Medicine Means Community | GMER Reflection
Hamdi Sheikhsaid, center-left, joins colleagues on her last day with the OB team
Hamdi Sheikhsaid, a fourth-year student at the University of Minnesota’s Medical School, participated in the Global Medical Education and Research Program in 2022. Organized through the Center for Global and Social Responsibility, the program provides global health experiences for interested medical students. The future Doctor Sheikhsaid shares her experiences while participating in the program at her chosen international site: Arusha, Tanzania.
The open, sun-filled and peaceful courtyard of the hospital with its surrounding greenery, fountain water running, bird chirps and fresh air seemed to be a place of refuge for patients and their families. Kids played together to pass time. Mothers chastised them and spoke in small groups, while others sat alone. Any time that I took a small break to walk through the courtyard, I didn’t know what brought any of these people to the hospital. However, it tucked into my own memories living in Kenya, going to a similar hospital and playing with other kids who came to be treated. If there was anything I learned in Tanzania, it is that medicine means community.
Getting off the plane, I was hit with warm air that was a stark difference and welcome to my Minnesota weather of -11 degree fahrenheit. I stayed at a house with two other medical students that was owned by an amazing organization called The Plaster House. The house was about an hour walk or a 15 minute drive from Selian Lutheran hospital. Going into downtown Arusha and the second hospital I worked at (Arusha Lutheran Medical Center, ALMC) was about 30 minutes of a taxi ride. Despite being further out of town, the Plaster House was beautifully surrounded by green forestry and made for an amazing home to come to at the end of a long day at the hospital.
My time in Arusha was split evenly between Selian Hospital and ALMC. My first three weeks at Selian, I rotated through Internal Medicine, Pediatrics and Obstetrics. During my IM rotation, I learned how the medical system worked from the interns as well as what intern year was like at Selian hospital. The education system of Tanzania is such that most people attend medical school after high school for 5 years. After graduating, they apply for an internship which is 1 year of rotating through Internal medicine, Pediatrics, OB, and Surgery. Interns do not get a single day off the whole year. At Selian, there are 8 interns who each have 1 day of call per week where they take care of all the patients in the hospital overnight as well as any new admissions. The hospital day starts out with a chapel service where most of the hospital staff attend at 7:30am. After the service, the oncall intern gives the admission report and any significant events overnight.
After intern year is done, most people work as registrars. Residency in Tanzania is an expensive masters program that must be paid for. A lot of interns get hired by hospitals to work in any department and they save up during their registrar years in order to be able to attend residency. Most departments at Selian had 1-2 registrars as well as 1-2 attendings.
Because Selian hospital is similar to a county hospital of sorts, the patient population it served was extremely impoverished. A lot of the patients paid out of pocket and this meant on any given day, whatever the medical team ordered must first be checked with the patient if they can afford it. 80% of the time, patients would tell us they can only afford 1 or 2 tests and as clinicians, we’d decide which labs would help in making a diagnosis. This was probably the most difficult part for me.
I transitioned to ALMC (which is a private hospital that has an emergency medicine department) for my last 3 weeks to work in the ED. The patient population was primarily people with insurance and we as the medical team could treat patients without restrictions. The ED was set up as an urgent care with a lot of mild to moderate complaints. There were 2 Tanzanian EM attendings with 6 registrars. The ED had a stabilization bay with 3 beds and 6 clinic rooms with curtains that divided them. Each day, 1 registrar was the emergency doctor which meant any trauma, or unstable patients that came in, they would lead and take care of them with the attendings. Other registrars doctors would see patients. The ED was extremely busy every day.
The day started at 7:30am with a simulation in the stabilization bay. The attendings would have a case and one of the registrar doctors would be team lead. This was by far my favorite. The attendings created an environment that was super easy to learn in. Mistakes were normalized and teamwork was encouraged. Nurses, techs and the registrars participated in these daily simulations that ranged from GI bleeds, septic shock, toxic ingestion, and many more topics that challenged us to think logically and systematically about treatment plans.
Cost of medicine is an obscure thing in the USA. That was not the case in Tanzania. Patients had finance tabs that showed what they have paid so far and what they owed. No single thing was ever done in the hospital until patients and their families paid for it. I learned the importance and need of prioritizing the things we get in medicine. It also was a frustrating and heartbreaking thing for me.
One day in the ED at ALMC, we had a known hypertensive man who came in with sudden loss of consciousness as well as 3 days of headaches. Family members mentioned he had weakness in his left side. We were concerned about a hemorrhagic stroke and decided to obtain a head CT. I was helping the nurse with transferring the patient to the radiology department. The hospital only had 1 CT and unfortunately, it was being used. While we waited, the nurse left to fill out paperwork. The 5 minutes I was alone with this man in the hallway was the most terrifying 5 minutes. He had increased work of breathing and I was concerned he could go into cardiac arrest in the hallway. At that moment, the radiology tech came out and started to speak to me about whether the patient was insured or not. And I couldn’t find it in my bones to understand why that mattered when this man was fighting for his life.
Being Somali, there were a lot of similarities I found in Tanzania. Greetings were always done with the usage of “brother, sister, aunt, uncle, grandpa and grandma”. It was something I identified with because culturally it’s disrespectful to call people by their first names if they aren’t your age or younger. It comes from a place of respect and it made the transition into Tanzanian culture easier. An interesting thing was that most people thought I was Tanzanian and I had many hilarious encounters where I would get scolded for not knowing Swahili.
One of the most beautiful things I noticed about Tanzanian people and its healthcare was how medicine felt extremely intimate. Doctors sat on their patient’s bed to give them a comforting hand or to joke about a particular thing. Despite most wards being crowded and having at least 5-6 beds with no privacy, most people seemed to get comfort from it. The neighboring bed of a patient would help with getting water, or giving a report to the team on changes noticed the night before. In the Obstetrics department, I found a couple of patients sitting together on 1 bed to watch something on a phone. A 4-year-old child was left in the ED treatment room so her mom could get medications, and an elderly family member of the neighboring patient consoled this crying child, wiping her tears, straightening her blanket. Physical touch was not in short supply and it brought laughter, dried tears and made a community.
Tanzania was an amazing country. The people, the culture, and how lush and beautiful the land is. I was privileged to travel within the country and see the wonders of the African continent from going on a safari and seeing the white beaches of the Indian ocean. And most importantly, I grew as a learner being challenged daily to think outside the box and get out of my comfort zone. Overall, it was an extremely valuable experience to learn about a different health care system and reflect on my career goals within global medicine.
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