As a pediatrician, Antke Zuechner knows that the health status of children is in a large part determined by the health and knowledge of their mothers. Dr. Zuechner is working at Bugando Medical Centre in Mwanza Tanzania for three years with a German nonprofit called AGEH (Association for Development Cooperation); one of the main reasons she has committed her time and expertise to this East African hospital is the great need in terms of the sheer volume of children in Tanzania and the lack of pediatricians and other health professionals.
Dr. Zuechner divides her time between working in the wards, particularly in the Neonatal Intensive Care Unit (NICU), and teaching students in the adjacent university, Bugando University College of Health Sciences. For a start, women need to know their HIV status in order to ensure they do not pass the infection to their newborns, especially since new drugs and practices make infection of the child so preventable. Education about HIV/AIDS, breastfeeding and other topics related to child health are important aspects of prenatal and antenatal care that Dr. Zuechner engages in on a daily basis. It is not uncommon for the mother to face a problem with breastfeeding due to calorie or vitamin deficiencies that are driven by a poor diet and poverty. A well recognized fact is that the economic status of a person affects their health-seeking behavior. A woman would need the means to travel to a hospital or health facility in order to receive and pay for their necessary treatment; fortunately, the government of Tanzania mandates that treatment for women and children under five is free of charge.
In Sengerema Hospital outside of Mwanza, a novel initiative to reduce the risk of pregnancy or delivery complications is at work. A housing complex has been devoted to pregnant at-risk women so that in the event of an emergency they are close to a well-equipped and staffed facility. This addresses a slue of the problems in Tanzania and throughout Africa: the lack of transport to health facilities, the unavailability of equipment and chronic understaffing. Perhaps programs such as this are possible in other areas in an effort to reduce maternal mortality. Dr. Zuechner has witnessed too many women that go into labor in transit to a health facility and put their child in danger.
Dr. Zuechner chose the medical profession because its dynamic and interesting work, research and experiences amaze her. Only one year into her three year stretch at Bugando, she realizes that she has quite a bit to learn still about the culture and medical situation. Driven by visible improvements to the situation, motivated students and residents, and a commitment to care for the 20 million children in Tanzania, she will continue to battle one of the world’s highest maternal and child mortality rates through her work.
As part of our unite4moms! initiative, the Who Cares? Campaign blog is exploring maternal health from April 15 to June 15, 2010.
Globally, childbirth is the leading killer of young women. More than 500,000 women die each year from pregnancy- or birth-related complications and 99% of maternal deaths are in developing countries. In the vast majority of cases, deaths could be prevented if women receive improved access to skilled healthcare workers.
The maternal health statistics in sub-Saharan Africa – and in Tanzania in particular – are shocking. On average, 1 woman and 6 infants die each hour from preventable, birth-related complications in Tanzania.
The connection between the lack of healthcare workers and poor maternal health is clear. Risks of mortality for women and their babies are highest at the time of birth. Maternal deaths decrease dramatically if a woman receives access to prenatal care and if a trained health worker is present while a woman gives birth.
Sadly, in Tanzania, fewer than 50 percent of women have access to a doctor, nurse or other skilled medical worker during childbirth. The Touch Foundation is working to address this dire shortage of healthcare workers in Tanzania.
As part of our new unite4moms! campaign, we are promoting 4 ways that people like you can join the effort to advance maternal health. For example, you can purchase global crafts – from hand-woven baskets made by women artisans in Swaziland to chic New York charm necklaces featured in Vogue – to benefit the training of healthcare workers in Africa.
On November 21, at a graduation ceremony that was both energetic and dignified, the number of doctors in the Lake Zone region of Tanzania grew by ten percent. It was a joyful day for the 15 million people in this region who rely on the healthcare system that the graduating doctors and other health professionals will serve. But more tangibly, it was a day that immortalized the hopes and dreams of dedicated young individuals.
This was Bugando University’s second graduation ceremony of MD students. In addition to the 24 MD graduates, 166 graduates from Bugando’s seven other health disciplines graduated in 2009: post-graduate MDs, nurses, nurse-anesthetists, assistant medical officers, radiographers, pharmacists and laboratory technologists.
When the graduates received their diplomas, proud friend or family members would run up to the stage, showering their loved ones with festive lay necklaces and gifts so that the graduates returned to their seats with arms full and the classic gowns rendered more colorful. The confidence and hope that the graduates’ mentors, educators, friends and family members have invested in the new health workers were palpable. This optimism filled the space like the band diddling on their electric instruments.
From under the graduation awnings situated on Bugando’s campus, the view was panoramic – the classrooms and hostel were 100 meters behind us, the graduates were seated adjacently, and Bugando’s world-class laboratory (nearly completed) provided the backdrop. The past, present and future of their careers – and the patients whom they will help – was in focus and resonated deeply with everyone that day.
So hongera sana, congratulations to all of the graduates! The effort and dedication to reach this pinnacle moment should be recognized and commended as a tremendous accomplishment.
Habari – News From Bugando – is a periodic blog posting by Liz Pavlovich, a Program Officer for the Touch Foundation who is based in Mwanza Tanzania. Since 2004, the Touch Foundation (www.touchfoundation.org) has been working with Tanzanian partners to address the health worker shortage by expanding the Bugando regional medical training college and teaching hospital. Bugando’s University is the second largest of five institutions training medical doctors in the country. It also trains health workers in seven other disciplines – post-graduate MDs, nurses, assistant medical officers, radiographers, pharmacists and laboratory technologists. The school is now training 900 students.
For the month of August, the Who Cares? Campaign will focus on how malaria and tuberculosis impact the healthcare system in Tanzania.
Often the stepchildren to HIV/AIDS, malaria and tuberculosis collectively kill nearly three million people each year. In Tanzania alone, malaria and TB account for nearly 22% of the disability-adjusted life years (DALY) loss. Significant investment has been channeled into vertical initiatives – addressing the specific diseases rather than the entire health system – to target these diseases, achieving mixed results. The Touch Foundation’s recent diagnostic study, Catalyzing Change- Molecular strengthening of the health system in the Tanzanian Lake Zone, reveals that such investment is compromised, in part, due to the lack of integration to the existing health system.
With malaria, for instance, the lack of diagnostic equipment and limited health worker training severely inhibit effective treatment. Due to its fast and short life cycle, malaria needs to be diagnosed quickly- getting treatment in the first 48 hours of the disease often means the difference between life and death. Without diagnostic tools and with only poor access to health facilities, this window of opportunity can easily be missed. During the onset for malaria, for example, frequent misdiagnosis occurs due to lack of laboratory access. The study also reveals that only 26% of dispensaries have blood smear testing to properly diagnose for malaria and during the treatment phase; nearly 40% of the health facilities lack second line drugs needed to properly treat malaria.
Though vertical investment in both malaria and TB has made impact in Tanzania, it is clear that significant opportunities exist for focusing on Tanzania’s health systems, particularly on human resource capacity in which to optimize such vertical investments. The World Health Organization estimates the current deficit of health workers in Tanzania to be around 90,000. Join the Who Cares? Campaign today to help us address this deficit and to put a stop to malaria and TB.
Emily Bell is Head of Advocacy and Communications at the Touch Foundation.
Born in a poor family with no hopes, I grew up in one of the local villages in the country, which was faced with natural disasters. Life would seen to be normal even though people were dying of diseases that can be cured, but because of lack of doctors and personnel, dying was a daily song.
When I was 9 years old there was an outbreak of cholera, an epidemic that is due to contamination of fecal matter and people in my village died from this. Humanity was in no man’s mind because of lack of personnel — i.e., doctors or nurses who could identify the disaster and save lives.
I decided to become a doctor when I was 10 years old, knowing that the chance to become one was zero because of financial problems. What hurt me most was when I watched close family members die because of lack of access to treatment. You might not understand, but the truth is there was no doctor or hospital facility to assist them.
My neighbor died while delivering on the roadside next to our house while I was watching her without help. People doing traditional circumcision, too, both girls and boys without any knowledge on what they were doing would bleed to death. I remember seeing my moth put cow dung as treatment after locally cutting an umbilical cord from a baby! And you can imagine what most of the outcomes were. But neither you nor I can blame them!
After performing well in my advanced secondary school, I was like the hero in my village community, but remember I knew nothing about health except the concepts I had learnt in biology and chemistry. I was supposed to join university to do medicine (MD), but it was absolutely impossible because money was needed to pay fees, accommodation and food. I was really hurt, I remember spending around six months in deep stress trying to look for sources of fees, but it was all in vain.
I got a person in the city who told me he would only help me study clinical medicine (diploma in medicine) in order to help people in my village which I did study for 3 years in one of the colleges. After that, I became a clinical officer and started helping people greatly in my village and even in the next seven villages because I was the only clinical officer (not doctor) for more than 5,000 people.
I was moved to a mission hospital built by the Netherlands government in coordination with the Catholic Church where I worked for quite some time.
But the problem is there were so many diseases that I didn’t know just because I wasn’t a fully qualified doctor.
After I heard of the Touch Foundation in Weill Bugando University College of Health Sciences, I applied and really prayed for God to help me to be chosen.
To me, it was a miracle. It was the first time in my life to see a miracle. I was admitted to Weill Bugando University and up to now I am through my first year. To my village and local mission hospital, it’s a celebration and during this holiday vacation I am going back to continue treating them.
I wish that you all could come and see what you have done to us. We are now an asset to our communities and even to the whole country.
This is just a summary of my story, it’s too long, and I have photos that will make you know the complete story.
Presently, because of your contribution I am studying comfortably and I see a future working back in my home village and improving Tanzania.
Sitting around the table, doctors from Weill Bugando Medical Centre, the second largest hospital in Tanzania, were discussing the barriers to effective trauma care at their institution. One of those barriers was the lack of an available emergency theatre. This results in an unacceptable delay in life saving intervention.
The question asked was: “Why?”
An insightful intern observed that an emergency theatre was set aside for caesarian sections. He stated that the hospital was required to report their maternity mortality statistics in detail to the Ministry of Health. The fact that maternity mortality is a high priority (and rightly so) for the Ministry is reflective of the priorities of international funders. No one could argue that maternal mortality should not be a priority.
During my first week in Tanzania, an orthopedic surgeon approached me about his dream for the hospital to become a trauma centre. His first step was to create a trauma registry.
In health statistics published by the World Health Organization for Tanzania, road traffic accidents are listed as one of the top ten causes of death, just behind syphilis.
Really? More people die from syphilis than road traffic trauma in Tanzania?
Paradoxically, it has been demonstrated that as a country makes economic progress, more people die from trauma. This can be understood by anyone driving on the tarmac roads of Tanzania, where speeding SUVs share the road with push carts, animals and children, or by anyone like myself, who has worked in a casualty ward observing mothers whispering quietly to their whimpering children with open wounds and deformed legs. These children lie patiently on stretchers between casualty beds, each containing two or more patients waiting their turn for medical attention.
Other published data from sub-Saharan Africa list trauma mortality in the top three to four causes alongside HIV, malaria and TB.
So what are the take home lessons? A couple of clichés will suffice. You can’t manage what you don’t measure. Follow the money.
The orthopedic surgeon was right on target when he suggested a trauma registry as a first step towards his dream of a trauma centre at Weill Bugando Medical Centre. Good data could establish the burden of trauma in Tanzania. Should this data establish what seems anecdotally true, then the need to address the high burden of death and disability from trauma will become apparent. Leaders within the Ministry of Health, the private sector and international non-governmental organizations must then step forward to address this need.
Dr. Steve Justus has spent 22 years as an emergency physician in North Carolina. In August 2008, he joined our efforts at Weill Bugando. His position in Tanzania is supported by a grant from the United States Government’s Agency for International Development (USAID).
I had the privilege to work at Bugando Medical Center as a visiting physician during my 3rd year of medical residency during the summer of 2007. The experience was among the most meaningful of my life.
The most immediate reason for this significance was the obvious need. The simplest way to describe the enormous need for Tanzanian doctors is this: there were more internists-in-training at my hospital in New York City than in the entire city of Mwanza. In fact, there were more pediatricians at my hospital than the entire nation of Tanzania! Given that infectious diseases like HIV and Tuberculosis are epidemic in the developing world (about the same proportion of Tanzanians have HIV as Americans with high blood pressure), that Tanzanians suffer from diseases like Malaria that most Americans will never even think about, and that Western illnesses like diabetes and heart disease are on the rise there, this lack of doctors is even more devastating than one might fear.
Yet, though they had few resources – inconsistent access to laboratory and imaging tests, power outages, and overcrowded wards with some patients sleeping two to a bed – the determination and idealism of the Tanzanian doctors and medical students was never less than inspiring. All expressed, consistently and generously, a desire to improve quality of and access to healthcare in Tanzania. Above all, it was their courage that made my time in Mwanza a life-changing experience.
I taught (and learned from!) many students, assistant medical officers, and junior doctors at Bugando. Together, we treated many patients. One patient in particular stands out: S., a young boy. At Bugando, the shortage of pediatricians meant that children above the age of twelve were admitted to adult wards. When I first saw S., my first thought was that he couldn’t be over the age of 8. An AIDS orphan, raised by his brother, his growth had been stunted by years of chronic illness. He came to Bugando with meningitis, a severe infection of the membranes of the spinal cord. He was feverish and unconscious but still screaming in pain. Together, the Bugando doctors and I performed a spinal tap, analyzed his spinal fluid, and instituted treatment. A week later, S. walked out of the hospital. Shortly thereafter, he attended Bugando’s well-run outpatient HIV clinic to receive the antivirals that I hope will help to keep him healthy for many years. This story has stayed with me because I think that, prior to the Touch Foundation’s involvement with Bugando, I think it is probable that S. would have died. Without the exchange of learning between American and Tanzanian doctors and students that Touch has made possible, there might not have been a doctor to see S. Without Touch’s infrastructure support, vital laboratory tests and antibiotics might not have been available. So while my time in Mwanza was immensely gratifying on a personal level, it was only possible thanks the incredible persistence and dedication of Bugando’s physicians and the support of the Touch Foundation.
In short, something exciting is happening at Bugando. Something that will have, and has had, a real and major impact on the lives of Tanzanians. I can’t wait to go back.
About the Author:
Andreas Mauer earned his M.D. from the University of Chicago Pritzker School of Medicine in 2001. He completed residency in Internal Medicine at New York Presbyterian Hospital Weill-Cornell Medical Center and is currently pursuing a Master’s Degree in Clinical Investigation at the Rockefeller University.