A healthcare perspective from Mwanza
Suppose you were to fall ill in Mwanza. Where would you seek care? What would your journey through the Tanzanian health system entail?
Mwanza, the city that BUCHS calls home, lies within a region that boasts probably the second-best coordinated healthcare delivery in all of Tanzania. Yet the frustrations for patients and providers in almost all areas of treatment often seem utterly overwhelming.
Healthcare in Mwanza can be broken down into six levels, the first being the home. If you were a typical resident of Mwanza, you would be unable to afford healthcare. More than half of Tanzanians live as subsistence farmers on the equivalent of less than a dollar a day. Few can furnish the two dollars necessary for treatment at a dispensary or health center or the ten dollars needed for treatment at a regional or referral hospital.
Mwanza has a population of 600,000 people. Yet Tanzania’s national government allocates only about $420,000 to support the healthcare infrastructure in Mwanza city, along with some additional funding for health workers’ salaries.
Part of this funding is legislated to ensure full coverage for all children under five, pregnant women, those with chronic illnesses, the indigent, and seniors – but the level of funding this coverage requires far surpasses the government’s allocation. And other patients must pay out of pocket. Although minimal by our standards, the costs of healthcare are insurMOUntable to most Tanzanians – which helps explain why many wait too long to seek treatment and why the average life span in Tanzania has dropped from 53 to 44 years over the past decade.
Suppose, in your case, home remedies were to prove ineffective. You would then seek treatment at the second level: local traditional healers, who apply natural remedies handed down for generations.
Next, you might proceed to the third level, your nearest dispensary. Mwanza has 25 dispensaries, each staffed by a clinical officer holding a two- to three- year degree or diploma in community health, and one to five nurses and nursing assistants also specializing in community health or midwifery.
If you lived near the BUCHS campus, you would visit a dispensary that extends coverage to a local population of about 9,000. It is a tiny, four-room structure staffed with a clinical officer and five nurses and nursing assistants who provide treatment for malaria, tuberculosis, cholera, pneumonia, worms, and diarrhea; deliver babies (in the examining room); and perform a host of other services. You would not have the option of staying overnight, as this dispensary – like most others – is closed after 3:30 p.m., as well as on weekends and holidays.
If your ailment were to prove too complicated for a dispensary’s capacity – or if you were to require treatment in the evening or on a weekend – you would be referred to one of Mwanza’s four community health centers (level four), where you might have access to a doctor for the first time.
You would be responsible for your own transport to the health center, which might mean hitching a ride in a car or on a bike, taking a bus or van, or walking or being carried for miles. Because many women in labor are delayed in their attempts to reach a community physician for emergency surgery, Tanzanians suffer a high rate of fistula, a delivery complication that, unless corrected, causes severe incontinence.
At this level, assuming you lived near BUCHS, you would visit the Butimba Community Health Center. It is staffed by one doctor, one assistant, five clinical officers and two clinician assistants, one community health nurse and three maternity nurses, and a handful of additional healthcare assistants – yet it is the main hub of healthcare treatment for approximately 150,000 of Mwanza’s residents.
Last year alone, the staff at this center treated nearly 5,000 cases of malaria. And although the center lacks a delivery theater, anywhere from five to ten babies are born here each day. Expectant and nursing mothers line the walls. Beds are available for overnight stays and observation.
But suppose you were suffering from a particularly acute illness and the health center’s treatment capabilities proved insufficient. In this case, you would be referred to a regional hospital (level five) staffed by a handful of doctors and a larger number of assistant healthcare workers than a community health center would employ. Your regional hospital would be equipped with an operating and delivery theater. But it would also be responsible for treating hundreds of thousands – if not millions – of patients. Most of BUCHS’s graduates will receive their first hands-on experience as community doctors in regional hospitals, treating tropical diseases and performing a range of surgeries under trying conditions.
Finally, the sixth level of healthcare: Your place of last resort is the Bugando Medical Center (BMC), one of only four referral hospitals in Tanzania. The BMC has 850 beds and covers six geographic regions and 12 million people. The cases referred here are the most severe in the nation – often in the world. The wards teem with patients suffering from every imaginable condition. Perhaps most painful to observe is the pediatrics ward, where young burn victims wail in agony and deformed newborns nurse in their mothers’ arms. It can take hours for patients to crawl through the admissions process and secure a bed, and days for an available doctor to perform emergency surgery.
Mwanza is a place of hardship and deprivation –but it is also a place to witness miracles. At the Bugando Medical Center, the staff is underpayed and overworked. But all of them – doctors, nurses, assistant medical officers, even maintenance workers – walk through the wards wearing a smile; the patients endure the treatment with dignified strength; and hope is not lost.