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!