Machame Hosptial

     After returning from Zanzibar, I spent one final night with my host family in Moshi and then was driven to my internship placement at Machame Hospital in Machame, Tanzania. Only about a 30 minute drive from Moshi, Machame is a collection of villages on the slopes of Kilimanjaro. At roughly 10,000 feet, I now am always wearing pants and the one bright green Patagonia fleece I brought with me.

            It was a sad goodbye leaving my host family in Moshi. Although at times I felt like I was an intruder and completely out of place, it now feels like a home and I think I would be warmly welcomed back when I return.

            The Machame Hospital is a very different organization than KCMC. When I had my stomach rash (which has now subsided altogether), I walked through a very busy regional hospital that was constantly filled with patients and had clearly distinct wards. Machame, a private hospital set up by Lutheran missionaries in 1904, now beds about 50 – 60 patients, of which the majority are women preparing for childbirth. I often feel like there is not a lot going on, especially when there are no surgeries. I expressed this sentiment with one of the newer doctors, Dr. Garrison, and he said that when he first came to Machame, he felt bored because he had finished all of his work by about 1 every day.

One cool aspect about Machame is that it caters to the Maasai women from all across northern Tanzania. Many will walk for days to get to admitted to Machame, spend a month or two before the delivery, have their baby and then walk home. “Typical” Tanzanian life (cooking, clean, farming, childrearing) is hard on women, especially the Maasai because of the environment in which they live, so the month or two at Machame before childbirth is often a much needed break.

            Another interesting aspect that I have had to deal with is the daily morning devotion. Every morning, at about 7:45, the majority of the staff gathers in the hospital church located at the very bottom floor of the building, fairly close to my house. After about 20 minutes of singing and a small sermon, all of the non-medical staff are dismissed and the nurses and clinical officers (like a Nurse Practitioner) that were on duty the previous night stand up and state new cases and give an updated total of the patients in the hospital. Often, the doctors critique the nurses and clinical officers for their diagnoses or try to get the staff to get in the habit of stating all the necessary information regarding a certain patient.

It is during this time that I find out if there are any interesting surgeries that day or if a person has come in with a new sickness. I also use this time when all the doctors are together to ask if I can follow a particular doctor around on his rounds to the wards or if I can accompany them in surgery. I have spent most of my time in surgery but am hoping to spend these last two weeks seeing other aspects of the hospital, including the pharmacy, laboratory, and radiology departments. I find the orthopedic surgeries the most intriguing so if a particular surgery comes up, I may sneak back to the surgery theaters. So far, I have seen: two c-sections, a re-circumcision, a screw/plate removal from a woman’s ankle, two pins put into a fractured elbow, a pin placed into a dislocated finger, a hysterectomy, and a cleft foot operation. I think the hysterectomy and the cleft-foot operations where the coolest so far.

I think the hysterectomy surgery was technically an incomplete hysterectomy because they did not remove the woman’s cervix in addition to the uterus. The entire uterus was removed because of benign tumors that were causing internal hemorrhaging and pain. After its removal, the doctors noted the size, which was about the size of a soccer ball when it should have been the size of your fist.

A cleft foot is a condition found in about 1 out of every 1,000 births in which the tendons and ligaments on the medial side, or inner arch of the foot. This makes the foot point inward and the person becomes very pigeon-toed. To correct this problem, Dr. Lyimo, the orthopedic surgeon, sliced the ligaments and tendons down the middle, cut one of the strips closer to the foot and then cut the other closer to the leg bones. By tying these two strips together, he was able to lengthen the ligaments and tendons and with a cast, correct the issue.

Spending so much time at a hospital and around patients has really affirmed my desire to go to medical school. Seeing surgery, I constantly want to learn how I can perform these operations and help people. I feel useless a lot of times because I see someone with a distinct predicament but I don’t know how to fix it. Hopefully now, with a lot of hard work, I’ll end up at a medical school.