The first step

4th August 2008

It has been almost 4 weeks since our arrival here in Moshi to begin the collaboration between Duke and KCMC in women’s reproductive health. The transition has been smooth in many ways and rough in a few. Our housing issues seem the most pressing while two Hitchcock movie-like attacks of fire ants have been the most challenging and somewhat frightening to these US doctors. Many of the projects that seemed simple to achieve from that side of the ocean look more daunting when confronted face-to-face. These realities are balanced by a host of other interesting and worthwhile opportunities that have emerged since arriving. Grant Smith, the Hart Fellow scholar who came with us for the year, has been an invaluable addition to the team. He’s bright, energetic, technically savvy and really a joy to be around. One can see why Harvard Med wanted him there

The first two days here were sunny and warm with Kilimanjaro resplendent in our front window. Since then, the mountain has barely shown itself for the clouds and rain. We understand that the dry season is coming soon. With all the clouds and rain, everyone who has lived here for more than a few months is feeling cold and damp. The climate is actually quite nice; Especially when compared to Durham at this time of year. I spoke to Alice yesterday and she said it was in the high 90’s and humid. I’ll take Tanzania weather any day.

KCMC is situated in a beautiful campus on over 500 acres of land. A huge new medical school building is going up and is planned for opening in October or November. There has been a mandate from the government to continue to increase the number of medical school positions and KCMC is no exception. This mandate has not necessarily been balanced by a commensurate increase in capacity or resources for the institution. A common theme of such mandates….. We’re looking forward to a bright and energetic group of first years coming in at the end of September.

The Department of Community Health at KCMC sends the first and second year medical students to surrounding villages for a day every week or every other week to learn about community health and to develop service based initiatives for these communities. This experience sensitizes the students to the community health care issues that are often unseen in the larger cities and in relatively affluent towns such as Moshi. We are working with this department in the hopes of establishing a longitudinal assessment of supplemental medical student education in women’s reproductive health. After completing medical school, doctors complete a one year rotating internship and then are sent to an area of need as a medical officer for a year. This is usually in a remote location and they are often then only doctor present. They have to take care of everyone and their training is often lacking in the care of women. We hope this will not only sensitize students to the special issues of women’s health in this setting, but also give them some practical tools to use in the care of acute obstetrics and gynecologic emergencies as well as basic family planning, antenatal care etc. We hope to track this group of students as they march through medical school and see how an additional program of education affects their career choice, decision making and knowledge base in women’s health among other issues.

We have the first Advanced Life Support in Obstetrics Course tentatively planned for the first week of November. From what we have seen so far, a systematic approach to managing obstetric emergencies is strongly desired and needed here. We will be working with a colleague from University of Copenhagen who is working in Kagera District, which is in the northwest of Tanzania bordering Lake Victoria.

The laparoscopic equipment generously donated by Stryker surgical sits waiting for shipment in the warehouse in California. We are working on a plan to safely introduce the equipment here without having it rapidly break, get lost or fall in to disuse or create more problems than it solves. The leadership of the hospital, physicians and staff are motivated to see this happen, but a number of complicated things have to happen before we can start.

Dr. Oneko, the head of the department of ObGyn at KCMC, is eager to help develop an East African Maternal Health Network and we hope to have a preliminary meeting on this in January. This would involve women’s health care providers and researchers from Tanzania, Uganda and Kenya. We hope to establish similar data collection tools, clinical protocols and best practices in key areas of women’s reproductive health and learn from each other.

We’re pressing ahead with plans to assist in the cervical cancer screening, prevention and treatment efforts that are already underway and to help develop further capacity, infrastructure and study of the problem of obstetric fistula in Tanzania. We’re trying to refine our focus to avoid getting over-stretched…..perhaps the most difficult task.

Looking forward to seeing you in Moshi!

Jeff and Sumera