Dr Michael Conroy on Tanzania, TLM and life at Muhimbili National Hospital
I decided, when travelling to Tanzania this year, to arrive in daytime. I figured it wouldn't do to make first landing in this new country at night, when it was so remote and exotic to me, with my life for two months in my backpack.
And so I chose the later flight on December 31, celebrated the New Year somewhere over North Iraq and, after a brief stop in Doha, arrived into an entirely sunlit Dar es Salaam at two in the afternoon, the dense hot air ready to ambush me as soon as I stepped off the plane.
And the welcome! As I was to learn again and again in the coming months, Tanzania is not a country that shakes you by the hand or gives a dry nod of the head, or an arid smile. It's one that grips and embraces and warmly engulfs, and lets you know plainly that you have arrived. And so when I later learned that Swahili allows about a dozen ways to greet someone but almost none to say 'I feel bad', it wasn't so much of a surprise.
I was one of many Irish professionals and students, from backgrounds in medicine, nursing, pharmacy, development and others, who have travelled to Muhimbili National Hospital (MNH) over the past 11 years. We travelled to learn from Dr Trish Scanlan, Dr Jane and their team, and to play a part in the astounding service they have developed to treat Tanzanian children with cancer, and give them the care they deserve.
My early days, settling in, were the time for fastest learning. I learned that I could not barge straight into work-talk with somebody. A salutation ('Mambo') and response ('Poa') were key first, because we're people and not robots, and then we could talk business. I discovered that Tanzanian patients and their parents are a self-sufficient bunch, who don't expect mollycoddling, and that I should follow suit if I wanted to make an impact. And I learned very rapidly indeed, in one day in fact, that skinny jeans and a humid tropical climate do not mix.
Freshly clad in billowing, airy scrubs, I took a deep breath and embraced Tanzania like it had embraced me.
I worked on the ward for two months alongside Catherine, Bronwyn and Gill, three fellow Irish doctors. Their training was in paediatrics and mine, in oncology (treating cancer), so we put our heads together at every chance we could to try and make things work. Each day the most important work came first: seeing the children themselves. Our unit cared for children with cancer from across Tanzania, a country 13 times the size of Ireland with 55 million people.
While some can be cared for closer to home, the most complex come to Muhimbili. Of these children, the sickest of all came to Upendo Ward. Here we cared for children with leukaemias, the most common childhood cancers; Burkitt's lymphoma, the extraordinarily aggressive cancers that cruelly affect Subsaharan Africa most of all; retinoblastoma tumours of the eye.; and the many other rare cancers that can arise in kids. In rounds, each child got seen by a doctor, who checked for changes overnight, examined the child and sought an update from the foremost expert: the child's mamma. Following a discussion with the child's nurse, and the specialist on duty, we would put a new plan together an kickstart it.
Some parts of the experience were bewildering and new to me: I spoke no Swahili and had to become familiar with looking at X-ray films again rather than looking at computer images. More surprising, though, was how much was similar to home. The principles of the medicine, of listening and talking, examining and reassuring, of working together with the team to help these children and trying to learn myself along the way: this was not so different.
And though the first few days were tough, we improved rapidly. We absorbed essential Swahili phrases, got a grip on bizarre computer systems and the red tape that seem to be a constant in hospitals worldwide, and struck up a rapport with our Tanzanian colleagues that was so fresh and new after years of working in Ireland.
Following rounds, we assisted with procedures. These were the 'hands-on' jobs necessary to complete the children's treatment: lumbar punctures to check spinal fluid, bone marrow biopsies to check for cancer in the bones, and intrathecal chemotherapy delivered straight into the spinal cord fluid.
While working with a lot less to hand then back home, we managed to get the job done for these children with a combination of elbow grease, pragmatism and the support of the rest of the hospital. One of the team's biggest assets here is self-sufficiency. For example, checking a child's blood for cancer cells involves a lab and six different stages in Ireland. In MNH, we did the smearing, fixing and staining of samples ourselves so that we could take a blood sample in the morning and have a diagnosis within an hour if necessary. This practical approach was one of the things I admired most in MNH, and showed their commitment to making more of less at all times.
Each day finished with tutorials for an hour from Trish, no matter how busy things had been, so that within a month we had learned much of the essentials of paediatric oncology. And not too long after we began, the things that had seemed so intense and intimidating at the start - the heat, the culture, the language, the stiff resilience needed to get the job done - seemed not so intense anymore.
Like any challenge in life, no matter how towering, it got worn down by familiarity to something achievable and enjoyable. The heat, after a while, was simply warmth and our stiff resilience became a new flexibility, a collaborative spirit that was in turn more effective at getting the job done.
And so maybe it's not a surprise that February 28th crept up on me unawares, like a lion on one of those safaris I never actually tried. It pounced and before I knew it, I was sharing a last dinner with the team in our favourite Indian restaurant, frantically sharing email addresses and career plans, and doing my best to ensure that the small changes we made while there would endure and strengthen TLM's battle against childhood cancers.
That was particularly important to me because sustainability and independence, characteristics I learned to be so important to Tanzanian people, are also the essence of TLM. All employees are Tanzanian, most of the treatment is delivered by Tanzanian doctors, and the arc of its progress is never guided by subservience or dependence, but instead self-reliance and ingenuity.
And when I finally flew away, it felt less like an relief from the heat and intensity of Dar es Salaam, and more like a break from a bracing bear hug. Although they say all good things must come to an end, and this was better than most, I believe TLM's remarkable and inspiring work disdains this cliché and the years ahead look more promising than ever.