You don’t come on elective thinking that you’re going to change the world. If you do, you’re disabused of that notion quite quickly. The system in Tanzania is what it is and no medical student is going to change that in a four week or a three month elective. All we can do is watch and learn and take away from our time here what we can. A few of the people I’m living with here have already had that sometimes uncomfortable truth reinforced through harsh experience.
But you do meet the doctors whose home this is and who are still going to be here when we’re long gone and who try to change the system in the best way they know how.
In 2003, there was no real cancer service in northern Tanzania. My consultant was working in general medicine at the time and persuaded his hospital that an oncology department should be created. It wasn’t right or efficient or good practice, he said, for either group, when oncology patients were all mixed up with general medical patients. He went to Italy to be trained in haematology and oncology, hoping that when he came home it would be to join a department with a radiation oncologist, a paediatric oncologist, a haematologist, and perhaps another medical oncologist. But when he came home in 2009, he hadn’t yet even been allocated the rooms to make up an oncology ward. He started building an oncology service from the ground up, persuading the hospital to give him a ward and recruiting junior staff. It opened in 2010 and he runs it now, just him and two registrars and rotating interns.
He still doesn’t have his subspecialists.
He had a screening programme for a little while, funded through a charitable donation, for breast and cervical cancer. Those diseases are just as common in Africa, but they present later and they have worse outcomes. In the time that the programme ran, there was a huge increase in early detection and treatment with curative intent. It was saving so many womens’ lives. But the money ran out and screening is now only available to the women who can pay. He’s been petitioning the Tanzanian government for funding to reinstate the universal programme, but has been unsuccessful.
He can’t do the appropriate diagnostic investigations because few patients can afford the $90 USD for a CT scan. He tries to manage with chest X-rays and ultrasounds.
He’s only recently raised the money to build proper rooms so that radiotherapy treatments can be given. So far, only surgery and chemotherapy have been available. A lot of patients may not even get that. In this country, most forms of medical insurance don’t cover cancer therapies. I saw one patient whose six cycles of chemotherapy were going to cost her 500,000 Tanzanian Schillings: about $260 USD. A nurse in Tanzania makes $33 USD a month.
My ward is a general oncology ward, but proportionally we see more children than we do adults. A parent will willingly go hungry so that their child can get the proper treatment, but they won’t let their children go hungry so they can get the proper treatment themselves. That is an almost universal constant.
It makes you think about what an incredible thing we have in the NHS.
The cancer services here are very very far from perfect, especially for someone like me who comes in and looks at it with the eyes of a privileged Westerner. But he’s changed the way things are done. I think he’s holding his department together with his bare hands, with passion and grit and sheer bloodymindedness, and all of that counts for an awful lot.