Sunday, February 10, 2008

Tanzania Kazi: work

What am I really here to do?

A couple principles to keep in mind while working here:

-Our ultimate goal here is to make ourselves unnecessary.

-It is not impossible to get things done; it just might take much much much longer than you would ever expect.

The first three weeks of my time in Tanzania consisted of prepping for and running two week-long training courses on the management of HIV/AIDS.

The first training was in Tabora, at Kitete Hospital, one of the government-sponsored district hospitals. Teaching a mixed group of ESL nurses, pharmacists, clinical officers (equivalent of NPs or PAs) and medical officers (equivalent of general practitioners) on the finer points of HIV opportunistic illnesses and treatment failure is an interesting challenge. There were a few Makapa Fellows in the group – these were clearly the best and brightest of the bunch. Makapa Fellows are part of the program funded by the Clinton Foundation – they are nurses, clinical officers, medical officers and pharmacists given extra training in HIV/AIDS and higher-than-normal salaries to work in exceptionally under-resourced parts of Tanzania. And then there were a few old-school nurses and clinical officers who had very little English proficiency (the entire course was taught in English with very little Kiswahili mixed in) and health management proficiency (yikes). It was quite a spread.

It was my first time as a trainer in this group – Royce Lin was the lead trainer (he’s done this training many times already), and we had a few Tanzanians doing pieces of it: Elitumaini Mziray taught about HIV drugs and neurological complications; Amos Nsheha taught about pediatric disclosure issues; Werner Schimana (a German ex-pat) taught pediatric HIV drug issues. I taught a big section on pulmonary complications of HIV (TB, PCP, bacterial pneumonia), which I must admit was a big hit, as well as a difficult section on treatment failure. The usual Sub-Saharan African snafus happened, including several power outages (after I had spent hours putting together a great slide set of chest x-rays, etc.) and hospital meetings in our training room that went an hour over its slated end time, thus delaying us for an hour.

This is an exercise in patience and in letting go.

I remind myself of this often.

There are some absolutely awesome parts of this type of teaching, such as seeing nurses doing a perfect pulmonary exam and asking the appropriate sexual history questions and speaking out about the treatment of TB to clinicians who are doing it incorrectly.

The second training was with the Elizabeth Glazer Pediatric AIDS Foundation (EGPAF, whom we are sub-contractors for here in Tanzania) program officers, many of whom were rusty in their HIV care and treatment knowledge. Given that they are helping Tanzanian district hospitals and clinics provide HIV care and treatment, they figured that it would be good to know something about the actual practice of it. They asked us for the training, so we trained them. Since they have NGO money, we spent the week at the Millenium Seaview Resort in Bagamoyo. Posh. Is this the proper way to spend PEPFAR (i.e. American tax-payer) money? Hmmm…

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