Day 18: Medical Agency Visits

Participatory Reflection and Action aims to build the capacity of the community to reflect on health issues and identify priorities and interventions. It has achieved a revitalization of family planning (in fact, the instance of family planning use in the communities where this project has been enacted has just about doubled). They've also reduced wait time at health facilities from 4 hours to 1 hour. The second project, the Families Matter Project, teaches parents of pre-teens about how to communiate to their children about reproductive health. The primary aim is to reduce risky sexual behaviors among youth and ultimately decrease both HIV rates and early pregnancies among school children. Part of this presentation focused on the Tanzanian policy toward school-age children and sex. It states that when a school girl gets pregnant she must leave school. Advocates are trying to negotiate with the government to change this so that she can stay until time of delivery, give birth, have adequate maternity leave, and then return to school. These advocates believe that chasing the girls out of school condemns them to a life of poverty. Finally, the Pamoja Tuwalee project aims to mobilize communities to provide sustainable support to the most vulnerable children through the use of community health funds and microfinance options. This project has worked to improve access to medical care and has even successfully constructed a dispensary building. 

The presentation was good overall, and touched on some hot-button topics that was interesting to learn about. When it was over though, we piled into the bus and headed to Muhimbili National Hospital for a lecture on what medical social work in Tanzania is like. Social workers here face many of the same challenges as social workers in America such as lack of funding, lack of transportation, and destitute patients. We also learned that health care for children under 5 years of age is free and health care for anyone with a long-term issue such as diabetes, cancer, head injuries, HIV/AIDS, etc. is also free. This is a good and bad thing because it puts major strain on the hospital and can lead to a lower quality of care in many facilities (though the quality of care I observed at Muhimbili was surprisingly good compared to my other experiences with Tanzanian health care facilities). 

After the lecture, a snack, and a group photo we split into smaller groups to go on tours of the hospital. Our group was taken to the pediatric ward which was amazing and HUGE! It is a whole building dedicated to taking care of kids, and it currently housese about 300 children. There are seperate wings for malnutrition, cancer, gastroenterological issues, long-term care, burns, etc. We got to go into the malnutrition and burn units. The malnutrition unit was weird, and in one area (a consultation room of sorts) there was just one random crib with a baby in it in the corner. We asked about him and the social worker told us that the baby had been dumped by his mother and the police had brought it to the hospital. They had just found out the whereabouts of the mother and were going to bring her in soon. 

We also went into the burn ward which was sad but very impressive. I've been on burn wards before and usually there is a strong, foul stench of burned flesh and ooze that is accompanied by moans and screams from pain. However, when we walked into this ward, the children were all quiet and calm. There was no stench, only a faint smell of wound that comes with all hospitals. The mothers were allowed to stay with the babies 24-7 and were taught how to keep them hydrated and nourished through their feeding tubes. All of them were well-fed and none were crying. The doctor explained that they adhere to a strict 4-hour schedule of anti-anxiety and pain meds to keep the babies comfortable so that they don't further damage their wounds. All of their bandages were fairly clean too. It was sad though because some were covered almost entirely in bandages. 

The social worker explained that children ended up burned mostly due to lack of supervision and the type of cooking methods used in the homes. Many houses use open-flame methods, combustible gases, and/or unsafe electrical methods all of which cause house fires and injuries. The walls of the ward also illustrated how some of the children had come there through murals that taught about being watchful and knowing where your kids are. Apart from these murals there were also adorable murals of happy children and cartoon characters all over the pediatric building. They were gorgeous! I really enjoyed our tour.