We arrived to Kilema Hospital in the Kilimanjaro region of Tanzania late Tuesday evening. After a good night’s sleep to ward off our jet lag, we woke Wednesday morning and met Sister Charles, the Matron of the hospital. She, with graceful and quiet authority, introduced us to the campus of Kilema Hospital. Despite the isolated location among the hilly base of Mount Kilimanjaro, reachable only by a rocky dirt road, the facilities house a number of departments: outpatient, inpatient, maternity, an operation theater and a counseling and treatment center for HIV/AIDS and Tuberculosis. This compilation of health care is spread out within a beautifully kept land, and the buildings are filled with natural light and air, every window open to facilitate adequate ventilation – concepts that take us back to Florence Nightingale’s foundational text "Notes on Nursing."
The differences between this place and what we expect for health care in the U.S. were easily and readily noticed. Wednesday, I think the whole group would agree, could be described as a shock to the system. We’ve been in class for eight months, learning the regimented and strictly structured techniques that underlie American medicine, and now we find ourselves at a long-standing and effectively functioning hospital in Tanzania that doesn’t have the luxury of being able to implement many of those things the way we do. Rooms lined with simply framed beds, as many as 10 or 12 in the same room, were speckled with home-brought linens and patients diagnosed with a variety of issues. For Kilema’s total capacity of 150 beds, there are just seven doctors and only about one nurse for every 10 or more patients. The public-private partnership between the Tanzanian Government and the Diocese of Moshi supports the hospital, which serves a catchment area of 300,000, but the funding is limited and inconsistent, resulting in a scarcity of resources. We went to bed Wednesday struck by how differently two places function even when serving the same goals of health care.
Today we completed our first full day of clinical rotations, and I think the dust is beginning to settle now. Every member of the staff here at Kilema has welcomed us with open arms and readily been willing to include us in their care for patients. The doctors and nurses are putting forth such an effort to teach us in English what they do and why. Their gratitude and tendency toward hospitality are truly amazing and humbling. There are obvious procedural differences in our health systems, yes, but we’ve seen firsthand that they are able to provide patient care whether or not it is in a familiar way. As we continue, I have no doubt we will be learning quite a bit from their resourcefulness, and I have a growing appreciation for the value of differences.