Mwanza, Tanzania from Anesthesia Program Director's Perspective

This post was written by Matt McEvoy, MD

Rob Bartlett and I travelled to Mwanza, Tanzania in October and November of this year. Rob was there for a month and I was there for two weeks. While there, we picked up on the great work that Carlee Clark had previously done, and the story continued…. I will try to capture some snapshots for you, and I am afraid that you will see some snapshots of me in Rob’s account of our trip! Bugando Medical Center is a 900-bed tertiary care hospital that sits atop the highest hill in Mwanza overlooking the beautiful Lake Victoria. However, the hospital in picture is contradistinction to the natural surrounding, as you will find 2-3 patients in many of these 900 beds! There is no such thing as a ‘maximum capacity’ alert for Bugando. The surgical population at Bugando normally has very advanced disease, which occurs for several reasons. First, the access to healthcare in Tanzania is very poor. There are tremendous socioeconomic barriers and just paying for travel to the hospital is prohibitive for many families in outlying villages. Second, most of the patients with a palpable mass or significant symptomatology go to the traditional healer first (essentially a witch-doctor). During these visits, the patients often receive burns or cuttings over their body. They then wait for weeks, months, or years before seeking help at Bugando after the incantations have failed. Thus, patients often present with very advanced disease that places them at greater perioperative risk. There is a nurse anesthetist school at Bugando, which is headed by Dr. Matasha. Each class has roughly 10 students and the coursework lasts for 12 months. Carlee talked about the daily routine previously. In short, the goal is to have pre-op rounds in which all of the cases and case plans are presented to Dr. Matasha. The students then spend the day in the OR with the senior anesthetists; and, there is a goal to have a didactic curriculum in place, but this does not appear to happen regularly. Our department will have a huge opportunity for impact in this aspect of education. The opportunities for teaching are unlimited. I am excited that we will have an ongoing ACGME-approved rotation for our CA-3’s, and I hope that residents, faculty, and CRNAs in our department can be a part of our continued presence there. I think that Rob can say that he learned a ton about teaching and learning in a cross-cultural setting! Speaking of that, Rob did an excellent job with the lectures that we had planned for him to give. Of course, one of the main things that is needed on adventures like this is flexibility and patience. So, while we went with a teaching plan in hand, only a portion of it was executed. Rob and I would talk each afternoon about what we had observed that day as the real learning needs, and he often spent long hours at night re-working (or creating de novo) his PPT presentations for the students. Rob was already an excellent teacher, but he advanced even further in his teaching skills while there. His teaching actually led to practice change in monitoring by the end of the month!