Video Presentation of my Experiences

The presentation explores some of my experiences undertaking the elective placement in Dar es Salaam, Tanzania; including some background to some of the issues that are affecting the country. I hope that the photos bring across at least a little of this vast and colourful country; but also the hospital environment, where I spent my time.

The most valuable experience that the placement has provided to me: is a broader context and insight into the issues that are affecting radiology services in a developing country. One of my personal observations, and one shared with many of the other students, is the most powerful thing that we can provide countries like Tanzania is knowledge. Money and other resources can be thrown at any situation, but it does not always provide the answer.

Furthermore; during my time working in the hospital, but also whilst travelling within the country I met many Tanzanians, who wanted to talk about their nation and the problems that affect its development. Despite these issues, it is very apparent that in a traditionally tribal nation with a near 50/50 split of Christians and Muslims: there is a near lack of tribal or religious problems that destabilise a lions-share of the continent. The people for the most part see themselves as Tanzanians first and foremost. What this demonstrates, I believe, is a country that will help lead the continent forward. For me, I feel blessed to have a direct insight into this diverse nation. For which, I have everything to thank both the Society of Radiographers and Work the World; for providing me with such valuable life experience.

Initial Reflections on my placement in Tanzania

I think that it would be appropriate to say before beginning that it has been rather overdue; for me to write some new content for this blog. I most certainly haven't lived up to my personal goals in terms of the amount of content that I intended to write beforehand. But with that elephant in the room at least slightly addressed, I think it's about time that something was said about my time in Tanzania; which, was frankly an out of this world experience!

Yes, out of this world! I do think that it can be somewhat clichéd to write about certain types of new experiences in such superlatives, yet I cannot help to say that this of my time Tanzania. It was a 'life-changing experience'. It is for this reason I want to take the time to do the entire experience some justice, both for my personal reflection and to share my experiences with other students, Radiographers and other interested parties.

I would like to begin the journey by giving a brief overview of my placement experience. 

This was obviously the main reason that I was in Tanzania to undertake my Diagnostic Radiography elective placement, during this time; I worked between two hospitals: Muhimbili National Hospital and Muhimbili Orthopaedic Institute. These two separate institutions are located on a single campus alongside the Muhimbili University of Health and Allied Sciences. The former of these two hospitals, the National Hospital, is one of the premier teaching hospitals in the country and as the name implies, takes referrals from across the country. With its hand-written reports being made from film and trips to the darkroom a necessity; it was fair to say that this was far from my norms, yet extremely exciting. Though the hospital was fairly well equipped with: Conventional and Fluoroscopic Radiology, CT, MRI and Ultrasound. With this mixture of equipment and range of referrals: the caseloads were fairly varied and interesting. This became particularly apparent for me in fluoroscopy, where I got to see procedures that I have never seen before, for example a Matriculating Cystogram; the experience has certainly left my portfolio with some rarer examinations. I also saw some difficult things, for which I do not want to be overly critical for that seems to easy. Yet there were issues with patient care and technique, to name a few, but I think the real issues at hand were a lack of funding and perhaps harshly: a lack of knowledge. I think that was something a lot of the students within the Work the World house struggled to deal with at times, having the difficulty to see outdated and poor techniques used across the board.

The other hospital, the Orthopaedic Institute, had a different situation on its hands: the main orthopaedic, trauma and neurology centre for the whole of the Dar es Salaam region; yet currently lacking in CT and MRI. This means that patients have to be sent over to the National Hospital for their cross-sectional imaging. Which is fine, until you are dealing a fairly major trauma situation and the patient has blood gushing from their skull: as attempts are made to produce plain-film skull radiographs. Overall this lead to an eye-opening experience, where I got to see some interesting fractures though often as the go-to-person for using the CR reader.

The contact that I did get with patients in both hospitals was varied: as despite the official language status of English, a majority of people could only speak a few basic phrases. This left me using the rather basic phrases that I had learnt in Swahili beforehand and during my time in Tanzania, or quite often a range of non-verbal communication methods. This was actually really part of the experience that was worth having, it really struck home to me the importance the learning of other languages than our mother-tongue, even (especially!) for us English speakers!

Overall I have little to nothing to complain about during my time in Tanzania, and there is a lot more that needs to be said. But, I want to take my time and reflect properly on my experience, this is something where time taken to reflect seems to help. I do have plenty more content including some 'photo-essay' style posts and more reflections, both on the hospital and Work the World experience. I would also like to touch a little more on Swahili and talk about the country in general. I think that I will work on this over a longer period of time, for that will allow me to really share my experiences in a comprehensive manner.

Travelling on a budget.

I might be in the extremely fortunate position of winning the SOR's Work the World Competition; this means that a lot of my expenses for my placement in Tanzania have been paid for. However, I am planning to travel following my placement, which means that I need to consider how best to take care of my money. At the day I’m still a student! 

So I have been doing some, admittedly simple, research that has led me to the above video. Created by Graham Hughes aka thatgingerscouser, who has visited every country in the world using only surface transport. I cannot attest for all of his advice, but I thought that I might break it down and consider how some of it shall be relevant (or-not-so) to me and throw in my two-pennies worth whilst I am at it.

20 - Avoid Expensive Countries 

At this stage my choice of country has been made, however in terms of costs – apart from going on Safari – it seems that Tanzania is a fairly cheap country. The documentation that I have been given by Work the World, cites some example costs, for example:

• £0.50 for a bus from the accommodation to the main hospital. 
• £3.50 to £5.00 for a taxi from the accommodation to the main hospital. 
• £0.75 for a beer in a local bar. 

Compared with the UK these costs seem damn cheap, but I guess compared with other countries they might seem expensive. However, considering whilst on placement/university I can spend £3.00-£4.00 on a bus, £20-30 on a taxi (which I sadly did once, never again!) and perhaps most importantly over £3.00 a pint.

I will therefore be more than pleased for the opportunity to travel to work for £0.50.

19 - Travel Light 

Thankfully, I am not completely inexperienced when it comes to travelling; and this is one that I have learnt the hard way over time... and that is just from spending time in the United Kingdom! I seemed to get the balance right when in Nepal, a couple of things that I picked up:

• Travel with a rucksack, mine is a hand-me-down from my older brother: it has been all over Europe and came to Nepal with me... It shall also be coming to Tanzania. 
• Just because it is 40/50/60 litres doesn't mean that you have to use every single litre, imagine if you want to bring something additional back from your trip. If you have packed up every inch then you are simply not going to have the space. 
• Take clothes that you might be happy to donate whilst you are there. Again, to refer back to Nepal, I took lots of t-shirts that I was happy to not come back with: donating them to a local orphanage. It's quite simple really: there are always going to be people in need of additional clothing, and if not there is always charity shops (certainly in many western-countries) that you can donate your items to. 

I guess for most people these things will be common sense, but even if you think that you cannot live without X, Y or Z. Then just consider the costs that might be saved by not taking those things, a lighter bag means that it is easier to take public transport rather than a taxi... keeping costs down.

I guess that point ended up being my personal advice, but I need reminding sometimes!

18 - Purchase a decent guidebook. 

I have to admit that this is something that I have not done as of yet, and is something that seriously needs to be done. My dearest girlfriend who will be joining me for the two weeks that I travel after my placement has taken out some books from the library: but she is currently in a different country and the books are in German… i.e. not useful to me right now!

I guess the argument against guidebooks is that the information they can provide can quickly become out of date, and that in this great-age of information that we live: the internet can be the benevolent provider of such data. This is actually very true, with websites such a TripAdvisor and Lonely Planet's Thorn Tree, allowing us to converse with previous visitors and experienced travellers. For example, TripAdvisor has already helped me to get up to date information about organising a budget Safari in Mukimi National Park. However, I think that it will always be useful to have a guide to reference at a moments notice, knowing that you will not have a constant access to the internet.

A brief search on Amazon.co.uk, shows that the normal offerings are available for Tanzania: Lonely Planet, Rough Guide... Though which is the better of these products is not so obvious, thankfully I have an older sister who has travelled to Tanzania: so I think that is a conversation to be had.

17 - Bring a laptop. 

I know for me that this simply would be a bad idea, I know myself, and I don't trust myself.

Also, we live in a wonderful world where Internet cafés exist to serve the internet-deprived traveller. Therefore I think that I shall be stick with that. Whilst in Tanzania I intend to update this blog (hopefully more regularly than now!) by handwriting my notes and taking plenty of pictures, then typing them up for posting in an internet café. I am therefore a lot less likely to loose £1000 worth of equipment… Which is good.

16 - Unlock your mobile phone / Purchase a local SIM-card. 

I must admit that this is something that I have never tried before, but it is something that I have seen others do to different degrees of success. The example that immediately comes to mind is some friends of my parents did this quite successfully whilst in South Africa, using it to contact my Mum at one point. Also as pointed out in the video, this is also allows you to make emergency calls if needs must.

Work the World's documentation suggests that a SIM-card in Tanzania can cost as little as £0.40 and a handset £15. – In my situation it might also be useful, considering that I will be working in the same hospital for four-weeks, opportunities may always arise from having a telephone number to give to people.

15 - Travel Insurance 

I cannot add anything concerning travel insurance, it is a no-brainer, it can never be understated to travel without insurance is beyond stupidity. Just be careful to ensure to check the premiums and that any activities that you intend to undertake are covered by the package that you choose.

14 - Bring a Debit Card. 

I am in the fortunate position of not having to have a credit card, so this is not too difficult for myself.

However it is important to remember ATM safety, even when using a debit card: as the additional-charges are not the only thing that needs to be worried about. In the UK there is an increasing rate of thefts taking place at ATMs, and this problem is not going to disappear in any other country.

Though the alternative, taking cash with you, presents its own obvious risks. So it is important to weigh these up for yourselves.

Personally, I am not going to reveal here how I intend to handle money whilst in Tanzania. You never know who might be watching... I am looking at you!

13 - Book cheap flights, travel during off-peak times. 

In terms of my trip to Tanzania, there is little that I can say, the cost of my flights is included within the competition prize package. For which, I shall be eternally grateful to the Society of Radiographers. And, gives me a reason to encourage all-eligible students to enter into next year's competition.

I also think the same principle can apply to other forms of transport, something that I know to well being at the behest of the Isle of Man Steam Packet. I will therefore take the time when in Tanzania to shop around when booking any forms of longer-distance transport.

12 - Be creative. 

I think the advice that is given in the video seems apt, I guess that it is a case of "Ask and it will be given to you," don't and it won't! Not that I am always the best at following such advice, too British and polite... Or something like that.

11 - Take a student card. 

As a student it is always a good idea to have an ISIC, and if you live in the UK it can be included within the NUS Extra Card for a small additional fee. These cards combined will open discounts both at home and globally, including flights.

I shall be ensuring to take mine...

10 - Travel Overland 

I guess that it is quite simple, overland transport is nearly always going to be cheaper than travelling by air.

As I have previously mentioned, I am intending to Safari in Mikumi National Park; and though flying can be an option whilst travelling around Tanzania, it is a very expensive one. Bus travel using the Mikumi example with Scandinavia Express (a strange name admittedly...) costs 7000 TSH for a single, roughly £2.80.

A further example using the Work the World documentation, the cost of flying to Zanzibar compared with using the ferry, is a difference of £65 to £23 though the later is assuming that you have a residence permit.

It seems that overland travel is the way forward, as it were.

9 - Sneak into places. 

I am not sure if I can condone this action, but if you must then do it at your own risk and morals. It is outlined a little within the video, but I guess if you choose to do this that you have to get creative. And, perhaps most importantly accept that there always might be negative consequences to your actions...

8 - Have a good story. 

This is something that I am going to need to think a little about before I go, I'm not sure I am so good at telling stories about myself... At least I know lots of card tricks! I guess the theory here – if it needs breaking down – is that if people like you, they are more likely to do things for you.

7 - Eat from Roadside Stalls or Buy Food from the Supermarket. 

I have to admit to not having very much experience with street food, but I certainly know that taking the time to buy and prepare things from the supermarket is going to be more pleasant on your wallet.

In terms of the difference in cost between road-side stalls and restaurants, Work the World suggest that street food in Dar es Salaam will cost around £1.00 to £2.00, whilst a western-style meal in a restaurant £3.50 to £7.50. The latter of these is not exactly breaking the bank account, but considering that you can get a similar priced meal in your local Weatherspoons, then it seems that street food might be the way to go. I would also assume that eating from these stalls would give me a better insight into Tanzanian cuisine.

6 - Drink with the locals. 

This is a really simple one, the locals are always going to know the best places to drink, and the best drinks to have. But perhaps most importantly they will know the cheapest places to drink, if you’re that way inclined.

5 - Avoid countries that demand Visas. 

I can see the point that is being made in the video, but admittedly it is not always something that can be avoided. Tanzania requires a Visa for entry, and I shall be working therefore I will require additional work permits. I guess that if you were travelling the world, then avoiding countries that require a Visa would be a good way of keeping costs down.

4 - Bargin and Haggle. 

Being able to haggle for the price of an item really is a skill onto itself, and it something that can be developed with experience; but there will always seem to be people who are naturally talented at getting those costs down. This is something that I picked up slowly whilst in Nepal, but it made a massive difference: onetime a friend and I haggled down a pair of boots to a quarter of their original cost. In the right countries, this skill will get you an awful long way when it comes to saving money.

There are plenty of videos of Youtube that serve as a good introduction to haggling.

I really like the advice given in the video: "haggle for quids not pennies".

3 - Don't get ill. 

Of course, it is not always going to be possible to avoid getting ill, we can't even avoid that at home. But, it is important that you take available precautions, check NaTHNaC for individual advice about each country.

The majority of GPs in the UK offer free travel clinics where you can get advice on a range of topics, plus any medications/vaccinations available on the NHS. Unfortunately not all vaccinations are available on the NHS, and therefore must be sought privately. However different clinics are likely to offer these at different costs.

If you get ill whilst travelling it might ruin a few days travel, at worse it could mean hospitalisation in a foreign country and the associated high costs. This is also the reason that it is important that you take travel insurance before you travel.

2 - No souvenirs. 

This is possible a more personal choice, and so long you are practicing ethical travel (i.e. not buying ivory) then the harm in buying souvenirs is probably somewhat limited. However, there is no denying that the cost of buying tacky ornaments is high; and will my Mum serious need a Dar es Salaam key ring in her life? I doubt it.

Despite this I think a point could be made about supporting local trade, I think as a traveller it is important to support different aspects of the local economy. At the simplest of levels, this might mean bringing back a bottle of that local tipple that you enjoyed so much. Or even better, organisations that work with disadvantage people often operate craft programmes. For example: a Google search for 'Tanzanian crafts' returned Neema Crafts, who operate to provide training and employment for disabled people in Tanzania. Spending money on such items will both promote the growth of positive groups and support the local economy.

1 - Couch Surfing. 

Couch Surfing as a concept that is explained rather well in the video, basically people around the world will let you sleep on their couch for free: assuming that you will return the offer to other travellers.

I am signed up to the website, but I have no experience with trying it out. My girlfriend used it a fair amount last year, and that wasn't for physical couch surfing. With people using the website to organise events to meet up with likeminded people in the local area, which seems a potentially good way to drink with the locals.

I also have heard second-hand success stories about Couchsurfing.org, with people travelling the world spending nearly nothing on accommodation. However, this service cannot be seen without having its risks and in-depth-critical reviews have been produced. The greatest practical risk stands from a safety point-of-view and though I have no real experience with the service, I would suggest that a healthy attitude of "If it seems to good to be true, then it probably is." It won’t remove all the risks, but it seems a sensible start.

I am certainly keeping an eye on the Dar es Salaam group on Couch Surfing, it appears that it might be a positive way to open new doors of opportunity; saving money and meeting new people.

Radiotherapy in Tanzania!

As I have previously mentioned, I am not the only winner of the 'Society and College of Radiographer's International Elective Competition'; with the competition awarding this exciting opportunity of an international elective placement to two of the Society's student members.

I would therefore like to this opportunity to introduce you to to +Kim Balsdon, a Radiotherapy and Oncology student at Cardiff University, she too will be travelling to Dar es Salaam. Excitingly, she has also chosen to write a blog about her coming experiences: http://tanzaniaradiotherapy.blogspot.co.uk/

I would highly recommend keeping an eye on her blog, as she will be travelling to Tanzania in June; therefore her experiences in the country should be posted in near future. I know that I shall certainly be monitoring it, with the hope of gaining some insight of what to expect in Tanzania.

I am also going to take this opportunity to mention and thank David Evans, a previous winner of the competition and Radiotherapist, who also travelled to Dar es Salaam for his placement. You can view his experiences in Tanzania via Facebook, including interesting updates and photographs concerning the cancer centre in Dar es Salaam. I must admit that I emailed him over a month ago asking if he would like to share a short piece about his experiences in Tanzania, I have been beyond tardy in acting upon his swift reply; however this seems the appropriate moment to share with you what he said:

I can’t believe that it’s nearly two years since I was out in Tanzania on my Work the World adventure! When I met the two most recent winners of the competition at the Annual Student Conference it was hard to put into words how much I valued the experience and how much it meant to me both personally and professionally. As the first winner of the competition it was a voyage into the unknown both for myself and the team at Work the World…but I can honestly say it was one of the most challenging and also uplifting experiences of my life.

Work the World make it very clear that you are out there to experience life as it is rather than trying to change it, which is difficult in two ways. Firstly, as healthcare professionals we are focused on providing a level of care which is supported by some of the best equipment and facilities in the world. Say what you like about the NHS but comparatively we have life very easy, and it can be difficult not to be shocked by the differences. Secondly, Dar is nowhere near the normal tourist trail so seeing a “mzungu” becomes quite a talking point, and a lot of time was spent comparing cultural differences. Also, being so different compared to the locals (this means tall and very pale) made blending in very difficult.

The Work the World house in Dar is incredible. Well, except the cold showers…I never got used to them! All of the staff are so generous with their time and within days you feel like part of a very large family. There was such a blend of people there from different professions and of different ages, it was a great inter-disciplinary learning experience. I should also say that although Work the World is based around working placements, there is plenty of time to explore the area and the culture first-hand, including weekend trips on safari and to the island of Zanzibar.

When Richard asked me to write a short piece about my experience I was a bit apprehensive; firstly, peoples’ holiday stories are never that interesting and because I had such an amazing time while I was out there I thought it would just sound like someone droning on about their gap year and about how it’s changed them in such a deep and spiritual way. But more importantly, I didn’t want my experience to shape Richard or Kim’s view of Tanzania. Winning the Work the World competition is a once-in-a-lifetime experience but half the fun is not knowing what it’s going to be like. So all I would say to anyone who is going to Tanzania would be learn as much Swahili as possible, take lots of mosquito repellent, and throw yourself into everything Work the World and Tanzania has to offer.

My congratulations go out to both winners of the SCoR’s Work the World competition: Richard Betteridge and Kimberley Balsdon…it’s an experience you’ll never forget!

My Absence...

I would firstly like to make an apology for a lack of content over these past few weeks. The Easter holiday was an extremely busy period for me: going home; visiting my girlfriend's family in both Luxembourg and Belgium; and the all-important university deadlines.

Nevertheless, I do come bearing some good news. All being well, I have my flights to Dar es Salaam organised; travelling via Doha, Qatar. I have also made arrangements for remaining in Tanzania for a further two weeks post-placement. This additional time will be at my own cost, however I think that it would be foolish to miss out on such an opportunity to expand my understanding of the country.

At the moment, I am in the middle of my university exams; therefore content may continue to be slow til they are over. However, in the build-up to my placement I do have further items planned, I am especially interested in taking a further look at the Swahili language. Hopefully, the first of these posts will be ready to publish soon.

Comparative Health Statistics - Tanzania and United Kingdom

When I initially decided that I would create a blog about my experiences of travelling to Tanzania, I thought that it might be quite interesting to compare the statistics from the World Health Organisation: between the United Kingdom and Tanzania.

I feel that this helps to give some perspective concerning the potential issues that I might face whilst working in Tanzania, for example a greater prevalence of infectious diseases – such as TB and HIV – amongst other issues.

I was interested in sharing these statistics – however in a bit more of an interesting-way than plaintext – I have therefore created this 'infographic-of-sorts' to present the information. I must admit that my creative-skills are not the best, but I hope that you appreciate my effort!

You may find the source of these statistics:

• United Kingdom – http://www.who.int/countries/gbr/en/
• United Republic of Tanzania – http://www.who.int/countries/tza/en/

Swahili Body Parts (English - français - Kiswahili)

At the beginning of this week, my sister (who is a school teacher) set me a 'homework' to learn the names for parts of the body in Swahili. She had produced a proper workbook for me, including a list of all the names and also exercises for me to complete! It therefore feels apt to use this topic for first post concerning the Swahili language.

Language learning is something that I have recently taken a great interest in, as I aim to become a lot more proficient in French. I have therefore chosen to include the French translations, for which I hope might be of use to Francophones. 

Au debut de la semaine, ma sœur m'a envoyé un email avec les noms des parties du corps en swahili pour que je les apprenne. Un de mes passe-temps est d'apprendre le français, donc, j'ai aussi ajouté la traduction en français. Je l'espère utile à des personnes francophones.

English - français - Kiswhaili

Body - le corps - Mwili

External - externe - Nje

Head - la tête - Kichwa

Hair - les cheveux - Nwele

Eye (Eyes) - l'œil (les yeux) - Jucho (Macho)

Eyebrows - les sourcils - Nyusi

Eyelashes - les cils - Kope

Iris - l'iris - Kiini cha macho [Literally translates as the 'yolk of the eyes' / Cette traduction est littéralement: 'le jaune d'œuf des yeux'.]

Ear (Ears) - l'oreille (les oreilles) - Sikio (Masikio)

Nose - le nez - Pua

Mouth - la bouche - Kinywa

Lips - les lèvres - Midomo

Tongue - la langue - Ulimi

Teeth - les dents - Meno

Chin - le menton - Kidevu

Cheek (Cheeks) - la joue (les joues) - Shavu (Mashavu)

Neck - le cou - Shingo

Shoulder (Shoulders) - l'épaule (les épaules) - Bega (Mabega) 
Arm and Hand (Arms and Hands) - le bras et la main (les bras et les mains) - Mkono (Mikono)

Finger and Toe (Fingers and Toes) - le doigt et l'orteil (les doigts et les orteils) - Kidole (Vidole)

Thumb (Thumbs) - le pouce (les pouces) - Kidole Gumba (Vidole Gumba)

Elbow (Elbows) - le coude (les coudes) - Kisugudi (Visugudi)

Wrist (Wrists) - le poignet (les poignets) - Kiganja (Viganja)

Chest - la poitrine - Kifua

Breast (Breasts) - le sein (les seins) - Ziwa (Maziwa) [also the word for milk / aussi le mot pour le lait] / Titi (Matiti)

Nipple (Nipples) - le mamelon (les mamelons) - Chuchu (Machuchu)

Abdomen - l'abdomen - Tumbo

Navel - le nombril - Kitovu

Back - le dos - Mgongo

Buttock (Buttocks) - la fesse (les fesses) - Tako (Matako)

Anus - l'anus - Mkundu

Thigh (Thighs) - la cuisse (les cuisses) - Paja (Mapaja)

Leg and Foot (Legs and Feet) - la jambe et le pied (les jambes et les pieds) - Mguu (Miguu)

Knee (Knees) - le genou (les genoux) - Goti (Magoti)

Penis - le penis - Mboo / Mboro / Ume [Ume also means Masculinity / Ume aussi veut dire la masculinité]

Vagina - le vagin - Kuma / Uke [Uke also means Femininity / Uke aussi veut dire la féminité]

Swahili Body Parts