A Glimpse into Tanzanian Health Care

Tom, our gardener, told us that his wife, Martha, is pregnant. He was concerned because apparently she’d been pregnant before but had a miscarriage. We thought that something radical, like prenatal care, might be in order, so took them to a clinic that is used by many ex-pats.

“They’re going to do an ultrasound, okay?” I told Tom. He nodded and said that was fine. “Do you know what an ultrasound is?” I asked. “Not exactly”, he said. I explained how they work and he got excited.

The doctor at the clinic told me that the obstetrician who worked at the clinic and was very good, also worked at Muhimbili National Hospital. And if he gave the okay for Tom and Martha to go there, even if it was out of their district, they’d get the same treatment and service at a fraction of the cost.

Martha's appointment was set for two weeks out.

Coincidentally, the day before we went, the local newspaper had a headline that read “Mental Patient Kills 2, injures 5 at Muhimbili”. Apparently a patient “clobbered his victims to death as they slept” with a drip infusion stand. The article noted that the incident follows several recent mishaps, such as: “a horrendous mix-up early in the year that saw two patients subjected to wrong surgical operations.” A man who had his very-working knee operated on instead of his head to remove a suspected tumor (and then died), and a man who needed a knee operation but received a head operation and is now in a wheelchair.

Muhimbili is that largest hospital in Tanzania and serves up to 1,400 patients a day. It is a sprawling mass of buildings across a hillside, many in a state of either construction or deterioration. There is little signage to direct anyone, so trying to find where you need to go - which involves one building to pay, another to check-in, and another to see a doctor -- is complex game of asking anyone official looking over and over where to go.

According to it’s website, “Hospitals are complex organizations and Muhimbili National Hospital is no exception. It has been and will continue to be necessary to manage and coordinate many changes which are taking place. It will be the task of management team to maintain a comprehensive health care services during this period of changes.”

This is on a website and supposed to make a prospective patient feel comfortable? Well, health care here, except for the rare few, is a nationalized affair and you take what you can get, public management upbraiding and all.

We wandered the grounds trying to find where to go. Open air verandas had patients sitting or sprawled out, waiting, some with clothes over their head to protect them from the sun. Gurney’s with patients were lined up like the entrance to a freeway by the front door of one building. The grounds were littered with open trash cans that looked like they had to many types of hospital waste in them; construction debris littered the grounds and had to be navigated to get from one building to the next. We waited through several lines and several hours.

We were directed to room 50, which was locked. And then to room 78, which had someone checking an old man’s stomach. There is no master schedule of which doctors are using what consultation rooms, so we were reliant on which administrators had been paying attention to who might be where. We finally found the the obstetrician.

It seems Martha is doing ok. She is due in January and her next appointment is in a month.

Tom told Hillary and me that they would be honored if we would name their baby. Our marriage saw perhaps its most trying times in trying to come up with a name for our baby. Now we have to name theirs? Of course, it could prove a good way to use a name that I can’t stomach, but Hillary simply won’t let go. Tom and Martha, we want you to meet your baby, Enzo.