Haydom Lutheran Hospital is a series of squat brick buildings with metal roofs, nestled in the heart of a rural town called Haydom. It’s in northern Tanzania, a country on the east coast of Africa. The hospital is 300 kilometres from the nearest major city and serves an area that’s home to nearly 1 million people. It’s also where Jung In Kim, a third year pharmacy student, spent a co-op work term.
“My father is a pilot and as a child I travelled with him and visited many places,” explains Jung In. “But he didn’t take me to touristy locations or major cities. Instead, we went to developing areas around the world.”
This early exposure to standards of living so different from her own inspired Jung In’s interest in health care.
“I knew that I wanted to experience health care in a developing country, so I checked the Canadian government website about safe countries where students could work, and I started Googling hospitals in these countries.”
Working with Anthony Miller, Waterloo Pharmacy’s Experiential Coordinator for co-op, Jung In identified Haydom as a potential co-op site. They contacted the hospital and arranged for her to travel to Tanzania and work from May to August of 2018. The position was unpaid, but Haydom provided food and living accommodations in the guest houses on the hospital grounds.
“I was the first pharmacy student to ever work at Haydom,” says Jung In. “There were around twelve other students – medicine, physio, nursing – mostly from the Netherlands and a few from Norway, America, and New Zealand. There were also some Dutch doctors pursuing a tropical doctor specialization.”
Haydom hospital was founded by a Norwegian doctor back in 1955 when Tanzania was under British rule. It grew slowly with the help of Norwegian missionaries and is now a robust facility of 420 beds. Though the hospital was originally isolated, surrounded by only fields and the ruddy red Haydom mountain for which it is named, the township of Haydom grew around it as more families moved into the area to be closer to health care services. The hospital is now completely under Tanzania management and the majority of staff are born and educated in the country.
Working on Haydom’s wards
At Haydom, clinical pharmacists are not present on the various wards. Tanzanian pharmacists only work in the hospital’s inpatient and outpatient pharmacy. Unlike these pharmacists, Jung In was assigned to the general medicine and pediatric wards, where she faced the challenge of carving out a role for herself.
“It took time to adjust to an entirely different health care system,” she explained. “For example, we typically had access to very few medications. Often, there’s just one type of medication for disease states, and the process of dispensing medications was not controlled in the same way that it is in North America.”
Her day typically began with doctor meetings where department heads discussed difficult cases and patient deaths from the night before. This was followed by Sala – a church meeting – where a sermon was held and new members of the Haydom community were introduced. Then work on the wards began.
“I remember one shock I had early on, about 3 weeks in,” says Jung In. “An older patient looked quite sick, blood on her face and difficulty breathing. I checked her vitals and told the doctor that I thought she was going into septic shock.”
Jung In provided suggestions for how she thought the doctor should proceed, but he ignored her. Hours later, the patient died.
“Initially, I felt frustration and anger,” she remembers. “But the experience also taught me about the hospital’s system overall.”
At Haydom, the doctors are often working very long hours, seven days a week. They freqeuntly face the challenge of managing large numbers of patients. Jung In was new to the hospital and still a student herself – her counsel was not considered serious enough to act on.
“It’s easy at first to blame the culture or the individuals,” Jung In says, “and indeed many volunteers from western countries often do, pointing at the gaps in the local education system. But I asked myself what good I would do if I came here for three months and forced my opinions on others. Instead, I strove to work within the system and do what good I could in that way.”
Jung In’s first step to achieving this was learning Swahali. Though Haydom Hospital was officially run in English, Swahili is the dominant language in the area and very few patients spoke any English. So Jung In spent two hours a day learning the language and strove to make friends in the community. Rudimentary Swahili proved immensely helpful in communicating with patients and staff.
“It wasn’t my knowledge that was the hard part, though I did log in to the Waterloo library countless times to search for information,” she remembers with a laugh. “But rather it was building relationships with the team and spending time with them. As they got to know me, they became more comfortable taking my recommendations.”
“Never forget the value of a life”
Despite a vastly different setting where many people live in poverty, many of the health issues Jung In encountered were familiar to her. Pneumonia was common, and often people would end up at the hospital not because they were ill with a very dangerous condition, but rather because they waited too long before seeking aid or because they tried medications that were not helpful for their sickness.
“Medications are exceptionally easy to access in town – there’s no requirement to have a prescription, and so you’d often see patients taking medications they don’t need for a condition. There is also a practice of visiting a witch doctor. The belief is that the doctor can cut the skin to induce healing of specific parts of the body.”
In her time on the wards, Jung In became seasoned at navigating cultural practices and weaving them into decision-making. The scars left from witch doctors, for example, could be incorporated into taking a patient history, as they often indicated previous health concerns.
“Two of the most important lessons I learned were to maintain a humble mind, and to never forget the value of a life,” she reflects.
“Death is unfortunately quite common, and I could see how some of the staff become desensitized to it. I’ve done CPR on a child who ended up dying, and I’ve felt how it can sometimes be easier to remove yourself from these moments. I had to keep reminding myself of the importance of a life.”
Jung In did this by identifying six to ten patients a day to focus on. During her pediatric rotation she would visit the ward after hours to record her patients’ vitals. But her time in Tanzania has also helped to spark an interest in global health and health systems.
“It made me realize that a good pharmacist can make a big difference in the lives of ten or twenty patients a day, but a good health system can help all four hundred patients,” she says.
With graduation approaching, Jung In has started to look into programs in global health. She hopes to spend some time each year going back to Haydom.
“Before my trip, I used to think there was one way to become the best hospital pharmacist. Graduate, pursue a residency, specialize. Now I know there are many more ways to improve my skills and knowledge and to make a difference for patients,” she reflects.
“An experience like this can be scary – it requires you to give up everything you know. But it’s life changing, and everyone I’ve met along the way has made it one of the best experiences I’ve had.”