We arrived in Dar Es Salaam after 2 flights and a stop off in Dubai at 15.15pm. We then had to go through passport control which is nothing like how it is in the UK. We spent a good hour queuing to give our passports in then we were told it was going to be $250 for a visa.. This was purely because we were volunteering out here - rather expensive don't you think? Considering we have come out here to help the country. So after queuing and paying we then waited another 2 hours for our passports to be given back to us, with no logical reason or explanation as to why we were waiting this long.
Anyway, we had met a few people on the flight out here also travelling with Gap Medics so we waited for one another. We then walked over to the Gap Medics team who was waiting for us, this was one guy with about 18 students ranging between 16 and 30 years old. We then had to get into 2 cabs, so this was 9 students in a 6 seater cab with 9 bags of luggage… I must say the only positive thing about leaving the airport was the free bottle of water we were given!
We bundled into the cab because really what choice did we have? We wasn't going to argue with this, we had been travelling for 16 hours, all we wanted was a nice comfy bed and some good food. Again, we was wrong to think this would be the case. The cab weaved and bobbed in and out of cars, lorries and buses, over taking on turns and bends in the road, we feared for our lives, the suitcases were sitting behind us and if the driver was to brake suddenly then the suitcases would have fallen on me, so to say we were slightly worried would be an understatement.
We finally arrived at the Landmark Hotel in Dar Es Salaam where we would be spending one night before travelling to Iringa the next day. We were immediately ushered in, to stop people from staring at us, so just from that we knew it wasn't very safe to be there. We were given our keys - to sleep individually on our own in a room. Myself and Louise were thankfully on the same floor, we went into my room first, i looked around, see the dirt and the grubby walls and the ceiling and wall leaks from god knows what, i turned to my friend in a panic and told her i wasn't staying in here on my own, we then both looked down and saw a pair of dirty red flip flops, we both gasped because we assumed we had been given someone else’s key and this room was occupied. We left immediately and walked into Louise’s room. This was just as bad as mine, but we agreed we would stay in one room and sleep together because we felt a hell of a lot safer doing this. To our amusement we then see 2 more pairs of red flip flops - we then clocked on that these were supposedly ‘complimentary’ - we were in fits of giggles at this because of the state of them, it was disgusting. The room felt damp and cold, the windows wouldn't shut properly, the smell of poo kept wafting through the windows from outside and the lorries, buses and cars beeped each other throughout the night, it was never ending.
Dinner was at 7, so we made our way downstairs into the restaurant, everyone was already in here before we arrived. As we walked in the smell of the food hit me, hard, and the heat was overwhelming, as one of the Gap Medics team walked over to us, i grabbed Louise in a panic as i was going to faint, my body felt heavy and my eyes began to roll, i wanted to be sick from the smell, they sat me down and the Gap Medics guy didn't know what to do, Louise was shouting at him just to get me some water, a simple request. From then on, i didn't want to eat, the food was not appealing to us whatsoever. We were forced to try something because we hadn't eaten for hours and when we did, the food was cold.
After dinner we had a quick briefing to let us know what the plan was for tomorrow and times we were leaving for Iringa etc. During this briefing we informed the Gap Medics staff that we were not staying in separate rooms as they were disgusting and we felt unsafe, i wish i could say they were supportive of this decision, but in fact the response we got was ‘but we've paid for 2 rooms for you’ well for one, no we had to pay for the rooms, and 2 we felt as though our safety was at risk.
They accepted the decision eventually and asked us to bring the second key back down to them. After this we then attempted to have a shower in the cold water and i ended up getting out feeling more dirty than what i went in. We tried to make ourselves comfortable in bed for a good nights sleep as we knew we had a long day ahead of us the next day, but that wasn't possible because of the noise and the beeping of the cars outside our window all night long.
Sunday 17th June - todays the day of the dreaded 10 hour bus journey, and although we had dreaded this before even coming to Africa, we were even more petrified now because we have witnessed first hand how all drivers out here drive and how dangerous it is. We feared our lives as the bus pulled up. You might be thinking why am i complaining about a coach/bus, but reality is that this coach is nothing like one back home, and this coach was not just for Gap Medics students, it is for locals to use aswell. Before we came to Tanzania, Louise had researched and asked about Gap Medics to which she found out there had been 1 bus crash with Gap Medics students onboard, so this added to our worries.
We were told we had to dress modestly for this bus journey, even tho we were not stopping off anywhere apart from a toilet break twice during a 10 hour journey.. So there we all were, guys and girls in long trousers and long tops so no legs or shoulders were on show. Yet as we set off on this bus journey, the small telly at the front was playing music videos of scantily clad dressed women dancing and kissing, as well as showing a very violent film during this journey with heads being chopped off and people dying. Now I'm not complaining about this, but its very contradictory don't you think? We have been told to dress modestly yet they show videos and films like that..
For 10 hours myself and Louise sat several times thinking we were going to die and not even make it to the Gap Medics House. I had never seen a driver or be in a car whilst they drive so dangerously, we had several near misses where the driver thought it would be a good idea to over take on bends or over take as we were watching a lorry come towards us. It was like they were playing chicken, who was going to be the first to move?
So our first toilet stop was 5 hours into the journey, oh. my. god. This was horrendous. So we had found out the night before that there toilets were not like ours, they were in fact just a hole in the floor. Together we queued for the loo with flies and mosquitos flying around us and the smell of urine and poo filling our noses. It was not what i had been expecting, it was worse. Louise went in and i waited outside, i went in and could not bring myself to use it so walked straight back out, so for another 4 hours i held it and waited. By the time we got to the second stop after nearly dying several times, again. I decided to try the toilet situation for a second time, personally i thought these were better but theres no way in hell i could ever live like how these people do.
Half past 5 and we finally arrived at the Gap Medics house, we were greeted by all the staff who were very nice and welcoming! We were given our room key and were sharing with 3 other girls, in fact we did really like our room and the girls we were sharing with were lovely! After about half hour we had a briefing to explain how the house works and what to expect.
The briefing was a little bit of a shock and an eye opener. So bare in mind we are all adults, ranging from 18 to 30 years old, you'd expect to be treated like an adult then right? Well in our eyes this wasn't the case, we had to pay for wifi, thats fine, but when i pay for wifi i expect to be able use this whenever i want to, not to be told i cant use it during several parts of the day and that its going to be turned off. I also didn't really appreciate being told i had to go to 6 hours worth of lectures over the 2 weeks that i was out there, so 3 a week, and these being 8-9pm after a very long day of being at placement and being told we had to attend several different activities as well. None of this information was mentioned beforehand, we was only told this when we arrived at the house. What they really should have done is set this out before you even book, ya know, just saying ‘by the way guys if you're going to book this you have no free time to yourself, you work from 7.30 up until 9 every day, you have no wifi and when you do want it you have to pay and you have to attend lectures, you don't get a choice’ Maybe that would have changed peoples minds about booking. The one other thing that annoyed people was the alcohol situation. Again, we are adults, we should be able to choose when we want to drink. But oh no, not in the Gap medics house, you are allowed to drink from 7pm up until 10pm, on Global health lecture nights from 9pm up until 10pm. Now to us this was a bit silly, everyone wanting to go into medicine and health care are not stupid people, majority of us are smart and have uni places already, so we wouldn't have paid over £2,500 to be here just to get drunk and be silly, wee can do that at home or for a lot cheaper elsewhere, so why can't i have a glass of wine when i want one?
During the briefing, clothing to wear to placement was also discussed as was leaving times and finishing times. As well as day to day activities and itineraries. It was nearly dinner time so we made our way into the kitchen, the food was okay, nothing special but you can't really fault it, it is Africa after all! However, after dinner we then had a kitchen briefing. This took probably half hour to do, the worst thing about this was every single drawer and cupboard and piece of equipment had a label on to say what it was or where things were, for example, one drawer had a label knives and forks another cupboard had bowls and plates and so on. It wasn't rocket science, yet they felt the need to explain for half hour where everything was when it was clearly shown. We was all starting to get a little bit irritated because we had had a few very long days and we knew the week was just going to become more tiring. Eventually they finished the tour and we could relax. We could finally go to bed and get some rest.
Monday 18th June - our first day on placement at Iringa Regional Hospital in Obs and Gynae department. I was really looking forward to this, being a midwifery student back in the UK already i was expecting things to be very different. At 8.15am we started the half hour walk down the dirt track to the hospital. This wasn't as bad as what i thought it would be and with getting to know each other on the walk the half hour passed really quick! By 8.45am we had arrived and was shown to our departments by one of the Gap Medics guys who escorted us down there, MD. We were introduced to our mentors Sister Vicky and Sister Tesha and was shown where to change into our scrubs. By 9am the day was in full swing, it was caesarean section day!
My very first birth in Tanzania was twins, 1 boy and 1 girl, this was such an amazing experience. Although I’ve been in many c-sections before, to see it happen in Tanzania is an eye opener. The anaesthetist took well over 40 minutes to get the needle in the poor lady’s back as she couldn't get this in the right position. It was hard to watch because you could clearly see the lady was in so much pain but here in Iringa no screaming or making noises are allowed so it was very difficult to witness. Finally the needle was in and the c-section was underway. One baby was out, and then the second. They were cleaned and wrapped in cloths and left on top of the resuscitator. We found this very strange because in the UK the mums are shown their babies immediately, but nobody here seemed bothered about giving the babies to their mum, so myself and Louise took it upon ourselves to each take a twin over to mum, she cried as we brought them over to her, confirming that this is not a usual thing that happens in Iringa.
We were then told to take the babies out of theatre and to put them on the side under a heater. Again, this was very different to the UK where the baby stays with the parents unless they go to special care. But in this case the babies are wrapped and placed on a metal table with one heater which is supposed to heat the whole table, but this was pretty impossible.
After a long exciting morning we finished at 1pm and made our way back to the house as we had a tour round town later that afternoon. The tour started around 3, we were shown the best restaurants to eat in, the masai market, the supermarket, the ATM and money exchange places. By the time we got back home it was nearly time for dinner.
Tuesday 19th June - Up again at the crack of dawn, breakfast, leave for placement, finish placement, orphanage visiting, swahili lesson, dinner, global health lecture, then finally 9pm and we can now talk to other people about our day, or as its put on our whiteboard itinerary, we can ‘socialise’. Now you might understand why we started to call it Medical Boot Camp!!
The rest of the week was pretty much the same process, the only difference was on a Thursday night when Global health would be form 6 till 7 and we would have a BBQ out on the decking, we then had the option to go out for the evening to a local bar called Shooters, although we did have to be back by 12 *yawn*!
If I'm being honest on the first Thursday Louise and I were that tired we didn't even make it to placement. We were mentally and physically drained, exhaustion had taken over. But because we weren't going the doctor then visited us, in the end we turned round and said to everyone in our room, we were just tired and we weren't going in. So Thursday was a lovely relaxing day, we showered for as long as we wanted, cleaned ourselves up and refreshed by dozing on the decking in the burning sun, thats all we wanted.. One day off, we wasn't asking for much considering they were giving us a 14 hour day that we didn't sign up for!
Friday also came and went a lot more quickly because it was the weekend of Safari!! We were so excited to see all the animals. By 3.30pm we had left the house and everyone was in high spirits because we was away for the whole weekend, no silly rules, no lectures, wifi and can drink when we want, woo!! We arrived at Ruaha National Park around 5.30pm. The place was lovely and the view from our room and the lounge itself was just incredible, you could not fault it. The money i paid for the safari trip was definitely well worth it. Friday night we had dinner a few drinks and went off up to bed ready for the fun day we had ahead of us on Saturday.
Saturday morning the alarm went off and up we got to get ready, only there was not water and no electricity. Oh god! We then discovered the small solar panel sitting outside our room, this explained a lot! We laughed about this because really what can you expect when you're on a safari!! We made our way down to breakfast and left shortly afterwards to start our safari!
The safari was amazing, we see Impala Deers, Lions, Lionesses, Giraffes, Zebra, Elephants, Baby Elephants, Crocodiles, Buffalo and Warthogs! The animals that we did see were the ones that we wanted to see most and asked our driver to take us too, but in a wildlife safari you can’t expect to see everything so we was thrilled as we had passed several other drivers who hadn't seen any lions, safari is just pretty much luck i suppose! It had been a very long day and we arrived back home around 5.30, ready again for dinner and a few drinks round the fire admiring the view, this was the life, and what i had paid for!
Sunday morning we got a lay in, by lay in, we mean 8am!!! We couldn't contain our excitement for this time, honestly we could have cried when we were told we didn't have to be down for breakfast until 9! Although the same thing happened with the electricity and water again this morning we was prepared so had organised everything the night before! Today we were going to the Masai Village to see how they live! This was so surreal, they live completely differently to other Tanzania residents, it was amazing to see and so interesting to hear there stories. There houses/huts are made from cow poo and sticks and twigs and they rarely sleep, they have a solid hard ground with a cow skin to sleep on, this is because of the lions that may come to kill there goats and cows!
After watching the cows being milked and feed there young we walked in and around some of there little huts and then into there little ‘shop’. Some of the things they sell are incredible, everything is hand made and hand painted, they are such talented people! And then to top the end of our lovely morning off, the Masai Village women sung and danced to us!
It was time to make our way back to the house, which i can say nobody was to impressed about going back, ergh, another week of bootcamp.. But we had to leave, so we travelled back home another 2 hours where we awaited the newbies to arrive!!
By 5pm the new people had arrived, we greeted them with silly comments like ‘welcome to Auschwitz’ and ‘welcome to medical bootcamp’ we were laughing and joking so they probably didn't take us to seriously anyway. The introductions then started where everybody int he group said there name where they were from and what department they were in for that week. The new people then got to settle in there room whilst we stayed in the communal area hoping the wifi would be on!!
Week 2 was going to be very different for myself and louise as we was going to be in a health centre rather than a hospital. So instead of walking down with everyone in the mornings we would get a cab to the centre! The cab driver was fab though, he would play english music and one song in particular every morning, Try Me! It became a morning ritual to sing this every day then.
We were introduced to our mentors for the week, Sister Happy and Sister Mary. On our first day we were mainly located in the labour room. This was a 2 bed room with a moveable curtain stand in between. Anybody was free to walk in and out of this ward, which they did. Through the doors there was also the postnatal ward, with around 7 beds here.
During labour the women bring there own clothes with them to give birth on, these are laid out on the bed, they then have a large washing up bowl which is used for them to vomit, urinate and poo in. Once these women deliver, the clothes are then also thrown in to this bowl and the women then clean this up.
Labouring women and the midwives in Tanzania are very different from the UK. Women are not allowed to make any noise, they can not scream or shout, which is strange to us, because you will walk up a corridor in an english hospital and hear constant cries of ‘i want an epidural’ or ‘get this thing out of me’ but not here in Tanzania. Here, the women slap there own leg for them to be quiet, if they do make a noise the midwives will hit them.
On one occasion a labouring woman came through the door, she set up her own bed and took her underwear off and got on the bed, she left the underwear on the floor, the midwife looking after her picked the underwear up and flung it in this poor lady’s face, we were disgusted, but theres nothing we could say, as its cultural differences and we would be seen as undermining the midwives, but it was such a shock to see.
On a different occasion another lady needed stitches, bare in mind these women deliver with absolutely NO pain relief, the midwife had injected Lidocaine, but this wasn't enough and hadn't worked quick enough, the lady was wincing and crying out in pain, but still with the newborn on her chest, the midwife grabbed the woman’s legs and forcefully pulled her down the bed and pushed her legs open, things like this are difficult to watch because we want to help and thats not how we practice back home, but all we can take from seeing these experiences is realising how we want to practice, what will make us better midwives and what not to do back home.
Another incidence that occurred was a baby had just been delivered and was very mucusy and had nostril flaring, this indicates the baby having difficulty breathing, so back home baby would have likely gone into a neonatal unit and been checked over thoroughly. In Tanzania, the midwife took the suction vacuum in order to get rid of the mucus in the baby’s mouth and nose, she tried her best and we then put baby on his side. She said she could do nomore because the other lady was about to deliver and the suction vacuum needed to be sterilised again in order to be used for the next baby if there was a problem. Shocked was an understatement. We could all clearly see this baby struggling, but no midwife was willing to do anything about it.
The lack of equipment is unbelievable out here, not just in the health centre, but in the regional hospital aswell. Both centres have just one sphygmomanometer for blood pressure, one stethoscope, one pinnard, one doplar (or CTG as they called it) they lacked sterile gloves and normal gloves. They needed scrubs, face masks, hair nets. But most importantly what all these midwives need are education, yes they are good at there job and they are skilled and qualified, but they are not up to date with this, not one labouring women changed position during delivery or labour, every delivery was a woman on her back. Episiotomy’s are carried out much to frequently when they are not needed, therefore we see it as them lacking the education and knowledge on these things. If we had known this we could have took more out to them, more sphygs, stethoscopes, face masks, hair nets, gloves. We could have taken posters with different positions for labour that can be put round the different rooms so women can make the choice themselves and be encouraged to deliver squatting or on all fours instead of on their back. But without someone telling us these things we can only leave behind what we came with.
During our time at the Health centre we also weighed babies and toddlers up until 6 ears of age. This was pretty interesting and fun today. Each child has there own cloth tied round them and are then hung from scales on a wooden bar. The older ones cried a little because they didn't want to be hanging there and the taller ones could rest there feet on the wooden bar below, so the accuracy was not always great, and in a country like Tanzania, accuracy is very important because of malnutrition in such young children.
We also carried out a few injections on women as well as observed some circumcisions on young boys. I can not express how sad and frustrating these were to watch tho. The boys are not in separate rooms, they are in one holding room, then 3 boys are all getting circumcised at the same time with a small curtain around them. Everyone can hear the cries and the pleas to stop but these boys have no choice, circumcision in Tanzania is a must, this is because it reduces the risk of HIV and STI’s as well as keeps the penis cleaner and tidier.
We witnessed one young boy walk in crying hysterically because he didn't want it done, he was then allowed to come back in, and cried again as he laid down, he lifted his head to look what was happening and the nurse slapped his head back down on the bed, she then pinched him with the clamps all over his body. My heart broke for the little boy, he was only around 6 years old, in the room on his own with no-one to tell him everything was going to be okay. You cant begin to imagine what kind of lives these poor children lead.
Its hard to envision that all of that happened in one day, but it did. And that is just a standard day for those working and receiving treatment in Tanzania.
Before we knew it was Friday, and the last day of placement was over, it had been a very long emotional 2 weeks thats for sure! We made our way back to the house and over a weekend the chefs don't cook for us because of the amount of students tat go on safari, so we cater for ourselves, so this night whoever was in the house was going out for dinner at an italian restaurant, half hour drive away! Dinner was nice enough, nothing to special, but it was lovely to get out the house and eat something different.
Saturday morning came and some of our friends were taking the 10 hour bus journey back to Dar for there flight Sunday. Fortunately for myself and Louise, a few days prior to this we decided that actually we would take the internal Aeroplane back to Dar because of safety reasons i mentioned earlier, and the fact that for the 2 weeks we were out there there had been 2 bus crashes with 20 people dead, it just wasn't worth risking. Although the flight cost $180 it was well worth it as it was only an hour and a half flight! However, this decision seemed to come with a lot of arguments with the Gap Medics Staff back home in England.
We booked the flight a few days before travelling home and were told that in order for us to stay in the Gap Medics house on Saturday night it would be an extra £45. Nothing else was said to us regarding payment, just the cost, we asked no more questions, no-one told us this could only be paid by card and had to be done ASAP and no-one said this could not be paid via cash.
So Saturday came and we brought up staying in the house again, for some unknown reason, one of the British girls, Holly who works for Gap Medics started to get involved with my situation as i presume she thought she was being helpful, to which she was not, and if I'm honest she was just being nosey, she wasn't even working at the Rock House so i have no idea why she felt the need to busy herself in my situation, she acted unprofessionally, arguing and crying with staff and students on several occasions.
On the Thursday my Phone had broke, i had no way of contacting anybody, my shillings had nearly run out and i did not bring a bank card with me. In all information packs it does not state anywhere that i needed to bring a bank card with me.
I had informed the staff of my situation and they told us we needed to ring the emergency number because unless i paid i wasn't allowed to stay there. My parents and I are absolutely disgusted at this whole situation. I am a 20 year old girl, in a 3rd world country, with no phone, money or bank card, yet Gap Medics were telling me that “theres no way in hell” i can stay in their house unless i paid the £45, they would rather chuck me out on the streets, and if i stayed there and didn't pay they would get the police involved. Its incredibly shocking from such a well known company and also very disappointing that after paying £2,500 to Gap Medics they wouldn't trust me enough to pay a mere £45 when i returned home the very next day…
I also find it incredibly unprofessional of the company that people constantly said to me down the phone “why can’t Louise pay for you?” Why should she have to pay for me? Why should any other student have to pay for me? I would love an explanation as to why people said this to me, because yes i came with Louise, but if i hadn't and i came on my own and made no friends what position would i be in then? Because like Gap Medics told me, id have been chucked out. Id have been on my own on a street somewhere in a 3rd world country. And right now i wish that was the outcome, because i wish i could have taken the company down for doing that to a vulnerable student, because then where would they be?
Gap Medics are a money making company that does not seem to care about the safety of their students at all. But all that i can say is that they are as good as there next review, as soon as a bad review comes about and the word spreads the company will come crashing down.