From Elective Reviews - Tanzania - Kilimanjaro Christian Medical Centre, 2003 - Joanna Coles, physiotherapy elective
I chose to spend my four-week physiotherapy elective placement at Kilimanjaro Christian Medical Centre in Northern Tanzania. KCMC is set in the foothills of the breath-taking Mt Kilimanjaro. It is one of the four largest hospitals in Tanzania with 450 beds and sees between 450 and 750 outpatients each day. KCMC is the only hospital in Tanzania that teaches a Physiotherapy diploma and they are at present trying to extend this teaching to degree level.
I chose KCMC as the site of my elective as I was keen to work in and experience a Christian working environment, for my own personal spiritual development. I was also keen to promote the link already standing between my university and the institution. From a 'physio' perspective I hoped that working in a developing country with its lack of equipment would broaden my manual skills. My limited Swahili would also extend my verbal and non-verbal communication skills!
My expectations were high: on day one, I went in raring to go, but the reality was very different! The hospital were not prepared for our arrival, as there had been a lack of communication; despite being very welcoming it was clear this was not the best time to descend on them due to the student's exams taking place. Had all my organising and saving up been a waste of time? I turned to God for the answers; after lots of prayers, a few days later we had been allocated a program and an educator and the staff had been more welcoming than I could imagine.
The first few days were tough: I had gone in early ready for some hard work, but Africa's hospital day only seemed to start about 10 and would wind down after lunch. It was difficult to imagine how my physio skills could be developed in this short working day. Something of a contrast to my placements in the U.K! I came to realise that there was something equally important. This was to develop as a Christian.
God was to provide for me in so many ways. Initially I had the demands of a new placement and the challenge of settling in to a new culture without support of friends and family around me. God provided support straight away, I was placed in a house with three other Christians who were very welcoming, who in turn introduced me into a weekly bible study group with missionaries from all over the world. I had more offers of evening meals than ever before! I was invited to join the church music group and even invited to a wedding within 3 days of being there. The other Christians I met were so open and welcoming I felt at ease to discuss any problems with them and knew I had their support and prayers. It was good to feel part of the community so soon. I turned to God's word so many times and he-never failed to answer my prayers, my daily readings from The Doctor's Support were very appropriate on so many occasions.
The general day-to day life in the hospital didn't come without its problems, Hidden behind the Christian name there were signs of corruption within the hospital, which was disheartening. Many people were praying about this and things were beginning to change even in the few weeks I was there. By contrast I also met many dedicated and caring staff, working extremely hard and making a real difference to the lives of so many people.
Sometimes the amount of suffering I witnessed was difficult to bear, it was a challenge to be "the light" in certain situations, but then to see a smiling face of someone I knew, be it colleague or patient, always raised my spirits and gave me the strength to keep strong and keep a smile on my face. The general attitude of the patients was very humbling, I didn't see much complaining considering all their situation and many had very positive attitudes, which they told me came from their faith in an all-loving God I will always remember the acts of kindness shown to me; I once got on a bus and saw the mother of a patient on it. Without me knowing, the lady paid my bus fair for me, something that she couldn't afford. I was extremely touched.
I often felt ill equipped as a student with limited knowledge and only basic Swahili and I wondered how could I help any of these people. It is easy as a physio to concentrate on the physical aspects of health, but healing requires holistic care, considering the psychological, spiritual and social issues. There was a need for hope here and I began to realise the value of a smile, a hug and the promise of a prayer. I felt that my learning was enriched in this environment, I had to get with it using the skills I have accumulated in my two years of study, to look at a patient and prioritise their problems without the large support network of experienced staff I would have at home, I am sure this will help me to become a more independent practitioner at this early stage in my career and has definitely increased my confidence in my own abilities in assessment, diagnosis and treatment of patients.
Despite witnessing suffering there was a huge amount of joy in the hospital, The day started off with morning prayer in the chapel and members of the church would go round and visit the sick; in the early evening the choir would sing in the wards. The African culture is very much based on Christianity: the family of God is very much apparent. Mothers in nearby beds will mind each other's children and share their food, the staff also related to the patients in an affectionate and empathetic way. It was very humbling to see this and also provided a good example for me as a future healthcare professional. The ethos was very much focused on God. It was the norm to be a Christian and God was not the almost taboo subject he is in the western world. The issues of life and death seemed to be dealt with much better; death to this society was not seen as the end, but rather the beginning.
The working environment differed in several ways to our country; 'Hakuna Matata,' meaning "No worries", captured the laid back spirit which differed so greatly from the rife stress which invades our hospitals. I was fortunate enough to attend the weekly lectures for all the hospital staff. One week the topic was stress. The speaker had very different ideas to us in the western world, but I thought he had an excellent point and therefore I quote some of his words "I don't want to sit in my office all day getting stressed, I'd never be able to spend the money I'm earning, so lets sometimes leave early and enjoy a soda with friends." This portrays the different priorities that were so obvious in the African culture, the great importance placed on time for friends and family rather moving up the career ladder, and I found myself agreeing with this. With the privileged background we have in the developed world we often think we are doing this right, but this showed me that perhaps we are not.
I would describe my placement in Tanzania as challenging, both as a Christian and as a physiotherapy student. I was humbled and encouraged by the people that I met. Whenever I had problems or doubts God was right beside me, and this has really strengthened my faith. I would strongly recommend this type of experience to other students.