Elvin from Hong Kong, Dentistry Student:

What type of internship did you do, when and for how long?

In Hong Kong, as part of the 6 years curriculum we are required to obtain 6 units of exchange program. Which is equivalent to 2 weeks of dentistry related internship in another country but on one occasion the maximum amount of credit given is 3 units. For our internship program in Arusha we stayed for 1 week in the hospital for both hands on dental treatments and observation under the guidance of the dental team there. Even though our elective within the hospital is officially just 1 week long we stayed for an extra week in Tanzania and Zanzibar to experience the culture there.

During which year of your studies did you complete your internship abroad?

I completed my dental elective during 4th year of my dental studies.

Please describe why you decided to do your internship abroad.

I have always wanted to experience dentistry from a different perspective and being able to go to Africa and perform dental work there has always been in my bucket list. Previously, there were also seniors that have been through the same program and their positive feedback about their experience has affirmed my decision to do a dental internship in Africa. A lot of seniors have described the trip as a once in a lifetime experience and it will be something they will not forget about. Furthermore, I believe I can gain a lot of dental insight from this trip. Through we were very troubled at first by the the vast mount of things we will have to organise for this trip but World Unite has taken a lot of the burden off our shoulder.

How did you come across World Unite?

During previous years my dental senior told me they went to Africa for their dental elective and when I asked about the organisation they got in touch with they introduced me to World Unite. We then asked other seniors about it and found out that a few year groups before us have been in contact with World Unite too and every year there were dental students from our hospital going on elective through World Unite again. A group of friends and I also thought it was a good idea to organise such internship through a well recognised and reputable organisation so we decided to go with World Unite as well.

Which departments of the hospital did you work in? Did you stay in one department or rotate through multiple departments and why?

In Mount Meru Hospital there was only one Dental apartment which handled all sorts of dental cases. These include paediatric, endodontic, prosthodontics, oral and maxillofacial surgery, operative, periodontic and oral medicine. Even though we had the chance to visit all the different apartments and medical wards, we mainly operated within the dental apartment. However, for more serious dental/facial reconstruction work related to dental surgery they had an operating theatre for those kind of treatments. Also there was a room where the dental technician will work in. In there is where he will take impressions of the patient’s mouth and fabricate dentures for them. In comparison to other departments within the hospital the dental department seems to be relatively small.

Describe a typical day at the hospital, including your work days, working hours and your tasks.

On a typical day we will have to wake at around 7:30am to have breakfast and be ready to leave and head to the hospital at 8am. After 15 minutes of walking time we will need to catch the local transport (dala dala) for around 20 minutes followed by another 10 minutes walk to arrive at the hospital. After reporting to the dental staffs there we will change into our clinical uniforms that we brought from Hong Kong and prepare ourselves for the day’s work. Before we perform dental treatments on patients the supervising doctor will usually share some of his dental experience or previous cases which he finds interesting to us until patients start to line up in front of the door at around 9am. For the first time there we didn’t start work immediately but instead we had a tour of the whole hospital and basically gone through all the drawers and equipment they had within the dental department to familiarise ourselves with our working environment. After the first day we proceeded to start our day as the patients come in. Depending on the difficulty of the dental procedure, the doctor will ask if anyone wants to do the treatment. For more difficult treatments the doctor will usually still ask if any of use had the confidence to take on the challenge. Most of the time my colleagues and I will take turns doing simple extractions and restorations until lunch time which is usually around 12pm. For the one hour lunch break we will go out to the local restaurants and eat, there are a lot restaurants nearby so it doesn’t take a lot of time for us to get there. Coming back from the lunch break at 1pm we will carry on with similar tasks in the afternoon. Occasionally we will be asked to observe some interesting cases and go visit the wards with the doctors. This usually the case for patients who had severe facial trauma and will require to rest in the hospital bed. When there are not much patients coming in for dental treatment we will go observe the dental technician and see how he manufacture dental prostheses. Throughout the day we are free to ask any questions we like and when we need help the doctors are always there to lend a hand. The working atmosphere is actually really friendly and free, we can request to see things or do anything as long as the doctor agrees. The day should end at around 4pm and then we will get changed and leave the hospital.

Describe a situation that surprised you or that seemed special to you during the internship.

The most surprising thing to me during my visit is how appreciative the locals are. During one of my first extraction procedures in Africa I was asked to extract a molar tooth. The patient had really long and strong tooth roots and the extraction didn’t go according to plan as I have fractured the crown of the tooth from the root. Which leaves the root still being embedded in the bone and took extra effort to pull out even with the help from the doctors there. However during the whole procedure the patient was extremely cooperative and afterwards he was gesturing to me that I did a great job and even asked to have a photo taken with me. That was one of the most heartfelt moment of my trip to Africa.

What did you learn during your internship abroad?

My experience in Africa has made me realised how lucky I am to be living in a developed city. Many of the essentials that we usually take for granted back in Hong Kong such as clean water for drinking, hot water for shower, and a sophisticated medical system are not always accessible to those in Arusha. Throughout the trip we were all extremely cautious to avoid any potential health hazards. The water we dared to drink from were always bottled, we continuously used hand sanitisers applied mosquito repellents. However at the same time the thought that all the local citizens here will not even have the luxury to be cautious made me truly realise that we do in fact come from two different worlds. Many do not have the financial resources to take the necessary precautions that we do, for instance during oral examinations the dentist at the hospitals did not use gloves as it was only saved for dental treatments such as extraction. Even though I may never be able to apprehend their way of life but my experience in Africa made me feel that I have breached some distance between our two worlds.

Which cultural differences did you observe between the medical systems / treatments / doctor-patient relation etc. in your host country and your home country?

During my time in Mount Meru Hospital I have noticed the difference in their dental equipments and procedures compared to Hong Kong. In Africa the importance of dental treatment is outweighed by more life threatening medical procedures hence not a lot of resources are allocated for dental procedures. The dental department in the Mount Meru hospital had a total of three dental chairs, two of which were out of order for more than half a year. Where in Hong Kong we have around 200 or so dental chairs. Periapical radiograph and Bitewings were available within the department but after processing there were always many artefacts on the films. The hospital only had one functioning suction machine so some patients had to spit out the water themselves. All of these equipments were taken for granted when we were back home. In Arusha usually an OPG are taken only in special cases and must be referred to venues outside the hospital to be taken but back in the education hospital in Hong Kong almost every single patient will have an OPG radiograph taken for screening purpose. Here in Arusha, a lot of the times extractions are performed without any radiographs which is unheard of back at home. Things like sensibility tests such as EPT and cold tests were never used in Mount Meru Hospital and endodontic procedures are to some extent simplified and they do not have access to an apex locators.

How did you spend your free time abroad? Did you get to know other interns at the hospital with whom you did activities? Did you go on trips? If yes, what did you do and where?

For our free time we went on a 3 days safari trip to see the wild life in the national parks there and also went on a trip to a local island called Zanzibar where the food is amazing, accompanied by their famous beaches and sunsets.

Elvin completed his dentistry internship with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Arusha, Tanzania, and learn how to apply for your own elective abroad!

Kwok from Hong Kong, Medical Student:

What type of internship did you do, when and for how long?

I completed a medical internship at Mount Meru Hospital, Arusha. The medical internship started from 5th August 2019 and lasted for about one week. Mount Meru Hospital is a government hospital in Tanzania and offer treatment to patients in multiple disciplines, such as surgery and dentistry. I finished the placement in the dental department in Mount Meru Hospital.

During which year of your studies did you complete your dentistry internship abroad?

I completed my dental elective during the 4th year of my dental studies.

Please describe why you decided to do a dentistry internship abroad.

I have always wanted to pay Africa a visit for its famous wildlife and sceneries. The medical internship provided me a perfect chance to learn about the oral health conditions in Africa and to learn from dental practitioners in Tanzania.

How did you come across World Unite?

A senior at university told me about his internship experience in Mount Meru Hospital with World Unite!. I was interested in having an organization helping me to arrange the entire internship trip and felt that it is much safer to have an organization which could offer me help and advice during the trip.

Which departments of the hospital did you work in? Did you stay in one department or rotate through multiple departments and why?

I worked in the dental department of the hospital. I observed and engaged in dental treatments such as extractions and fillings. It was a great chance for me to learn from dental practitioners in Tanzania, who offered me advice and skills on extraction in particular. I stayed in one department only because of the limited time available during the trip.

Describe a typical day at the hospital, including your work days, working hours and your tasks.

A typical day in Mount Meru Hospital started at 9:00am when we arrived at the dental clinic. There would already be a large crowd of citizens waiting outside the dental clinic as the demand for dental treatment in Tanzania is high. Patients would be called in one by one for dental treatment and we would observe treatments by the side of the dental chair. The dentist would first start by history taking, followed by taking radiographs and performing the treatments. If we were lucky enough, we could be asked to conduct simple treatments such as extractions and fillings for the patients, which was a precious experience. Afterwards, during breaks, the dentists there would share experiences and cases with us. We were able to learn much from hearing from them different cases. After the lunch break form 12:00-1:00, we went back to the clinic to continue our work until 16:30.

Describe a situation that surprised you or that seemed special to you during the internship.

I was surprised by how welcoming the host and the hospital are. The dentists in the hospital treated us as friends but not juniors. They talked to us about their own funny and interesting experiences and had lunch with us for a few times during our elective. Our host held a farewell barbecue party for us on the night we finished our internship. The bonding between us is special and unforgettable.

What did you learn during your dentistry internship abroad?

I gained a lot of clinical exposure to cases which we wouldn’t normally see in Hong Kong, such as serious maxillofacial trauma caused by the bite of a wild animal. I also had a precious experience on dental practice with limited resources available, such as how to provide a competent treatment for the patient even if the environment wasn’t desirable. It is truly something that could only be learnt by having an elective abroad. It truly broadens my horizon.

Which cultural differences did you observe between the medical systems / treatments / doctor-patient relation etc. in your host country and your home country?

Due to the limitation of resources, only simple treatment could be carried out in the dental setting. It could be due to inadequate government funding or poverty of the patients. Patients often only come to the dental clinic when there is symptoms, unlike in my home country where some patients would come for a regular dental check-up.

How did you spend your free time abroad? Did you get to know other interns at the hospital with whom you did activities? Did you go on trips? If yes, what did you do and where?

We went on trips during our free time abroad. We went to Zanzibar after the intern and went to the famous Serengeti safari. It was truly a rewarding experience.

Kwok completed his dentistry internship with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Moshi, Tanzania and learn how to apply for your own elective abroad!

Eva from Germany, Medical Student:

Which internship did you do abroad and where?

During my semester break in the clinical part of my medical studies, I had to do a four-month elective, out of which two months had to be completed in a hospital. I did one month of this elective at the Combase Hospital in Cochabamba, Bolivia, to get an insight into the health care system of another, non-European country.

During which semester did you do your medical elective abroad?

I was in the 3rd year of my medical studies.

Please describe why you decided to do a medical elective abroad.

It was clear to me right from the beginning of my medical studies that I wanted to do part of the mandatory electives in another country. Since I had never been to South America before, but this continent has always interested me, I chose Bolivia. Not only did I want to get an impression of the medical system there, but also to improve my Spanish and get to know everyday life and culture up close.

How did you come across World Unite!?

I found World Unite! through a website of my university that recommended various organizations. After comparing some organizations, reading some testimonials, and having had some contact with one of the coordinators, I found World Unite! was the most suitable option for me.

Which departments of the hospital did you work in? Did you stay in one department the whole time or rotate through multiple departments and why?

I had no real preference regarding the department I wanted to be placed in. At the Combase Hospital, that wasn’t necessary at all. The hospital is very small (only about 15 beds), but with a relatively large outpatient clinic (which mainly deals with orthopedic and general medical problems), a dermatology and a gynecology department. There is also a surgery theater. I was able to choose from day to day whether I wanted to stay in the outpatient clinic, or intern at either the dermatology or gynecology departments. If surgeries took place, I was also always welcome to observe the surgeon’s work in the theatre. My everyday life at the hospital was very varied and I was able to plan my elective just as I wanted and focus on what interested me the most. Since the inpatient beds were located close to the outpatient clinic, I was always able to switch to the inpatient ward quickly whenever there was something interesting to do. The small size of the hospital fitted my needs perfectly as I was able to quickly get to know all the staff, and they would inform me whenever there was something exciting to do.

Please describe a typical day at the hospital, including your work days, working hours and your tasks.

My day usually started with the morning visit at 08:30 am. The local medical students in their final year introduced their patients to the doctors every day and were then asked questions. After that, we mostly had breakfast together (at least a small one) until the outpatient clinic opened at around 09:30. Some of the patients had acute problems (mostly orthopedic or general medicine-related), others patients came for monitoring the course of long-standing diseases. In Bolivia the system of practices for general medicine is not as developed as in Germany. Therefore, patients with acute illnesses such as a cold, a sprained ankle, or knee pain, will come to the outpatient clinic and get treated there. The picture of diseases that I got to see was subsequently diverse. Usually there were a doctor and some students leading the outpatient clinic. The doctor would usually only give instructions and the students treated the wounds, sewed or issued prescriptions. I was also allowed to help every once in a while, (and if I had not done a technique or treatment before, it would be shown to me). The language barrier wasn’t a problem either and the doctors would explain things to me over and over again, until I had understood.

In addition, there often were treatments in the in-patient ward in the mornings, and I was occasionally allowed to assist. Sometimes I went to the gynecological consultation hour or the dermatology department, depending on where there were more patients.

Around noon I would usually have lunch. We almost always ate together –  the students, the doctors and the nurses. This was also a good opportunity to get to know everyone a little better. Every now and then we went to eat somewhere in a restaurant nearby. The lunch break lasted until 02:00 pm, after which the outpatient clinic continued. Surgeries were usually scheduled in the afternoons because the anesthetist came from another hospital. I also assisted in the surgical theatre every now and then, i.e. held the camera during laparoscopy, handed over the devices or sewed wounds – even though I had never done any of this before!

Basically, my official working hours usually ended at around 03:00 pm on most days, but mostly I stayed longer. Firstly, because I was always allowed to assist with surgeries in the afternoon. Secondly, there often were social activities in the afternoon when the outpatient clinic was empty and when there was not much to do: We sometimes cooked in the hospital kitchen, baked, or played some games. It was always great fun and only had very little to do with work. But that’s how I found a lot of friends with whom I’m still in touch now, a year after my elective.

What did you learn during your elective abroad?

I did not only get a lot of medical experience (I was allowed to do a lot myself and thus had a very hands-on experience), but above all I learned a lot about the people, the language and the culture in Bolivia. I was accepted as part of the community and felt at home very quickly and I do now understand the everyday life and mindset of the Bolivians much better than before. I could see how little you actually need to take good care of patients and that the community feeling at the hospital differs a lot to German hospitals.

What cultural differences have you observed between the medical systems / treatments / doctor-patient relationships etc. in your host country and your home country?

The way of working in Bolivia differs significantly from Germany: In Bolivia, we started working much later, but also went home much later. However, people tend to be much more flexible in Bolivia and it is not much of a problem if you show up a little late sometimes. I also noticed that in Germany the hospital staff rarely mingle: Nurses stay among themselves; doctors stay among themselves; students stay among themselves – there was little mixing. In Bolivia, the people mingle a lot more and in the evenings the students, doctors and even the head of the hospital would spend their leisure time together and have dinner together. For example, we often did a barbecue at the house of someone from the hospital.

People are also much more open about their private life: It is perfectly normal that the door of the consultation room in the outpatient clinic is always open during a patient’s consultation and the next patient is already standing in the door and listening. This is certainly something to get used to, but not always a bad thing.

How did you spend your free time in Bolivia?

I found a lot of friends in the hospital with whom I spent my leisure time in the evenings. But even after my elective at the hospital had ended, I traveled around the country and had the chance to see many places. Thanks to my host family, whose daughter was my age, I was also able to quickly find friends outside of the hospital with whom I went hiking, visited the Salar de Uyuni, or other cities. I am very happy to have chosen Bolivia, I had a very special experience and I will definitely come back again!

Eva completed her elective abroad with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Moshi, Tanzania and learn how to apply for your own elective abroad!

Pia from Germany, pre-medical student:

I did my internship at the Hosiana Prinmat Clinic, a small clinic for general medicine and births on the outskirts of the city of Moshi in Tanzania. I completed my internship during the (German) summer months and had applied for a medical degree program in Germany for the following autumn. At the time of my internship I did not have a lot of previous medical knowledge, but I was keen to learn and to get more exposure to prepare for my studies. Even if I interned for only about two weeks, I had a vast learning experience at the Hosiana Prinmant Clinic.

During which semester did you do your medical internship abroad?

I did my internship before I started my medical studies. After graduating from high school, I spent an entire year doing voluntary social services, to train as a paramedic and completed various medical internships. One of them was at the Hosianna Clinic in Moshi.

Please describe why you decided to do a medical internship abroad.

I chose this internship because I wanted to combine medical experience with a stay abroad. Before traveling to Tanzania, I had already completed a part of my mandatory pre-medical nursing internship in a German hospital. After that I wanted to get to know another medical system and find out in how far the medical care and treatment methods in Tanzania differ from what I knew from Germany. One of the main reasons to study medicine for me is for me to work as a doctor with the Médecins Sans Frontières (MSF) one day. Therefore, I thought it made sense to get an insight into different medical systems on the African continent as soon as possible.

How did you come across World Unite!?

I contacted World Unite! quite spontaneously. I had actually arranged an internship in Sri Lanka through a private contact for the same period, but due to the terrorist attacks in Sri Lanka which took place in early 2019, I was unfortunately not able to carry out this internship. I ended up looking for a medical internship abroad at very short notice and came across World Unite! on the internet just a few weeks before my set internship period.

Which departments of the hospital did you work in? Did you stay in one department the whole time or rotate through multiple departments and why?

The Hosiana Primat Clinic is a small clinic and the tasks for the medical staff are not divided between different departments. Instead, the head nurse would take me wherever something was going on. There is one main treatment room that every patient is brought too. I would spend most of my time in this room to observe and to assist the local team. Depending on what type of treatment was required, a patient would be taken to other treatment rooms from there. I accompanied the patients and nurses from room to room. Once a week, the head nurse carries out house visits in the surrounding villages. She was happy to take me along and to give me an insight into the everyday life of her patients.

Describe a typical day at the clinic, including your work days, working hours and your tasks.

During my time at the Hosiana Prinmat Clinic I wrote a diary in order to better reflect and process all my experiences. I would like to share extracts from this diary here:

• Day 1: On arrival to the clinic, I was warmly welcomed by nurse Happy. I was impressed by her warmth, friendliness and hospitality. She tried very hard to make me feel comfortable and I felt part of the team straight from the beginning. At the clinic, I have my own room where I can change my clothes and rest during my breaks and where I’m always invited to try local dishes for breakfast and lunch. “Karibu” (= “welcome” in Tanzania) is not only a word that you will hear people say here very often, they actually live it. My first day at work begins. Happy receives the patients one by one in the main treatment room. Patients rarely make appointments here. When people feel sick and can make time, they will simply come to the clinic. I sit in the treatment room with Happy and try to understand what the consultation is about by re-activating the few words I know in Kiswahili. After a bit of small talk about the medical part, Happy always tries to involve me and briefly explains what the patient has told her. Many of the patients come here because they have a diffuse, general feeling of illness. Happy will then measure the patient’s temperature, check the throat and lymph nodes and do a Malaria test. After I had observed how the Malaria test is done, I was always allowed to test the other patients, when necessary. I also took over other small tasks step by step under Happy’s supervision. I loved how much practical experience I was able to gain and to be allowed such a hands-on approach.
• Day 2: Today, Happy taught me how to give intramuscular injections. These are injected into the buttocks and under Happy’s supervision I gave many, many their injections today. After the injection, you always apologize with “Pole” to your patient for the pain caused and the patient thanks you by saying “Asante”. In addition to getting a Malaria test or an IM, many patients come to have their blood pressure and blood sugar measured. Many mothers bring their children to have them weighed. The scale we use here is actually a meat scale and the children are put in some kind of pants and hung on the hook to weigh them. Most cry. And I’m not just getting a lot of practical exposure here! The head of the clinic is also very keen to help me improve my theoretical knowledge. Although she always emphasizes that she is not a doctor, she knows a great deal and takes a lot of time to share her knowledge and experience with me. At the end of my second day we exchanged numbers so that she can notify me in case of a childbirth at night. I would very much like to witness a birth!
• Day 3: Today I was introduced to the topic of “family planning”. This is a very important topic for the Hosiana Prinmat Clinic and a difficult topic for many Tanzanians in general. Often, men do not want to use contraception at all and omit using condoms. This is why women often try to use contraception secretly and have a birth control implant. At the Hosiana Clinic, a lot of educational work is done about family planning and contraception. I was already quite familiar with the information provided to the patients, but it was very interesting to get insights into how family planning, sexuality, contraception, pregnancy and so on are seen in the Tanzanian society. In Tanzania, HIV plays a very important role during pregnancy. Women are encouraged to test their HIV status in the early stages of their pregnancy. If she tests positive, she will be given medication during pregnancy and while she’s breastfeeding to prevent the infection of the child.
• Day 4: Now I have already seen some standard treatments and know roughly which therapies and medications are used for the various clinical pictures. Compared to Germany, one can say that painkillers are clearly used less frequently here. Antibiotics are therefore given to patients all the more frequently. However, it must be considered that the patients come to the Hosiana Prinmat Clinic comparatively later and with more serious illnesses compared to what I’m used to from Germany.
• Day 5: I’ve noticed that the attitude towards work is really different here. There are always longer breaks when no patient is coming. But nobody gets impatient or bored here. When a patient comes, they are greeted joyfully and immediately have the staff’s full attention. Even if there is a small queue, neither the nurses nor the patients get impatient or stressed out. During my first days at the clinic I assisted with carrying out two pregnancy tests. The head nurse ordered the tests to be made to rule out pregnancy as the reason for the visit was stomach ache. Both tests were negative. I was shocked by the fact that a pregnancy test was suggested by the head nurse as one of the patients was a maybe ten-year-old girl who came to the clinic with her mother. Did the head nurse suspect that the girl might have had sexual intercourse at such an early age or worse – was she worried that the girl might’ve been raped?
• Day 6: Today, even if it is Saturday, is a normal work day at the clinic and the patients come as usual. So far, the patients at the clinic have mainly been babies, toddlers, women and elderly people and I was beginning to think that young men just don’t get sick here. Today I started to understand that especially young men don’t have time to get sick during the week and go to work no matter how sick they feel. On Saturday, some will make time to come to the clinic to get their advanced infections and diseases treated. I could tell that all of them felt very uncomfortable to be in need of medical treatment. During the treatments, however, they tried to maintain their tough facade and did not even bat an eyelid when we disinfected and infected wound with very sharp disinfectant.
• Day 7: I’m learning so much from the way the staff at the Hosiana Clinic treat their patients and definitely want to adapt my own ways of dealing with patients to this once I am a doctor. Every patient is taken seriously and treated in a respectful way and with enough time. In addition, patients will also speak to their doctors about private matters which creates a warm and trustful relationship here in the clinic. I cannot discover a single sign of impatience here, no matter how stressful a work day at the clinic is. Neither on the nurse’s side nor on the patient’s side.
• Day 8: Today we had the very first emergency case since I started my internship! All of a sudden, a young man stood in the doorway, his arm covered in blood and a slightly shocked expression on his face. He had a very deep, about 10 cm long cut on the arm that had to be sewn. While sewing I was allowed to assist and hand over the necessary things to Happy and cut the threads. Since the needle was very blunt, the sewing looked very painful despite local anesthesia. In total, she sewed the wound with seven stitches and then treated it with antibiotic powder and bromide swabs as usual. Happy actually wanted to prescribe the man antibiotics, but he refused. Maybe he wanted / had to save the money?
• Day 9: Today, a little body was admitted who had to stay for the morning. When admitted, he was feverish with his temperature being at around 38,8°C. He was treated with acetaminophen to lower it. When the boy’s temperature even rose sometime later, instead of falling as we had hoped, he was quickly put into a cold batch. Sometime later we measured his temperature again and luckily the fever had already dropped. I rather believe that the acetaminophen just took a little longer to show its effects and the cold-water bath didn’t help much. Moreover, we took the contraceptive implant out of a woman’s upper arm today which I found quite exciting. Maybe she decided that now is the right time to have children. The woman looked at the implant with astonishment.
• Day 10: Today we had a patient whose HIV test was positive. I was wondering how the staff at the clinic would handle the test result and what they would say to comfort the patient. But the team couldn’t do anything more than say “Pole” (“sorry”) to the patient. Did they assume that there wasn’t enough money for therapy anyway?
• Day 11: Today was my last day at the Hosiana Prinmat Clinic! I was pretty excited to see what my last day here would bring, because I still had a few pending tasks on my list: I wanted to visit a former patient, hand out a few farewell gifts to the clinic staff and children in the neighborhood, and last but not least talk to the head nurse about my idea of collecting funds for patients who cannot afford treatment. Later that day I would begin to understand even more how much money for medical treatments is needed here: To get an idea of what families in the neighborhood lack health-wise, the head nurse of the clinic accompanied me to the village and introduced me to some families. I got to know some dramatic fates today. In the first family we visited, the mother had died of AIDS. Two of the four children were tested HIV positive. Together with their stepfather, they lived in a small hut and were so happy about my visit! The little boy hugged me straight away, jumped onto me and wanted to be carried. It was hard for me to see the little boy being so happy and full of joy, knowing that he was seriously ill. The next family we visited was a grandmother who raises her grandson. The grandson’s father has been in prison for a long time and the boy’s mother had disappeared. The boy and his grandmother live in great poverty as there is no real pension system in Tanzania. The next family were a father and his little daughter. The child’s mother died when the girl was only five months old and is now raised by the single father. The father invited us to take a seat in front of his house where we waited for his son to arrive who was still outside playing. While we waited, a young boy approached. He had two disabled legs and to move forward, had to crawl on the floor and pulled forward with his hands. He must’ve seen me somewhere from a distance and even crossed a dirty little creek to come over. I later learned that his legs had to be amputated below his knees after a fall. He also had a disabled arm, breathing problems and a mental disability. But he was very happy to sit on the floor next to me and smiled widely the whole time. The encounters described here were the most touching ones from my village visit. But I was shown a lot more and was introduced to an infinite number of people who all greeted me very warmly and were excited to hear what I was here for. Back at the Hosiana Prinmat Clinic, I spent a while in the treatment room and prepared myself to say goodbye! I really hope that I will see the team at the Hosiana Clinic again someday. I would very much like to come back during my studies and after I have learned a little Swahili!

What did you learn during your elective abroad?

I learned a lot of practical things during my internship, i.e. how to do malaria rapid tests, HIV rapid tests and pregnancy tests, to give intramuscular injections and listen to breathing sounds. I can now weigh children according to Tanzanian habits and enter the examination results accordingly into the child’s mother-child-pass. I had already learned how to measure blood pressure and blood sugar and how to treat small wounds during my training as a paramedic, but thanks to my time at the Hosiana Prinmat Clinic, I got a lot of practice doing these things and became more confident in dealing with patients.

I also gained a lot of theoretical knowledge as the director of the clinic tried very hard to give me the greatest possible insight into health care in Tanzania. For instance she explained the most common diseases in Tanzania to me. These include diseases of the upper and lower respiratory tract, various infections, worms, skin diseases such as fungus, bronchitis, asthma, cholera and a few more. Most of the diseases can be traced back to poor hygiene conditions and are very different from the most common diseases of Europeans. For example, back pain in Europe is one of the most common reasons to see a doctor. I was explained in detail how the diseases arise and how you can recognize them. Antibiotics are the most common treatment.

What cultural differences have you observed between the medical systems / treatments / doctor-patient relationships etc. in your host country and your home country?

In Tanzania, patients are treated very differently than I am used to from Germany. And I definitely want to use the Tanzanian way of patient contact as a role model for my own future way of doctor-patient communication. Every patient is taken seriously and treated respectfully, warmly and with enough time. I was given the impression that the health of the patients really matters to the doctors. I would also like to convey this feeling to my future patients. I also think it’s nice that Tanzanians also talks about private matters with their doctor. This creates a completely different relationship of trust than I am used to from Germany. I also think it’s very important that there is simply no impatience here. Neither on the patient’s side when waiting for treatment, nor on the nurse’s side when they are waiting for patients. Without this subliminal feeling of impatience, the working atmosphere can be improved immensely! Furthermore, I would like to take with me that in Tanzania a newly incoming patient is perceived as a burden – whether shortly before work ends or during breakfast break, which I have observed differently in Germany.

How did you spend your free time in Tanzania?

During my time in Tanzania I also experienced a lot outside of the Hosiana Prinmat Clinic! I visited the Hot Springs with a group of young Tanzanian people and other foreign volunteers. We bathed, swung across the water with a trapeze and played football together. It was an amazing day and the whole trip turned into a real party!

Then I did a sunset tour. A little bus drove us onto the top of a small hill surrounded by fields just outside of Moshi. I have rarely seen such a beautiful sunset!

One evening I went to a Karaoke Bar with fellow volunteers and to a club afterwards. I am not the best singer at all, but I also like to laugh about myself a lot, so we were really having a blast.

One weekend, I did a trip to the Usambara Mountains which was by far my favorite leisure experience in Tanzania. We took a bus to the village of Korogwe which is located at the foot of the mountains. From there we continued by Boda-Boda, a motorbike taxi, which took us a dirt road up the mountains for about half an hour. Our final destination was the Lutindi Mental Hospital. The hospital is also a partner of World Unite! and volunteers can rent a guest room at this beautifully located hospital and enjoy the quiet mountain area and nature for a weekend. I got to see one of the most magical sunrises ever here for which getting up very early was more than worth it! We did a 23 km hike through Tanzania’s stunning nature and impressive landscapes. Along our way we had many nice encounters with locals and communicating with our rudimentary Kiswahili skills worked surprisingly well.

Pia completed her elective abroad with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Moshi, Tanzania and learn how to apply for your own elective abroad!

Pia from Germany, Medical Student:

I completed part of my mandatory elective at the Mnazi Mmoja Hospital in Zanzibar, Tanzania. I went to Zanzibar together with a lovely colleague of mine whom I met in med school. I worked in the hospital for fifteen days and completed the remaining one and a half months of my elective in German hospitals. At German medical universities, we have to complete electives in medical outpatient facilities, which I chose to completed in Germany as well. At the Mnazi Mmoja Hospital in Zanzibar I spent most of my elective at the pediatric ward but I also got to observe the work in the maternity ward every now and then.

During which semester did you do your medical elective abroad?

I did my medical elective during the term break of my 6th semester.

Please describe why you decided to do a medical internship / elective abroad.

I decided to do part of my mandatory elective abroad for many reasons: On the one hand, my friends in med school who had already done a medical elective abroad totally recommended this experience to me not only to develop my skills from a medical but also from a personal point of view. Some of these friends had completed their elective in Zanzibar and were absolutely thrilled about the experience. I’ve always wanted to get to know the medical system in another country and Africa was particularly interesting for me. I wanted to learn about the different health systems worldwide and be able to draw a comparison between Germany and a (developing) country. Another aspect that encouraged me to do my elective abroad was that I wanted to learn to be more independent and to improve my medical communication skills in English. And last but not least I was hoping to meet new people and to make international friends.

How did you come across World Unite!?

I found World Unite! on the internet. Their informative website spoke to me and after I had sent my inquiry, I quickly got a response from a team member who answered all my questions. I liked the fact that I could reach my World Unite! contact on WhatsApp and never had to wait long for a reply. Two friends of mine had completed their electives in Zanzibar through World Unite! before and I knew the organization was trustful and that everything had worked out well for them. Furthermore, I did not find many agencies offering electives in Zanzibar and I definitely wanted to go there, so the decision was easy to make!

Which departments of the hospital did you work in? Did you stay in one department the whole time or rotate through multiple departments and why?

I chose not to rotate through different departments and spent my entire elective in the pediatric department. However, the hospital staff encouraged me to visit the maternity ward and the delivery room from time to time to get even more exposure. I’ve also heard of other medical and nursing students or who rotated through various departments during their stay. However, in my opinion this does only make sense for a longer stay. For me, the best way to spend my 15 elective days was to stay in one department. The pediatric ward at Mnazi Moja Hospital has two floors which means that you can still somehow rotate from floor to floor internally. For example, the children in the monitoring room and premature babies were downstairs. The children with malnutrition and diarrhea were on the 2nd floor. I was able to see and experience a broad range of diseases and illnesses. Every day, there was an open consultation hour for children with acute diseases where a different specialist was present every day. Overall, I can really recommend pediatrics for an elective abroad!

Describe a typical day at the hospital, including your work days, working hours and your tasks.

Working in Zanzibar is more relaxed than in European countries. The doctors are very flexible about the working hours and won’t tell you how much time you need to spend at the hospital. It’s not a problem if you would like to leave earlier on some days, but it’s also totally possible to stay for the entire day, to observe the routines of the health care staff and also to carry out some tasks independently.

The day starts in the morning with an early meeting with the pediatricians. I was welcome to join the meeting and to actively involve. After the meeting, they would go back to the ward and start their morning patient visits. I usually accompanied the doctors to all rooms where they would take a close look at each child and do examinations, if needed. Blood sampling and venous catheters are usually done by the nurses. The doctors then make a diagnosis and suggest how to continue the therapy. The doctors usually take a lot of time for each child and the parents. I was lucky to have a great supervising doctor who was always happy to answer and translate all questions. Most patients only understand Swahili and no English, which made it difficult for me to get a detailed medical history from them on my own. Med schools in Tanzania teach in English and local students therefore speak very good English.

Mostly, the morning visits ended between eleven and twelve and depending on how you felt, you could either spend the rest of the day at the beach or stay at the hospital a little longer and see if you were needed for more tasks. I have rarely stayed longer than noon, since there are fewer medical activities in the afternoon.

What did you learn during your elective abroad?

I learned a lot from my medical elective. It was less of technical knowledge for my studies, but a lot of knowledge for my future life that I gained. As I had hoped, I made many new friends and also improved my English skills a lot. Honestly, I was quite proud of myself being able to manage my elective and everything related to it on my own and in a foreign country. African culture and life in an African country have made me appreciate a lot of things here in Germany, for instance not to take seemingly normal things for granted.

Which cultural differences did you observe between the medical systems / treatments / doctor-patient relationships etc. in your host country and your home country?

It was very exciting to see other diseases compared to Germany. For example, there were several children with sickle cell anemia in the pediatric ward, a disease which we rarely have in Germany. Another common disease for children in Zanzibar is malnutrition, whereas in Germany we struggle with obesity and high blood pressure. I also learned how different our medical resources, diagnostic and therapeutic options in Germany are compared to Zanzibar.  If you break your leg in Germany you might be able to play soccer and do sports only a few weeks after. Locals in Africa say that they don’t dare to play football because if they break their leg they may never be able to walk again. On the one hand because the standard in the local hospitals is very different and on the other hand many cannot afford the therapy.

How did you spend your free time in Zanzibar?

There are endless opportunities for leisure activities only in Stone Town/Zanzibar Town. Locals will be happy to give you recommendations, so I’d like to encourage you to speak to people and to mingle with the local community. Always remember to bargain if you want to shop on local markets. If you want to travel on the island, my recommendation is not to book the standard tours for tourists. Zanzibar Town has a Dala Dala (public mini bus) connection to almost everywhere on the island. From here you can do a spice tour, visit the Jozani Forest or take a boat to Prison Island. I highly recommend the night market and the numerous bars in Stone Town where you can even sing Karaoke. Once per week, World Unite! arranged a joint event for all volunteers and interns from their different projects, e.g. a meet-up for coffee in the afternoon or a pizza dinner. It’s not mandatory to join, but great fun! I highly recommend you to plan in some extra time after your placement and to travel the island. I would totally do my elective on Zanzibar again at any time and recommend it to anyone!

Pia completed her elective abroad with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Moshi, Tanzania and learn how to apply for your own elective abroad!

Jil from Germany (Pre-Medical Student):

My time in La Paz is now coming to an end, and it’s unbelievable how many things I experienced during my stay here. I immediately felt very comfortable at my host family and we did lots activities and excursions together in La Paz and the surrounding area.

Also the time in the hospital was an unforgettable experience. Right from the beginning I felt part of the team and despite my basic Spanish skills, none of my questions remained unanswered.

During the weekends I usually did tips and excursions to Coroico or to Lake Titicaca. Bolivia has so much more to offer than one can experience in just one month.

Thanks to everyone who made this trip possible and made my time here so special.

Best regards,

Jil, Germany

Jil completed her elective abroad with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about the Arco Iris Hospital in La Paz and learn how to apply for your own elective abroad!

Rosemarie from Germany, Nurse & Medical Student:

Why Moshi and Tanzania?

I’ve been wanting to volunteer in Tanzania for a long time, because I had heard so much about this country. I had tried to apply for a nursing placement before through other organisations but strangely may application never worked out. From another volunteer I got the contact information of World Unite! and got a fast and detailed reply about my future placement straight away! Moshi, Kilimanjaro, really spoke to me as a location.

To apply for my placement, I only needed an English CV and a letter of reference from my medical school. To prepare for my placement I used the information provided on the World Unite! website and on the information platform for participants. The information materials included information about vaccinations, living standards, public transport, general information about Tanzania and my place of work, among others. When my placement was confirmed, I only had to book my flight and paid for my service package. Considering the extensive services I got on-site and before my trip, booking my trip through World Unite! was totally worth it!

Arrival to Tanzania

I flew into Dar-es-Salaam (World Unite! recommend me to get an inexpensive flight to Dar first and to book a national connecting flight from there to Kilimanjaro). Make sure you allow a few hours to get to your connecting flight on-time, since getting the visa in Dar-es-Salaam can be quite time-consuming. I only had one and a half hours between my arrival in Dar and the next flight to Kilimanjaro International Airport and it was not enough, so I had to take the next flight five hours later. Of course, I informed my World Unite! coordinators in Moshi so that my pickup from the airport could be postponed.

When I finally arrived in Kilimanjaro in the evening, World Unite! had sent a driver to the airport to pick me up and to take me to my accommodation, where I met my local coordinators Adelina and her husband George.

When Adelina gave me a hug and welcomed me to Tanzania, I suddenly felt safe and at ease, considering that I had just arrived in a country that was totally new to me!

Adelina showed me around the accommodation and made sure I was comfortable. The next morning, Miriam, the other coordiantor, picked me up from my shared apartment to show me around the city. We had breakfast together and she gave me an introduction to Moshi, helped me to withdraw my first local money (Tanzanian Shillings) and to set up my phone with my local SIM card. She also showed me how to use the public transport system (Daladala = public mini bus) and explained which bus would take me home and which one to take to get to the hosptial. My shared apartment was located conveniently close the Daladala station KDC and it took me only about 15 minutes to reach the city center and my work place.

My Accommodation

Our shared apartment had three bedrooms and a kitchen and was located on the property of the owner, Mama Rose, and her family. Each room had its own bathroom with a western standard toilet, a small sink and shower. However, the water pressure was often very low and instead of using the ceiling shower head, we used the additional hand shower, which ultimately worked quite well. Whenever there was no water, it was worth asking the very helpful owner or her family members for help, as it may be that the water had accidentally been turned off and the problem was easier to sovle than expected. There were two gas stoves in the kitchen, where we could easily prepare our own meals so we did not always have to eat out. Due to the heat it was recommend to us to store everything edible in the refrigerator, including fruits and vegetables.

On a side note: My boyfriend came to visit me during my placement in Moshi and he was welcome to stay at my accommodation too.

My Placement at the Hospital

The Hospital I worked at was a Regional State Hospital and the central point of contact for sick people or emergency patients that can not be treated at the small rural dispensaries and clinics, or for patients who cannot afford a private hospital. There are many different departments and I was allowed to do weekly rotations. During my 30-day placement I was able to work in four wards: The pediatric ward, the maternity ward, the department of internal medicine and the HIV clinic.

How much you will learn and how much you will be allowed to do as a volunteer or intern, largely depends on your level of activitiy and how much initiative you show, just like in Germany. On the other hand, I recommend you to ask for help or to say “no” if you are expected to perform tasks that exceed your competencies as a student and could harm the patient. For example, I was once present when a woman was giving birth to her first baby and the doctor asked me whether I wanted to assist him. I knew that the doctor might trust too much in my abilities that I did not have yet, rejected the offer and prefered to shadow only.

Looking back, I was very happy about my decision because this birth turned out to be one of the most difficult I have ever seen and it was a mental and physical challenge for everyone involved – the mother, the doctors and the child.

It might happen that you, as a Western student, are very much trusted by the medical staff. Just make sure that you only perform activities that you already know how to master and that you would also be able to do in your own country.

Communication with the doctors and nurses at the hospital was easily possible in English, but very few of the patients had English language skills. That’s why it is very helpful to learn some Swahili before you arrive or to take a Swahili course on-site, so that you can also exchange a few words with the patients or at least ask some simple questions, such as “How are you?”, “How is your child?”, “Where does it hurt?”.

Getting Around in Moshi and Tanzania

Moshi is quite small and the best way to get around the city is on foot. If the distance is longer, you can also take a Daladala. Even the connections to rural areas and the villages outside Moshi are quite good. Moreover, there that run from the central bus station in all directions.

In Moshi there are several small and one large supermarket, as well as many cafes and restaurants, offering local and internationl food. It is highly recommended to buy fresh food such as fruits and vegetables on the street market, the taste is incredible!

Moshi also has an old-fashioned and shut down train station that which is nice and quiet place where you can have drink or just hang out.

Moshi is also a starting point for many Safaris: I spent a day in Ngorongoro Crater and it was well worth it! Don’t miss out on Zanzibar – it’s just a short flight away! I spent the last ten days of my trip there, exploring the markets and narrow streets in Stone Town and the white beaches of Nungwi in the north.

What the staff members of World Unite! offered to me was more than just a regular service. Miriam, Adelina, Katharina and George were there around the clock, if I needed help or had any questions.

When my roommate once did not feel well, Miriam and Adelina did not only take her to the doctor several times and looked after her on a daily basis, but also bought plenty of fruits and vegetables on the market for a quicker recovery. In addition, there were weekly non-binding meetings with all World Unite! volunteers and staff to share experience, to ask questions or to simply chat and have coffee.

I had a great time in Moshi and in Tanzania and would totally do this trip again. The placement also went well and was very interesting for me both in medical as well as in personal and cultural terms. World Unite! was very supportive and my secure base, that I could always rely on.

Wishing you all the best for your time in Tanzania!

Rosemarie from Germany

Rosemarie completed her elective abroad with World Unite!, a specialist provider for electives, internships and volunteering in medicine, nursing, therapies and midwifery. Click here to read more about their hospital options in Moshi, Tanzania and learn how to apply for your own elective abroad!

Andreas from Germany, Medical Student:

From October 5th, 2019 to February 1st, 2020, I completed a four-month stay abroad in Tanzania. World Unite! supported me with the organization of my stay, as well as with accommodation and a language course. World Unite! was also there when it came to organizing leisure activities and trips through the country.

World Unite! arranged my elective at a hospital in Mwanza, in the north-east of Tanzania. I arrived a week before the elective officially started, got picked up from the airport and brought to my accommodation. For the time of my elective I lived in the “Serengeti Guest House” near the hospital. I had Witness, as a coordinator and contact person on site, whom I would particularly like to praise here. She showed me the city on my first days, explained a lot about the culture and the people in Tanzania and taught Swahili through a language course. I am very grateful to her for her commitment, which made my transition into this new situation easy.

I completed my elective from October 14th until December 8th 2019 at Bugando Medical Center. The circumstances on site cannot be compared with the standards that I knew from Germany, but that was precisely why the time there was an important experience for me and taught me many new lessons – both medically and above all socially.

I completed a total of 5 weeks in surgery and spent 3 weeks in internal medicine. Although you are legally not allowed to do a lot of practical work yourself, you still learn a lot about diseases that rarely occur in Germany, such as malaria, schistosomiasis, HIV / AIDS and tuberculosis. You don’t only get to know another health care system, but you also learn to appreciate your own significantly more. The fates of some of the patients can sometimes be very moving and unfortunately, you cannot help all, as only a small proportion of patients are lucky to have health insurance.

I was part at the ward rounds, meetings and trainings. The tasks in the OR were often limited to holding hooks or smaller wound sutures. At the ward I was able to carry out minor medical activities such as taking blood samples, placing catheters, etc. The classic physical examination plays an important role in Tanzania, due to often lacking diagnostic equipment. They are very well trained in this and you can learn a lot from the doctors. Especially at the internal medicine ward, I was heavily involved in the therapy planning and was able to interpret findings (EKGs, heart echos, chest X-ray, etc.).

For me, the elective was very valuable because it allowed an insight into a different health system, a different culture and the department of tropical medicine.

After my elective, I traveled for two months. World Unite! was also able to help me here. A Safari and tours to Mount Meru and Mount Kilimanjaro were able to organize with Budget Safari. Here I would like to praise Adelina in particular, who coordinated all the participants’ activities reliably and was always available. I would also like to mention Ferdinand and his team, who enabled me to be part of breathtaking mountain tours. Tanzania offers such a very broad variety of experiences. You have the magnificent wildlife and beautiful mountains but also fantastic sandy beaches on Zanzibar.

The Tanzanians have a distinctly different culture to us Germans. Everything is a little more relaxed and a little slower (“polepole”) and often things simply take more time than we are used to. Nevertheless, people are very warm and hospitable when you open yourself to their culture. My time in Tanzania was an enormous personal enrichment and broadened my horizon immensely.

I can recommend a stay in Tanzania to everyone who wants to gain a different view on the world. The country and people are so interesting and I appreciate my time in Mwanza. World Unite! proofed to be a reliable organization at all times. I had a dedicated contact person throughout my stay, both during my time in Mwanza and afterwards while traveling. Particularly during these early days, I was very happy to know locals who showed me around and helped me organize so many things.

Kind regards,

Andreas

Andreas arranged his medical elective through World Unite!, a specialist provider for medical electives and internships in nursing, therapies and midwifery in Africa, Asia and Latin America. Click here to read more about Andreas’ placement and learn how to apply for your own elective in Tanzania.

Josie and Lara from Germany (medical students):

We traveled to Zanzibar and lived in a host family together were everyone treated us like a part of the family straight from the beginning.

We worked at the local hospital “Mnazi Mmoja Hospital Zanzibar”, the state hospital of the island. We were first placed in the oncology department and afterwards in pediatrics. All doctors, nurses and other staff treated us in a very friendly and open way. For us it was particularly exciting to make out the differences to the German health system. Often, less or very simple means are available compared to the ones we know from home, e.g. there were no tourniquets available for blood sampeling. Instead, the doctors used the rubber band from their rubber gloves.

At the end of our internship, we donated our gloves, disinfectants and work clothes tot he hospital, which they were very happy about.

We stayed in Stone Town for 5 weeks, the historic center of Zanzibar Town – the perfect base to go on excursions all over the island. World Unite! was very helpful and always assisted us with the arrangements of our trips and excursions. We can recommend the Safari Blue, the Spice Tour and a paddle tour. We also loved strolling along the beach and to explore the many narrow streets and small shops in Stone Town.

In the weekly meetings with our local coordinators we were able to discuss anything we needed assistance with and were always helped immediately. Also, the meetings allowed us to meet other World Unite! participants who worked in other projects in Zanzibar Town.

Our host family also helped us to get to know the culture, country, people and culinary delights. We were very grateful for that! A change for us was that in Zanzibar many things sometimes take a little longer than we are used to from home. Hustle and bustle does not seem to be common here. Always pole pole!

On of the best parts of our trip was a two day safari in Tanzania.

One can hardly put this journey into words and we highly recommend making this experience yourself!

Many thanks to the team of World Unite! It was an unforgettable time!

Best regards,

Josie and Lara

Josie and Lara arranged their medical elective through World Unite!, a specialist provider for medical electives and internships in nursing, therapies and midwifery in Africa, Asia and Latin America. Click here to read more about Josie’s and Lara’s placement and learn how to apply for your own elective in Zanzibar.