By Lilian Msambichaka: Help me! Someone help me please! My child is
dying, please someone help me!
A woman holds her convulsing son outside a café a few steps from the
Muhimbili University of Health and Allied Sciences (MUHAS) hospital in
Dar es Salaam, Tanzania. The café is frequented by patients and their
family members and MUHAS staff. I am there on an August afternoon to
meet a family friend after my orientation at the Tanzania Diabetes
Association (TDA), where I am doing a five-week project. I stand, look
in the direction of the crying voice, and notice that a nurse sitting
a few tables away continues to eat her lunch as if unaware of what is
happening. People gather around the crying woman and her seizing son
as his body jerks, his eyes roll upward, and blood-tinged foam covers
his mouth. I vainly try to recall what I’ve learned about first aid
for seizures. Then, people around her begin praying. When the seizure
stops, the mother thanks them and explains that her son has recently
sustained a head injury in a car accident and that he is going to
MUHAS to be examined.
That was not how I had envisioned health care in Tanzania. I hadn’t
expected to see such apathy. I had thought health care providers would
rise to the call of duty and offer their services despite whatever
strains they might be feeling. I was shocked and angry at the
indifference of the nurse. How could she not offer to help?
To begin to understand her, to begin to understand the health care
system in Tanzania, I had to look beyond this incident.
I had come to Tanzania in the summer of 2010 to do research on the
prevalence and management of diabetes mellitus. As it turned out, that
focus provided me with a lens through which I could see the bigger
picture of this country.
My parents lived in Tanzania, so I was familiar with the country. I
got interested in metabolic diseases in developing countries after
hearing Antoinette Moran, M.D., an endocrinologist at the University
of Minnesota, where I am a medical student, give a talk on diabetes in
Uganda. Before Dr. Moran’s talk, I had no idea how prevalent diabetes
was in Tanzania nor that the disease is on the rise and poses a
serious problem for the future because neither society nor the
health-care system is equipped to handle the management of people with
chronic diseases. Like most people who consider studying or working in
Africa, I was initially thinking of pursuing a project on infectious
diseases such as HIV or malaria.
Dr. Moran put me in touch with the TDA. The association was formed in
1985 with the assistance of Dr. Donald McClarty, a British physician
who taught medicine at Muhimbili Medical Centre and who noticed that
many patients with diabetes were unaware of their condition. He also
noticed many Tanzanian doctors were treating symptoms but missing the
diagnosis. And many Tanzanians regarded diabetes as a disease of
developed countries, rather than one that could affect them.
The TDA provides education about diabetes to the public, health care
professionals, and newly diagnosed patients, and gives free insulin
and glucometers to people younger than 22 years of age. During my
stay, I attended diabetes education sessions at the Temeke and Amana
district hospitals, and at the MUHAS diabetes clinic, all of which are
government-run facilities. At the district hospitals, a dozen people
gathered in small rooms for the two-hour sessions, during which
educators dispelled myths about diabetes being a communicable disease
or a curse. Many patients believed that people with diabetes should
only eat millet with a few vegetables three times each day. Those who
followed this regime got both constipated and hyperglycemic. It was
refreshing to see these patients’ relief as this folklore was
discounted.
The diabetes doctors who I worked with were as dedicated and
hard-working as their colleagues in the United States. But they are
stretched thin and paid less than most professionals in the private
sector. The doctor-patient ratio in Tanzania is 1:26,000. (World
Health Organization guidelines are 1:7,500. In the United States, the
ratio is about 1:400.) The Tanzanian physicians see as many as 50
patients during a three- to four-hour clinic. At Amana District
Hospital, a 350-bed facility, the one trained diabetes doctor is
occasionally assisted by other doctors who have attended only a few
seminars on working with patients who have diabetes.
As in the United States, the children with diabetes who do the best
have parents who are actively involved in the management of their
disease. The adults who can afford to buy medication or have some
education also do better than others. Adolescents and young adults who
don’t have jobs struggle the most. When they turn 22, their access to
the TDA’s free supplies ends. A month’s supply of insulin costs $10 to
$20; glucose strips and syringes bring the monthly treatment cost to
$65, far beyond the reach of many. Unless they come from families that
can afford to pay for the medications, patients frequently end up in
hyperglycemic crisis and return to the pediatric clinic at MUHAS
seeking free medication. One kid begged the doctor to let him stay at
the clinic forever.
Half of Tanzania’s 33 million residents live below an unimaginably low
poverty level. The cost of living is high, and people struggle to make
ends meet. The gap between the poor and the middle class keeps growing
wider. Those who have means can afford to go to a “good” hospital and
get good health care; those who don’t rely on under-resourced
government hospitals.
A few weeks after my encounter at the café, I was no longer angry at
the nurse who stood by while the young man had the seizure, nor was I
surprised that people resorted to prayer to solve their problems. I
was beginning to understand what scarcity and need could do to a
society. I saw that the public health care system in the country was
burdened, under-resourced, and understaffed. The medical personnel
were overwhelmed, which led them sometimes to the point of not caring.
Prayer gave people hope and a sense of peace. It made them feel
empowered when they felt the health care system and society had failed
them. MM
Lilian Msambichaka is a third-year medical student at the University
of Minnesota and a junior scientist in the department of medicine’s
hematology office.
Article source:
http://www.minnesotamedicine.com/CurrentIssue/DiabetesinTanzaniaAugust2011.aspx