Jambo from Arusha! This week, I did my last week of pediatric wards with the all-star team led by Joseph (the registrar- a role like our senior residents) and Dr. Steve Swanson (a pediatrician from Hennepin County Medical Center, now serving at ALMC and Selian full time) and comprised of Kahema (the intern), Sasita and Baraka (the two Assistant Medical Officer students- a role like physician assistant students). It has been a great experience working with this team, and I have been so impressed by their eagerness to learn, compassion for patients, and their cheerful attitudes. Joseph, as I have mentioned earlier, is one of the best assets at Selian Hospital. The registrar is a position given to an MD upon finishing the one year rotating internship and can be an indefinite position, or often one taken while seeking out a residency spot in a specialty. Their role is to attend on the wards and to supervise the interns, though there are many duties they fulfill behind the scenes such as teaching the AMO students, participating in hospital administration, and seeing patients in OPD (outpatient clinic). There are 4 registrars currently at Selian, all of whom are excellent, but Joseph stands above the rest in his medical knowledge, enthusiasm, ambition, and compassion for the community he serves. He actively pursues solutions to "upstream" problems that lead to the sad conditions that we often see: malnutrition, difficulty with accessing care early in the disease course, and recurrent respiratory infections. He often purchases essential supplies with his own money and stays late awaiting tests that return hours and hours after they were requested. He hopes to gain a residency spot in pediatrics this next fall, though this is a difficult task in Tanzania, since there is not a steady source of funding for these positions. Either a trainee has to pay their own way, which is thousands of dollars per year, or they must obtain a sponsorship from the government, church, or pursue an international training program. It would be a loss for Selian when Joseph leaves, but we truly hope for his success as a pediatrician, a field that is greatly underresourced in a country with greater than 50% of the population younger than 15 years old and two pediatric residency programs.
Though learning Swahili has been quite slow for me, certain phrases seem to be preferred by different people. I have already discussed "Karibu" and the greeting ritual, but we noticed fairly quickly the phrase most preferred by Joseph. "Hamna shida" (no problem) is mentioned in almost every interaction with Joseph. For Lion King fans, this phrase is a close cousin to "Hakuna matata", though for some reason wasn't chosen for musical glory; perhaps because matata is more fun to say. Examples of it's uses include responses to: "Joseph we don't have any oral rehydration solution and we don't think we'll be getting it anytime soon", "the family cannot afford the antibiotics you recommended", or "all of the thermometers have disappeared". He uses this phrase so much that Hope and I have taken to calling him Daktari Hamna Shida. To an observer, I think this phrase could be generalized to represent the people of Tanzania as laid back, care free, no worries. The slower pace of life, simplicity of material possessions, and emphasis on relationships here fit this mantra well, but one might easily interpret this as laziness compared to the frantic lifestyle we pursue in the Western world. I have seen, though, that there is a different usage for people like Joseph. I really do not see him and others like him resigned to be worry free in the midst of a community suffering under the weight of poverty and it's ghastly burden. "Hamna shida" is not permission to avoid reality, but I think it is one way to accept reality but not to let it frustrate or corrupt. Though I am clearly frustrated with the lack of resources that I take for granted in the practice of medicine in the US, Joseph is able to see what is lacking but to not give in to despair. For him, it seems, "hamna shida" is a recognition of factors beyond control and a challenge to strive for the best for his patients with the resources available. I truly hope that places like Tanzania will someday have the infrastructure and resources that all people deserve, but I am encouraged by people like Joseph who are able to overcome these circumstances and to make Tanzania better.
Ryan's Hamna Shida pose
Dr. Steve Swanson's new NICU at ALMC
Path en route to Selian, with Mount Meru in the background
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Registrar Joseph with Intern Christelle, blowing bubbles from soap and a plastic wand we gathered for a malnourished child with multiple readmissions
