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any country, there is still considerable honor and respect shown to doctors in most western nations. Doctors
are highly esteemed as intellectuals and are reimbursed relatively well for their services. This high status and
reimbursement undoubtedly negates many of the less desirable aspects of becoming and being a physician
for young people choosing a career in western countries. Therefore, the brightest and most ambitious students
are often those who fill positions as doctors. However, the difficulties that are inherent to being a physician
are multiplied tenfold in poorer countries such as Tanzania. In addition, the services that physicians provide
in Tanzania are very poorly reimbursed due to so many patients’ complete inability to provide compensa-
tion, and the equipment to which physicians have access is severely limited. These factors all contribute to a
de-motivation for students to become doctors and a decline in doctors’ career satisfaction and fulfillment. This
lack in motivation and fulfillment, which decreases job performance, lessens the public’s trust in biomedicine,
which further reduces the respect and career fulfillment that physicians feel. Thus, the cycle continues.
The insufficiency of resources that hospitals and small medical facilities possess also contributes to the dire
state of medicine in poor East African countries. Many hospitals in Tanzania have a severe lack of both medi-
cal equipment and medicine, making effective treatment of patients difficult, if not impossible. First of all, the
simple lack of clean facilities impairs most hospitals’ ability to provide patients with a safe environment when
they are ill. Patients are forced to share hospital rooms with up to fifteen other people, and when the hospitals
are exceptionally busy, they may even be required to share beds. The hospitals then become a breeding ground
for contagious diseases that frequently spread among all of the immuno-compromised patients. The beds
themselves are about fifty years old with absolutely no electronic control, and are rarely even made with clean
sheets (if made up at all) between patients. At St. Elizabeth’s, under-trained nurses mop the floors of the hos-
pital with dirty water each morning, further contributing to the uncleanliness. The labor ward and operating
rooms actually have windows open during periods of extensive patients’ exposure. Yes, the windows are open
during surgeries and births!
Not only are the facilities lacking in cleanliness, the medicine that is available is limited and medical
equipment used for diagnosis is either unavailable or rudimentary. For instance, one old x-ray machine and
ultrasound are all that constitute radiology at St. Elizabeth’s. Furthermore, the x-rays are of such low quality
that physicians are still greatly impaired even when films are available. I was also surprised that the district
hospital where I worked did not have access to a radiologist at all; I noticed that each physician or mid-level
provider was required to rely exclusively on his/her own limited knowledge of radiology to make a diagnosis.
The inability to complete many microbiological investigations, such as bacterial cultures, is another telling
example of the impairment that physicians feel when formulating a treatment strategy. Giving antibiotics is
nothing more than shooting in the dark. First, it is often difficult to know if a set of symptoms is even the
result of a bacterial infection and second, even if the diagnosis is clearly bacterial, it is often nearly impossible
to make an informed decision regarding which class of antibiotic to prescribe. I frequently observed patients
spending multiple extra days in the hospital due to an unsuccessful first course of antibiotics requiring a sec-
ond antibiotic attempt, which furthered their exposure to unclean conditions and other sick patients. In addi-
tion to difficulties in correctly prescribing medication, I was also aware at times that some necessary medicines
were simply no longer available in smaller health facilities, forcing doctors to use less than ideal medications.
Finally, many advanced pharmaceuticals that are used in western countries have not even been made available
in East Africa. Therefore, even when physicians have a surplus of supplies, they are often drugs that have long
become obsolete and may have been shown to be largely ineffective in more recent studies.
Perhaps the most concerning problem with medicine in Tanzania, however, is the overall lack of train-
ing that medical professionals receive. The schooling that doctors must complete in Tanzania is simply not
adequate to prepare them to diagnose and treat the wide array of illnesses and ailments with which they are
forced to deal. Because the education system in Tanzania is less sophisticated than in western countries, it fails
to prepare medical professionals to the extent that we in western nations would expect. I was once asked to
assist a successful surgeon in an adult circumcision, and I was not only appalled with the conditions of the
operation, but also with the imprecision that the surgeon showed while performing the delicate procedure.
During the reattachment of the two sections of skin, I felt that the surgeon’s stitches were terribly imprecise,
putting the patient in danger of having a vessel or nerve unintentionally severed. I also observed doctors far
too often coming to hasty bacterial diagnoses without considering differentials. They are taught, it seems, to
settle on a diagnosis that has the best chance of being treatable rather than pursuing other possible causes of a
patient’s symptoms, a practice with which I was not comfortable. Although medical schools are attempting to
educate Tanzanian physicians thoroughly, the training they provide is insufficient for doctors to deal with the
huge variety of ailments that persist there.
Although healthcare providers and government officials in Tanzania are sincerely attempting to solve the
problem of inadequate healthcare in the country, they are severely handicapped by the poverty and govern-
ment corruption that exists throughout East Africa. Improving the healthcare system would, even if policies
were implemented immediately, take many years and millions of dollars to bring both the standard of care
and the attitude toward biomedicine and its professionals to a satisfactory level. However, monumental