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November 1996
Volume 60 |
Number 11
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A Change in Perspective:
Experiences With the OTP in Tanzania |
K.A. Kelly McQueen, M.D.
I needed a fresh perspective. I had recently completed my residency
in anesthesiology. The job market and opportunities for young
anesthesiologists were deplorable, and I found myself feeling
generally uncertain about my decision to go into medicine. As
I searched the future for possibilities, I learned of the ASA
Overseas Teaching Program (OTP). As I read about the mission of
the program and the experiences of previous volunteers, I became
inspired. In fact, I felt called to participate.
So in November of 1995, I left for East Africa, excited by the
opportunity to participate, to teach, to change. And changed I
am, touched by the people and experiences of the OTP, inspired
by their determination, hope and faith.
Prior to leaving for my post in Moshi, Tanzania, I began preparing
myself by reading the materials supplied by the OTP. Several books
-- Isak Dinesen's Out of Africa, Nine Faces of Kenya
by Elspeth Huxley, and Oliver and Fage's A Short History of
Africa -- introduced me to the cultures and history of East
Africa and answered many of my questions on the political and
economic situation in Kenya and Tanzania. Travel books explained
geography, climate and the currency and began preparing me for
the sights and sounds I would encounter.
My general medical textbooks reminded me of the variation in
disease; I recalled malaria, schistosomiasis, typhoid and tetanus,
and I reviewed the ravages of AIDS, which was uncommon in my residency
training but rampant in East Africa. I became fascinated. I planned
a safari. I studied Kiswahili. I organized my packing, as I had
been warned of strict weight limits on baggage, especially on
inter-Africa flights. So I selected limited clothing, carefully
chose medical books and saved a little extra room for leisure
books, candles and peanut butter. I expected the hardships of
travel and daily living (limited electricity, communication and
transportation) as well as the challenge of teaching anesthesia
without including references to our modern modes of monitoring,
high-tech equipment or new drugs. I anticipated variation in medical
practice; I read about diethyl ether; after all, I had never given
this volatile agent during my training. I read articles on draw-over
vaporizers[1] and an article titled "Where
There Is No Anaesthetist."[2] And so
I was prepared.
And yet I was not prepared-- not prepared for all of the eye
- and heart-opening experiences, the beauty, the insight into
another world and the friendships I would treasure.
My departure date arrived. I initially landed in Nairobi, Kenya.
I spent the first several weeks of my adventure on safari in Kenya.
Initially, I felt as though I had stepped back in time, but I
gradually adjusted to the way of life in East Africa -- the open-air
markets; limited personal space; near-impassable roads somehow
traveled; new and wonderful foods; and vast, incredible scenery
full of color, culture and amazing animals. And then I stepped
back in time again as I traveled to Tanzania. Although equally
beautiful, Tanzania is a poor cousin to Kenya and not as frequented
by tourists. The limitations of travel are apparent but are definitely
worth enduring. I was immediately impressed by the splendor, the
beauty and the people.
After my safari, I felt adjusted, rested and ready to begin working.
I arrived in Moshi, Tanzania, several days before beginning my
tenure at Kilimanjaro Christian Medical Center (KCMC). All arrangements
had been made through the efficient travel agent serving the OTP,
and each contact was achieved without a hitch. As was the custom
of the OTP, I met my predecessor, Richard J. Hendershot, M.D.,
who guided me into the next phase of this adventure. He oriented
me to Moshi, KCMC and the "blue flat," the OTP apartment.
He shared with me stories and accounts of his medical and personal
experiences. He gave me some great advice: invaluable information
on how to repair a thorn-pierced bicycle tire, directions to town
and the superb open-air market, restaurants worth experiencing,
and even a few needed expressions in Kiswahili.
My most valued experiences began upon arriving at the blue flat,
my home for the next month. The blue flat is a simple accommodation
with all the amenities of home (even propane-heated water and
electricity!) and is located a short walk or bicycle ride from
KCMC. Its most endearing quality was the awesome view of Mount
Kilimanjaro from the huge window in the main room. My neighbors
were an American dermatologist, a British occupational therapist
and two African urology residents. There was a real sense of community
there, and I felt welcomed immediately (view
photo).
The experience of community continued at KCMC. KCMC is a large
regional medical center, located at the base of Mount Kilimanjaro
(view photo), that provides medical
and surgical care for local residents as well as visitors. The
hospital provides training for technicians, nurses and doctors.
The facility is 25 years old and has a proud tradition of medical
science. In spite of its size and tradition, however, it suffers
many inadequacies due to the economic state of the country. The
building needs to be updated (many of the operating theaters were
under construction while I was there), the equipment is sparse
and in poor repair, and supplies and pharmaceuticals were extremely
limited.
Nevertheless, the health care providers at KCMC do an excellent
job, and the anesthesiology department is no exception. The department
is run by two physicians and five anaesthetic officers, who supervise
the 30 anesthesia providers-in-training. The surgery schedule
is busy, with diverse and often complicated cases. While the majority
of surgery performed is general, urological, obstetrical and ear-nose-throat,
surgery for trauma and thoracic pathology is frequently needed.
The OTP has been assisting in the education of anesthesia providers
at KCMC for nearly five years. KCMC trains 20 new anesthesia providers
a year, sending them to remote locations throughout Tanzania.
The OTP volunteer's responsibilities are primarily didactic --
giving daily lectures and conferences, leading intensive care
unit rounds and teaching in the operating theaters. The students'
enthusiasm for learning was unparalleled to any residency experience
I had had to date. Any handout, any reference was greatly appreciated.
The students always had questions and were constantly seeking
knowledge. Their enthusiasm and dedication were contagious, and
I prepared lectures, handouts and conferences with new zeal. I
was newly appreciative of my education and training, and I felt
excited to share whatever I could.
My perspective is fresh. To be part of and contribute to such
a program and tradition was extremely rewarding, and the personal
returns were enormous. I am optimistic about my career and the
many opportunities that are available to me in the Western world.
I have more patience with the politics and inconveniences of medicine
in the United States. And most importantly, the sights, sounds
and feelings of East Africa and KCMC are stored in my heart like
a nourishing inner spring. In the midst of the most high-tech
operating room, I can hear it bubbling, and I am a better practitioner
and person because of it.
References:
1. Jarvis DA, Brock-Utne JG. Use of an oxygen
concentrator linked to a draw-over vaporizer (anesthesia delivery
system for underdeveloped nations). Anesth Analg. 1991;
72:805-810.
2. Leppaniemi AK. Where there is no anaesthetist....
Br J Surg. 1991; 78(2):245-246.
K.A. Kelly McQueen, M.D., is an anesthesiologist
at Barrow Neurological Institute, Phoenix, Arizona.
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