Field Trip to the Regional Hospital in Dodoma

Tanzania has both a public national national health system and a much smaller private system. The public system was designed to meet the needs of the populace from a small village to a regional metropolis. This week we saw two of these, the district hospital in Dodoma (a step below Muhimbili) and a Health Centre (one step above the smallest facilities know as dispensaries) in Mtiti, a community of 10,000 about an hour from Dodoma. Both were fascinating and worthy of a post. As you will see we are beginning to get a better feel for what the phrase "resource poor environment" actually means.

Outpatient meds for HIV are generally free as PEPFAR provides these. PEPFAR is the Presidents Emergency Program for AIDS Relief and was established by George W Bush. It provides millions of dollars annually for AIDS and has been judged as successful although any program of that size has worthy critics. Of note, PEPFAR provides almost all the funding for GHSP, our Peace Corp program. Seed Global Health, the Boston NGO behind GHSP, raises money independently which largely goes to tuition debt relief for GSHP volunteers. For those of us who are older and debt-free there is no support per se. The younger members of our cohort however cite the tuition relief as a major factor in their GHSP participation.

Dodoma's facility was not open for outpatients the day we end since it was Eid, the end of Ramadan and thus a national holiday. Although we missed seeing the bustle of the place the absence of all but inpatients made touring the facility much easier. All public health facilities charges modest fees for their services. Remember, this is the premiere facility in the nation's capital.

Welcome Sign at Dodoma Hospital Entrance

Prices are: Dental Extraction $1.50; Minor Surgery $3.50; Major Surgery $25

Insurance is available via government subsidy or on the private market. In some of the pictures you will see prices posted for services. At current exchange rates the sixteen hundred Tanzania schillings equal one US dollar (TZS1600 = $1).
Our visit to the Dodoma facility was eye opening.  It was very sparse. Patients being seen in the Emergency wait outside on wooden benches.

Our group outside entrance to OPD (Outpatient Department)

Outpatient Waiting Area

Admission Fees range from $7 to $2. An X-ray costs $2. 

Hospital Sheets on the line

Inpatients are in common wards with 24 beds/ward.  Separate buildings house different type patients sorted by type (medical, surgical, OB etc). These wards had patients in metal frame beds with mosquito nets and not much else. The laundry hangs outside on lines. I have no pictures since patients were in the beds.

Laundry Washing Station in background 

List of the Top 10 Conditions in the Surgical ward.

Many of these conditions require major surgery. Prostatectomy for $25! 

One of our number is a retired Indian-American surgeon who described the surgical theater as being comparable to "rural India in the 60's".  I missed the laboratory but was told by my group there were many modern diagnostic analyzers donated by Abbott. They had signs on them saying "unable to use since 2012 due to lack of reagents". 

This is an all to common problem in Africa - donations of high tech equipment that prove worthless over time because they are either not maintained or not used due to lack of training or lack of long term funding. The term for this is "Dead Aid". Sustainability is all important. GHSP addresses this by training human resources. Keeping doctors and nurses in Africa after educating them is ongoing issue. Many leave for a better life elsewhere, the "brain drain" phenomenon.

Ward Buildings 

I toured the ICU and noted one monitor, one oximeter, one suction apparatus, one oxygen concentrator and one mechanical ventilator for a four bed unit. All were quite worn and tired in appearance. 

The nursing staff were proud of their wards which were unfailingly clean but threadbare.

Much to my delight I discovered preferential "Doctor's Parking" (RMO=Regional Medical Officer) is world-wide! Hopefully the RHS drives a narrow car.