, being on safari or in Zanzibar and don’t meet many Tanzanian people.

 

 

 

 

 

 

 

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Extensions, safaris and Zanzibar

So, my 3 months on exchange are up. Time has gone so fast, I can’t believe it.  But, I have applied to extend my stay in Dar for another month to complete perioperative practice here. I have been to the operating theatre a few times already, and I found it interesting and I wanted to learn more about how things are done here with fewer resources and technology.  The principles are of course the same, such as preparing the patient pre-operatively, ensuring aseptic and sterile conditions, administering anaesthesia drugs and caring for the patient post-operatively.

I had to do quite a lot of organizing, extending my visa, changing my flights and applying for changes to the learning agreement with the school. But, now I will continue at the same hospital and will experience my first African Christmas!

 

After my 3 months of practice, I arranged to go on safari. We travelled by coach to Moshi. It was a long 10 hour trip, but it was nice to see the different countryside and landscapes. We spent 4 days on safari and started from Moshi to Maasailand, Serengeti, Ngorogoro and Lake Manyara. It was pretty amazing to see so many animals and our guide was so good we got to see the big five and so much more!

 

Mount Kilimanjaro

 

 

 

Maasai village

 

We also took long weekend break to Zanzibar. We spent one day in Stone Town and the rest of the ime chilling on the beach at Matemwe.Zanzibar was nice, and stonetown was interesting,but be prepared to be harassed by touts and random people wanting to sell you something, be that a tshirt, a taxi or a boat trip! But,it was a well-deserved break and now I am ready to carry on with the final month of practice in the operating theatres!

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Practice continues…..

My first few weeks in practice have been interesting, entertaining, frustrating and sometimes sad.  One of the premature babies had died because the hospital didn’t have the resources to take care of the baby.  Also, geriatric care is very limited compared to Finland.  I think this is because life expectancy is so short here : 58 years compared to 79 years in Finland.  I have read that the percentage of 65+ in Finland is 17% and in Tanzania it is less than 3%.  The leading causes of deaths in Tanzania are HIV/AIDs, malaria, pneumonia, stroke, diarrheal diseases and coronary heart disease, whereas in Finland they are cardiovascular diseases, cancers, dementia and alzheimers disease, respiratory diseases and alcohol-related diseases.  As life expectancy is improving in Tanzania, I think there will be more need for geriatric expertise in nursing as more of the age related diseases will become more common.

On the upside, I have been at  a caesarean section and 3 deliveries and I have seen several operations in the operating theatre.

I have also cannulated,done injections and helped to prepare the IV lines, medication and documentation.  I have only ever used computers to document patients records, so it has been quite challenging and time-consuming to read and write everything!

We have also visited the baby clinic in the hospital, which is well run and has lots of information about pregnancy, contraception and HIV in mothers and babies.  Mothers and children come here during pregnancy and for follow up monitoring and immunizations, HIV testing etc.

The hospital has many positive sides such as the well baby clinics and treating malaria and HIV but I think it will be challenging in the future as life expectancy increases for the health services to care for elderly people and age-related diseases.

Here are some more pictures from the hospital

 

As you can see, the equipment is basic, like I said before.  Hygiene and handwashing are of different standards.  There are no proper soap or hand sanitizers to wash your hands and no kind of paper towels to dry them.  There is also an interesting array of animal life in the hospital.  There are birds nesting in the walls, cockroaches scuttling across the emergency room floor and we even saw a  baby gecko sat on the anesthesia equipment during an operation.  I don’t think the anesthetist even noticed!

 


Goat races, traffic jams and car crashes – just another weekend in Dar

We went to the annual charity goat race in Dar es Salaam.  It is an annual event to raise money for various charities and health initiatives in the region.  It was my first time at a goat race and it was a very fun weekend.  I even won a bet on a race 🙂

 

The aim is for goats to race around a track with ‘jockeys’ pushing them with a large stick.  They sometimes get confused and run into the sides or just stop, but it’s entertaining 🙂

 

On your marks, get set….

On the way home, the traffic,like all days, was really bad.  It took us 3 hours to get home on the bus.  Everywhere you go there are traffic jams.  It is important to leave places in good time, especially to the airport, for example.  Our traffic jam on the way home from the goat race was the worst so far.  It was so bad that people just left our bus and walked back in the dark.  It seemed like everyone else in all the other tuktuks and dala dalas just left and started walking.  It was quite scary to be left in a small group with an angry bus driver, but we got back eventually and carried on partying 🙂

 

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Practical training starts

I started my practical training at Massana Hospital .  It is about 20 minutes travel from our accomodation in Bahari beach.  My first day there was quite a shock.  Even though it is a private hospital, by Finnish standards it is quite dirty and has basic equipment.  But, as with most things, it just seems to work.

I realized straight away that the nursing is quite different to what I have experienced before.  I think this is because the family members do so much of the basic care of the patients including dressing and feeding the patient and being with them most of the day.

I met my mentor Dennis and two other AIT volunteers there.  We started with night nurse’s shift report about patients who were already there.  We were mostly in the emergency room and day clinic and today was a comparably busy day.  There were patients from young to old, with diseases ranging from malaria to sickle cell anaemia, along with age related disorders such as hypertension and stroke to young children with severe burns.  It was quite a shock to get such a wide diversity of patients, but it was interesting to see how the nurses dealt with each case.  We also spent the day in the ‘dressing’ room where patients with wounds come for post-surgical dressing changes, stitch removal and other small procedures. We also went to the labour ward and looked round the neonatal unit and looked after a premature baby born at 30 weeks

After a hard day’s work we went to Kunduchi Beach, about 20 minutes tuktuk ride away

 

 

 


Karibu! Welcome

I left Finland early morning and arrived safely in Dar es Salaam.

I arrived at about 3am to the airport and getting the visa was easy, as long as you don’t expect an orderly queue like in Finland 🙂

I waited at the airport for a while probably looking bemused and tired.  Then my AIT ride came and we drove about 45 minutes from the airport to Bahari Beach – my accomodation.   The roads are quite bumpy and in a bad state and the road users seem to make up their own rules, but we got there 🙂

 

I finally arrived. The accomodation is basic but nice

There is a small bar where you can buy beer and water

 

There are also small classrooms where children come to learn English

The first morning I had an orientation around Bahari beach, the local market and wood carver’s market.  We also went to the mall and travelled by minibus and tuc tuc.  The traffic is almost always busy and there are always traffic jams.  The best ways to travel are by tuc tuc and minibus, but the fastest way is by motorbike taxi, if you have the nerves!

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Two weeks to go!!

Now that summer has pretty much disappeared from Finland,  I am getting quite excited to leave, but with so many things still to do and my summer job still going on, I don’t have much spare time to organize the small things.

I have taken my malaria medication test-run and I didn’t get any terrible side effects, except maybe headaches.  I finally got round to taking the cholera vaccine which is a liquid suspension which you have to drink in two separate doses 1-6 weeks apart.   It tastes quite weird 🙂

I got confirmation of my grant from school and all fees are paid to Art in Tanzania.  My visa application is ready and now the biggest thing to worry about is packing. Here is AIT’s packing list:  http://www.artintanzania.com/volunteers/packinglist.pdf .  Luckily I have 30 kg weight limit!  Is it too early to pack ?

 

 

 

 

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