Category Archives: Tanzania

International Day to End Fistula

Surgery repairs fistula and restores dignity and hope. Photo: David Synder

Today is International Day to End Fistula.  I’m glad that the international community is coming together to bring global focus on an issue that affects about 2 million women in developing countries, with 100,000 new cases each year.  The sad truth is, fistula is completely preventable with the right access to maternal care, trained birth attendants and availability of emergency obstetric care – in most cases a simple C-section.

When I think about fistula, I think about a young woman who received care in the AmeriCares fistula repair project at Bugando Medical Centre in Tanzania, with gift-in-kind support from Ethicon, part of the Johnson & Johnson family of companies.

Mercy* was 18 years old when she arrived at the hospital with a fistula she had acquired after 2 days of labor without medical intervention. Mercy lost her baby, but developed a fistula – a hole in her birth canal — which left her incontinent.  As a domestic worker earning less than $2 a month, Mercy could not afford curative surgery. But after learning about our project at Bugando Medical Centre which offers free care and a transportation fund to help impoverished patients like her, she was able to have her fistula reversed and her dignity restored.

This video, produced for Johnson & Johnson, was filmed in Ethiopia and Tanzania in March of 2013.

Mercy’s story is a common one in sub-Saharan Africa: a young girl living in poverty with no access to family planning gets pregnant and endures long hours of labor without the presence of a trained birth attendant.  Because most of these young girls have bodies not completely ready for birth, their babies have difficulties getting through the birth canal and often die – leaving the mother not only childess, but ostracized and stigmatized.  Many girls and young women just like Mercy suffer with this condition for years — even a lifetime — because of the lack of local awareness that fistulas can be reversed.

Today and every day, AmeriCares is working to change that.

In Tanzania, public service announcements on local radio get the word out that fistulas ARE reversible, and that care is available free of charge at Bugando.  We are also taking the message to the rural areas with outreach campaigns that not only inform the community about the cost-free curative surgery, but bring qualified doctors to conduct those surgeries to the local district hospital.

So one Mercy at a time, we’re providing hope and restoring dignity to fistula patients in Tanzania — something to celebrate on this International Day to End Fistula.

Learn more about our work in Tanzania here.

*Name changed

Expanding Health Workforce Safety in Tanzania

Hot, tired and dirty, my first thought upon arrival in Tanzania was how much I had missed Africa. The 35-minute drive from the airport to my hotel provided moving snapshots of life in Mwanza. The streets were busy and bustling with colors, people, traffic, the sound of horns honking and motorbikes roaring. I sank back into the shuttle’s seat, feeling completely and utterly elated.

Hours later, I awoke with excitement, knowing that I would soon see first-hand our Health Workforce Safety (HWS) program at Bugando Medical Centre (BMC), a three-year initiative aimed at addressing the health and occupational hazards for both health workers and hospital patients.  As I walked through BMC’s vast hallways during a hospital tour, the program’s impact was clearly visible.  I saw the AmeriCares logo on doors, waste bins, equipment, supply cabinets–simply put, everywhere. Health workers appeared content and devoted to their daily task of providing patient care.  The hospital provides a clean and safe environment for patients and health workers alike.

Seeing these accomplishments made me look forward to the program’s scale-out to three selected hospitals.

While working closely with our local consultant team and the HWS program’s technical advisor, my expectations of what we would observe at these selected hospitals during the baseline were formed. We would undoubtedly find shortages in the availability and supply of personal protective equipment; safety engineered devices; gaps in the hospitals’ ability to vaccinate all of their health workers; infrastructural challenges, and much more.

However, what we did observe was more unsettling than I had anticipated. I was struck by the lack of sanitation in some of the hospitals—some more so than others. It was disturbing to see the mingling and mixing of infectious waste such as used needle-sticks with non-infectious waste, as well as the evident lack of waste segregation practices. During my conversations with health workers at these sites, it became apparent that many were unhappy, demotivated and felt stagnant in their positions. Much of this was attributed to the unavailability of necessary resources to aid them in effectively carrying out their responsibilities—a direct consequence of considerably limited funding available to support hospital operations. Glaring was the realization that health workers held little regard for themselves and their safety.

There is a clear, crucial need for the HWS program at these institutions.

Although my take-aways from the baseline assessments were numerous, one stuck with me: essential aggressive behavior change interventions, coupled with ensuring the safety and wellbeing of health workers, will revitalize and empower these most valued members of the workforce.

World Day for Safety and Health at Work

In January, 2012, Justine MacWilliam, project manager for AmeriCares Health Worker Safety Initiative, traveled to Bugando Medical Centre in Tanzania to see first-hand the remarkable achievements that Bugando’s workers have made in improving hospital safety during the three-year pilot initiative. Here, Justine provides a glimpse of the life-saving culture of change the initiative has created among hospital staff.

Health workers wear protective gear in the Neonatal Intensive Care Unit at Bugando Medical Centre in Tanzania. Photo: Phil Farnsworth

“Many of Tanzania’s health workers haven’t had adequate training on preventing the spread of hospital-related infections and injury.”

Saturday, April 28th, is World Day for Safety and Health at Work, a day to raise awareness about the importance of preventing injury and disease related to workplace hazards. Hospitals everywhere pose workplace hazards, especially in developing countries, where health workers risk their lives each day on the job.

In Tanzania, where AmeriCares has its longest-standing Africa partnership, infectious diseases are still the leading cause of death, and access to vaccines is extremely limited. Many of the country’s health workers don’t have consistent access to safety-oriented supplies to protect themselves and most health workers haven’t had adequate training on preventing the spread of hospital-related infections and injury. Tanzania also has the lowest rate of physicians per capita of any country in the world, with only one doctor per 100,000 people. In an effort to protect Tanzania’s sparse and underequipped health care workforce, in 2008 AmeriCares launched the Health Worker Safety Initiative (HWSI), with a goal to develop a center of excellence in safety at  Bugando Medical Centre, a teaching and referral hospital staffed by 1,200 health workers and nearly 1,000 medical students who care for nearly 250,000 patients each year.

“During my most recent visit, all of Bugando’s health workers had already attended safety trainings, and big changes were evident.”

Through the HWSI, all of Bugando’s health workers participated in two-day safety trainings. These workshops include critical occupational safety topics ranging from infection prevention and control to proper use of personal protective equipment and fire safety. Trainings are led by a team of 40 Bugando health workers from different departments who were themselves trained at the launch of the project, using a special curriculum developed specifically for the HWSI. AmeriCares also supports the project with regular donations of safety-oriented supplies and equipment, vaccines against hepatitis b, tetanus, and yellow fever, and grants for infrastructure upgrades to improve hospital conditions.

During my most recent visit, all of Bugando’s health workers had already attended safety trainings, and big changes were evident. “Everyone is more aware of occupational hazards from what they’ve learned in the trainings and from seeing what happens when other people are injured,” explained Nurse Gemetilda Katongo, a health worker safety trainer who has 20 years of experience as a nurse at Bugando. “Since the project and the trainings began there have been less injuries and needle pricks among health workers. Also, when people are injured they now understand the consequences, so they follow proper procedure and use post-exposure prophylactics more strictly.”

 Photo: Phil Farnsworth 

“One of the greatest successes of the HWSI is the way that it has transformed the work environment for Bugando’s staff.” 

What struck me the most in my discussions with nurses at Bugando was how empowering the project has been for the hospital’s health workers, and the level of enthusiasm among health workers for applying the lessons of the trainings. Nurse Katongo explained “I know the hazards that can appear and I am teaching people and they respect me.” Nurse Deborah Mollel, a 30-year veteran of Bugando agreed, “All health workers are reinforcing good behaviors with one another. We work together as a team. The changes in behavior are the most important part of the project—these will be long-lasting.”

One of the greatest successes of the HWSI is the way that it has transformed the work environment for Bugando’s staff. Health workers told me that they feel more confident when treating patients now that they have been vaccinated against hepatitis B and have the gloves and other important pieces of equipment that keep them safe on the job. These improvements have changed the attitudes of health workers about coming to work each day. Nurse Mollel told me, “Now we are proud to say that we work at Bugando. Our safety and working conditions are now so much better compared to other hospitals, and we are well-stocked with the supplies to keep us safe.”

I know that this year on World Day for Health and Safety at Work, I will think about the hugely dedicated health workers at Bugando Medical Centre, and celebrate the great achievements that AmeriCares and Bugando have made together in building a safer, healthier place to work.