Return of the Learners

This week, the medical students returned to their duties at KCMC. It is an impressive thing to watch so many students fill the campus. Knowing that the medical school opened its doors in 1997 shows how quickly it has become established. Initially, there were only 10 students per class. However, it quickly became apparent that this low number would not help the severe physician shortage in Tanzania. Before KCMC College started its medical school, the only other government sponsored medical school was Muhimbili in Dar es Salaam.

When we arrived last year, it took Jeff and I a few months to finally realize a few things about KCMC hospital and medical school students:

1. The school year starts in October, not in august/September like American medical schools. The reason this matters is that when we arrived in July, instead of joining a new group of students, we landed in the middle of final exams for the entire hospital campus (all the schools: medical, assistant medical officer, public health, residency program, nursing, allied health, you name it). It threw us off for a few months. When Tanzanian students want to come to the US, they get thrown off their usual schedule as well, or may lose almost a year waiting to apply to US based residencies.

2. The medical school class size has undergone a massive increase in students due to a government mandate. At KCMC, this has included the creation of a brand new beautiful medical school facility right next to the hospital. What’s needed are instructors to fill the facility. Currently, the attendings (consultants they are called here), or senior level faculty, not only see patients, perform surgeries, oversee residents and teach students on the wards, they also provide lectures on basic science relevant to their specialty for other students. Because there are not enough faculty, the residents have to teach as well. Helps put the teaching issues at American medical schools in perspective.

3. The medical students, who used to number 10 per class year and now average 100 per class year, all have to rotate through KCMC hospital. The hospital has stayed the same size. So now this week, there are 18 new 5^th year med students who have joined our hospital rounds on the OB/GYN floor. Last year’s class had 10 students per rotation, and that already added to the crowd of 10 3^rd year medical students and 10 AMO students every rotation. We all don’t fit into the morning report room, so the latecomers stay in the hallway, hoping to at least hear the report if not see it. Students have to be extra assertive to make sure they are able to get necessary experiences in. Most medical students, right after they graduate, have to be able to perform c-sections in remote regions (usually without supervision) when they serve as Medical officers. I hope these students make the extra effort.....

4. The medical students follow the British system here, so they can start medical school straight after high school and earn their medical degree in 5 years. So most of them have not had any undergraduate experience or real-world health care experience before starting the path towards becoming a physician. Is this a good thing or bad thing? After our past year, I don’t know if undergraduate study is necessary. It is a nice thing for most undergraduates, especially if they are not footing the whole bill. In a country like Tanzania with such a paucity of doctors, with such poverty, it makes more sense to get students through the education system earlier.

5. The government pays for most residents to go through residency, but that is after requiring 1 year of ‘medical officer’ work in rural parts of Tanzania. In fact, similar to the US system until the 1960’s, medical students do not have to do residency, and after their 1 year of ‘medical officer’ work, they can stay on as a medical officer indefinitely. The government salary is even less than what US hospital residency officers make- and amounts to about $400 per month. I once calculated after a particular grueling shift in the hospital as a resident in America that I had earned $1.20 per hour. No matter what minimum wage was at that point, I knew I had earned less. I see the residents here working hard, making even less, and I feel bad now for complaining.

There are differences from what we were used to in the US medical system. But the things that matter most- trying to keep people alive, women delivering safely, newborns healthy- are the same. And that is why we became physicians in the first place.

Sumera