Category Archives: Global Health

Our Stellar Students: Sharmila Sandirasegarane, Post #2

Sharmila Sandirasegarane updates us on health care in Tanzania:

Compared to the Kibiti Health Center, equipped with a few consultation rooms and an operating room for minor procedures, the Lushoto District Hospital seemed to be stocked. Tanzania has a multi-tiered, decentralized health system with facilities ranging from rural dispensaries, with minimal services, to national referral hospitals, with the country’s highest level of care. Between these levels, patients can be referred to health centers and district hospitals.

We toured the district hospital’s various departments, including pediatrics, pharmacy, ophthalmic nursing, maternal health, labor and delivery, and phlebotomy. I was told about the modest patient records systems in many African hospitals, but it was definitely an experience to see the stacks of papers that filled a room. Handwritten sheets marked the numbers of each aisle, which were cross-listed with the patient names in the computer system. I was glad to learn that there was some kind of digital system in place, but the files only connected the names to the identification numbers of the patients, not their actual records. The records only existed in paper form.

We were pleased by the stocks of equipment, especially in the pharmacy, but we learned that it was fairly common for supplies to be out of stock. The medical students and the faculty emphasized their frustration about this problem, especially at a referral hospital. They thought the issue was out of their control as they blamed the lack of government funding for this issue.

This lack of funding is especially infuriating considering the corruption that the students frequently allege of government officials. For example, government officials in all districts own V8 SUVs that they use for a maximum of six years. Two of these cars can cost as much as a CT scan, while the country only had one machine in the country in recent years. This excessive spending is especially frustrating after seeing the lack of equipment in some of the health facilities. Even though the district hospital was relatively well-stocked, it could definitely have improvements in sanitation and infrastructure.

Particularity in dispensaries and health centers like in Kibiti, greater allocation of health funds could be very impactful. The methods of transportation for patients who move through the referral system is also inadequately developed; it is near impossible for patients in rural areas to move from dispensaries to referral hospitals for severe cases because of financial and infrastructure limitations. In fact, patients have to pay for the gas used in ambulances.

There are many underfunded areas in Tanzania’s health structure, even including the salaries of health professionals, which makes the lack of funding a fundamental issue in access to care. Actually seeing these issues first-hand has made me develop a deeper appreciation of the magnitude of the problem.

Our Stellar Students: Sharmila Sandirasegarane, Biobehavioral Health

Sharmila Sandirasegarane
Summer Abroad HHD Blog
May 30, 2014

Major: Biobehavioral Health
Minors: Global Health and Spanish
Hometown: Hershey, PA
Extracurricular Activities: Biobehavioral Health Society, Schreyer Honors College Student Council, THON, Mid-State Literacy Council
Career Goals: Aspiring physician

After months of anticipation, I was eager to go into the field in Tanzania. The challenges that were encountered during the day aligned well with the topics that were discussed during my Global Health minor classes. When we arrived at the first home of the village, I thought that we were not going to be able to survey other residents because they were working on their farms. Instead, the medical students and supervisor for the Muhimbili University of Health and Allied Sciences were working to establish a relationship with the family.

A woman from the home served as our guide, as we traveled from hut to hut to survey mothers about the vaccination status of their children under two years. If we did not have her flexibility and willingness to help, we would have never have made it through the village. Through high grasses, we walked on narrow, sandy paths to travel to each home, which were spaced at least ten minutes away from each other.

What struck me most was how the way of life was so detached from the rest of the world. I began thinking about the practical constraints with starting health interventions in the area, beginning with the challenges to travel from the village. It took the villagers about an hour to travel to their local clinics. If there were education initiatives conducted in the area, a major challenge would be the travel times for the children to meet. The concepts about individual perceptions of health became clearer to me as I considered that the locals knew what they knew, while modern medicine played a minimal role in the schemes of their lives.

After seeing a setting where global health initiatives could be implemented, I realized the essential nature of cooperating with local individuals. The village had specific needs based on its sanitation system, availability of water, accessibility of homes, and many other factors. Several of these factors could not have been observed if it were not for the cooperation with the locals. This relationship was only established by communicating with the village leaders, the woman who served as our guide, and the women that we interviewed, all in Swahili. I realized that specific conditions were necessary to study remote areas, in order to have any hope of establishing any kind of targeted program.

On a lighter note, I realized how much fun fieldwork can be. I loved observing a different, peaceful lifestyle. I had a great time speaking broken Swahili with our guide, and laughing with her as we walked on the tall grasses as we tried to avoid the water that had taken over a quarter mile of the path. I found the fieldwork experience both eye-opening and exhilarating.