Friday, May 19, 2017

Neurology teaching ward in urban Tanzania

Robert W. Regenhardt, MD, PhD
Resident in Adult Neurology at MGH/BWH

Neurology teaching ward in urban Tanzania
Picture with Maijo, Neurology Fellow, outside Neurology Ward
My first day of rounding on the Neurology Ward at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania was a unique and life changing experience. MNH was established as the Sewahaji Hospital in ~1910 and is the largest referral hospital and academic teaching hospital in Tanzania. There are >1500 inpatient beds. Each week, 1000-1200 patients are admitted to the inpatient services and 1000-1200 outpatients are seen. There is one male and one female neurology unit. While the physical appearance was quite different compared to MGH and BWH, I was surprised at many of the similarities in terms of the teaching culture.

As I approached MNH during the walk from my lodging, it was clear that the hospital lacked the surplus of funding that hospitals such as MGH and BWH have. Many of the wards are connected by dirt roads. There was only air conditioning available in one building, the Cardiology Ward, which had just received a large donation to be built. As I entered the Neurology Ward, I noticed that paint was peeling off of the walls, the windows were all open allowing some bugs entry into the building, there were mosquito nets hanging over the patients, and 15-20 patients were placed in one common space. On a few occasions there was a lack of running water on the wards, and jugs of water were brought in so we could wash our hands.

Despite the relative lack of resources compared to MGH/BWH, I was surprised at the many similarities. It was clear the house staff really cared for the patients. Many of the same services we offer patients at MGH and BWH were available at MNH in scaled down versions. I was perhaps most surprised by the structure of rounds. In the same fashion at MGH/BWH, the most junior person, usually the rotating intern, presented the patient. He or she was “pimped” to assess knowledge and give feedback. There was a similar hierarchy, where sometimes the most senior staff would even make fun of junior trainees. “Weren’t you previously a student of mine before you graduated to intern?” asked one of the senior clinicians to an intern. “You were a lot better back then!” the senior clinician joked. I was surprised that this same social dynamic exists on the other side of the world. I suppose fear of public embarrassment is a strong motivator for studying more and perfecting your clinical skills. While there was a hierarchy, it was clear that everyone wanted to learn and care for the patients as best as possible.

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