Settling In

Mwanza is a quaint city of 400,000 people (Tanzania's second largest) nestled among the rocky hillsides of Lake Victoria's southern shore. Although bantu tribes have inhabited the area for hundres of years, the settlement of Mwanza was not officially founded until the late 1800s by German cotton farmers. In the early 1900s the British gained control of the town. The discovery of gold and a new railroad made Mwanza an increasingly important center of trade between western Tanzania and the other nations in the lake region and Zanzibar in the East. Today Mwanza remains an important port city on Lake Victoria and there is still a significant amount of mining done in the surrounding region. The fishing industry, as expected, is an important contributor to the Mwanzan economy. Agriculture (bananas, rice, goats) is important in the region. Finally, tourism brings in a considerable amount of foreign currency as many of the game parks in the Serengeti are easily accessible from the city.
The Sukuma comprise the largest ethnic group in the lake region, but there are dozens of different tribes as well. Although most tribes have their own local dialect, Swahili is spoken nearly universally and serves as a unifying factor for most of the country. Christians and Muslims live side-by-side peacefully. It is just as common for a person to seek medical care from a medical doctor as from a traditional healer, and many patients in the hospital bear the signs of their attempts to seek alleviation of their ailments from these traditional healers before coming to the hospital.

Bugando hospital is the third largest referral hospital in Tanzania and is a referral center for all of western Tanzania (approximately 7-12 million people). It was built between 1968 and 1971 and is associated with the Catholic church. It has a capacity of 850 beds (not a good indicator of the number of patients in the hospital because two patients often share on bed) and offers services in internal medicine, pediatrics, surgery, gynecology, and opthalmology. It hosts the Bugando University College of Health Sciences and this year the first graduating class of medical students will matriculate. The hospital is also a training cite for interns, residents, nurses, and assistent medical officers (AMOs). Read more about the hospital at www.bugandomedicalcentre.go.tz .

For several years Bugando Medical Center, Weill Cornell Medical College and the Touch foundation, with the help of generous financial support from Joan and Sandy Weill, have collaborated to try to help Bugando Medical Center improve its capacity to both care for the large number of patients seen at BMC yearly and to train new health care workers to help meet the great need that exists in Tanzania, where there is only one doctor for every 25,000 people. As part of this collaboration two full-time Cornell faculty members, one trained in OB/GYN and one in Medicine/Pediatrics, are now on staff at BMC and each month cornell residents rotate through the internal medicine department to help teach medical students and AMOs and to participate in daily ward rounds in the hospital. A similar collaboration has been established with pediatric residents from Northwestern University and Anesthesia residents from several other institutions.

I did not know what, exactly, my role would be in coming to Bugando. I had med Rob Peck (the Med/Peds physician from Cornell now working at Bugando full-time) several years earlier in Boston and from the little that I had heard about his new position in Tanzania it seemed that joining him for a few months would be an ideal fit for me, as his job seemed to incorporate many of the components that I have developed a passion for over the years. I have long had a passion for traveling and diving into other cultures and since I can remember I have had a desire to practice medicine in resource-poor regions. In recent years I have discovered that I enjoy teaching very much (though I wish I were more gifted at it!). Mentoring relationships have been vitally important in my life and I am certain that I want to be for others what a handful of mentors have been for me. It seemed, at least from the little I had heard about it, that Dr. Peck's job involved all of these things, and I was excited to get a chance to see first-hand what it would be like to be involved in the medical education environment in a region of the world that has long been faced with health problems that far outweighed their health resources. That excitement, however, was tempered by uncertainty of what awaited me and fear that my medical knowledge would be so lacking that I would find myself learning from my Tanzanian colleagues but having nothing to offer in return.
I arrived at Bugando on a Saturday and had the weekend to get settled in before starting on the wards on Monday morning. I spent most of those two days walking around Bugando Hill, at the top of which sits the impressive structure of the hospital. Much about Mwanza seems familiar to me as a result of the time I have spent across the lake in Uganda. The climate is comfortable, as the tropical heat is moderated by the breeze that usually sweeps up the hill from the lake. As in other areas of Africa I have visited, wealth and poverty co-exist with extravagant mansions adorning the hilltops and expanses of impoverished neighborhoods clinging to steep slopes and resting in valleys where waste-water from more privileged people naturally flows. Children entertain themselves with rusted bicycle wheels steered by sticks held in hand and play soccer with anything that even partly resembles a sphere. Women carry everything from water to bananas to sacks of coal on their heads and their babies almost invariably silently enjoy a view of the world strapped tightly to mom's back. Men work as carpenters, fishermen, laborers transporting heavy sacks of grain or coal or cement. Throughout the city new buildings are being erected. Anywhere man has not left his mark, something green and full of life has made its stand and an array of birds has made it their playground. An army of hawks patrols the skies at all times and mavericks regularly spiral heavenward riding invisible currents of air sliding up the lakeside slopes. Songbirds invariably announce the coming of the morning light. Marabou storks populate the treetops- semblances of some prehistoric creature that somehow survived whatever force caused the extinction of the dinosaurs. And at the end of the day God seems to blaze his signature on the canvass that is his latest masterpiece in the form of a sunset that always seems to be more brilliant than the one yesterday.