Good evening, 

Welcome to another installment of my elective to Tanzania - pull up a chair as this is a long post. If you are anything like me you may wish to get a coffee☕...just a suggestion.

Now, a little bit of context to this letter below. I applied for a grant from my University Alumni Panel. I gave a presentation to them and they very kindly decided to award me a sum of money. 

In doing so, I agreed to write to them about my trip and how it will benefit my future career. 

So, I thought that you may wish to read what I put. 

Anyways, enjoy your coffee, sit comfortably and read on ....

ttfn

K xx

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Dear Donors of the Alumni Fund,

Re: Award for my three-week nursing elective to Tanzania in August 2017

My sincerest thanks for the very kind and generous award.

I was able to use this money to facilitate a visit to a Masai tribe/family. This was an extension to my planned safari trip and allowed me to appreciate more fully, the culture of the Masai.

Some funds were used to allow me to call home more frequently using only mobile data. This also meant that equally, I could share information with my Tanzanian colleagues, about some of the theory and practices that we use in the UK within mental health.

Naturally, it also helped towards the general cost of the overall elective.

For the time that I spent in Tanzania, at Muhimbili National Hospital, I experienced various areas of mental health provision.

This included spending time in the child & adolescent outpatients’ clinics, where I was able to join the psychiatric team and meet with young children with ADHD and autism. I was made to feel a part of the team and was asked for my opinion on some of the cases. 

I spent time in the general psychiatric wards too and was able to assist the staff in caring for the patients residing there. I felt extremely comfortable in spending time with all of the patients and enjoyed some fun times which included singing and dancing. I had feedback from staff to say that the patients had enjoyed this time very much.

There is just one female and one male ward I was given access to patient files and readily discussed the presentations and delivery of treatment to patients. 

On the acute ward, staff were able to help me understand the process of admission and the pathway that a patient takes through the department. Normally there would be two wards; one female and one male. However, currently, due to high admission rates of males, the two wards are used for males only. Female patients are placed either in the female psychiatric ward or, if in dire need, patients are placed on the general female wards elsewhere in the hospital. The patients enjoyed teaching me aspects of speaking Swahili and I too was able to help them with their English.

For a number of days, I spent time in the methadone clinic. Here, I was able to give out medications for HIV and TB to the patients that attended every day. On occasions, I was trusted to do this on my own with minimal assistance from other nursing staff.

I was given information on the health authority’s/hospital’s thinking around treatment for addiction. In this clinic I was able to share a theory that we use in the UK, around change and the process of change. Staff found this very useful, and thanks to the data that I had added to my mobile phone, I was able to do this at the time, without having to wait until another day.

Throughout my time within the mental health department at Muhimbili National Hospital. I was given full respect and was supported throughout to observe and take part in patient care. I was given endless help with speaking Swahili, both by staff and patients. I was complimented on my ability to learn the language adequately, so that I could start to tackle the language barrier between us. In doing this I felt that I was able to gain a little trust from patients and staff alike.  

My Tanzanian student colleagues were also helpful to me with language. On one occasion, three students invited myself and another WtW elective student, to have lunch with them. This was cooked for us all to share, by the students in their accommodation. We were able to discuss practices and learning in the UK, Tanzania and also in the USA, thanks to my WtW student colleague being from Tennessee. We could also discuss how life is very different in the 3 countries, covering life’s expectations both by self and from others.

I feel that the patients especially liked to be able to assist me with the language and learning, appearing to enjoy teaching me about something that they know best. I was able to enjoy laughter with them, mainly at my pronunciation of certain words.

Whilst my main objective was to see what staff in Tanzania do for mental health with presumably nothing as much as we have in the UK, I feel that I gained a lot more from it than just that.

I feel that I gained a sense of being quite humbled by the work that is done there. I continuously felt heartened by the attitude of the staff to the treatment and care of patients. They were using terms that I was used to such as patient centred care and holistic care.

Staff explained to me the reasons for patients being admitted to hospital. Together we were able to discuss the ideas and hurdles around stigma and adherence to treatment. I understood, and observed, that this was being changed through access to public health classes for patients and families. This included advice covering topics such as sexual health, maintaining good mental health and wellbeing, to environmental advice around housing and nutrition.  All these sessions were given to the patients and families/carers free of charge, enabling them to have a place to ask questions and get the help and/or advice, relevant to their individual needs.

My observations and discussions with medical and nursing staff at Muhimbili National Hospital, having gained their trust and mutual respect, highlighted many things to me. In the main, we were able to agree that whilst mental health treatment and provision is some 30 years behind that of the UK, they are heading in the right direction. One doctor I spoke to appeared disheartened in saying that things were moving very slowly forward. I was able to counter this and reframe it positively in saying that yes whilst it may feel that things are moving slowly, they are, and will continue to be, moving in the right direction. I used the idea from Confucius who said something along the lines of ‘a journey of a thousand miles starts with the first step’. She liked this idea and I am hopeful that she was able to share in my feelings of positivity.

I made some great friends while in Dar-es-Salaam and feel that it was a total privilege to experience the care and treatment within the hospital setting.

I made two large blog entries whilst in Tanzania to give an update on my progress and how I had been spending my time in Dar-es-Salaam, both during work time and down time. I am happy to make this available to you and it can be found at http://myelective.ollosson.co.uk/Blog.php. Please feel free to visit and use any information you wish. I will be leaving my website and blog up for historical purposes so that future elective students may read about my trip and hopefully take some inspiration to, as the UEA’smotto states, “Do Different”. 

I am thankful to the Alumni Fund/Donors in awarding me substantial monies for my elective. It has helped me in better understanding the importance of public health, early intervention, community working and talking therapies. This is something that is applicable, regardless of age.

This elective has been an experience that will stay with me for always and will shape the way that I see patient care during my future career in the ways that I have alluded to above.

My sincerest thanks once again to you all for the generous award.

With my kindest regards and best wishes

Karen Ollosson 

Habari za asubuhi from Tanzania

Well, here we are at 2 1/2 weeks in and only a few days to go until I come home to the UK and to my dear admin' of course. I have missed him loads while here.

But, I made a promise that I would throw myself into the elective and do my best to enjoy the time here.

I feel that I have done that totally with what I have observed while here.

It has been fascinating to have insight into the various clinics that are run here. How referrals happen and how a patient can go through the system.

Its been good to see that there are a number of similarities to practice in the UK such as person centred care and holistic care. Those in the health care line of work will know that these are big words when it comes to mental health and general health care too!

Coming out here I maintained that I did not wish to read about the care provided as I wanted to experience it first hand and form my own opinion on how things are done here.

I have also maintained the idea that "this is the way it's done here and I am not going to change it - it is what it is".

I have observed that the staff at the hospital do the very best for the patients with the resources they have.

And, whilst they may have limited resources, the interaction between staff and patients has been noted to be respectful at all times.
Some may be lead into thinking that this is just because they are being observed by us mizungu (white foreigner) students from the UK looking at what they are doing.
However, I would beg to differ.

I have spoken to staff that like to give patients accompanied grounds leave and go for walks to make sure they get fresh air and sunshine. It is known that fresh air and sunshine can boost low mood in some patients.

I feel that I have been extremely privileged to be able to spend time in the mental health department at Muhimbili Hospital here in Dar-es-Salaam.

On Friday I plan to take all the donated items to the head of the mental health department, Mr Peter, and hand these over as a way of thanking him for allowing me this opportunity.

I am hopeful that these gifts will be welcomed by him and will help his department as best as possible.
I can only thank those of you that have donated items for this elective and say that they have been most useful and have helped me no end in my time here.

So what about other news?  I hear you say.

Well, I have required a few days off :-( not because i wanted to but because I had to!
One day of the ol' Tanzanian Tango and yesterday and today off sick!
This is due to a culmination of things amounting to a student coming here hacking n coughing everywhere and not treating it, humidity, dust and there is also building works going on next door. This causes much cement dust so you can see how these things can happen.
So rather than go in with a cough and cold around unwell patients, I have opted for the professional grown up option of getting treatment from the pharmacy and staying at the house. Not ideal as I wish to go in and miss being there. But I cannot go there feeling less than 100% can I?

Therefore I am sitting here at the house updating my blog to let you guys know how it's all going.
I'm trying to be productive!!

In other news....

During down time I have been to Bongoyo Island with a couple of other student nurses. It's reached by a "ferry" and is quite small but lovely. The day we went, it was a bit grey but we did have sun and in fairness it was still lovely and warm.

What else...?

Ah yes, we went to the Mwenge market to buy some bits for home. I got postcards and some other bits and bobs so will need to post them today!

We have been out for meals and eaten well with good company.


Today, I am to go to a charity football match at the national stadium in Dar'. I understand that it is a charity shield match, a friendly between the two big names in Tanzanian football. The whole house is going to go and Mohammed (the Work the World placement/house manager) has arranged for us to go by coach as there are 20 of us going. Well basically its the whole house.



Whilst I am not the biggest football fan and much prefer rugby, I understand that the atmosphere there is fantastic and as the whole house is going as well as some of the WtW staff too, I thought sod it, why not?

We'll leave here at 2pm and should, in theory, be back in time for tea :-) I hope to take some photos which I will post up once back in the UK.

Ah yes, talking of photos, given the confidentiality and consent and all that, I have very few pictures from my placement. Any that I have and will put here will have been taken with consent.
So apologies if there haven't been many piccies from Muhimbili.

Pictures from elsewhere though? these I do have.

What else? ah yes...the football kit that I was given.
One of my lecturers very kindly gave me some junior football kit of Norwich City FC and a signed football. I have agreed to hand these over to the MH dept head, Mr Peter, as they are in the process of sorting out a mental health inpatient ward for kids. I feel that it would be good for them to use there.
Football as I am sure you will be aware, is a huge past-time here, so I feel that it will benefit the kids that will come in to this new environment and give them something that they can do together that may improve mood etc. So my thanks to Steve Wilkinson for the kit and especially the ball. The kids will love it.

I did think of giving it to the orphanage but I had heard reports that although nice things may be taken in like notebooks etc, they were not always being given to the kids. This is sad and may be indicative of how things are here in such situations. That  said I have not seen this first hand but the number of reports I have been given saying the same thing leaves me feeling slightly disheartened for the kids.

Hence it going to the hospital for the new inpatient unit that is coming soon.

Ah yes.....the other big thing that happened.......SAFARI .....

Was it like a wildlife park in the UK? Most definitely not....

It was so fantastic to see the animals in their natural habitat, not surrounded by high fences and wires. We had  a herd of elephants go behind our jeep, they were so quiet. Amazing given that they weigh around 3 tonnes each.
We saw most of the big 5 - lioness, hippo's, elephants, gnu's, wart-hogs, giraffe, zebra, crocodiles and the most colourful birds I have seen outside of India.
The team that took us to Mikumi National Park were Rama' and Henry.
Of note, Henry is of Masai heritage and was a fabulous chef, cooking all our food on something resembling a BBQ. He made really tasty food tho. Everyone needs a Henry in their kitchen!

Given Henry's heritage and links with the Masai, we were privileged to spend a few hours with the local Masai family. They dressed us up in the purple material in a way that they dress. Bart, one of the dentist students, being the only male there, was dressed as a Masai warrior.

I learned that Masai are farmers meaning that they take care of cattle. In the UK, farmers can be working with cattle or crops. Here in Tanzania, crop farmers are referred to as pastoralists.
I had a fab time there and was respected as an older person. One of the older women was able to show me how they dance and before you ask, yes I too was expected to dance.

Now for those who have never seen Masai women dance, it involves much jumping around and chanting/singing. Now, I am not a slim effort of a human and am not much into exercise. But, I did "dance" like them. Naturally we all loved but they seemed to like the fact that I took part at least.

I think overall, that the experience that I have had here, will remain with me forever. I think that it has left its mark on my heart and that I will always have good memories of my time here.

So I guess I am left asking myself the question about what will I take from here for my further career and my practice?
I could say its seeing how little they actually have and how the practice done here differs to the UK. I think that it makes me appreciate exactly what we do have in the UK and when people moan about services offered, I can speak with confidence about the level of resources here and how they are used.

I thought I would come here and take home particular skills and ideas. On reflection I feel that the whole experience has changed my outlook towards mental health and has only acted to enhance my passion of working in the mental health field.

Will  it make me a better nurse? who knows....but what I do know is that my calm nature has been noted by others while here and that my outlook on Tanzanian practice is as non-judgemental as possible.

I have had many laughs and conversations with patients and have appreciated the time that they have given to me. I don't think they will ever understand how lucky I feel coming here and meeting them.

It has been helpful to have a Swahili teacher twice a week and has served me well in practice.


So, as I sit here, nursing a soddin' cold, I ask myself would I do it again? Would I recommend it to others?
Yes, most definitely. It not for the fainthearted, I think that is a given. However, to broaden your experience in your own field of nursing and to discuss these with other like-minded people at the house? then yes, I would certainly give it the thumbs up.

I am sure that in further posts I will recall bits and bobs of this elective and I hope that I will be able to continue to post them for your reading pleasure.

Meanwhile, this mizungu is going to make a chai with some honey and take some more meds.

I may even have a sneaky coffee - as ya do!

ttfn peeps

Kwaheri

K xx