Last Thursday, the Uganda and Tanzania groups left for Africa. The charter bus arrived outside of our DC hotel around 12p. We traveled to Dulles International Airport for a 6pm flight, and luckily the Peace Corps added in extra time for incidentals, such as forgetting my wallet on the bus, the ticket counter giving me the wrong boarding pass and lovely TSA security. Somehow, we all managed to reach our gate with enough time to grab a beer (or two) and an early dinner! Hakuna Matata.

After a lengthy flight, one layover in Amsterdam airport, and a pit-stop at Kilimanjaro airport, we arrived in the capitol city of Dar Es Salam at approximately 6pm EST Friday.

The Tanzania team consists of 11 individuals, including 3 MDs: a cardiac anesthesiologist, an endocrinologist and myself (an OBGYN), 6 RNs: two midwives, 1 medicine/surgery, 1 critical care, 1 family practice NP, and 1 pediatric specialty nurse; and 2 “trailing spouses”, a teacher and an engineer, who have joined their wives as Peace Corps Response volunteers. I feel humbled and honored to spend my days with these wonderful, intelligent, and empathetic individuals.

This week we have orientation at the Peace Corps office in Dar. I must confess it has been rough for us health care providers who are not used to sitting in a classroom. We leave at 0715 each morning to miss “the (traffic) Jam” and then usually end around 5pm. We have had lectures on Safety and Security, the Peace Corps infrastructure, and how to stay healthy as a foreigner in Tanzania. We are all itching to get out into the community, yet each day that passes we gain another layer on our protective cocoons. We are longing to fly, to work, to unpack our suitcases, and begin integrating into our respective neighborhoods: Dar, Dodoma, Mwanza, and Sengerema.

Wednesday we visited the (one and only) National Referral Hospital, Muhimbili, the referral hospital for the entire country (49.25 million people according to a 2013 census). Two of our volunteers, the cardiac anesthesiologist and the critical care nurse, will be teaching at Muhimbili Hospital. We have been briefed that the country has approximately 350 specialty trained physicians (which includes OBGYN) and perhaps 1 endocrinologist. The hospital complex boasts the one and only Emergency Department and Emergency Medicine Residency program in the country. Can you imagine only 1 ED for a population of nearly 50 million?

There is also a cardiac facility where they conduct surgeries and outpatient care. We toured the cardiac ICU where the team is caring for an 11-month-old s/p tracheal-esophageal fistula repair and a teenager s/p mitral valve replacement secondary to damage from rheumatic fever. The building was built in collaboration with a Chinese company and is quite fancy. We also toured the gastroenterology suite where they conduct endoscopies, colonoscopies and simple procedures. There is also a pediatric oncology facility which includes a ward for families to facilitate treatments and long-term stay for those that live far away. There is also a medical school, a nursing school, and a school of dentistry on site. Needless to say, it is a pretty developed medical complex, but not for your average health care consumer.

Most people that seek medical care will travel to a Zahanati (dispensary), which is situated in mostly rural areas and services a population of 10,000. Theses dispensaries have very limited lab capabilities, mostly pregnancy tests, urine dipsticks and rapid malaria tests. If stocked, they only carry the essential medications as dictated by the WHO. The staff mostly consists of nurses and clinical officers. The next step-up in care is the Health Center (Kituo cha Afya), which serves a population of approximately 50,000. Again, there are no physicians staffed in these facilities only nurses and clinical officers. The District Hospitals service a population of 100-200k, and here you will find General Practitioners (MDs) but rarely any specialists. I will be working at a District Hospital as one of two OBGYNs. The next level is the Regional Referral Hospital, one for each of the 30 regions in Tanzania. The highest level is the Consultant Referral Hospitals in which all of your specialists are staffed, which includes Muhimbili and Bugando Medical Center (another hospital where our volunteers will serve.)

A snapshot of Tanzanian demographics:

• The life expectancy is 51yo for males, 54yo for females +/- 3yrs.
• 44% of the population is less than 15yo.
• 15% have access to electricity, 6% have access to a refrigerator
• 15% have access to CLEAN drinking water (apparently I was NOT supposed to drink tap water the last time I was here!)
• 73% use firewood for cooking
• The illiteracy rate has risen to 18% for males and 28% for females.

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Wow! Apparently I have been a good learner this week. I promise pictures soon 🙂