Rachael Bowis

Dar es Salaam is nothing like I’ve experienced before. I’d never left Europe, and it was so completely different to what I was used to at that point. I loved the culture, the vibrance of the city, and the people of Tanzania. I chose Dar es Salaam as I’ve always wanted to go to Africa, and the fact that I could go on Safari there made it more tempting. It was very difficult to choose between all of Work the World’s destinations, but the culture, people and the Swahili language, really drew me to Dar es Salaam.

When I arrived, the Work the World staff met us at the airport. I found out after the journey there were six others doing a placement on the same flight as mine, we just hadn’t realised until we had put our t-shirts on! We got there on the Sunday, and we spent the evening settling into the house, introducing ourselves and getting to know each other, and meeting our new roommates. On Monday, it was time for the city orientation. We took a dala-dala (an inexpensive public minibus) and Mo, our Programme Manager, showed us how to get around the city. We also did a tour of the hospital, then the local area, and then went for something to eat. The meal was really nice as it gave us another chance to chat and get to know each other!

As I mentioned, we saw some of the hospital during the city orientation. Mo pointed out some different areas of the grounds. It was a lot bigger than I was expecting, in fact, it was a lot bigger than some of the hospitals I’ve been to in the UK! There were a lot of people sat outside waving at us, and we later found out that they were waiting outside the hospital for visiting hours.

The cultural differences were obvious right away. Patients didn’t seem to  have any say in their own care, and the lack of choice in healthcare options was really eye-opening. I saw one case where a patient was held down so that staff could put a feeding tube in, and there was no communication from the patient as to whether they approved or not. In Dar es Salaam, a lot of patient care — such as feeding and washing — is undertaken by patients’ families, whereas in the UK, nurses would be delivering that care. There were no meals on the wards. Families brought food in for their loved ones who were in the hospital.

Much of my time was spent working with local students and doctors, and understanding some of the conditions I’d not seen before, like Malaria and TB. I also spent a lot of time re-writing doctors’ notes. As there was no online system for us to update, we copied notes by hand into a book after the doctors had done their rounds. We’d then go to the patient’s beds with the correct medicines. Observations were different, too — they’d be conducted at 6am and not repeated.

On the wards, a language barrier did exist, but most doctors spoke English and were helpful enough to translate anything that didn’t quite come across. There was a lot of confusion among patients about their diagnoses because healthcare education is lacking. For example, patients would come in presenting late stage malaria and not understand what they were sick with.

I was in Dar es Salaam for two weeks, but managed to get fit a lot in. Safari, in particular, was incredible. A lovely chef called Henry came with us and cooked some of the most amazing food. The lively personality of Emmanuel—our safari driver—made the trip extra special. One day after placement, we also managed to fit in a trip to the waterfront and a shopping trip, which included bartering for bargains! There are also quite a few nice restaurants at the waterfront. At the end of the day we went to a nearby beach hotel that we went to for a couple of hours to wind down and relax.

On Wednesday night after placement, it was karaoke on the beach, which was always fun. Mo would come with us because he loves karaoke!

True to the words on the Work the World website, the house really was a home away from home. The food was amazing. Breakfast and dinner were always freshly prepared. There was a lovely seating area to relax in the evening,where We would all catch up and tell stories after a day on placement.

There were students in the house from all over the world, and we all enjoyed comparing our healthcare experiences from back home. We were lucky enough to have a pool in our house, so when we came back from placement we would go for a swim and enjoy the beautiful poolside weather! BBQ nights every Thursday were a real highlight. We would sit on the terrace and try out some traditional African dancing. Someone would always end up being pushed in the pool by the end of the night!

If I could give advice to someone about to leave for Dar es Salaam, I’d encourage them to learn some basic Swahili. There are language lessons in the house, but it won’t hurt to get ahead beforehand. Clinical terms are really useful because some nurses weren’t able to get across more complicated ideas in English. The same goes for patients, too.

I would definitely recommend a Work the World placement. I’d go back to Dar es Salaam tomorrow if I could. It made me appreciate my work back home, and the resources I have access to every day. I remember one particular moment on the ward, when I went to pick up a few cotton buds and a nurse stopped me, saying “No, you only need one!”. The nurses were really inspiring, the way they did their absolute best with the limited resources they had was incredible. They really welcomed me as an outsider.