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“What we really want to do is to leave behind a legacy and help these countries become more self-sufficient.” |
In mid-July, Dr. Beres traveled to Tanzania and Kenya with the Physician Training Partnership, a branch of Progres- sive Health World-wide, whose mission is to cultivate independent medical professionals in the developing world. The first resident to travel with the group, Dr. Beres fulfilled a desire she’d had since medical school. “I feel like I’ve been given a gift to use my hands and my abilities to help people,” she says. “I think it’s important to give back.”
A world apart
From the moment the group landed at Kilimanjaro International Airport, Dr. Beres’s experience was drastically different from anything she has known in the states.
The team, which consisted of three neurosurgeons, a neurologist, a physician’s assistant, and a handful of medical students, was stationed at Haydom Lutheran Hospital in the small town of Haydom, more than eight hours—by mostly dirt roads—from the airport. A 450-bed facility, the hospital’s average census runs closer to 600.
Once word spread that a neuro team had arrived, the corridors filled with patients, many of whom had arrived via the handlebars of a bicycle. It didn’t take long for Dr. Beres and her peers to discover the many challenges of practicing medicine in a developing country.
Like most parts of Africa, physicians are scarce in Tanzania. In fact, the only MDs at Haydom Lutheran are those who come through on mission work. Otherwise, patients are treated by assistant medical officers whose education is the equivalent of a high school degree and some advanced technical training.
Healthcare obstacles
A mission hospital founded by the Norwegian government and the Lutheran church, Haydom Lutheran houses one of the country’s six CT scanners—and not much else. Aside from an x-ray machine and a rudimentary lab, there is minimal equipment or medications. Electricity is sporadic and the water isn’t drinkable. Due to poor sterilization, infection is rampant. Partially because of a lack of adequate diagnostic equipment, patients are usually given one of two diagnoses—malaria or tuberculosis.“It was very frustrating to figure out how to best treat patients with the resources available,” says Dr. Beres. “So many times we would want to do other procedures, like checking sodium levels or intracranial pressure, but we didn’t have the resources.” Instead, they improvised. The hospital doesn’t have an electric drill, so the team performed craniotomies with a hand drill and a wire saw. To get more light, they attached flashlights and camping headlights to their heads. While doing a mother/child outreach clinic, they weighed babies with a weight tossed over a tree branch and a sling.
The conditions at the hospital where Dr. Elisa Beres spent six weeks last year are nothing like the facilities at Barrow where she is in her sixth year of Neurosurgery residency.
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In addition to the lack of resources, the team also encountered cultural differences and language barriers. They saw patients who had been receiving treatment from the local witch doctor and whose conditions had deteriorated beyond surgical treatment. And even if they were able to find someone to translate one of dozens of tribal languages, crucial information was still often lost in translation.
Medical self-sufficiency
One of the more obvious obstacles to healthcare in Africa is financial hardship. While care provided by the PTP group was free, paying for healthcare in other situations often becomes a burden. For example, a head scan at Haydom Lutheran costs 30,000 Tanzanian schillings—the equivalent of roughly $30 dollars. Brain surgery costs the equivalent of $50. These prices are unheard of in the American healthcare system, but a $50 expense could force a Tanzanian family to sell off everything they own, including their livestock.
“Deciding whether or not to pay for a procedure often becomes an ethical dilemma for the family,” says Dr. Beres.
During her two-month stay, Dr. Beres participated in 29 surgeries, implanting shunts, removing tumors and more. But for every patient the team helped save, there was another they couldn’t help for one reason or another. Often, she says, it was a matter of deciding to do surgery or to send a patient home to die.
“It’s easy to go down and help people temporarily, but at the same time, a mission isn’t the answer,” says Dr. Beres. “What we really want to do is to leave behind a legacy and help these countries become more self-sufficient.”
That’s why the group also dedicated time to educating hospital workers on basic skills such as reading CT scans and performing neuro work-ups. They visited government officials to advocate for the development of training, recruitment and retention programs. In East Africa especially, potential physicians have to leave the region for adequate training—and very few return to practice in their homeland.
In fact, there are only three neurosurgeons in the entire country of Tanzania, and all are located in the coastal city of Dar es Salaam. The World Healthcare Organization recommends a ratio of one neurosurgeon to every 100,000 people. The ratio in North America is about one to 81,000; in Africa, it’s one to 1,352,000.
Such staggering statistics make it easy to see why Dr. Beres doesn’t feel that her short stay made a dent in the dire situation. However, the dozens of patients who received potentially life- saving surgeries would probably tell a different story. ■
(For more information about the Physician Training Program, visit www.ptpafrica.org.)
