Canadian Medical Caravan Heads to Tanzania
Moshi, Tanzania
“This spot here is ringworm,” Doctor Karen Yeates says, pointing at her face and inviting people in for a closer look. Necks crane curiously to catch a glimpse. It is mid-afternoon in Moshi, Tanzania, and a large tarp is doing little to protect the 20-odd Canadian members of a week-long medical caravan from the intense heat.
On a clear morning, snow-capped Kilimanjaro looms unassumingly over this drowsy city of 150,000. Its presence is not insignificant – in just five days most members of this mobile clinic will trade their stethoscopes and rubber gloves for pick axes and gore-tex, and make the seven-day trek up the 5,900 metre peak.
For today, however, the jet-lagged volunteers seem oblivious, and participate keenly in the afternoon’s debriefing session. It is the first day of this free mobile clinic, and for the majority, the first real experience they’ve had with tropical medicine.
Dr. Fiona Manning of Victoria with patient
“We don’t stick needles in joints because it’s not sterile enough. But we can stick scalpels in something if it looks like it’s going to blow,” she advises, in response to a question about protocol for treating abscesses and infections.
Yeates is an associate professor of nephrology at Queens University in Kingston and is leading this caravan, the first of two she has planned this year. Yeates also heads up the Global Health Placement Program for the Canada Africa Community Health Alliance, the Ottawa-based non-profit sponsoring the caravan, and through which Yeates first came to Tanzania as a volunteer four years earlier.
Gathered before her is an odd assortment of enthusiastic team members, each having paid between $3,000 and $6,000 for the opportunity to be here.
There is Louise Moist of London, Ontario, a former pharmacist turned nephrologist, along with Sandy Sousa, a Kingston-based lactation consultant. There is Damon Ramsey, 22, a McMaster University medical student, and Nini Cohen, a retired pediatric nurse from Ottawa. There’s Kingston’s Jason Budd, an urban planner turned “pee” expert, who spends his time testing for protein levels and pregnancy. And there’s Zoe Beiko, 16, and Kashani Thomas, 18, the youngest volunteers in this monumental effort to provide free examinations, referrals, medicine and eyeglasses to some of Tanzania’s poorest citizens.
Jason Budd testing protein levels
Over a five-day stretch the crew will see just over 1,000 patients, and treat a range of ailments from worms to hypertension, pneumonia to pelvic inflammatory disease – primarily acute conditions with immediate treatment possibilities.
The set-up is basic and mostly outdoors. Visitors head first to one of two triage stations where their blood pressure is noted and where they are weighed and questioned about why they have come.
“I don’t want you guys to ask if they are having eye trouble,” Yeates warns the triage crew, “because everyone will have a problem with their eyes and everyone will want a pair of glasses.” Sure enough, as word gets out that the caravan is dispensing hundreds of pairs of donated eyeglasses, the number of people reporting sight trouble suddenly jumps – even the least costly glasses are beyond the reach of most Tanzanians.
Patients head next to a physician and translator where, speaking quietly about sore joints and headaches, dizziness and coughs, they extend fingers for poking and tummies for prodding. There are no curtains, no examining tables, no beeping monitors, no charts – just plastic chairs and rubber gloves, and boxes of rapid malarial tests and syringes. Yeates has set up her camp on the grounds of Pamoja Tunaweza, a women’s centre she co-founded in June 2007, and that houses both a shelter for abused women and a small medical clinic.
Logistical volunteers guide some women inside the spacious two-story building where they are examined for pelvic inflammatory disease, and signs of cervical cancer, among other gynecological conditions. Intestinal parasites, diarrhea, hypertension, scabies – they are among the most common illnesses the volunteers will treat during their stay.
But in a country where, according to the UNDP’s Human Development Index, more than one third of Tanzanians don’t make it past their 40th birthday, where 22 per cent of children are seriously underweight, and where 74 of every 1000 births result in death, do caravans like this actually make a difference?
Put differently, is the more than $130,000 investment in this massive international aid effort (which includes the $2,000 volunteers paid for the privilege of climbing Kilimanjaro) achieving the biggest bang for the buck?
Yeates is the first to acknowledge the limits of the clinic. “Our own personal challenge is seeing patients who we know have life threatening conditions that we know we could take care of in Canada,” she says. “There is almost no cardiac care program in Moshi, for example. Much of the heart failure is valvular disease from rheumatic fever. They need surgery, (something) not really available to them in Tanzania.”
Indeed, many visitors to the clinic arrive with serious, chronic illnesses – there is a child with cerebral palsy, an infant clearly suffering from malnutrition. With more than 30 per cent of Tanzanians living in conditions of abject poverty, and over 5 per cent of gross domestic product already being spent on health care, these are illnesses the caravan can’t hope to cure.
There are also clear differences in the standard of care. “When in doubt, treat with meds,” Yeates advises, explaining her decision to prescribe antibiotics to a visitor whom she suspects of having pneumonia after the hospital Yeates referred her to refused to give her a diagnostic x-ray. This “better safe than sorry”, pragmatic approach is necessary, she says, as few of these women have the money or time to seek follow-up care or medicines.
There are limitations too, in the kinds of drugs the team dispenses. Heather Hiscock, 28, a pharmacist and graduate of Memorial University in St. John’s, runs the caravan’s drug dispensary. “I’ve been given one kind of diuretic to treat hypertension,” she says in a distinctive Newfoundland accent, “back home, oh my gracious, there’d be at least half-a-dozen.”
But Yeates is also quick to defend the caravan. Advertised widely as a clinic for women and children – those least likely, she points out, to afford or to seek medical attention – her caravan represents often the first time many will have ever visited a doctor. Yeates says the caravan also tries to take a more holistic approach to medicine by offering women follow-up care, legal counseling and shelter should they require it. And, Yeates argues, the $40,000 they’ve raised through the caravan (after expenses) is enough money to cover the centre’s operational costs for almost two years.
Still, few if any of this year’s visitors want legal counseling, and none appears interested in the income-raising course one volunteer wants to offer. The numbers, also, are down from last year when more than 2,300 visitors lined up for a check-up.
But Yeates is adamant. “You do what you can for people you can help. I take a utilitarian approach to things. We do refer people to the HIV program (testing over the five days yield eight HIV positive results) and for cervical screenings. We refer skin lesions to the two consultant hospitals in Moshi. These people have no resources at all. Even when the services do exist, they are just so out of reach for most people,” she adds.
She also points to the public health role the clinic fulfills: all visitors to the clinic, for instance, receive a small baggie with essentials – some albendazole for deworming (diarrhea is one of the four major causes of death in children under five), paracetemol for headaches and fever, and the option to have an HIV and malaria test.
The volunteers also take every opportunity to educate. “Not a lot of women here understand their bodies. So there will be a lot of education that goes on in the gynie room,” adds Jenn Carpenter, an emergency doctor from Toronto and a seasoned volunteer. “Like, there is no Swahili word that we can tell for menopause. Women will come in and think that they are dying.”
For Ritika Goel, a first year family medicine resident at the University of Toronto, this type of education is critical. “People come in for malaria testing, but don’t know anything about how to prevent infectious diseases (by using a net to protect against mosquitoes, for instance). People are dying not just because of a lack of medication, but also a lack of understanding of a disease.”
Ritika Goel counting pills
Yeates is determined to spread that message further. Clearly disappointed at the turnout – fewer than 75 Tanzanians have shown up today, far fewer than the 300-400 they were expecting – Yeates gets busy. A radio ad is recorded and set to run over the weekend, and the team is divided with half the caravan heading to Shimbwe, a village where healthcare services are even more scarce.
For McMaster medical student Damon Ramsey, the caravan model, while imperfect, still serves a purpose. “In what we do, there is no transfer of skills. We’re just doing soldiers’ work,” he says suggesting that there are other, more sustainable approaches to strengthening health care in developing world countries. “But the caravan concept is more about an exchange, a show of solidarity and partnership. And that’s important.”
Others acknowledge that helping to train local doctors and investing in health care facilities may have a more lasting impact on the health of Tanzanians. But, they say, pointing to Yeates as an example, through the caravan, they’ve established a bond with Tanzania, one that is not likely to be severed soon.
“I think it’s an experience that will change my life,” Kashani Thomas says. “I want to come back each year, if I have the opportunity and time”.
Kahani Thomas of Ottawa
Given that Thomas is only 18, that’s a very sustained contribution indeed.
