School Begins!

My apologies to all for the prolonged silence but we have been very busy with the return of the nursing and medical students and the resumption of classes. Suddenly there are nearly a thousand students milling around both the MUHAS (university) and MNH (hospital) grounds. White coats abound.

Students Leaving Main Lecture Halls

Laurel is teaching three courses, two graduate level and one undergraduate. She has been extremely busy with getting those off the ground. She is also regularly conducting in-service training for the nurses on the Psych Ward, something new at MNH. Nurses have a more limited role here than in the US. She has taken an educational approach to this problem. She has met with some success in trying to enlarge their role and offer the education needed to support those expanded roles. She is to be commended as driving change at Muhimbili is not an easy task we have both discovered. Like any large complex organization the systems change very slowly.

Faculty of the School of Nursing

Laurel's big news is her new office. For the past three months she has not had one. It is difficult to not have a place on campus from which to operate. However, she ended up in prime real-estate in the School of Nursing offices when she inherited the old office of the new Dean. Not bad...

Laurel in her New Office

As is my usual I am doing everything at the last moment and have been scrambling to catch up on my lesirely two months without students. I have a role in lectures and bedside instruction for both third and fifth year medical students as well as seminars for IM residents. The clinic work and ward rounds continue as before. I have started a weekly course on interpretation of chest x-rays and CT scans for the IM residents that has been fun but a lot of work. I am now making teaching rounds in the ICU and giving some lectures to the nursing staff there. There is no shortage of things of to do for either of us.

The semester started with the "white coat' ceremonies for both nursing and medical students. Then we were off to the races with multiple duties and lectures etc.

White Coat Ceremony

Professor Magusi, my counterpart, lecturing to third year students

Resources are seriously constrained here. The library is dated in terms of its holdings. Most of the materials students use are online or shared .pdf files of texts etc. Once you understand most are struggling with tuition etc you begin to grasp the level of sacrifice it takes to get where they are going. Some have some stipends from the Ministry of Education but most do not. Not everyone has a computer or internet access so their task is difficult. Most live quite a ways from campus without internet access in their hostels. There is free internet access on campus for students but the access points are limited.

Pulmonary Books in the Library. The textbook is 20 years old.

Overall I find them to be quite committed and remarkably good natured about the difficulties they face in acquiring the education many of us take for granted back home. Tanzania is a poor country with a large base of rural, uneducated peasants who survive via subsidence farming. Most lack education. Students from those families rise in the Tanzanian educational system based on merit and access to the most coveted professional training is limited. Freedom of choice does not always exist in that the government may tell bright student they are going to become a pharmacist rather than a business person regardless of personal preference. Not everyone is happy with their destination but all understand that is their only way out of poverty so they embrace the opportunities as they are presented. Most struggle due to their limited financial resources. As a rule they are engaging young people who brighten our days.

Muhimbili Welcome Sign

Muhimbili National Hospital is a huge place with seemingly infinite small buildings and nooks and crannies. I have gradually been discovering new places there as the months roll by. It is a warren of fiefdoms spawned by prior donor grants and the construction those necessitate. The long term problem boils down to this. Donors like building things with their money but frequently do not provide adequate operational expenses for the long haul. Clinical programs end up operating on a shoestring without many of the "consumables" they require to optimally deliver care to patients.  Quality facilities go unused for lack of financial resources to operate as intended.

Main Entrance to Covered Walkways

Often the Tanzanian response is to build your way out of the jam using more grant monies earmarked for construction of new programs and spaces. A new donor comes along offering monies for construction and short term operation of a new facility that partially duplicates what is going unused. You take advantage of the opportunity and build something new because it offers short term relief. Then the problem of sustainability rears its ugly head and you are back where you started but now have an additional facility you cannot operational support. This is often the only option. It is a recurring problem in most developing world settings.