Karah Waters
Karah Waters
Tanzania 2017
VIEW FINAL REPORT
Mambo! I am a recent nursing graduate seeking to experience healthcare and African culture in Tanzania. I will be working in a hospital in Dar es Salaam as well as a clinic in the Kidodi village. Join me as I embark on this escapade of being engulfed in healthcare abroad.

Aga Khan- September 5th

Being the Patient

 

This last week was probably the first time I was really home sick and wanted to be back in the states. When you’re not feeling well in a foreign country it really makes you long to be home. I honestly wasn’t sick or anything! I was just in a lot of pain. Thursday of last week I had a little red spot under my left armpit. Over the next 5 days it kept getting bigger and was hurting more and more. It got so bad to the point that on Tuesday, September the 5th, when I was at work I couldn’t even lift my arm up. I had to hold onto my arm at the hospital to help decrease the pain. When I got home from work I knew I needed to get it checked out. I went to Mo who is the program manager and asked him if I could be seen by a doctor anywhere. He said that I will go to Aga Khan and that it’s a mzungu hospital. Meaning that it somewhat similar to western hospital’s. This is a private hospital in Dar which is a lot different to Muhimbili which is a public hospital and is the biggest regional hospital in Tanzania. Private hospitals are way too expensive for people to afford in Africa so the everyday person in Dar would not go to a private one.

 

I was extremely hesitant and scared that I was having to actually go to the hospital! In AFRICA. I made sure to get two different kinds of international health insurance because I was so worried about something like this happening and the last thing I wanted to happen was to get treatment here. Not that it’s a bad place but it’s severely under resourced and not everyone abides by hand sanitation and proper sterile technique. It was SUCH an eye-opening experience being on the flip side of the healthcare system. Like being a patient rather than a nurse or healthcare professional. My heart was beating extremely fast and I was so scared. I didn’t know what I was going to have to have done. Mo said I would go with Jessica who is the program assistant and they called a taxi for me and we were off. My heart was beating so fast and I was so scared. I didn’t know what I was going to have to have done. I kept asking Jessica if there was another place we could go to as an a doctor’s clinic like we have back in the states. For example, a Walgreens walk in clinic or fast pace. However, she said that there aren’t any places like that and if there are they’re extremely rare and under resourced. So, you have to go to the hospital. We got there and walked up to a counter to explain what was going on. Everyone was speaking Swahili around me and Jessica would translate after they were done talking. The woman at the counter had told Jessica since I was a new patient and had never been there before that I needed to check in and give my information to the new patient area. We went to this room and opened the door but no one was there. Therefore, we waited outside the room until a gentleman approached us and asked if we needed to be seen. A few moments later he got a lady who told me to come into the room. She spoke English as well as Swahili. I sat down and she went to a computer. There was a tv that I could view that showed everything she was typing. She asked my name, DOB, emergency contact, etc. Instead of asking where I was from she just put foreigner. She asked what doctor I was seeing. I told her I didn’t know. After she got my information she then made me a folder with all of my information. She told me to go to billing with the folder. I went to billing (which by the way nothing was laid out easily. Everything was all over the place). Once I arrived to billing they asked me what doctor I needed to see. I honestly had no idea! I thought a skin doctor maybe? Jessica said we weren’t sure so we’d have a nurse look at me. This entire process was so different and almost frustrating me up to this point. I felt like a ping pong ball constantly being shifted to the next person with nothing actually getting done. We then went to a hallway where a nurse was sitting and taking someone’s vitals. Jessica explained the situation and she said to have a seat and that she’d be right with us. However, once she finished with that patient she left the hallway and went to another room. She then came back to the hallway a few minutes later and started talking to someone on her cell phone. It’s so interesting here how the doctors and nurses will do that! I’ve seen several nurses hanging up IV bags and then they get a phone call on their personal cell. They’ll stop what they’re doing with the patient right there and will begin to talk on their phone and have a full-on conversation. While we were waiting Jessica explained how she was at awe at the hospital. She had never been in one like this before. In my head I was like, “Really... ? This place compares to nothing back home really.” She was saying how clean and nice it was and how fast we were being seen. For me though I thought it was taking AGES. However, in other hospitals’ like the public ones you can wait multiple hours just for someone to sign you in.

 

30 minutes went by and I was getting a little upset. How the culture is here can be very different and almost annoying. Usually I can let it roll off my back and it doesn’t bother me. Everyone is just very hakuna matata, no worries. No one ever rushes or stresses about things. There’s a saying they use, “Swahili time.” Which basically means they’ll get to it when they get to it. They may say they’ll be there at 8am. They may be there by then or they may be there at 10am. Not because they’re late but just because. Jessica told me to sit beside the nurse because she may have forgotten about us. I uncomfortably got up and sat right beside the nurse while she was still on the phone with her friend. I was just staring at her (internally this was going against my typical Karah ways. I always try to be respectful and considerate. However, I did not feel like she was treating me that way). She looked at me and soon ended her phone conversation. She apologized to Jessica in Swahili and simply said she had forgotten about me. Without even asking my name or telling me her name she simply asked me what was wrong. I showed her my arm. She didn’t even touch it or look at it for more than 5 seconds. She started making phone calls to the hospital and got me a spot with a Dr. We went upstairs where we waited once again for the doctor to see us. Someone finally stepped out of one of the rooms and summoned me into his office. He was on his phone talking with someone at his desk. He pointed to the chair for me to sit down. Once again, I was just twiddling my thumbs while he was on his cell phone with a friend. It was so strange to me! He was an Indian man problem in his late 50’s or early 60’s with a thick accent and peppered hair. Once he got off he just looked at me and was like, “So, what’s the problem?” No introduction or anything! I explained I had a big red bump under my armpit and he just said go sit over there. He was pointing to an examination table. Once I sat down he walked over towards me and touched the mass under my arm. Without gloves on or anything. After looking at it for about 10 seconds he was like, “That’s an abscess. We’re going to have to make an incision and drain it.” He began writing orders down. It was so different compared to the US. Typically, the nurse will get your vitals, take your history, etc. and the doctor will ask you the same questions. No one had even asked if I had any allergies! He began to collect his backpack and belongings while saying I would have to have surgery. S U R G E R Y ?!?! I tried to maintain my composure and simply said, “How big will this incision be?” He said, “Oh, not that big. It’ll be a minor surgery.” He just subpoenaed me to the door at that point and we stepped outside his office. When I asked him where we’re going he explained that I had to go to billing and pay and that his assistant would do the minor operation in the OPERATING ROOM. At this point I was holding in all my tears and fear. It was like I was in a bad dream. This was something I had to address and get fixed. I couldn’t ignore it. But the place I was in was extremely scary. It was like facing a fear you never knew you had all of a sudden and you knew no matter what you did you couldn’t prevent it from happening. He pointed to billing which was on the same floor we were on and then he pointed downstairs and said to go through those doors after I paid. I literally felt like I was walking to my death. I may be over exaggerating here but I really did. Every step I took, every breath I breathed, every time I swallowed my heart beat just kept getting faster and faster. I wanted to run out of there and not look back. The doctor then left and I approached the billing counter where I pre-paid for the surgery, dressings, and the 5-minute doctor consultation. Jessica and I then went downstairs to the operating area. We were just standing in the middle of the hallway waiting for the assistant. Within 15 minutes a lady probably in her late 20’s or early 30’s approached me. I felt a lot better with her compared to the main doctor. Her interactions with me were better and I was more at ease with her. She explained she was the assistant and would be doing my surgery. She pointed me to the operating room I would be in. I sat up on the bed and just took a big gulp. I was staring around the room just taking everything in. The lights were a bit dim and there were mosquitoes flying nearby the bed. I looked at the sheets on the bed and there was a dark droplet of blood that had stained the sheet about 2 inches from where my legs were hanging off the table. The assistant began to get everything prepared. I was eyeing her like a hawk. Making sure she never contaminated her sterile field. She didn’t. I was very relieved and at the same time impressed. It made me feel a little bit better knowing that I was in competent hands of someone.

 

It was time for the minor procedure. I was lying down on the bed with my left arm up over my head. She tried injecting me with an anesthetic but it didn’t work. She kept asking if I could feel what she was doing. She was stabbing the needle in my armpit. I could feel it. She tried injecting more in me. After three times of doing this it still wasn’t working. She ended up saying that she was just going to have to proceed with the surgery. I could feel EVERYTHING. She sliced my armpit open and drained everything. I was positioning myself against the wall clamping my eyes shut trying to keep my tears from coming out. However, I broke down. I was just bawling and bawling. The pain was hellacious! Jessica came over to me and started rubbing my leg. It felt like it was taking her so long to do it. Every second seemed like ages. The pain was unbearable. She ended up having to stuff my armpit with a gauze 2 inches deep. 2 INCHES! I didn’t realize how deep it was stuffed until the next time I went to the hospital to have the dressing changed. I had to go back every day and then every other day for almost a week. When I wore my bandage under my armpit it was quite uncomfortable. One of the staff members at the Work the World house said I looked like a bouncer because I had my arm always positioned outwards, haha. Too funny. But that was just because of how thick the dressing was.

 

When I went back to the hospital the next time around it was worse than before. Ample times worse. I don’t know how it was possible but it was so dreadful. I honestly couldn’t remember another time I had been in such pain as I was in that day. They had given me pain meds but I had taken them because I was worried they would contraindicate the antimalaria pills I was taking. I was NOT a fan of the nurse that did my dressing change. Whatsoever.. This man I had just clashed. He was very forceful and not empathetic whatsoever. As he was preparing his sterile field I asked if he could please put his sterile gloves on before he touched my wound. He stared at me with wonderment in his eyes. He simply said, “Why would I put on sterile gloves when your wound is not sterile?” My internal buzzer was going off in my head! How could he ask that? I wanted to restate what he had just said to me so he could hear his own statement. I simply said politely, “Can you please wear your sterile gloves?” He just glared at me and said, “No.” The rest was history. He yanked the dry gauze from out of my wound. Imagine a wound that was trying to heal and the skin closing in on the gauze and then someone just ripping it out of you. O U C H. I felt like I was a child lying on the surgery table. I was pushing his hand away, clenching my jaw, and just letting the tears flow. I was excruciating. Every second agonizing. I was dripping in sweat from no A/C and from the pain. This is going to sound mean but I just wanted to slap him. He was staring at me like I was a complete imbecile. In their culture it is not proper to cry and show pain. Even the children will endure pain without flinching. In his eyes he thought I was being absurd and totally unreasonable. After he was done repacking the wound he tried to get me to do exercises by lifting my arm up and rotating it. I shoved his hand off of me and walked away with tears weltering up in my eyes. I was in so much pain that was not the right time to do that.

 

When we got back to the Work the World I called Sam (my boyfriend). I was just crying and crying on the phone to him telling him I wanted to come home. I was at my breaking point. I will never forget that phone call. I was in despair and anguish. I felt trapped in a foreign country. I was so worried about it getting infected. Up until this point I was okay. Sam calmed me down on the phone and I caved into taking one of the pain pills. Once I wasn’t in pain anymore I was able to truly reflect on the situation.

 

When I take a step back I am able to see how this situation I was acting a bit extreme. Mainly because I was in a healthcare environment that was foreign to me. It is ironic. I have been here for so many weeks working in the hospital and seeing how healthcare is implemented. However, when I was finally on the other side of it I lost it. I can’t put into words the feelings I felt when I was the only white person in the hospital. Everyone would just stare. I had been tolerant of not knowing the language that well up to this point but when you are needing treatment and can’t understand what is being said because it’s being spoken in a different language it is extremely frightening. I felt like an outsider. There was no way I could blend in. I was okay being that way when I was working in the hospital but now that I’m the patient I felt extremely vulnerable and uncomfortable. It was like I had, had an epiphany from this event. Is this what minorities feel like? Being stared at and singled out just because of their appearance? Is this how the patients felt at Muhimbili when the nurses and doctors would talk to me in English and they didn’t understand the language? It was SUCH an eye-opening experience being on the flip side of the healthcare system. Like being a patient rather than a nurse or healthcare professional. Now that I am on the up mend of recovery I can truly say how grateful I am for this experience. I now have my little scar from the incision that I refer to as my Tanzanian tattoo. It will always be a constant reminder that everything happens for a reason and that I should always try to emphasize with people I come into contact with. Cultural competency is so essential. Especially in the healthcare industry.

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