Summer in Mwanza, Tanzania - Hannah Dee

Hannah Dee spent two months in Mwanza, Tanzania at the Weill Bugando Medical Center. 

"The health care discussion in the States is often framed around the “haves” and the “have nots.” The fortunate have health insurance or a financial safety net – and they have the capacity to seek treatment and preventative care. The “have nots” flounder in a for-profit system that paradoxically ignores those who most often need care. It’s convenient to talk about the American healthcare system in black-and-white terms, to talk about the privileged versus the underserved, the fortunate versus the forgotten. I needed to leave New York to remember that the American system is a pale reflection of broader, more extreme disparities in global health. It’s easy to take certain aspects of public health for granted at home: the clean tap water, the (relatively) smooth paved roads, the flushing toilets. The inequities in access are vast, but so too are the resources.

Before going to Tanzania for the summer, I knew that we would gain exposure to diseases and conditions that are rarely discussed – let alone seen – in the United States. The first day we arrived in the Bugando ICU, we learned firsthand how to identify the stages of tetanus. During our rotation in Obstetrics and Gynecology, we saw surgeons repair debilitating obstetric fistulas, and in Internal Medicine, we saw the long-term sequelae of schistosomiasis infections. I was struck most, however, by the challenges of delivering care in a city where the average yearly salary is less than 2000 dollars, and the only in-country MRI machines are often only found 500 miles away. America is certainly not immune to the effects of poverty, but poverty in Tanzania has a different, even more devastating presentation.

During my  two months at Bugando Medical Centre, I spent most mornings rotating through the Departments of Internal Medicine, Surgery, and Obstetrics and Gynecology. We also worked with various faculty members – from both Tanzania and New York – on projects relating to disease and injury burdens in the region. With Dr. Jennifer Downs, we traveled to outlying villages for her project on the association between schistosomiasis and HIV infections in men. We also helped collect data on traumatic brain injury patients admitted to Bugando. In the process, I realized that the burden of disease in Tanzania goes far deeper than HIV and malaria. The healthcare system in Mwanza is fighting a convergence of epidemics, as high rates of maternal mortality and infectious diseases linger next to a rising tide of non-communicable diseases.

Even as I noted the onslaught of diseases in an overburdened system, I was also struck by the dedication of many of the students and hospital staff. Providers were juggling multiple positions to make ends meet and to reach more patients. As our day in the hospital ended, many staff members were just leaving for their second or third jobs at other clinics. And despite medication and personnel shortages, the hospital and medical school have achieved incredible progress over the last few years. In 2004, there were only ten students enrolled in the first medical school class. Today, the per-class enrollment is more than 150, and students come from throughout the country to learn medicine in Mwanza.

Many of this summer’s clinical experiences will stay with me, as will lingering questions surrounding our role in global health work. It will be difficult to forget the teenagers semi-paralyzed by tetanus, or the young boy convulsing from an AIDS-related infection. I think some of the most memorable moments, however, came from the medical students and staff who welcomed us to Tanzania. Whether they were patiently explaining clinical cases or taking us to the best barbeque stands in the city, the people we met here were wonderful teachers – and valued friends."

-Hannah Dee, WCMC, MD Class of 2017